Food Packages – Staff Roles - health.state.mn.us the steps involved in food package assignment ... The amount of breastfeeding the woman/baby pair does will determine the amount

Food Packages – Staff Roles

Objectives

After completing this lesson, you will: Identify the steps involved in food package assignment

Understand your role related to food package assignment.

Overview

One of the WIC Program’s primary services is to provide nutritious foods to eligible participants. The combination of nutritious foods with WIC nutrition education and referrals can have a positive influence on the health of participants we serve.

What is involved in the food package assignment process?

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For each WIC category there are specific foods allowed, but WIC CPAs work with individual participants to determine which combination of foods best meets their needs and helps them be as healthy as possible. WIC staff ensure that participants are able to use their vouchers to obtain the right foods. There are a number of steps involved in making sure that a participant receives and uses the WIC foods that are most appropriate for them. Step 1: Completing a full assessment as part of a certification During each certification, the CPA completes a full assessment to collect information from the participant about health or special medical conditions, dietary habits or restrictions, cultural and/or personal preferences, living situation and shopping habits. This information helps guide risk assignment and nutrition education, and provides the certifier with information about which WIC foods would be the most appropriate for a particular participant. Step 2: Nutrition education and counseling during the certification The CPA talks with the participant about what they want to do to be as healthy as possible and how the foods WIC provides can help them achieve optimal health. Step 3: Food package assignment The CPA works with a participant to select the set of foods that best meets the needs of the participant and assigns that food package. Step 4: Voucher issuance Vouchers for the foods in the food package are printed and given to the participant.

Step 5: Shopper education WIC staff explains to the participant how to use the vouchers at the grocery store, including which foods are allowed or not allowed. Step 6: Voucher use The participant selects the foods she wants at the grocery store based on what is listed on her vouchers and what is allowed in the WIC Shopping Guide. The participant uses the vouchers to pay for the foods at the grocery store. Step 7: Second nutrition education and counseling WIC CPA meets with the participants at the next WIC visit to talk further about what foods and food behaviors will help them be as healthy as possible, and to adjust the food package if needed.

Medical Documentation Some food packages require special documentation from the Health Care Provider (HCP) in order to be issued. The information from the HCP will need to be reviewed and documented in the WIC Information System (HuBERT). Communication with the Health Care Provider There are times when information needs to be shared between WIC and the Health Care Provider. The WIC CPA may want to consult with the health care provider about his/her recommendations. Occasionally information on the medical documentation form needs to be clarified. Food Package Changes Participants may request a change to the food package in the middle of the certification period for a variety of reasons. They may find that a formula doesn’t work, or there might be a change in medical condition or living situation. CPAs may assign a different food package. Taking Complaints Sometimes a participant will be unhappy about a transaction at the grocery store. WIC staff should report this to the state WIC office on a Store Incident Report form. When reporting a complaint, try to be as specific as possible. For example, document the time of day the incident occurred, the name of the person at the store who was involved in the incident, and what was specifically said or done. When it is a simple matter (e.g., a vendor misunderstanding or a food item not being available), the WIC Coordinator may call the store manager to discuss the

Additional Steps May Be Needed to Address Special Concerns or Situations

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http://www.health.state.mn.us/divs/fh/wic/vendor/fpchng/shopguide.pdf

http://www.health.state.mn.us/divs/fh/wic/localagency/program/mom/exhbts/ex1/1i.pdf

http://www.health.state.mn.us/divs/fh/wic/localagency/program/mom/exhbts/ex1/1i.pdf

situation. Many small issues can be resolved quickly this way and will help the local agency develop a relationship with the vendor.

As a CPA, you are responsible for determining the participant’s eligibility for the WIC Program, providing appropriate nutrition education, and assigning the appropriate food package. To do this effectively, you must first complete a full nutrition assessment, which was discussed in previous modules. Through the nutrition assessment process, CPAs gather information from the participant about their specific situation. This information is used to assign risk codes, guide nutrition education and provide you with clues about what food package to assign. Critical thinking will help you use the information you collected to determine which food package to assign.

The Importance of Assessment for Food Package Assignment

Critical Thinking Critical thinking is the process a CPA uses to determine the best course of action. It includes 4 steps:

1. Collect all pertinent information from the participant. 2. Ask additional questions if needed for clarification. 3. Analyze and evaluate all the information you have collected. 4. Determine the best course of action.

