HomeMy WebLinkAboutChapter 07 - Food deliveryIdaho WIC Program Policy Manual
CHAPTER 7: FOOD DELIVERY
Approval Date: Dec 2023
Supersedes: Mar 2023
OVERVIEW
The Idaho WIC Program operates according to WIC program specific federal regulations including
food package issuance and authorized foods.
PURPOSE
The sections in this chapter describe the different types of supplemental food packages available for
issuing to participants. Supplemental Foods are defined as those foods containing nutrients
determined by nutritional research to be lacking in the diets of pregnant, breastfeeding, and
postpartum women, infants, and children, as found in the Child Nutrition and WIC Reauthorization Act
of 2004.
SCOPE
The policy applies to all State and local agency staff operating within the Idaho WIC Program.
IN THIS CHAPTER
Section A Food Packages
Section B Infant Formulas and Medical Foods
Section C Issuing Food Benefits /CVBs
Idaho WIC Program Policy Manual
SECTION A: FOOD PACKAGES
OVERVIEW
The Idaho WIC Program authorizes food packages based on federal requirements and the nutritional
needs of the participant. Food packages are available by category, age and breastfeeding percentage of
participant with the federal maximum quantity allowed. Multiple food packages may be available for each
participant category. An individual participant may be issued a tailored food package based on further
nutrition assessment nutrition risk and/or participant preference.
IN THIS SECTION
Approved Foods
Breastfeeding Food Packages
Standard Food Packages for Participants by Category
Food Packages Requiring Medical Documentation
Homeless Food Packages
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Approved Foods
DEFINITION
WIC has specific requirements for the supplemental foods it allows. These foods are determined at the
federal level with some of the options being left up to the states to decide.
Criteria for approving products for inclusion in the Idaho WIC Authorized Food List are based on federal
regulations, State agency requirements, cost, nutritional value, and cultural/participant acceptability.
The Idaho WIC Program Food Selection Committee determines all aspects of the Idaho Authorized Food
List per the Food Authorization Procedure and based on the criteria found in this policy.
▪ WIC food products shall meet all federal requirements governing the WIC food package to be
considered for approval through the Idaho WIC Program.
▪ WIC food products shall be widely available throughout the state.
▪ WIC food products shall have been available in retail stores in Idaho for six months prior to
request for approval. In addition to the criteria specified in this policy, the Idaho WIC Food
Selection Committee reserves the right to restrict the number of brands and types of products in
order to contain costs and/or minimize confusion on the part of participants and vendors. This
includes restricting specialty items that cost more than other approved products in the same food
category.
▪ Idaho WIC also reserves the right to disallow food category substitutions offered to participants in
order to contain costs following the criteria in FNS Instruction 804-1 WIC Program – Food
Package Design: Administrative Adjustments and Nutrition Tailoring.
▪ WIC food product composition and marketing approach must be consistent with the promotion of
good nutrition and education.
FORMULA
Federal Standards Infant Formula
All authorized infant formulas must:
▪ Meet the definition for an infant formula in section 201(z) of the Federal Food, Drug, and
Cosmetic Act (21 U.S.C. 321(z)) and meet the requirements for an infant formula under section
412 of the Federal Food, Drug and Cosmetic Act, as amended (21 U.S.C. 350a) and the
regulations at 21 CFR parts 106 and 107.
▪ Be designed for enteral digestion via an oral or tube feeding.
▪ Provide at least 10 mg iron per liter (at least 1.5mg iron/100 kilocalories) at standard dilution.
▪ Provide at least 67 kilocalories per 100 milliliters (approximately 20 kilocalories per fluid ounce) at
standard dilution.
▪ Not require the addition of any ingredients other than water prior to being served in a liquid state.
Exempt Infant Formula
All authorized exempt infant formulas must:
▪ Meet the definition and requirements for an exempt infant formula under section 412(h) of the
Federal Food, Drug, and Cosmetic Act as amended (21 U.S.C. 350a(h)) and the regulations at 21
CFR parts 106 and 107.
▪ Be designed for enteral digestion via an oral or tube feeding.
WIC-eligible Nutritionals
▪ Certain enteral products that are specifically formulated to provide nutritional support for
individuals with a qualifying condition, when the use of conventional foods is precluded, restricted,
or inadequate.
▪ Must serve the purpose of a food, meal or diet (may be nutritionally complete or incomplete) and
provide a source of calories and one or more nutrients.
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▪ Must be designed for enteral digestion via an oral or tube feeding.
▪ May not be a conventional food, drug, flavoring, or enzyme.
State Standards
▪ Must be part of the State formulary. See the Formula Handbook.
MILK & MILK ALTERNATIVES
COW’S MILK
Federal Standards
▪ Must conform to FDA standard of identity for whole, reduced-fat, low-fat, or non-fat milks.
▪ Must be pasteurized and contain at least 400 IU of vitamin D per quart (100 IU per cup) and 2000
IU of vitamin A per quart (500 IU per cup) following FDA fortification standards.
▪ May be flavored or unflavored, fluid, shelf stable, evaporated, or dry.
▪ Dry whole & non-fat milk must conform to FDA standard of identity for dry milk.
▪ Cultured milks (buttermilk, acidophilus) must conform to FDA standard of identity for cultured
milk.
▪ Acidified milk (acidified kefir milk, acidified acidophilus milk, acidified buttermilk) must conform to
FDA standard of identity for acidified milk.
▪ Whole milk is the standard milk for issuance to 1-year old children (12 through 23 months). Fat
reduced milks may be substituted for whole milk as determined appropriate by the healthcare
provider and with CPA approval.
▪ Low-fat (1%) or fat-free/skim are the standard milk for issuance to children 2 years of age and
older, and for women (pregnant, postpartum, and breastfeeding). Whole milk may be substituted
for low-fat (1%) or non-fat milk as determined appropriate by healthcare provider. Reduced fat
(2%) milk may be substituted for low-fat (1%) or non-fat milk with registered dietitian (RD)
approval.
State Standards
▪ All fluid milk products (non-fat milk, low fat (1%), reduced fat (2%), and whole) may be purchased
in gallon, half gallon (0.5 gallon) or quart (0.25 gallon) size containers.
▪ Non-fat dry powdered and canned evaporated milk is authorized.
▪ RD approval and documentation is required prior to issuing acidophilus, lactose reduced, lactose
free, or reduced-fat (2%) milk for women and children.
▪ Fat-reduced milks are not allowed for children ages 12 through 23 months.
▪ Organic, sweetened, flavored, sweetened condensed, and UHT milks are not allowed.
GOAT’S MILK
Federal Standards
▪ Must be pasteurized and contain at least 400 IU of vitamin D per quart (100 IU per cup) and 2000
IU of vitamin A per quart (500 IU per cup), following FDA fortification standards.
▪ May be flavored or unflavored. May be fluid, shelf stable, evaporated, or dry.
State Standards
▪ Powdered or flavored goat’s milk is not allowed.
▪ RD approval and documentation is required prior to issuing goat’s milk.
CHEESE
Federal Standards
▪ Domestic cheese made from 100% pasteurized cow’s milk
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▪ Must conform to FDA standard of identity 21 CFR part (133)
▪ Monterey jack, Colby, natural cheddar, Swiss, brick, muenster, provolone, part-skim or whole
mozzarella, pasteurized processed American, or blends of any of these cheeses are WIC-eligible.
▪ Cheeses that are labeled low, free, reduced, less or light in the nutrients of sodium, fat, or
cholesterol are WIC-eligible.
State Standards
▪ Monterey jack, Colby, natural cheddar (mild, medium, sharp, white) Swiss, brick, muenster,
provolone, part-skim or whole mozzarella, or blends of any of these cheeses are authorized.
▪ Natural, regular, or low-fat block cheese, unsliced, vacuum-packed in a 16-ounce (one pound)
package is approved. Only 16-ounce multi-stick bag of mozzarella string cheese is authorized.
▪ Shredded, grated, cubed, organic, extra sharp, flavored, added ingredients, or cheese purchased
at the deli are not allowed.
▪ Cream cheese, cottage cheese, Velveeta™, cheese food, spreads, or cheese products are not
allowed.
YOGURT
Federal Standards
▪ Must be pasteurized and conform to FDA standard of identity, whole (21 CFR 131.200), low-fat
(21 CFR 131.203) or non-fat (21 CFR 131.206).
▪ Must contain no more than 40 g of total sugars per 1 cup yogurt.
▪ May be plain or flavored.
