WIC Futures Report Meeting 3 19 2008

The meeting was facilitated by Mary Beth Frideres of the Montana Primary Care Association. The desired outcomes for the day were as follows:

By the end of this session –

· Participants will hear from the WIC Regional Office representative and receive answers to their questions;

· Federal mandates/areas where the state may interpret directives and develop approaches will be clarified;

· The group will have a clear understanding of the State WIC budget;

· Data form the state epidemiologist will be reviewed;

· An understanding of examples of current county support to the WIC program will be gained; and

· An agenda for the next meeting will be developed.

Opening Comments

Opening comments were made by Joan Bowsher, DPHHS WIC Director. Introductions were then made and the group reviewed the agenda.

Perspectives from the Regional WIC Office

Jean Liekhus, Program Director, USDA Food and Nutrition Service, Mountain Plains Region WIC Program discussed the WIC program from a national and regional perspective. She provided a handout which listed the staff at the regional office. She informed the group of the role and responsibilities of each staff member.

Jean noted that she understands the problems of delivering WIC services in a large state with a small population. She described the State Nutritional Action Plan (SNAP) as an effort to get everyone to give the same message (MCH, WIC, Public Health, etc.). Breastfeeding programs and support are increasing and they are trying to encourage breastfeeding through the food package by offering less formula.

The feds, she says, are also moving away from manual systems and to totally automated systems. Management Information Systems – new systems, replacements and EBT are the priorities for funding. EBT is difficult for WIC because of prescriptive food packages. This system is expensive and difficult to implement without extensive infrastructure changes in Montana.

In regard to funding, money is very tight this year – you must use it or lose it, she said. Rebates are down. Food dollars are being reallocated, and reporting is crucial to maintain funding. There is not enough money to serve the clients on WIC but they do not want waiting lists. If people come to the door and cannot be served, let the state office know and they will tell the regional office. Jean said they would try to find funding somewhere to serve those folks. Good participation projections are needed. This is done on the 798 report that is submitted monthly to the regional office.

Jean said there is outcome data available through the “Participant Characteristic Survey.” Jane Smilie and Ellen Leahy requested that this data be shared with the Montana Program. Jean also talked about the CDC Pediatric Nutrition Survey data which can be obtained from CDC if Montana participated. Jo Anne and Mark said that Montana did participate. Jean also mentioned several other program areas briefly –WIC Farmers’ and Seniors’ Markets, Disaster Planning, audits, and faith-based education – and referred to the regional staff who are responsible for these areas. She also mentioned the National WIC Association, and Douglas Greenway, Executive Director. This organization is an advocate, education, and lobbying organization for WIC, headquartered in Washington, D.C. An association “2008 Legislative Agenda” handout was provided.

Jean reminded the group that WIC is a discretionary program and not an entitlement program like foodstamps. Congress must annually allocate funds thorough the budgeting process. When Congress does not finalize the budget, the program has gone into “continuing resolution” status where they receive funding at the previous year’s level on a monthly basis until the federal budget is finalized. WIC is regarded as a public health program but it is funded through the Department of Agriculture. Even though it is public health and, arguably, might be placed more appropriately in HHS, there are concerns that if that happened, the cost of WIC might be shifted to the states. USDA does not require matching funds at either the state or local level at this time.

After 30 years, WIC is in the process of adopting a new Food Package which includes whole grains, fruits and vegetables, soy beverages, and tofu. The food package was presented as being cost neutral, but with constantly changing food prices, Jean agreed that this has been difficult. Implementation of the new food package needs to be completed by October 1, 2009.

Funding of the WIC Program with all of the changes is a constant concern. Management is anticipating using contingency funds for caseload food dollars where there are lines forming outside WIC delivery sites. This will effect funding for MIS systems nationally, but because of state efforts to apply for funds last year for the Montana WIC Program, Montana’s MIS system (SPIRIT) funds are secure. Congress is currently working on the FY2009 funding proposal. With participation and food inflation both rising, increased funding is needed. There is a great need for grassroots advocacy to improve the funding picture for WIC.

