Joan,

Kim was out of her office, so I am sending this to you. Thanks linda

Cogswell Building 1400 Broadway Helena MT 59620

MEMORANDUM

TO: Regional WIC Directors

FROM: Joan Bowsher, Montana WIC Director

DATE: March 12, 2008

NUMBER: A-08-07

SUBJECT: WIC Futures Study Group Request

The WIC Futures Study Group will be having their second meeting on Wednesday, March 19. In order to provide the group with as much information on WIC services as possible, we are requesting your input in two areas.

1) What are your five biggest "time takers" in WIC?

Question 1:

It’s not one specific task, but a gradual accumulation of small tasks. Each minute that we add to an appointment adds up to a large amount of allotted time in the course of a year.

For example, a successful SIS check (assuming that the system doesn’t fail and that the name on the Medicaid card is the same as the one in the system) takes about 1 to 1 ½ minutes. If a WIC worker sees 12 clients per day, that’s an average of 15 minutes per day. 49 weeks per year x 5 days per week = 245 days x 15 minutes = 3675 minutes per year = 61.25 hours per year. In other words, a full time worker is now spending more than a week and a half per year checking SIS.

Is it really worth it? Is it federally required? Most MT WIC clients do not lie about Medicaid eligibility. There are occasional client errors: they are often unaware of their current status or have missed a deadline. However, WIC staff members are spending a huge amount of time checking accountability when we could be engaging with clients.

Two of our computers are “scrambling” almost daily. Better equipment would save us a lot of time.

2) What does Montana WIC require of local agencies which is not required by WIC Federal Regulations?

Question 2: We do not have time to pour through Federal WIC Regulations, and would ask the state WIC staff to constantly evaluate requirements in an effort to streamline services.

There have been many welcome additions to the WIC task list in the last decade. WIC staff is happy to take the time to track BMI, track pregnancy weight gain on the three new grids, track tobacco use, fill out Farmers’ Market coupons, recommend infant vitamins, distribute breast pumps, etc.

The following is a list of less welcome additions—tasks which take time and often create a barrier to client service.

Validating Medicaid eligibility on SIS

Residency proof (does it have to be a “service into the home” or could we use the 1040, driver’s license, or something else that exists in the chart)

Proof of Pregnancy (already required by MT Medicaid. Participants do not lie about pregnancy)

Interruptions to change food packages for aides (would it be possible to divide “how-many –pounds-of-cheese?” type requests from “increasing-formula-provision” type requests, and allow the aides to do the “grocery request changes”. In a hospital setting, aides take menu requests and the dietitians simply assure the diet assignment)

Release of information form (can the green cert form be adapted as a release, rather than adding another piece of paper?)

Void\Reissue forms for formula (how about screen 302 + brief documentation in the chart?)

Voter Registration (is keeping the registration cards on our reception desk adequate?)

Checking initial contact date on 102 and transferring date to the green form (it’s already in the computer. Do we also need it on paper?)

Only RDs approving special formulas. Many states allow RNs to approve special formulas. Do we really want to take both RN and RD time by creating an extra interface?

Documentation of breastfeeding history on the Special Formula approval form

Breast pump release forms could be simplified

Breast pump tracking forms (much of the info is redundant—phone number, participant ID)

Farmers market tracking sheet. (Could the state office hire a work study student to hand tally the hundreds of priorities and categories?)

Farmer’s market client survey (way too many surveys expected. How about a focus group?)

Formula authorizations on the computer (eliminate either paper or computer approval?)

Duplicate end of cert notices

Food package options exponentially increasing (simplify)

Tracking donated and returned formula

Thank you for taking the time to look at these individual tasks!

Due to the approaching date of the next meeting, we are requesting your response quickly. Please e-mail your response to these two questions to Lynn Van Aken (lvanaken@mt.gov) by Friday, March 14.

Thank you for your thoughtful input. We are working hard to make WIC a successful quality nutrition program for the future. If you have any questions please call me at 406-444-4747.