▪ Yogurts sold with accompanying mix-in ingredients such as granola, candy pieces, honey, nuts
and similar ingredients are not authorized. Drinkable yogurts are not authorized.
▪ Yogurts fortified with vitamin A and other nutrients are allowed at the SA’s option.
State Standards
▪ Only the brands and flavors of yogurt in 32 oz containers that appear on the current Idaho
Authorized Food List are authorized.
▪ Must contain no more than 35 g of total sugars per 1 cup yogurt.
▪ Yogurts that contain no artificial dyes or sweeteners will be given preference.
TOFU
Federal Standards
▪ Calcium-set tofu prepared with calcium salts (e.g. calcium sulfate). Must be calcium-set (contain
calcium salts but may also contain other coagulants (magnesium chloride).
▪ May not contain added fats, sugars, oils, or sodium.
State Standard
▪ Tofu is not currently an allowed Idaho WIC food.
SOY-BASED BEVERAGE
Federal Standards
▪ Must be fortified to meet the following nutrient levels: 276 mg calcium per cup, 8 g protein per
cup, 500 IU vitamin A per cup, 100 IU vitamin D per cup, 24 mg magnesium per cup, 222 mg
phosphorus per cup, 349 mg potassium per cup, 0.44 mg riboflavin per cup, and 1.1 mcg vitamin
B12 per cup, in accordance with fortification guidelines issued by FDA.
▪ May be flavored or unflavored.
State Standards
▪ Only types and brands of soy-based beverages that appear on the current Idaho Authorized Food
List are authorized.
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▪ RD approval and documentation is required prior to issuing a soy-based beverage to women or
children.
JUICE
Federal Standards
▪ Must conform to FDA standard of identity for fruit juice (21 CFR part 146) and vegetable juice (21
CFR part 156) as appropriate.
▪ Must be pasteurized 100% unsweetened juice.
▪ Must contain a minimum of 30 milligrams of vitamin C per 100 milliliters of juice, or 72 milligrams
of vitamin C per 8-fluid ounces of juice.
▪ Juices fortified with other nutrients may be allowed at the state agency’s option.
▪ Juice may be fresh, from concentrate, frozen, canned or shelf stable.
▪ Vegetable juice may be regular or lower in sodium.
▪ Blends of authorized juices are allowed.
State Standards
▪ Only brands and types of juice that appear on the current Idaho Authorized Food List are
authorized.
▪ Any brand of shelf-stable 100% orange juice in allotted container sizes is authorized.
▪ Calcium/vitamin D fortified orange juice is authorized to accommodate participants whose diets
may be low in these nutrients.
▪ Juice is authorized in 64-ounce plastic containers or 11.5-12-ounce frozen cans.
▪ Country style (extra pulp), pulp free, or reduced/low acid orange juice is authorized.
▪ Juice cocktails or artificially sweetened juices are not allowed to decrease participant and vendor
confusion.
EGGS
Federal Standards
▪ Fresh shell domestic hens’ eggs or dried eggs mix or pasteurized liquid whole eggs. Must
conform to standard of identity. Hard boiled eggs, where readily available for purchase in small
quantities, may be provided for homeless participants.
State Standards
▪ One-dozen carton, any size eggs including white, brown, cage free, free range, nutrient enhanced
(omega 3/vitamin E), and specialty such as Eggland’s Best™ are authorized.
▪ Organic eggs, egg substitutes, and dried egg mix are not allowed.
BREAKFAST CEREAL
Federal Standards
▪ Hot or cold cereal that contains a minimum of 28 milligrams of iron per 100 grams of dry cereal
and not more than 21.2 grams of sucrose and other sugars per 100 grams of dry cereal (6 grams
per ounce) is authorized.
▪ At least half of the cereals authorized must have whole grain as the primary ingredient by weight
and meet labeling requirements for making a health claim as a “whole grain food with moderate
fat content.”
▪ Infant cereal may be substituted for adult cereal at a rate of 32 dry ounces of infant cereal to 36
dry ounces of adult cereal. A medical prescription showing the need for increased iron, finer
texture for swallowing, or other reason must be documented.
State Standards
▪ Only brands and types of cereal that appear on the current Idaho Authorized Food List are
authorized.
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▪ Idaho WIC reserves the right to determine the number and brands of cereal which include at least
one hot cereal and at least one cereal from each grain group. Grain groups are defined as corn,
wheat, oat, rice, or multi-grain.
▪ Cereals that contain greater than or equal to 200 micrograms or 50% Recommended Dietary
Intake (RDI) of folic acid, greater than or equal to 2 grams of fiber per serving, contain no
partially-hydrogenated fat/trans-fat, contain less than 325 milligrams per dry ounce of sodium,
contain no artificial dyes or sweeteners, and are made from whole grains will be given preference
for their higher nutritional standards.
▪ Culturally acceptable cereals, cereals targeting specific ethnic groups, or cereals more suitable
for children shall be considered.
▪ The minimum package size authorized is 9.8 ounces for hot and 12 ounces for cold.
FRUITS AND VEGETABLES
Federal Standards
▪ Any variety of fresh whole or cut fruit without added sugars
▪ Any variety of fresh whole or cut vegetable without added sugars, fats, or oils
▪ Any variety of canned fruits that conform to standard of identity; including applesauce, juice pack
or water pack without added sugars, fats, oils, or salt. The fruit must be listed as the first
ingredient.
▪ Any variety of frozen fruits without added sugars, fats, oils, or salt.
▪ Any variety of canned or frozen vegetables that conform to FDA standard of identity without
added sugars, fats, or oils. May be regular or lower in sodium. Vegetable must be listed as the
first ingredient.
▪ Any type of dried fruits or dried vegetables without added sugars, fats, oils, or salt (sodium).
▪ Any type of immature beans, peas, or lentils, fresh or in canned forms.
▪ Any type of frozen beans (immature or mature) may be purchased with the WIC Food
Benefits/CVB. Beans purchased with the WIC Food Benefits/CVB may contain added vegetables
and fruits, but may not contain added sugars, fats, oils, or meat as purchased. Canned beans,
peas, or lentils may be regular or lower in sodium content.
▪ Organic forms of WIC-eligible fruits and vegetables are allowed.
▪ Herbs or spices; are not authorized, except fresh herbs sold in bunches that could be eaten as a
salad green, like cilantro or parsley.
▪ Creamed or sauced vegetables; vegetable-grain (pasta or rice) mixtures; fruit-nut mixtures;
breaded vegetables; fruits and vegetables for purchase on salad bars; peanuts or other nuts;
ornamental and decorative fruits and vegetables (painted pumpkins, garlic on a string); fruit
baskets and party vegetable trays; home-canned and home-preserved foods; and baked items
(blueberry muffins) are not authorized.
State Standards
▪ Only physical forms listed on current Idaho Authorized Food List are authorized.
▪ Organic fruits and vegetables are authorized for purchased with WIC Food Benefits/CVB.
▪ Participants may pay the difference if the total purchase price for the selected fresh fruits and
vegetables goes over the specified WIC Food Benefits/CVB amount.
WHOLE GRAINS
Federal Standards
▪ Whole wheat bread must conform to FDA standard of identity. “Whole wheat flour” and/or
“bromated whole wheat flour” must be the only flours listed in the ingredient list.
▪ Whole grain bread must conform to FDA standard of identity, AND whole grain must be the
primary ingredient by weight in all whole grain bread products, AND whole grain bread must meet
labeling requirements for making a health claim as a “whole grain food with moderate fat content.”
▪ Brown rice, bulgur (cracked wheat), oats, and whole-grain barley without added sugars, fats, oils,
or salt (sodium). May be instant, quick, or regular cooking.
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▪ Soft corn or whole wheat tortillas are authorized. Soft corn tortillas made from ground masa flour
(corn flour) using traditional processing methods are eligible. “Whole wheat flour” and/or
“bromated whole wheat flour” must be the only flours listed in the ingredient list.
▪ Whole wheat macaroni (pasta) products must conform to FDA standard of identity and have no
added sugars, fats, oils, or salt. “Whole wheat flour” and/or “whole durum wheat flour” must be
the only flours listed in the ingredient list.
State Standards
▪ Only types of whole grains that appear on the current Idaho Authorized Food List are authorized.
Organic options are not allowed.
▪ Any brand of 100% whole wheat bread in 16-ounce (1 pound) loaf that meets federal nutrition
requirements will be allowable on the Idaho Authorized Food List. Bread must state “100% whole
wheat” on the label and “whole wheat flour” and/or “bromated whole wheat flour” must be the only
flours listed in the ingredient list.