Jean reviewed the funding formula handout from the first meeting. This is posted on the study group website under the first meeting section: http://www.dphhs.mt.gov/PHSD/family-health/nutrition-wic/WIC-futures-study-group.shtml. The food grant is 75% of the total state allocation, she told the group, and the nutrition services administrative (NSA) funds are 25%. The state receives the amount spent the year before, then, the feds take 80% of the money that is left and it is divided amongst the states to mitigate inflation. The remaining 20% is then divided among the “under fair share” states. Montana is one of these. All of the calculations result in the state grant total.

Jean told the group that Montana should look at the “potential eligibles” that are not being reached by the WIC program. Montana is missing approximately 25% of the clients who could be receiving WIC. If the state could get this number up, more funds can be given to Montana. But this is tricky - if the total number of participants does not meet the number that the Montana program projected, funds will be deducted the next year from the WIC grant. This is calculated every 3 months and the state has an opportunity to give money back along the way. This explains why 3 years ago, food dollars had to be given back to the regional program.

Jean and Joan discussed OA funding which may be awarded to the states for unique needs. Montana received almost a million OA dollars for special projects for 2008. Montana’s first request was caseload maintenance which was subsequently funded. Joan reviewed the list of projects and the amounts funded. This handout is posted on the website under the first meeting section: http://www.dphhs.mt.gov/PHSD/family-health/nutrition-wic/WIC-futures-study-group.shtml. Some participants were surprised to see that renovation projects had been funded. They said that if they had known OA could be used for that, they would have requested funds for renovation projects completed in the past year. There was much discussion about how these OA funds might better support the overall WIC program. Jean cautioned the group that as they discuss options, they should remember that: 1.) OA funds are not guaranteed, and as such, 2.) should be viewed for use as one-time-only support (so don’t plan to use them for salaries). However, she acknowledged that there might be ways to strategically plan for the use of these funds so that more program needs can be covered. The group discussed how requests can be made. Two members requested better communication between WIC and AMPHO, as AMPHO would like input. They recognize that there is a limit to the flexibility on what you can ask for and why, but they requested the state provide clear guidance.

Infrastructure funds may also be requested. The state may apply each year to the regional Office and $200,000 is available each year. A state may take up to 2 years to spend awarded funds.

Jean’s suggestions for the funding of local agencies include strategies that take advantage of economies of scale. Local agencies need to look at staffing needs and hours of operation - do you need as much staff as you have and the hours you are open? Be as efficient as possible. Outreach this year needs to be targeted for high risk, most needy participants. The regional program will not let the rollout of the SPIRIT system fail.

Jean promised to provide a spreadsheet of other state funding to Joan for the next meeting.

Jean presented comparisons of Montana and other states in the region.

Number of local staff to participant is 1/229 (lowest in the region) – this may be due to geography – they usually recommend 1:300
7.5 state staff - does not include state IT or financial staff (regional office recommends an increase)
.28 state staff per local agency (lowest in the region)
.08 state staff to local clinic

There is a meeting scheduled to be held in Colorado for Vender Managers and Nutritionists to discuss and plan for the new food package implementation. The new food rule is still open for comment.

Federal Regulations That Can Be Left to State Interpretation

Joan Bowsher provided a handout to the group entitled “Federal Regulation/State Plan Crosswalk.” This is a list created by the state WIC Program staff which identifies areas where the state has some leeway about how the state program is carried out. She also referred to the summary sheet that the state staff constructed from the responses of local WIC program staff on this topic. Joan reviewed the items and the group had the opportunity to ask questions. These handouts are also posted on the website under the first meeting section: http://www.dphhs.mt.gov/PHSD/family-health/nutrition-wic/WIC-futures-study-group.shtml.

Montana WIC Program Budget

Dale McBride and Joyce Taranik from the State DPHHS fiscal services department then provided a handout (posted on the website under the first meeting section: http://www.dphhs.mt.gov/PHSD/family-health/nutrition-wic/WIC-futures-study-group.shtml) which tabled the WIC Administrative, OA, and Food Grants that have been received since FFY2002 and how the money was expended. Local agency contracts were noted on these pages. The group observed that the local agency contracts have not increased as rapidly as the state “cost allocation” expenses. State staff indicated that IT staff are not now identified as WIC department staff, and the cost for them is now located in the cost allocation. Some thought this move was good because it opened up communication with other IT projects across the department. Also included in the cost allocation are charges to fiscal services, legal services, director’s office, and quality assurance auditors. Dale said that it would be illegal to charge WIC funds for services that were not WIC related. Joan clarified that the indirect costs cover all of the WIC funds (NSA, Food and OA.)

