Memo To: Jane
Smilie; Joan Bowsher and WIC Study Group
From: MAWA
Board of Directors including Mary
Pittaway, Connie Undem, Susan Tefre, Jeannine Lund,
Date: March
13, 2008
Subject: Response
from to request for input from local agency staff for WIC Study Group
Thanks for inviting input on ways that Montana
WIC might be improved. What follows is a
list of ideas that have been discussed by our board, with input from others
across the state. Thanks for your
consideration of the recommendations presented.
1. Institutionalize an annual coordinated State WIC outreach
effort for WIC that includes targeted advertising in those places with
underserved populations. We still need
data on the eligible population by region, county or reservation to do this which
we understand is being assessed at this time. For example, $25,000 was spent on
the most recent WIC outreach effort, but the ads were put on AM radio stations
that target the agriculture community listeners. How many new clients were brought in? And how many more would have been brought in
if it had been aired in high density areas?
As part of the annual plan, include the principal of evaluating outcomes
of various outreach strategies rather than repeating ones that don’t work. Coordinate WIC outreach with each and every
other state run program that is likely to serve families who may be eligible
for WIC such as Child and Adult Care Feeding, School meals, Food Stamps,
Medicaid, CHIP, LIEAP, TANF, MCH, Children with Special Health Care Needs, etc. It appears that some of this is done, some of
the time, rather than a more routine and comprehensive program
2. Clarify the
difference between WIC and MCH. There continues a
perception that WIC is a subset of MCH creating tensions and confusion by local
administrators. For example, what are
the respective missions, goals, staffing, target population, eligibility
criteria, caseloads, annual unduplicated and monthly caseloads, budget, funding
source, outcomes, appointments per year and anything that might help compare
and contrast the two programs. www.whitehouse.gov/omb/expectmore/detail/10003027.2006.html
3. Set up model of
templates for MOUs and contracts. For example,
a. WIC MCH Coordination, referrals, shared information.
b. Running satellite clinics in other counties
c. Contracts for Registered Dietitian services
4. Supplemental
Funding When USDA announces RFP’s for supplemental
WIC grants,
5. Cost allocation: From 2002 through 2008, the proportion of the money going to local
agencies compared to total administrative costs for MT have dropped from 77% of
the funds to 68% of the funds. Why? And why has the state cost allocation risen
from 20% of total administrative WIC funds for MT in 02, to 35% in 08. In what way is cost allocation negotiable?
Who verifies that the charges are fair and reasonable? Which DPHHS programs, if
any do not pay cost allocation?
6. Finish the MOU
between WIC and the state IZ program which was
started over 10 years ago. This would
allow a seamless immunization records exchange between WIC and IZ program. Since the state doesn’t have an MOU in place,
we are told by the state IZ program staff that WIC is losing out on the funding
was available through IZ program for sharing of WIC IZ records. And the IZ program is losing out on a substantial
number of records available for entry into the registry.
7. Automated System: Assure that if data is entered into the automated system locally,
reports of that data by clinic site are available. For example if we enter a code for the
ethnicity of a client, we should be able to access information on the number of
clients with that ethnicity. If we enter
the date about exclusive breastfeeding for mothers, we should be able to get a
report of the same, etc.
8. Update training
systems, e.g. the lap top program to train new
employees on the WIC system is fraught with errors and bugs and is nothing
short of an insult for use in training.
9. Provide regional dietitians to cover areas where there are no RDs.
Locals could either hire or contract with an RD or contribute to budget
to fund a regional RD
10. Combine the
Spring Public Health meeting with the MPHA meeting to improve attendance at both, to minimize duplication of planning
effort, decrease costs and enhance WIC staff’s exposure to the broader public
health field.
11. Develop a systematic process of soliciting input and feedback for
program changes from local staff, and/or clients or other affected groups
(grocers, physicians, etc). Recent fiascos and costly mistakes, such as
eliminating organic foods rather than focus on lower priced brands; pulling out
of the computer consortium, and mandating an inappropriate hemoglobin testing
system would be avoided. Before making
financial decisions, that impact local agencies, send idea out for consideration
and comment, including justification (data rather than gut reactions),
anticipated outcome etc. If DPHHS were
to use data to make decisions and include the data in justifications for
changes, buy in and follow-through by local agencies will be enhanced E.g.