▪ 100% whole wheat macaroni (pasta) products in 12-16-ounce package sizes that appear in the
Idaho Authorized Food List.
▪ Any brand of brown rice in 16 oz bags (plain, short, medium, or long grain) with no added
seasoning, ingredients, or flavors.
▪ Whole wheat and soft corn tortilla brands in 12-16-ounce package sizes that appear in the Idaho
Authorized Food List.
▪ Bulgur (cracked wheat) and whole-grain barley are not allowed. Oatmeal is not allowed as a
whole grain substitute.
CANNED FISH
Federal Standards
▪ Light tuna and salmon must conform to FDA standard of identity.
▪ Sardines, mackerel, and jack mackerel are allowed.
▪ May be packed in water or oil. Pack may include bones or skin.
▪ May be regular or lower in sodium.
▪ May contain added sauces and flavorings (tomato sauce, mustard, lemon, or herbs as a State
option).
State Standards
▪ Any brand chunk light tuna or pink salmon packed in water or oil is authorized.
▪ Only 5-ounce cans are authorized.
▪ Atlantic and wild Alaskan red (sockeye) salmon are not allowed.
▪ Added sauces and flavorings or herbs are not allowed.
▪ Smoked, organic, snack packs, and pouches are not allowed.
MATURE LEGUMES
Federal Standards
▪ Any type of mature dry beans, peas, or lentils in dry-packaged or canned forms, including but not
limited to black, black-eyed peas, garbanzo (chickpeas), great northern, kidney, mature lima
(“butter beans”), white (navy and pea), pinto, soybeans/edamame, fava and mung, refried, split
peas, and lentils are authorized.
▪ All categories exclude soups, immature varieties of legumes such as those used in canned green
peas, green beans, snap beans, yellow beans, and wax beans.
▪ May be dry or canned.
▪ May not contain added sugars, fats, oils, meat or fruits and vegetables.
▪ Canned legumes may be regular or lower in sodium.
▪ Canned beans may contain onions and/or garlic as seasoning.
▪ Baked beans without any added meat may be provided for participants with limited cooking
facilities.
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State Standards
▪ Any brand of plain dried beans, peas, or lentils or any brand of canned beans.
▪ Only one-pound (16 ounce) package of dry beans or 15-16 ounce cans of beans are authorized.
▪ Canned beans may be substituted for dry beans at a rate of four 16-oz cans of beans for one-
pound dry beans.
PEANUT BUTTER
Federal Standards
▪ Must conform to FDA standard of identity for peanut butter or reduced fat peanut butter.
▪ Creamy, chunky, regular or reduced fat salted, or unsalted forms are authorized.
▪ Added marshmallows, honey, jelly, chocolate or similar ingredients are not authorized.
▪ Peanut spreads are not authorized.
State Standards
▪ Any commercially prepared brands of peanut butter, including creamy, crunchy, and extra
crunchy are authorized.
▪ Peanut butter may be substituted for dry beans at a rate of 18 ounces of peanut butter for one-
pound dry beans.
▪ Only 16 to 18-ounce containers are authorized.
▪ Fortified, low sodium, gourmet, reduced-fat, added honey roasted, added honey, other added
ingredients not listed, and low carbohydrate diet peanut butters are not allowed.
INFANT CEREAL
Federal Standards
▪ Infant cereal must contain a minimum of 45 milligrams of iron per 100 grams of dry cereal.
▪ Any plain, dry infant cereal, including mixed grain
▪ No added infant formula, milk, fruit, or other non-cereal ingredients
State Standards
▪ Only brands and sizes listed on Idaho Authorized Food List are authorized.
▪ Organic, added DHA/ARA, added specialty ingredients, or specialty infant cereal are not allowed.
INFANT FRUITS AND VEGETABLES
Federal Standards
▪ Any variety of single ingredient commercial infant fruit or vegetable without added sugars,
starches, or salt (sodium). Texture may range from strained through diced. The fruit and/or
vegetable must be listed as the first ingredient.
▪ Combinations of single ingredients of fruits and/or vegetables are authorized (e.g., peas and
carrots, apples and squash).
▪ Fresh banana may be substituted.
▪ Mixtures with cereal or infant food desserts are not allowed.
State Standards
▪ Only brands, texture (stage), and size listed on Idaho Authorized Food List are authorized.
▪ Organic, added DHA/ARA, added specialty ingredients, or specialty infant foods are not allowed.
▪ Fresh bananas are not currently allowed.
INFANT MEAT
Federal Standards
▪ Infant meat is only for infants of fully breastfeeding women.
▪ Any variety of commercial infant food meat or poultry, as a single major ingredient, with added
broth or gravy. Texture may range from pureed through diced.
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▪ Added sugars or salt (sodium) are not allowed.
▪ Infant food combinations with meat, pasta, cereal, dinners, or desserts are not allowed.
State Standards
▪ Only brands and size listed on Idaho Authorized Food List are authorized.
▪ Organic, added DHA/ARA, added specialty ingredients, or specialty infant foods are not allowed.
REFERENCES
Public Law 108-265; WIC Reauthorization Act of 2004
7 CFR 246 FNS Special Supplemental Nutrition Program for Women, Infants and Children (WIC):
Revisions in the WIC Food Packages; Final Rule, March 4, 2014
ASM 99-105
ASM 99-112
Food Packages for Participants by Category
Food packages are available by category of participant. The food packages are designed to be consistent
with the current Dietary Guidelines for Americans for the specified category and must meet the federal
and state requirements. Food benefits are determined by month. Refer to Section B of this chapter for
more information about infant formulas.
Full Nutrition Benefit (FNB) and Maximum Monthly Allowances (MMA) are used when issuing formula.
The MMA allows for changing can sizes, this amount should not be exceeded. FNB is considered the
minimum amount to be issued.
Some formulas may not fall within the MMA and the FNB so rounding up methods are used. Rounding up
is used when an infant formula’s yield in fluid ounces results in the issuance amount not falling within the
maximum monthly allowance and the full nutrition benefit. Methodology for rounding up found in CFR
246.10(h) should be used to determine how much formula the participant should receive. See the
formula handbook for guidance on how to round up.