Several members of the study group requested more detailed information to be provided at the next meeting. The question was asked: What can be done to slow down the trend of increasing expenses due to the cost allocation? Ellen said that the state takes care of itself and the clients are the last to be considered. Dale said the food dollars generate lots of work but the money to do the work is taken out of the NSA funds, not the food side. The cost of shifting to a “local agency” model was also discussed. Theoretically, this should have reduced the work of state staff. Jane said she would talk to Marie Mathews regarding the cost allocation plan for WIC. Dale stated that the state has looked at it in the past. He said if WIC doesn’t pay, then the general fund would have to cover the costs and the division does not have general funds to cover these expenses. Dale will also work on getting more information and clarification for the next meeting.

WIC in Montana – Notes from the Epidemiologist

Next, Dianna Frick from the DPHHS Family and Community Health Bureau gave a PowerPoint presentation on national and state data which is available regarding WIC coverage rates, eligibility, and participation. A copy of this presentation is also posted on the website under the first meeting section: http://www.dphhs.mt.gov/PHSD/family-health/nutrition-wic/WIC-futures-study-group.shtml.

Local Support Provided to WIC

The group then heard from a panel of local health department officials from small, medium, and large counties who offered examples of how the local WIC programs are supported by county or other funds which are not covered by federal WIC funds. Ellen Leahy, Missoula County, Lora Weir, Teton County, and Riki Hanstede, Hill County, offered their insights regarding the actual cost of providing WIC services. Basically, others must come up with money to serve the WIC clients. Some of this is because of the change in the way the WIC program funded local programs. For example, Missoula County is funding 12% of the cost of their WIC program.

Report on State Query: What are the five biggest time-takers in WIC service delivery?”

Joan Bowsher provided a handout of all responses to the query and a summary page for the group to review. A copy of these documents is also posted on the website under the first meeting section: http://www.dphhs.mt.gov/PHSD/family-health/nutrition-wic/WIC-futures-study-group.shtml.

Agenda Topics for Next Meeting

- Impact of the SPIRIT system

- Follow up on cost allocation and budget items

- Brainstorm problems

The facilitator told the group that the next meeting will be held on April 7^th and 8^th at the Hampton Inn in Great Falls. On Monday, April 7^th, the meeting will be held from 10:00 a.m. – 5:00 p.m. and on Tuesday, April 8^th, the meeting will be held from 8:00 a.m. until 3:00 p.m. She asked the group to bring in 5 problems that they have identified and 2 supporting problems for each of the five.

Public Comment

There were no comments offered from those present.

Evaluation

The group performed a short evaluation of the strategic planning process. In regard to what was liked or appreciated about the meeting, many people mentioned that it was good to have a federal representative there and thanked her for coming. Others noted that good information was handed out during the meeting, some of which had been requested for a long time. This will help, as one person said, in important decision making. Another person appreciated “everyone here and their opinions.” Another described the meetings as “a rare opportunity.” One person said that it seems like the message is that it is ok to get information out on the table. Several others appreciated the participation of Jane and Jo Anne and their obvious commitment to the process. Another liked that “everyone has a voice in the outcome.” One person noted that as the SPIRIT system is implemented, it will be important to have input and suggestions. One participant liked the diversity of the group. Several participants appreciated all of the work that the state staff has put into getting the information ready and putting together the folders, survey summaries, etc. Many said that it has been a “good process.”

Regarding things that should change or could improve the session, some mentioned that it is important to have the survey information early. One person would have liked an earlier lunch or breakfast. One requested that problem statements for the next meeting be brought in written format and shared with everyone. The facilitator told the group that with the “sticky wall” tool which will be utilized, everyone will be able to share their information so that it will be seen by others. One person would like panel members reminded that they have volunteered to speak. One person noted that there was no time set aside to “look at things.” One person would like to move around more and two would have liked more breaks. One participant appreciated the folders but would like to know “what papers everyone has.” One person would have liked meat for lunch instead of salad. And another noted that they would like to “get to solutions.”

Addendum

Handouts, documents, presentations, and the report of this meeting are available at: http://www.dphhs.mt.gov/PHSD/family-health/nutrition-wic/WIC-futures-study-group.shtml