“Based on x, y, z data, we anticipate food costs will exceed the USDA
grant. We propose x, y, z to prevent
this problem. E.g “Please comment on the pro‘s and cons of each of these
strategies by x date. “
12. Limit indirect
costs to a figure lower than the current 25%. All the additional charges to the WIC budget
such as rent and indirect, cost allocation, etc drain resources that are needed
for basic client services. Could DPHHS approach
the legislature about funding cost allocation expenses charged to
WIC by the state agency for a specified period of time, while measures to
increase caseload can be put into place? Or permanently? Project the caseload impact MT would see if
local agencies were not allowed to charge indirect, rent or administrative
services.
13. Encourage innovated ways of delivery of WIC nutrition education,
especially in the rural and frontier areas. For example, phone follow-up
education appointments, email contact with WIC clients, telemedicine
education. Share results of pilot
studies e.g. web cam education in
14. Routinely send
caseload and total food and NSA expenditures out,
by county and reservation to community leaders e.g. county commissioners,
mayor, tribal councils etc. This would help to demonstrate the financial impact
of WIC in an area. When sharing WIC
impact on economic health of communities also include information on how much
additional money would be available if full participation were to happen.
15. Develop a “new to
WIC” employee training program that includes client
services, food packages, risk issues,
care plan development, referrals, how to manage a clinic, the computer system,
vendor relations, trouble shooting computer problems, all the issues that
confront a new employee who now often has to learn this on the job through
trial and error. Could WIC 101 be incorporated into an existing
annual meeting such as MPHA or the summer Public health institute for
16. Follow the process used by other states (e.g.
17. Share findings
from monitoring visits (names removed) so all
local agencies can benefit from learning of what weaknesses and strengths
locals around the state are.
18. Could we figure out a way to
decrease the number and frequency of required signatures for client
appointments? E.g. could we use initials? Combine forms?
19. There are redundant questions on breastfeeding through out the
documentation process, yet, we still cannot say how many clients breastfeed
exclusively for 6 months. Instead of
collecting irrelevant data, lets consider using our resources to collect
meaningful evaluation information so we can assess which interventions are
effective and which are not.
20. We are told that even though congress has approved the new WIC food
packages which include fresh fruits and vegetables rather than juice
products, among other enhancements,
21. Staff Food Committee with RD’s. The last time authorized foods
were removed and added from the
22. “WIC Certifiers” freeing up valuable professional RD, RN and home economist time for
higher level services. We are told that
our regional office doesn’t like certifiers. So what, if it s allowed under the
regulations, we should consider doing it.
That way para-professional staff could perform certification and food
package assignment duties, as part of the routine certification appointment. Those clients with specific nutritional risks
would be seen by an RD, but many WIC clients only require routine care, which
could be handled by RD driven protocols.
23. Could the state research and present how
24. Eliminate requiring proof of
pregnancy for certification of prenatal clients, except if there is
question as to the pregnancy. It is
optional. (Page 331 WIC
regulations.
ii) For a State agency opting to require
proof of pregnancy, the State
agency may issue benefits to applicants
who claim to be pregnant (assuming
that all other eligibility criteria
are met) but whose conditions (as
pregnant) are not visibly noticeable
and do not have documented proof of
pregnancy at the time of the certification
interview and determination.
The State agency should then allow a
reasonable period of time, not to exceed
60 days, for the applicant to provide
the requested documentation. If
such documentation is not provided as
requested, the woman can no longer be
considered categorically eligible, and
the local agency would then be justified
in terminating the woman’s WIC
participation in the middle of a certification
period.
27.
Alcohol swab… $.02
Gloves…
$.13
Lancet…
$.25 -.34
Microcuvette... $.79
Band-aids…
$.05-.11
28. Could
(vi) Purchase price. A space
for the
purchase price to be entered. At the
discretion of the State agency, a maximum
price may be printed on the food
instrument that is higher than the expected
purchase price of the authorized
supplemental foods for which it will be
used, but that is low enough to protect
against potential loss of funds. When a
maximum price is printed on the food
instrument, the space for the purchase
price
must be clearly distinguishable
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