Food Package 1 – Infants birth through 5 months
Package
Description Age Formula Amounts
Fully breastfed A fully breastfed infant will not receive a food package until s/he reaches 6
months of age
Partially breastfed Birth through 1 month Infant must be >1 month of age in order to receive
a partial formula package
Partially breastfed 1 through 3 months
FNB is 364 fl oz reconstituted amount per month;
maximum of 435 fl oz reconstituted powder, 388 oz
reconstituted liquid concentrate, 384 oz RTF
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Package
Description Age Formula Amounts
Fully formula fed Birth through 3 months
FNB is 806 fl oz reconstituted amount per month;
maximum of 870 fl oz reconstituted powder, 823 oz
reconstituted liquid concentrate, 832 oz RTF
Partially breastfed 4 through 5 months
FNB is 442 fl oz reconstituted amount per month;
maximum of 522 fl oz reconstituted powder, 460 oz
reconstituted liquid concentrate, 474 oz RTF
Fully formula fed 4 through 5 months
FNB is 884 fl oz reconstituted amount per month;
maximum of 960 fl oz reconstituted powder, 896 fl
oz reconstituted liquid concentrate, 913 oz RTF
Food Package 2 – Infants 6 through 11 months
Package
Description Food Amounts Formula Amounts
Fully breastfed
Infant cereal – 24 oz
Infant fruits/vegetables – 256 oz
Infant food meat – 77.5 oz
Partially breastfed
Infant cereal – 24 oz
Infant fruits/vegetables
– 128 oz
FNB is 312 fl oz reconstituted amount per month;
maximum of 384 fl oz reconstituted powder, 315
oz reconstituted liquid concentrate, 338 oz RTF
Fully formula fed
Infant cereal – 24 oz
Infant fruits/vegetables
– 128 oz
FNB = 624 fl oz reconstituted amount per month;
maximum of 696 fl oz reconstituted powder, 630
oz reconstituted liquid concentrate, 634 oz RTF
Food Package 4 – Children 1 through 4 years
▪ Juice – 128 fluid ounces (two 64-ounce containers)
▪ Milk – 16 quarts (4.0 gallons)
▪ Breakfast cereal – 36 ounces
▪ Eggs – 1 dozen
▪ Fruits and vegetables - $ 26 WIC Food Benefits/CVB
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▪ Whole wheat bread/whole grain – 2 pounds (32 ounces)
▪ Legumes– 1 pound dry/64 ounces canned (4 cans) or 18 ounces peanut butter
Food Package 5 – Pregnant and Partially Breastfeeding Women
▪ Juice – 144 fluid ounces (three 12-ounce frozen concentrate containers)
▪ Milk – 22 quarts (5.5 gallons)
▪ Breakfast cereal – 36 ounces
▪ Eggs – 1 dozen
▪ Fruits and vegetables – $47 WIC Food Benefits/CVB
▪ Whole wheat bread/whole grain – 1 pound (16 ounces)
▪ Legumes–1 pound dry/64 ounces canned (4 cans) and 18 ounces peanut butter
Food Package 6 – Postpartum Women
▪ Juice – 96 fluid ounces (two 12-ounce frozen concentrate containers)
▪ Milk – 16 quarts (4.0 gallons)
▪ Breakfast cereal – 36 ounces
▪ Eggs – 1 dozen
▪ Fruits and vegetables – $47 WIC Food Benefits/CVB
▪ Legumes– 1 pound dry/64 ounces canned (4 cans) or 18 ounces peanut butter
Food Package 7 – Fully Breastfeeding, Pregnant with Multiples, Partially (mostly) breastfeeding
multiples, pregnant and partially (mostly) breastfeeding
▪ Juice – 144 fluid ounces (three 12-ounce frozen concentrate containers)
▪ Milk – 24 quarts (6.0 gallons)
▪ Breakfast cereal – 36 ounces
▪ Cheese –1 pound
▪ Eggs – 2 dozen
▪ Fruits and vegetables - $52 WIC Food Benefits/CVB
▪ Whole wheat bread/whole grain – 1 pound (16 ounces)
▪ Fish (canned) – 30 ounces (6 cans)
Legumes–1 pound dry/64 ounces canned (4 cans) and 18 ounces peanut butter
Food Package 7M – Fully Breastfeeding Multiples (Food Package 7 amounts multiplied by 1.5 and
averaged over two-month timeframe)
Month A
▪ Juice – 240 fluid ounces (five 12-ounce frozen concentrate containers)
▪ Milk – 36 quarts (9.0 gallons)
▪ Breakfast cereal – 54 ounces
▪ Cheese – 2 pounds
▪ Eggs – 3 dozen
▪ Fruits and vegetables - $78WIC Food Benefits/CVB
▪ Whole wheat bread/whole grain – 2 pounds (32 ounces)
▪ Fish (canned) – 45 ounces (9 cans)
▪ Legumes– 2 pounds dry/128 ounces canned (8 cans) and 18 ounces peanut butter
Month B
▪ Juice – 192 fluid ounces (four 12-ounce frozen concentrate containers)
▪ Milk – 36 quarts (9.0 gallons)
▪ Breakfast cereal – 54 ounces
▪ Cheese – 1 pound
▪ Eggs – 3 dozen
▪ Fruits and vegetables - $78 WIC Food Benefits/CVB
▪ Whole wheat bread/whole grain – 1 pounds (16 ounces)
▪ Fish (canned) – 45 ounces (9 cans)
▪ Legumes–1 pound dry/64 ounces canned (4 cans) and 36 ounces peanut butter
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Allowed substitutions/Tailoring Equivalencies
Substitutions are federally allowed to meet the needs of participants. The following are allowed in Idaho
without a special authorization (Medical Documentation form, Registered Dietitian approval, or
Homeless):
▪ The substitution rate for evaporated milk is 16 fluid ounces of evaporated milk per 32 ounces
(0.25 gallon) of fluid milk or a 1:2 fluid ounce substitution ratio.
▪ Dry milk may be substituted at an equal reconstituted rate to fluid milk.
▪ Cheese may be substituted for milk at a rate of 1 pound of cheese for 3 quarts (0.75 gallons) of
cow’s milk. Only one pound of cheese, maximum, is allowed for children, pregnant women and
postpartum women. Fully breastfeeding women can receive a maximum of two pounds of
cheese.
▪ Yogurt may be substituted for milk at a rate of 1 quart (0.25 gallon) of yogurt for 1 quart (0.25
gallon) of milk. Only one quart of yogurt, maximum, is allowed for children, pregnant women and
postpartum women.
▪ For infants 9 to 12 months of age WIC Food Benefits/CVB for fresh (only) fruits and vegetables
can be substituted for some of the infant fruits and vegetable. For fully breastfeeding infants the
substitution is $8 WIC Food Benefits/CVB for 128 ounces of infant fruits and vegetables. For
partially- or non-breastfeeding infants the substitution is $4 WIC Food Benefits/CVB for 64
ounces of infant fruits and vegetables.
Special AuthorizationS
Special Authorizations are required to provide foods that are different from the base or base tailored food
package. There are three types of special authorizations, MD Doc (requires a Medical Documentation
form), RD Approval (requires review and approval by a registered dietitian), and Homeless (for
participants with limited access to a stove or refrigerator). Participants can have one, two, or three special
authorizations at the same time depending on their circumstances.
MD Doc Special Authorization- Medical Documentation /
Food Package 3
This special authorization is reserved for issuance to woman, infant, and child participants who have a
documented qualifying condition that requires the use of a WIC formula (infant, exempt, or WIC-eligible
nutritional) because the use of conventional food is precluded, restricted, or inadequate to address their
special nutritional needs.
Participants with qualifying medical conditions will receive up to the same maximum monthly amount of
supplemental foods unless medically contraindicated, as those same participant categories. Women and
children may also receive up to 455 fluid ounces liquid concentrate WIC formula (infant, exempt, or WIC-
eligible nutritional). Please refer to Section B of this chapter for further guidance.
The following supplemental foods will require a local agency registered dietitian to obtain medical
documentation from a health care professional licensed to write medical prescriptions under State law
using the Medical Documentation form. The health care professional must have made a medical
determination that the participant has a qualifying condition (refer to Section B of this chapter for further
clarification).
All Medical Documentation forms must be completed by a healthcare provider and stored as an electronic
or written copy. A facsimile or confirmation via telephone to a local agency registered dietitian must be
kept on file until the completed medical documentation form is received within one to two weeks.
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Use of electronic documentation, storage and signatures are allowable. It is the responsibility of the State
and local agencies to ensure the reliability and integrity of the technology used to receive and store
documentation. Local agencies are encouraged to follow the policies and procedures established by their
health district or tribal organization.
A Medical Documentation form is required for issuance of the following:
▪ Any infant formula prescribed to a child or adult
▪ Any exempt infant formula (refer to Section B of this chapter for further clarification)
▪ Any WIC-eligible nutritional (refer to Section B of this chapter for further clarification)
▪ Any authorized supplemental food issued outside of the participant’s category
Medical oversight of medically fragile participants is required in order to issue supplemental foods for
participants with a MD doc special authorization. However, the healthcare provider has the option to refer
to a local agency registered dietitian for identifying appropriate supplemental foods (excluding formula).
The prescribed amounts and the length of time the supplemental foods is required. The healthcare
provider will have the option to refer on the Medical Documentation form.
A VOC Medical Documentation form from another state (for an exempt formula or WIC-eligible nutritional
with a medical diagnosis) will be accepted by the receiving Idaho local agency for the remainder of that
certification period without requiring an Idaho health care professional to complete medical
documentation (unless the other state’s medical provider has indicated on the form that the prescription
expires sooner). If a VOC participant has been receiving an exempt infant formula or nutritional prior to
transferring to an Idaho local agency and does not bring the needed medical documentation form, the
Idaho local agency will contact the out of State agency to request the medical documentation form be
faxed or sent electronically. However, receipt of such documentation is not required for the transfer of
benefits.
RD APPROVAL SPECIAL AUTHORIZATION – REGISTERED DIETITIAN
This special authorization requires approval by a registered dietitian (RD). Sometimes RD Approval will
be required in conjunction with a MD Doc special authorization and sometimes it will be used alone. The
participant’s qualifying condition must be documented. Examples of qualifying conditions requiring only an
RD Approval include, but are not limited to: milk allergy, severe lactose maldigestion, underweight, vegan
diets, unsafe drinking water or inability to properly mix infant formula.
The following are authorized foods that can be issued with an RD Approval as long as appropriate for the
participant’s category:
• soy-based beverage
• acidophilus milk
• goat’s milk
• lactose reduced/free milk
• 2% milk
• ready-to-feed contract formula
NOTE: Ready-to-feed contract formulas require an RD Approval special authorization, even though
they are included on the options/tailoring for homeless food packages.