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Information that will impact food package assignment includes: • How much Mom is breastfeeding or her concerns about breastfeeding • If the woman is pregnant with twins or breastfeeding twins • The type of formula used • A medical condition which requires a special diet • Any medical foods or formulas recommended by the health care

provider • Food likes or dislikes • Diet restrictions based on religion or beliefs • Common foods eaten or not eaten by the participant’s particular culture • If the participant follows a special diet, such as vegan or vegetarian • If the living situation lacks refrigeration or cooking facilities • Clues about the participant’s circumstances, such as homelessness or migrancy • The participant’s developmental stage and readiness-to-change • Any food allergies or intolerances

Observe how food package assignment is conducted in your clinic. Answer the following questions for each certification you observe.

1. Was a full assessment done prior to food package assignment?

2. Were there any special concerns that had to be addressed for food package assignment?

3. Of the information gathered, what was especially important or helpful in determining the food package for the participant?

Practice Activity - A

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Food Packages – Allowed Foods

After completing this lesson, you will:

Identify the WIC allowed food groups Describe the food alternatives available in the WIC Shopping Guide Understand the differences in food packages for women who are mostly

breastfeeding versus women doing some breastfeeding.

WIC provides participants with specific nutritious foods each month. The foods provided were included because they are rich in certain nutrients and contribute to a healthy overall diet. WIC regulations specify the foods and quantities each category of participant is eligible to receive each month. This combination of foods is called a food package. WIC usually gives the maximum quantity of food allowed, to provide the most nutrients needed by the participant.

WIC-allowed foods are the foods that participants may buy with their WIC vouchers. WIC-allowed foods include:

• Milk (including cow, goat, lactose-free, powdered and evaporated milk) • Milk substitutes: cheese, tofu, soy-beverage • Eggs • Fruits and vegetables • 100% fruit and/or vegetable juices • Whole grains • Cereal • Peanut butter • Dry beans, peas or lentils • Canned beans • Canned fish (tuna and pink salmon) • Infant formula • Infant fruits and vegetables • Infant cereal

Objectives

Overview

What are WIC-allowed foods?

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WIC-allowed foods are selected to improve the health and nutrition of WIC participants. These foods:

• Provide key nutrients. • Support the Dietary Guidelines for Americans. • Are aligned with the American Academy of Pediatrics feeding recommendation

for infants. How are WIC Foods Determined?

1. WIC federal regulations specify nutrient requirements for each WIC food item. For information on each of the food requirements, go to: WIC Federal Regulations Here’s an example of the nutrient requirements for cereal:

How are WIC-allowed foods selected?

NUTRIENT REQUIREMENTS – CEREAL Cereal must meet the following minimum requirements and specifications: • Must contain a minimum of 28 mg iron per 100 g of dry cereal. • Must contain < 21.2 g sucrose and other sugars per 100 g dry cereal

(< 6 g per dry oz). • At least half of the cereals authorized on a State agency’s food list must

have whole grain as the primary ingredient by weight AND meet labeling requirements for making a health claim as a “whole grain foods with moderate fat content”.

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2. Minnesota State Rules further define the foods available for purchase with WIC vouchers in Minnesota. For Minnesota WIC state rules, go to: Minnesota WIC State Rules

3. State WIC staff review product specifications of each food item to determine if it meets the nutritional requirements of the federal regulations.

4. Foods that meet the nutritional requirements are then evaluated for cost, availability and participant preference.

5. Refer to the WIC Shopping Guide for exact types and brands of foods allowed for purchase with WIC vouchers in Minnesota.

6. Refer to the Minnesota WIC UPC listing for specific brands of individual food items. For the Minnesota WIC UPC listing, go to: Minnesota WIC UPC Listing

http://www.fns.usda.gov/wic/lawsandregulations/WICRegulations-7CFR246.pdf

http://www.fns.usda.gov/wic/lawsandregulations/WICRegulations-7CFR246.pdf

http://www.health.state.mn.us/divs/fh/wic/localagency/program/mom/rules.pdf


http://www.health.state.mn.us/divs/fh/wic/vendor/fpchng/upc/index.html

Participants have a lot of choice about which foods to purchase. Having a variety of foods available makes it easier for participants to find nutritious foods that they want to buy and are willing to eat. The CPA can help the participant figure out which foods are most appropriate for their situation and will help them achieve their desired health outcomes. For most foods, there is more than one option available that will provide similar nutrients. The WIC Shopping Guide will help you understand the options allowed by WIC for each food type. In fact the WIC Shopping Guide has specific information on what is allowed and not allowed for each food. Flavors or Brands For many of the foods WIC provides, participants are able to choose between different brands or flavors. Examples include cheese, cereals, juice, or infant foods. Since the WIC Shopping Guide has a variety of flavors and brands for the foods that are allowed, most participants are able to find one they like. The Shopping Guide also indicates which cereals are high in folic acid and which are whole grain.