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HOMELESS SPECIAL AUTHORIZATION
This special authorization provides additional food options to participants who may not have access to a
stove, refrigerator, or safe water supply. The homeless food options may not be appropriate for all
homeless participants. Tailoring should be based upon the family’s individual needs. Often, a standard
food package will work for a homeless family. Food packages tailored for homeless participants may be
issued for one, two or three months.
Below are possible tailoring options for homeless participants. Some require the Homeless special
authorization, Ready-to-Feed (RTF) infant formula requires RD Approval special authorization, and some
don’t require any special authorizations.
Food Package 1 – Infants birth through 5 months
RTF infant formula in place of standard powdered or concentrate.
Food Package 2 – Infants 6 through 11 months
RTF infant formula in place of standard powdered or concentrate.
Food Package 4 – Children 1 through 4 years
▪ Juice – individual juice packs in place of 64-ounce containers of juice
▪ Milk – evaporated milk, dry powdered milk, or shelf stable soy beverage in place of standard
liquid cow’s milk
▪ Eggs – canned beans or peanut butter in place of eggs
Food Package 5 – Pregnant and Partially (Mostly) Breastfeeding Women
▪ Juice – individual juice packs in place of 12-ounce frozen concentrate containers of juice
▪ Milk - evaporated milk, dry powdered milk, or shelf stable soy beverage in place of standard liquid
cow’s milk
▪ Eggs – canned beans or peanut butter in place of eggs
Food Package 6 – Postpartum Women
▪ Juice – individual juice packs in place of 12-ounce frozen concentrate containers of juice
▪ Milk - evaporated milk, dry powdered milk, or shelf stable soy beverage
▪ Eggs – canned beans or peanut butter in place of eggs
Food Package 7 – Fully Breastfeeding, Pregnant with Multiples, Partially (mostly) breastfeeding
multiples, pregnant and partially (mostly) breastfeeding
▪ Juice – individual juice packs in place of 12-ounce frozen concentrate containers of juice
▪ Milk - evaporated milk, dry powdered milk, or shelf stable soy beverage
▪ Eggs – canned beans or peanut butter in place of eggs
Food Package 7M – Fully Breastfeeding Multiples (amounts to be averaged over two-month
timeframe)
Month A
▪ Juice – individual juice packs in place of 12 ounce frozen concentrate containers of juice
▪ Milk - evaporated milk, dry powdered milk, or shelf stable soy beverage
▪ Eggs – canned beans or peanut butter in place of eggs
Month B
▪ Juice – individual juice packs in place of 12 ounces frozen concentrate containers of juice
▪ Milk - evaporated milk, dry powdered milk, or shelf stable soy beverage
▪ Eggs – canned beans or peanut butter in place of eggs
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HOMELESS SPECIAL AUTHORIZATION TAILORING EQUIVALENCIES
Standard Food
Package
Homeless Food
Package Options Tailoring Equivalencies
Juice Individual juice
packages
Individual juice packages will be issued by ounces
according to the participant category, allowing
participants to select different juice package sizes
in the store.
Eggs Canned beans or
peanut butter
Four 16-oz cans of beans or one 18-oz container
of peanut butter for 1 dozen eggs
Milk
Evaporated milk,
powdered milk or shelf
stable soy beverage
21 12-oz cans evaporated milk for 16 quarts liquid
milk, or a 1:2 fluid ounce substitution ratio.
1quart powdered milk or shelf stable soy beverage
for 1-quart liquid milk
REFERENCE
7CFR Part 246: Revisions in the WIC Food Packages: Final Rule
Idaho Code 28-50-101. (2000). Uniform Electronic Transactions Act.
CRF 246.10 (h)
Breastfeeding Food Packages
OVERVIEW
The goal of the breastfeeding food package is to promote and encourage breastfeeding among
participants by providing additional WIC foods that support the extra nutritional needs of these
participants.
Food Package 7 – Fully Breastfeeding
A breastfeeding woman whose infant does not receive any infant formula from the WIC Program, a
woman who partially breastfeeds multiple (two or more) infants from the same pregnancy, a pregnant
women also partially (mostly) breastfeeding one infant, or a pregnant woman carrying two or more
fetuses will receive food package 7.
Breastfeeding Enhanced Multiples Food Package (7M)
A participant who is fully breastfeeding multiple infants (two or more) from the same pregnancy may
receive 1.5 times the supplemental foods provided in this food package.
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PROCEDURE
A fully breastfeeding participant can be issued food package 7 for one, two, or three months. A fully
breastfeeding participant of multiples (two or more) can be issued food package 7M for one, two or three
months, depending on the local agency policy and procedure for multi-month food benefit issuance and
the nutritional risk assessment of the participant.
Idaho WIC Program Policy Manual
SECTION B: INFANT FORMULAS AND WIC-ELIGIBLE
NUTRITIONALS
OVERVIEW
Breastfeeding provides a healthy and economical means of feeding an infant. The WIC Program strives
to promote and support breastfeeding by providing food packages that encourage continued
breastfeeding when mothers choose not to fully breastfeed.
Infant formula and nutritionals are the most expensive items in the WIC food package. In 1988, Congress
mandated that all WIC state agencies implement some form of infant formula cost containment. In 1989,
Congress added the requirement that states use competitive bidding in their cost containment efforts. The
Idaho WIC Program is part of the National Association of State Procurement Officers (NASPO) to contain
the costs of infant formula. Once the contract is awarded, the contract brand iron-fortified formula is
issued for the length of the contract. The money saved through infant formula rebate contracts is used to
serve more participants.
IN THIS SECTION
General Policy
Contract Brand Infant Formulas
Non-contract Brand Infant Formulas
Returned Infant Formula
MD Doc Special Authorization: Participants with Qualifying Medical Conditions
Packaging
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General Policy
Local agency staff shall issue infant formula and nutritionals according to the following guidelines set forth
by the State agency:
▪ Infant formulas and WIC-eligible nutritionals are issued only to active participants.
▪ Infant formulas and WIC-eligible nutritionals may not be provided to participants while they are
hospitalized.
▪ The Medicaid Program is the primary payor for exempt infant formulas and nutritionals needed by
WIC participants who are also Medicaid beneficiaries. Please refer to the most current Idaho
Medicaid Provider Handbook at www.healthandwelfare.idaho.gov.
For more information about procedures related to infant formulas and WIC-eligible nutritionals, refer
to the Idaho WIC Formula Handbook.
REFERENCES
Section 412 (h) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 350a(h))
WRO Policy Memo 804-Q: Medicaid Primary Payor for Exempt Infant Formulas and Medical Foods
7CFR Part 246: Revisions in the WIC Food Packages: Final Rule
Contract Brand Infant Formulas
Contract brand iron-fortified milk-based and soy-based, infant formulas will be issued to all infants unless
there is medical documentation for an exempt formula or a WIC-eligible nutritional. Non-contract non-
exempt infant formulas that are nutritionally equivalent to contract brand formulas or low-iron formulas will
not be issued and prescriptions will not be accepted under any circumstances.
Contract brand iron-fortified infant formulas can be issued by Certifiers
At this time, the contract formulas are:
▪ Similac Advance (cow’s milk-based) – powder (small cans), liquid concentrate, RTF *
▪ Similac Soy Isomil (soy-based) – powder (small cans), liquid concentrate, RTF*
* RTF = ready-to-feed. See packaging policy in this section for guidance on issuing RTF.
Non-Contract Brand Infant Formulas
Idaho WIC can approve the issuance of non-contract brand infant formula when it is determined the
current contract brand does not have a comparable equivalent.
Non-contract brand infant formula can be issued by Certifiers with a Medical Documentation form (MDF).
Current approved non-contract formula is:
▪ Enfamil A.R (cow’s milk based with added rice starch)- powdered (small cans), RTF*
* RTF = ready-to-feed. See packaging policy in this section for guidance on issuing RTF.
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Approval/ Issuance of Non-Contract Formula
Issuance of non-contract formula is reserved for the following circumstances with complete medical
documentation:
• Transition to an alternate contract formula is medically contraindicated for pre- or post-operative
recovery
• NICU discharge warrants continuation of a tolerated non-contract formula
• Participants diagnosed with a condition that requires a non-exempt formula that does not have a
contract formula equivalent.
If medical documentation has been received, but the infant does not meet the criteria for non-contract
formula issuance, the local agency dietitian (RD) shall work with the participant and healthcare provider to
find an alternative formula.
Returned Infant Formula
To ensure program accountability, participant safety and consistency; any formula purchased with Idaho
WIC benefits that is returned to a WIC clinic must be destroyed. Formula cannot be reissued to a
participant or donated.
WIC staff must destroy returned formula:
• Within two (2) business days of receiving the formula.
• By opening the containers and either dumping in the trash or pouring liquid down a sink.
In order to minimize returned formula, WIC staff are encouraged to ask participants to only purchase one
to two (1-2) containers of any new formula when it is unknown whether it will be tolerated. This should be
recommended, but not required by the participant if it creates a barrier to using their food benefits.
It is important to help infant caregivers understand that WIC is a supplemental food program and may not
provide enough formula for a full month for an older infant. Appropriate referrals such as the food bank
should be provided to the participant.
MD Doc Special Authorization: Participants with Qualifying
Medical Conditions
The Medicaid Program is the primary payer for exempt infant formulas and nutritionals needed by WIC
participants who are also Medicaid beneficiaries. Please refer to the most current Idaho Medicaid
Provider Handbook at www.healthandwelfare.idaho.gov.
Exempt infant formulas and WIC-eligible nutritionals are issued to woman, infant, and child participants
because the use of conventional foods is precluded, restricted, or inadequate to address their special
nutritional needs. Participants eligible to receive exempt infant formulas and WIC-eligible nutritionals must
have one or more qualifying conditions and have a completed Medical Documentation form prior to
issuance.
All information on the Medical Documentation form must be completed by a physician or other licensed
health care professional who is authorized to write medical prescriptions under Idaho state law to issue
an exempt infant formula or WIC-eligible nutritionals and, if tolerated, supplemental WIC foods. A local
agency registered dietitian may complete the form via telephone. A completed Medical Documentation
Form must still be signed by a healthcare provider and obtained within one to two weeks.
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The Medical Documentation form is needed:
▪ To issue an exempt formula, non-contract formula, or a WIC-eligible nutritional
▪ Every 12 months for children or women
▪ Upon a change in amount or type of product or supplemental foods issued
The form is kept hard copy or electronically in the local agency clinic.
The WIC Program is not required to provide exempt infant formulas and WIC-eligible nutritionals if the
diagnosed medical condition does not warrant such product. Qualifying conditions include, but are not
limited to:
▪ Premature birth
▪ Low birth weight
▪ Failure to thrive
▪ Inborn errors of metabolism and metabolic disorders
▪ Gastrointestinal disorder
▪ Malabsorption syndromes
▪ Immune system disorders
▪ Severe food allergies that require an elemental formula
▪ Life threatening disorders
▪ Diseases and medical conditions that impair ingestion, digestion, absorption, or the utilization of
nutrients that could adversely affect the participant’s nutrition status
Exempt infant formulas and WIC-eligible nutritionals may not be issued for the following:
▪ To any participant solely for the purpose of enhancing nutrient intake or managing body weight
without an underlying qualifying condition
▪ Infants whose only condition is a diagnosed formula intolerance or food allergy to lactose,
sucrose, milk protein or soy protein that does not require the use of an exempt infant formula
▪ A non-specific formula or food intolerance
▪ Women and children who have a food intolerance to lactose or milk protein that can be
successfully managed with the use of one of the other WIC food packages
The following are not authorized for reimbursement by the WIC Program:
▪ Medicines or drugs
▪ Hyperalimentation feedings (nourishment administered through a vein)
▪ Enzymes
▪ Oral rehydration fluids or electrolyte solutions
▪ Flavoring agents
▪ Feeding utensils or devices (e.g., feeding tubes, bags, pumps) designed to administer a WIC-
eligible formula
For a complete list of exempt infant formulas and WIC-eligible nutritionals, refer to “Formulas Provided by
the Idaho WIC Program” in the WIC Formula Handbook.
Formulas or WIC-eligible nutritionals may be provided for oral or enteral tube (i.e. nasogastric tube or g-
tube) consumption.
NOTE: Formulas or WIC-eligible nutritionals are not provided by WIC to participants while they are
hospitalized.
REGISTERED DIETITIAN (RD) APPROVAL
RD Approval or denial of all requests for WIC-eligible exempt formulas/ nutritionals by a local agency RD
must happen immediately upon receipt of the request.
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• Certifier can obtain verbal approval from the RD.
• Certifier should enter the verbal approval Special Authorization- RD Approval into WIC Computer
System. However, the RD must have written documentation in WIPSr approving the request to
support the initial verbal approval.
• If the RD enters the Special Authorization- RD Approval into WIC Computer System, no further
documentation is required, unless required with the nutrition risk and / or RD referral criteria.
• Contact between the RD and First Cardholder or caregiver is at the discretion of the RD unless
required with the nutrition risk and / or RD referral criteria.
• Participants receiving an exempt infant formula or a WIC-eligible nutritionals must be seen by a
local agency RD at least once during a certification period. Typically, high risk participants would
be seen more frequently in clinic depending on their nutritional risk codes. Food benefits will be
issued for one, two, or three months at the discretion of the local agency RD.
• Exempt formulas and WIC-eligible nutritionals can be issued by a Certifier after a local agency
RD has received a prescription and approved its use.
Clarification: An RD Approval Special Authorization and an RD Approval are two separate things. The
medical foods/ exempt formulas and nutritionals are broken down into two subgroups Low-Risk Food
items and or formula and High-Risk Medical Foods/ exempt formulas/ nutritionals.
1. RD Approval Special Authorization- is simply a special authorization entered into the WIC
computer system.
2. RD Approval- is the RD’s review of the participant and the proof (documentation) that they
reviewed the participant’s information.
The food items listed below require an RD Approval Special Authorization and an RD Approval and are
considered Low-Risk food items when provided by themselves and when not in conjunction with high-risk
NRC or referrals.
• soy-based beverage
• acidophilus milk
• goat’s milk
• lactose reduced/free milk
• 2% milk
• ready-to-feed (RTF) contract formula*
* RTF = ready-to-feed. See packaging policy in this section for guidance on issuing RTF.
3. The steps for documenting low-risk food items depends on who enters the Special
Authorization, the Certifier (CA) or the RD.
a. Scenario 1: A participant says she has bloating when consuming milk products and says
she is lactose intolerant.
i. The CA can obtain verbal approval from the RD to enter the RD Approval
Special Authorization for Lactose Free Milk into the WIC computer system.
ii. Since the CA entered the verbal RD Approval Special Authorization, the RD must
have written documentation, an RD Approval (a note, alert, care plan, etc.)
approving the verbal request to support use of Lactose Free Milk entered by the
CA.
1. The RD Approval Special Authorization must include the reason and the
name of the RD.
Note: The State Agency’s recommendation is to document the RD Approval for the Low-Risk food item,
(the different milks, RTF, removing formula) within 24 hours.
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b. Scenario 2: A participant says she has bloating when consuming milk products and says
she is lactose intolerant.
i. The CA calls the RD, or the RD is seeing the participant themselves.
ii. The RD enters the Low risk- RD Approval Special Authorization into the WIC
computer system, and no further documentation is required by the RD. The RD
entering the approval themselves will replace the need for the RD Approval
documentation, unless required with the nutrition risk and / or RD referral criteria.
1. The RD Approval Special Authorization must include the reason .
c. Scenario 3: A participant says she has bloating when consuming milk products and says
she is lactose intolerant. Also, the participant is pregnant and has Gestational Diabetes
(NRC 302). NRC 302 requires the RD to see/review/ document on the participant
minimally once per certification period.
i. In this scenario either the CA or the RD can enter the RD Approval Special
Authorization and the RD can document the Lactose Free milk RD Approval
within their note completed for NRC 302. (either a note, alert, care plan, etc.)
1. Documentation requirements follow guidelines above depending on who
enters the special authorization.
Contact between the RD and the First Cardholder or caregiver is at the discretion of the RD unless
required based on the nutrition risk criteria.
Participants receiving an exempt infant formula or WIC-eligible nutritionals must be seen by a local
agency RD at least once during a certification period.
o Typically, high risk participants would be seen more frequently in clinic depending on
their nutritional risk codes.
o Food benefits will be issued for one, two, or three months at the discretion of the local
agency registered dietitian.
Exempt formulas and WIC-eligible nutritionals can be issued by a Certifier after a local agency RD
receives a verbal or written MDF and approves its use.