Food Options or Alternatives Some food categories offer options or alternatives, allowing the participant to choose their preference. That way if they don’t like or don’t use one food, they have another option to try. Some examples:

OR OR OR

OR OR

OR

WIC Allowed Foods

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Fruits and Vegetables The voucher for fruits and vegetables specifies the dollar amount, but leaves the selection up to the participant. Additionally, the option to purchase fresh, frozen or canned fruits and vegetables provides participants with more flexibility.

Food packages for breastfeeding women and infants

The amount of breastfeeding the woman/baby pair does will determine the amount of foods in the packages for breastfeeding women. The food package for fully breastfeeding women is the most complete one. The amount of food is reduced if the woman is breastfeeding less. If a woman is supplementing her baby with formula, she is partially breastfeeding and partially formula feeding.

Partially breastfeeding women are divided into two groups – women who are mostly breastfeeding and supplementing with a small amount of formula, or women who are doing some breastfeeding and providing a substantial amount of formula. There is a direct connection between the amount of formula being used and the amount of food the woman receives in her food package.

Make sure you use active listening skills to assess the mother’s breastfeeding goals and her understanding of the impact of supplemental formula on her breast milk supply.

• Determine the reasons mom feels she needs to supplement with formula. • Work with the mom to assign a food package that supports her

breastfeeding goals and provide her with the appropriate support and counseling.

• If mom hopes to continue to breastfeed, assign a food package which supplements with the smallest amount of powdered formula possible.

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1. Observe a CPA help a new participant select foods for their food package.

(Observe an appointment for a woman or child.) • How did the CPA explain the options for whole grains?

• How did the CPA explain the options for canned beans, dry beans or peanut butter?

2. Observe a CPA explain how to select WIC foods at the store. • Describe how to use the Cash-Value Fruit and Vegetable voucher at

the store.

• Describe how to select a WIC-allowed juice.

Practice Activity-B

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Use the WIC Shopping Guide to answer the following questions.

1. What are the criteria for selecting WIC-allowed fresh fruit?

2. What are the criteria for selecting WIC-allowed frozen vegetables?

3. Which canned tomato products are not allowed?

4. WIC-allowed juice must have ____% Vitamin C.

5. Which whole grain items may be purchased in bulk?

6. WIC-allowed brands of bread must be purchased in _____ oz. loaf size.

7. Which canned bean products are not allowed?

8. WIC-allowed peanut butter must be purchased in ___ to ____ oz. jar.

9. WIC provides __________ or _________ milk for women and children 2 years of age.

10. Cheese must be purchased in packages _____ oz. or larger.

Skill Check- #1

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The Seven WIC Food Packages

After completing this lesson, you will be able to:

Identify an appropriate food package for each type of participant.

There are seven food package categories. A food package is a combination of WIC-allowed foods that are given to a participant based on the participant’s WIC type, age, nutritional need, and personal preferences. As a CPA, you must determine the appropriate food package category for each participant. The seven food packages are described in the table below.

Table of Food Package Categories

Category: Food package designed for: Food Package 1

• Infants 0 through 5 months

Food Package 2 • Infants 6 through 11 months

Food Package 3 • Women with qualifying conditions • Children with qualifying conditions • Infants with qualifying conditions

Food Package 4 • Children 1 through 4 years

Food Package 5 • Pregnant women • Mostly-Breastfeeding women

Food Package 6 • Non-breastfeeding postpartum women up to 6 months postpartum • Some-Breastfeeding women up to 6 months postpartum (whose

infants receive more formula than allowed in the Mostly-Breastfed Infant food package)

Food Package 7 • Breastfeeding women up to 1 year postpartum whose infants do not receive infant formula from WIC

• Women pregnant with multiples • Women who are Breastfeeding multiple infants (at least one infant

receiving the Mostly-Breastfed Infant food package). • Women pregnant and fully-breastfeeding an infant up to 1 year of age.

Food Package 7+ • Women Fully Breastfeeding multiples (These participants receive 1 ½

times the food in food package 7)

Objectives

What are the WIC Food Packages?

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Skill Check-#2 Skill Check 2Skill Check #2

1. A mom of a fully-breastfed infant (receiving no formula) is eligible forwhich food package?

2. A woman who is pregnant and fully-breastfeeding an infant up to 1 yearof age is eligible for which food package?

3. An infant 8 months old with no qualifying conditions is eligible forwhich food package?

4. A three-year-old child is eligible for which food package?

5. A mom of a some-breastfed infant is eligible for which food package?

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The following sections describe the WIC food packages 1 through 7. It will be helpful to refer to MOM Chapter 7 as you review the following Food Package sections.

Infant WIC Food Packages

included in each WIC Food Pack

Objectives


List the foods included in the food packages for infants;

Describe procedures for assessing breastfeeding and determining food packages for a breastfeeding dyad (breastfeeding mother and infant);

Understand the relationship between the breastfeeding mother and infant food packages.

Focus on Breastfeeding

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WIC food packages for women and infants assume Full Breastfeeding to be the standard for infant feeding. The food packages promote Full Breastfeeding by: • Providing Fully-Breastfeeding women greater variety and larger quantities of

food. • Providing Fully-Breastfeeding infants greater variety and larger quantities of

food. • Delaying complementary foods for infants until 6 months. There are four Infant Feeding Options:

Infant Feeding Options

Fully Breastfed Infants No Formula

<50% maximum quantity Mostly-Breastfed Infants of formula

>50% maximum quantity Some-Breastfed Infants of formula

Fully Formula fed Infants Maximum quantity of formula

See Food Packages 1 & 2 below for specific quantities of formula.

http://www.health.state.mn.us/divs/fh/wic/localagency/program/mom/ch/ch7.html

Remember to assess breastfeeding before assigning food packages. The amount of breastfeeding determines the food packages for breastfeeding women and infants. Since many factors influence mom’s decision to breastfeed and to supplement with formula, it is very important to do a complete assessment before assigning any formula to a breastfed infant. Food packages must be individualized to the needs of each breastfeeding mother and infant. One of WIC’s goals is to support breastfeeding. Formula supplementation can sabotage a mom’s breastfeeding goals.

Critical Thinking Use your active listening skills to assess mom’s breastfeeding goals and her understanding of the impact of supplemental formula on her breast milk supply.

• Determine the reasons mom feels she needs to supplement with formula. • Work with mom to assign a food package that supports her breastfeeding

goals and provide her with the appropriate support and counseling. • If mom hopes to continue to breastfeed, assign a food package which

supplements with the smallest amount of powdered formula possible.

FP 1: Food Packages for Infants – 0-5 months of age

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Infants from birth through 5 months of age receive Food Package 1. There are four feeding options for infants in Food Package 1. The age of the infant and amount of formula they receive from WIC determines the feeding option.

Steps to determining appropriate feeding option for mom/baby pair: 1. Carefully assess breastfeeding. 2. Promote and support full breastfeeding. 3. If mom is feeding formula or has concerns about breastfeeding, ask probing

questions to learn more about the situation. Work with mom to determine ways to maintain or increase breastmilk supply.

4. If formula is assigned, provide the smallest amount necessary. 5. The baby’s food package will determine mom’s food package.

An infant with a qualifying condition needing a medical formula receives Food Package 3. Food Package 3 is described in a later section of this module.

Feeding Option 1: Fully Breastfed Infants (Mom is eligible for the Fully-Breastfeeding Food Package 7)

• Consider fully breastfeeding as the standard for infant feeding. • This option is best in supporting mother’s and baby’s health, & mom’s

milk supply. • Fully breastfed babies need no formula – no formula is provided by WIC.

Feeding Option 2: Mostly-Breastfed Infants (Mom is eligible for the Mostly-Breastfeeding Food Package 5)

Contract Formula Maximum Quantity

per Month 0-1 month

Maximum Quantity per Month

1 through 3 months


4 through 5 months

# cans 12.4 oz Powder* 1 can 1- 4 cans 1- 5 cans

# cans 13 oz Concentrate 0 1-14 cans 1-17 cans

# cans 32 oz RTF 0 1-12 quarts 1-14 quarts

* 12.4 oz can Similac Advance yields ~ 90 fl. oz. reconstituted. Refer to MN WIC Contract Formula Amounts Guide for quantities of other contract formulas.