An RD Approval Special Authorization is active until the next certification date and must be re-evaluated
for continued use at each certification. This means a new RD Approval Special Authorization and an RD
Approval must be completed each time.
NOTE: Upon a change to a Special Authorization- RD Approval, the RD is required to complete a
new RD Approval documentation. Follow steps outlined above.
It is possible the RD may have to contact the health care provider for additional information. The local
agency RD must document the recommendations given by the health care provider. The responsibility
remains with the participant’s health care provider for medical oversight and instructions; however, the
healthcare provider has the option to refer to a local agency RD to determine the appropriate issuance,
prescribed amount and length of time required for supplemental foods based on the participant’s qualifying
condition(s). If the healthcare provider declines selections to be made by the local agency RD, it is still the
responsibility of the local agency RD to ensure that only the amount of supplemental food prescribed by
the participant’s health care provider are issued in the participant’s food package.
If an exempt infant formula or WIC-eligible nutritionals are not available at a local vendor, a medical
supply company may provide it. In these cases, the contracted medical supply company will mail the
exempt infant formula or WIC-eligible nutritional to the participant’s residence. Refer to Section C of this
chapter for issuing a food package using a medical supply company.
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QUANTITIES
Participants with qualifying medical conditions will receive up to the same maximum monthly amounts of
supplemental foods, unless medically contraindicated, as those same participant categories. In lieu of
infant foods (cereal, fruit and vegetables), infants greater than 6 months of age may receive exempt infant
formulas or WIC-eligible nutritionals at the same maximum monthly allowance as infants ages 4 through 5
months of age of the same feeding option. Women and children may also receive up to 455 fluid ounces
liquid concentrate WIC formula (infant, exempt, or WIC-eligible medical food). Powder and ready-to-feed
may be substituted at rates that provide comparable nutritive value.
Children over age 2 and women who are receiving WIC-eligible nutritionals and need additional calories
may receive whole milk if necessary.
REFERENCES
Oregon WIC Policy Manual
WRO Policy Memo 804-Q: Medicaid Primary Payor for Exempt Infant Formulas and Medical Foods
7 CFR 246.10 Supplemental Foods
7 CFR 246.16a Infant Formula Cost Containment
7CFR Part 246: Revisions in the WIC Food Packages: Final Rule
Packaging
The First Cardholder may freely choose either powder or concentrate formula. Women who are partially
breastfeeding infants are encouraged to choose powder formula.
The reasons for an RD providing the RTF are as follows:
• unsafe water supply
• lack of refrigeration
• the participant is homeless
• the infant’s caregiver has difficulty correctly mixing concentrate or powder formula
Healthcare providers may determine a participant needs ready-to-feed (RTF) formula on rare occasions.
The two conditions which may be used for issuing RTF with a special authorization – MD Doc includes:
• if an RTF form better accommodates the participant’s condition
• if it improves the participant’s compliance in consuming the prescribed WIC formula
The reason for issuance must be documented in WIC Computer System.
If the water supply is deemed unsafe but the caretaker refuses to use RTF formula for personal reasons,
a signed refusal statement should be obtained and kept in the participant’s chart.
EXCEPTION
Formulas or nutritionals which are available only in RTF form may be issued regardless of the above
criteria.
REFERENCE
7 CFR 246.10 Supplemental Food
Idaho WIC Program Policy Manual
SECTION C: ISSUING FOOD BENEFITS
IN THIS SECTION
Shopping for Authorized Foods
WIC Cards
Food Benefits
Food Benefit Issuance Frequency
Alternative Benefit Issuance for Exempt Formula and Nutritionals
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Shopping for Authorized Foods
AUTHORIZED STORES
WIC participants can only shop at Idaho WIC authorized stores.
FOOD BALANCES AND DESCRIPTIONS
Food balances and descriptions are accessible electronically through the WIC processor’s website or the
WICShopper app. They can also be found by printing the WIC card balance from the WIC Computer
System, by requesting a balance inquiry at the store, or by calling the WIC processor’s Customer Service
Line (also called the IVR). An Idaho WIC Authorized Food List is given to the WIC participant, First
Cardholder, or Second Cardholder to identify foods/brands allowed.
PAYMENT FOR WIC FOODS
▪ WIC card food benefits are issued on a tri-monthly, bi-monthly, or monthly basis.
▪ If the store requires it, WIC foods need to be separated, from non-WIC foods at the register.
▪ When redeeming food benefits, the participant verifies the purchase price is correct before
approving the transaction.
▪ To complete the transaction the participant swipes their WIC card and enters their PIN.
WIC Cards
Assigning WIC Card(s)
Only two WIC cards may be assigned on behalf of a family. A WIC card is assigned to a First Cardholder.
An additional WIC card may be assigned with verbal or written consent from the First Cardholder to add a
Second Cardholder. A Non-Cardholder will not be assigned a WIC card.
WIC cards must not be transferred. This includes to another cardholder or caregiver. A new WIC card
must be assigned. For example, if there is a change in First Cardholder such as a change in custody,
foster caregiver change, or new Second Cardholder is added.
The following steps are taken when assigning a WIC card:
▪ Verify identification
o New cardholders must provide an acceptable proof of identity per policy. Identity is
verified at every certification for First Cardholders.
o Security questions (DOB, address, and zip code) may be used to verify identification at
follow-up appointments or to replace WIC cards.
▪ When a WIC card is assigned in the WIC computer system, the Cardholder must provide a
signature for proof that the WIC card was received.
▪ Staff must help set a PIN at the clinic. If Cardholders decline assistance, offer resources for PIN
setting on their own, if applicable.
▪ New Cardholders must be offered information on how to use their WIC card and the Idaho Food
List.
REPLACING WIC CARDS
If a participant needs a replacement card (for example, reports the WIC card as lost, stolen, or damaged)
have them call WIC Processor’s Customer Service Line immediately to deactivate their card. WIC cards
can be replaced by calling the Customer Service Line. Cards will be replaced within 7 business days.
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WIC cards will not be mailed from the clinic. In emergency situations Local Agencies can replace a WIC
card for participants in the clinic. Applicable circumstances may be determined at the discretion of the
Local Agency Coordinator.
Examples include:
▪ A participant designated as homeless
▪ An infant needing formula immediately
▪ Less than 10 business days left in the month
The Customer Service line will not be responsible to update DOB, address, or zip code for the First
Cardholder or Second Cardholder. WIC staff may need to update this information before a card is
replaced by the WIC Processor’s Customer Service Line
DEACTIVATING A WIC CARD
WIC cards are deactivated in WIC Computer System. The person responsible for deactivating the WIC
card will have their name time stamped in WIC Computer System. A reason will be required.
REASONS
▪ Lost
▪ Stolen
▪ Damaged
▪ Returned
▪ Undeliverable
▪ Change Family Status
Food Benefits
ISSUING
Food packages are assigned based on category and age. Food benefits may be tailored based on
participant needs and preferences. Food benefits may be issued in-person or remotely.
The following steps are taken when assigning and issuing benefits to an account:
▪ Cardholders should be made aware they can contact WIC staff to change foods at any time.
▪ Tailor food benefits or add special authorizations as needed.
▪ Assign the appropriate food benefits for the participant.
▪ Ask the Cardholder if they would like a WIC card balance printout to examine the food benefits for
the correct foods. They can also review the WIC card balance on the computer screen.
▪ Remind Cardholders that food benefits do not need to be redeemed all at one visit or at one store
location but can only be used between the “First Day to Use” date to the “Last Day to Use” date.
REMOTE LOADING
Issuance of benefits may occur remotely from the clinic when the participant is not present at the time
benefits are issued to the WIC card.
Best practices when remote loading includes:
▪ Communicating to the Cardholder benefits have been issued to their WIC card.
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▪ Offering to review food benefits to ensure the correct food package has been assigned or desired
tailoring has occurred.
▪ Follow-up at their next appointment (for example, regarding goals and nutrition education).
Remote issuance of benefits is allowed in the following situations:
▪ Discussion occurred and the food package/tailoring assignments have been saved in the WIC
computer system for issuance to the WIC card later.
▪ The participant requests benefits to be remotely loaded.
▪ Nutrition education has been completed remotely.
▪ Food package exchanges not requiring formula to be returned to the clinic.
▪ To help transition all family members to the same food issuance schedule.
▪ There is a system outage/issue and benefits cannot be issued to the account while the participant
is present
▪ Emergency/natural disaster, extreme weather or health conditions prevent either the participant
or staff members from traveling to the clinic.
▪ The Local Agency Coordinator may develop procedures to include other situations where remote
loading may be appropriate such as missed or rescheduled appointments.
Remote issuance of benefits is not allowed in the following situations:
▪ To replace a certification appointment.
▪ There has been no contact and no next scheduled appointment with the participant.
▪ The participant prefers in person nutrition education and/or food benefit issuance.
ISSUING FOOD BENEFITS OVER THE PHONE
When issuing food benefits over the phone, confidentiality must be maintained during the entire
interaction. Applicable trained staff member(s) may issue benefits after DOB, address, and zip code have
been verified.
Phone issuance of benefits is allowed in the following situations:
▪ The participant requests benefits to be loaded in discussion over the phone.
▪ Nutrition education has been completed remotely.
▪ Food package exchanges not requiring formula to be returned to the clinic.
▪ To help transition all family members to the same food issuance schedule.
▪ There is a system outage/issue and benefits cannot be uploaded to the WIC card while the
participant is present.
▪ Emergency/natural disaster, extreme weather or health conditions prevent either the participant
or staff members from traveling to the clinic.
Phone issuance of benefits is not allowed in the following situations:
▪ To replace a certification.
▪ The participant prefers in person nutrition education and food benefit issuance.
Voiding
Food benefits may be voided for future months when applicable. Reasons must be documented in WIC
computer system.
REASONS
▪ Food Intolerance
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▪ Moved to new area
▪ Participant refused
▪ Staff Error
▪ Category Change
▪ Breastfeeding % Change
▪ Nutrition needs change
▪ Situation Change
Food Benefit Issuance Frequency
WIC participants are eligible to receive 1-, 2-, or 3-months of food benefits at each visit. Participants have
the option to request and receive monthly issuance, even if the local WIC agency has decided to
schedule multi-month issuance for all appropriate participants.
NOTE: The State WIC Office has the option to direct local agency staff to issue monthly benefits to a
participant, for example, if the participant is under investigation for non-compliance.
The local WIC agency has the option to limit certain categories of participants to 1- or 2-months of food
benefit issuance. If the local WIC agency decides to limit certain categories of participants, the local WIC
agency will develop a written policy to include:
▪ A statement authorizing the Certifier or local agency registered dietitian (RD) as the person
responsible for determining participant eligibility for 1-, 2- or 3-month benefits.
▪ A list of participant characteristics which would require the participant to receive 1- or 2-month
benefit issuance. Distinction should be made between participants able to receive 2-month versus
1-month benefits.
▪ A statement or notation describing the reason why a participant has been determined to receive
1- or 2-month benefit issuance.
NOTE: The policy and proposed revisions shall be submitted to the State agency for review prior to
implementation. A copy of the policy will be on file at the local WIC agency.
JUSTIFICATION
The choice of 1-, 2-, or 3-month benefit issuance provides flexibility for participants and for clinic staffing.
Multi-month benefit issuance can enhance clinic resources, participant satisfaction, and nutrition services
because each benefit issuance is associated with nutrition education.
PROCEDURE
Local WIC agency clinic(s) have on file the policy for 1-, 2-, or 3-month benefit issuance before
implementing 3-month issuance.
▪ Review participant’s priority status, care plan and your local agency policy to determine
appropriateness of 1-, 2-, or 3-month benefit issuance.
▪ Advise participants that if their nutritional status changes, they may need to come in more
frequently for WIC to provide better follow-up of care.
▪ Advise participants that 2- or 3-month benefit issuance is on a case-by-case basis decided by
each local agency to better serve WIC participants and meet specific local agency requirements.
2- or 3-month benefit issuance is not one of their rights as a WIC participant.
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PARAMETERS
Rationale for limiting participant eligibility for multi-month benefit issuance will vary across the State. In
writing the local WIC agency policy regarding 2- or 3-month benefit issuance, clinic staff may want to
consider the following issues:
▪ Nutritionally high-risk participants: These participants may require a follow-up nutrition education
contact with an RD or breastfeeding consultant more than once during a certification period. The
RD may want to determine multi-month benefit issuance for these participants on a case-by-case
basis.
▪ Pregnant women: Pregnant women who have not seen a health care provider may need to be
seen monthly for better monitoring and follow-up of referral needs.
▪ Breastfeeding or postpartum women and their infants: Breastfeeding or postpartum women may
need to be scheduled more frequently to ensure feeding is well established and supported during
the first three to six months.
▪ Participants who missed their second nutrition education appointment or the six-month health
screen assessment: Reschedule the missed appointment as soon as possible and try to keep the
participant on the same issuance schedule. If the appointment must be scheduled for the
following month, the participant may need to change to a different issuance schedule (e.g., 1- or
2-month benefit issuance).
▪ Foster children in short term care: It may be beneficial to schedule these participants on a
monthly basis.
▪ Participants receiving WIC-eligible nutritionals: Special circumstances per local agency
Coordinator and/or RD discretion. See policy on remote loading of benefits.
▪ Transfers from one clinic to another or from one state to another: See policy on VOC and mid-
certification changes.
▪ Changing food packages, formula intolerance, or returning formula: See policy on redeeming one
to two (1-2) cans with new formula to reduce returned formula (returned formula must be
destroyed in the clinic).
▪ Any food benefit violations/sanctions or other issues related to food benefit misuse.
Alternative Benefit Issuance for Exempt Formula and
Nutritionals
HOME DELIVERY SYSTEMS
Exempt infant formula and WIC eligible nutritionals that cannot be purchased with a WIC card or is not
available at an authorized vendor may be purchased through a contracted medical supply company using
home delivery. See the Idaho WIC Program training guidebooks and formula handbook for specific
procedures.
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MEDICAL SUPPLY COMPANY
The Idaho WIC program contracts with a medical supply company to provide exempt infant formula and
WIC eligible nutritionals. The order may be submitted via Idaho WIC approved form or electronic ordering
system.
PARAMETERS
Local Agency:
▪ Initial orders are completed by a WIC registered dietitian (RD). Subsequent orders may be
completed by the WIC RD or qualified staff with RD oversight.
▪ Order no more than one-month supply at a time.
▪ Provide Cardholders with instructions on delivery/receiving packages.
▪ Refer to Idaho policy for remote issuance and issuing benefits over the phone or TeleWIC.
State Agency:
▪ Monthly oversight such as review of the WIC Computer system and invoices for policy
compliance.
▪ Ensure that participants and/or Cardholders are notified that they have the right to complain about
improper home food delivery contractor practices with regard to program responsibilities.
Medical Supply Company:
▪ Must submit a legible copy of the order such as an Idaho WIC approved form or documentation
through an electronic ordering system with the original invoice to the State agency for payment.
▪ Include the amount (include number and size of cans) and specific formula/nutritional(s) must be
itemized under the appropriate section of the order.
▪ Will only be paid for what is listed on the order.
▪ Deliver no more than one-month supply at a time.
DIRECT BILL
A Direct Bill is an approved Idaho WIC form used as an alternative to issue food benefits to the WIC card.
The form is used in limited circumstances when formula/nutritional cannot be purchased with a WIC card
or through the contracted medical supply company.
VENDOR
When the Direct Bill form is used, the vendor must submit a legible copy of the Direct Bill with the receipt
or original invoice to the State agency for payment. See the Idaho WIC Program training guidebooks and
formula handbook for specific procedures.
PARAMETERS
Local Agency:
▪ Forms must be filled out completely.
▪ Initial forms are completed by a WIC registered dietitian (RD). Subsequent forms may be
completed by the WIC RD or qualified staff with RD oversight.
▪ Order no more than one-month supply at a time.
▪ Provide Cardholders with instructions on use of the form.
▪ Recommend contacting vendor with instructions on form use and product availability.
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▪ Refer to Idaho policy for remote issuance and issuing benefits over the phone or TeleWIC.
State Agency:
▪ Monthly oversight such as review of the WIC Computer system and invoices for policy
compliance.
▪ Ensure that participants and/or Cardholders are notified that they have the right to complain about
improper vendor practices with regard to program responsibilities.
Vendor:
▪ Must submit a legible copy of the form with the receipt or original invoice to the State agency for
payment.
▪ Include the amount (include number and size of cans) and specific formula/nutritional(s) must be
itemized under the appropriate section of the form.
▪ Will only be paid for what is listed on the form.
▪ Issue no more than one-month supply at a time.
REFERENCE
State policy
CFR 246.12 Food delivery methods