Feeding Option 3: Some-Breastfed Infants (Mom is eligible for Some-Breastfeeding Food Package 6)

Contract Formula Allowable Range

per Month 0-1 month

Allowable Range per Month

1 through 3 months


4 through 5 months

# cans 12.4 oz Powder* 2-9 cans 5-9 cans 6-10 cans

# cans 13 oz Concentrate 1-31 cans 15-31 cans 18-34 cans

# cans 32 oz RTF 1-26 qts 13-26 qts 15-28 qts


Feeding Option 4: Fully Formula-Fed Infants (Mom is eligible for Non-Breastfeeding, Postpartum Food Package 6)

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http://www.health.state.mn.us/divs/fh/wic/localagency/infosystem/hubert/info/contractamtsguide.pdf




Contract Formula Allowable Range

per Month 0-1 month


1 through 3 months


4 through 5 months # cans 12.4 oz Powder* 2-9 cans 5-9 cans 6-10 cans

# cans 13 oz Concentrate 1-31 cans 15-31 cans 18-34 cans

# cans 32 oz RTF 1-26 qts 13-26 qts 15-28 qts


Requirements for issuing vouchers for formula: • Only contract formula may be issued. Other standard formulas are not

allowed. • Refer to the MN WIC Contract Formula Amounts Guide for allowed

contract formulas and quantities. Allowed formula and quantities are listed by WIC type.

o CPAs are responsible for issuing correct amounts o Adjust quantities to the amount needed for baby

• Infants requiring medical formulas are provided Food Package 3.

Additional Information about Infant Formula

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Formula Forms: Formula is available in three different forms: powdered, concentrate and ready-to-feed (also called ready-to-use). Powdered and concentrate formulas must be mixed with water according to the directions. Ready-to-feed formula does not need any additional preparation but must be refrigerated after opening. Due to the cost of ready-to-feed formula, issuance is limited to special situations. Issuance of ready-to-feed formula should be for short periods and re-evaluated frequently.

Ready-to-feed formula may only be issued in the following situations: • Water supply is unsanitary or restricted due to emergency circumstances

(e.g., during a flood). • Refrigeration is lacking. • Participant/caregiver might have difficulty preparing formula. • Formula that is needed is available only as ready-to-feed. • Ready-to-feed formula best fits with the baby’s medical condition. This

reason applies only to some infants needing medical formula, and receiving FP 3. (For example, premature babies are at risk of Enterobacter sakazakii infection. Because the bacteria have been found in powdered infant formula




products, many health care providers will prescribe the ready-to-feed version of a medical formula, such as Similac Neosure, be given.)

Formula Amounts: The amount of formula a baby may receive is based on reconstituted ounces. Reconstitution means that the water has been added to the concentrate or powdered formula. Since various formulas reconstitute to different amounts, the number of cans of formula WIC provides will vary depending on the type and form of formula. That is, the amount of a specific formula that an infant may receive is based on how much formula a can provides after being reconstituted. Refer to MN WIC Formula Amounts Guide for allowed contract formulas and quantities.

FP 2: Food Packages for Infants – 6 through 11 months of age

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At 6 months: • Infant fruits and vegetables are added to the Food Package to enhance its

nutritional value. • Fully Breastfed babies receive infant meats. • Formula maximums decrease.

o Formula needs decrease as babies start eating other foods. Infant fruits and vegetables are added to the food package replacing some of the calories from formula.

o Decrease in formula keeps the food package cost neutral. Infant fruits and vegetables are an added cost and less formula helps control the cost.

o Decrease in formula amounts better supports breastfeeding.

FP 2: Formula Quantities for 6-11 month infant by Feeding Option

Contract Formula Allowable Ranges of Formula per Month

Fully BF

Allowable Ranges of Formula per Month Mostly-BF

Allowable Ranges of Formula per Month Some-BF and Fully

Formula fed

# cans 12.4 oz Powder* NA 1-4 cans 5-7 cans

# cans 13 oz Concentrate NA 1-12 cans 13-24 cans

# cans 32 oz RTF NA 1-10 qts 11-20 qts


FP 2: Added Foods for 6-11 month infant




Contract Formula Maximum Quantity

per Month Fully BF

Maximum Quantity per Month Mostly-BF


Some-BF and Fully Formula fed

Infant Cereal 24 ounces 24 ounces 24 ounces

Infant Fruits and Vegetables

256 ounces = 64 (4 oz) jars



Infant Fruits and Vegetables with Banana Option*

240 ounces = 60 (4 oz) jars +

2 lbs. fresh bananas


2 lbs. fresh bananas


2 lbs. Fresh bananas

Infant Meats 77.5 ounces = 31 (2.5 oz) jars NA NA

*2 lbs. fresh bananas replace 16 oz. infant Fruits and Vegetables

Additional Information about Baby Foods

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Babies are developing and changing rapidly during these months and baby food is designed to help transition babies to table foods. Adding these foods helps to introduce new textures and flavors to the baby’s diet. These foods contribute to a diet that is consistent with the recommendations from the American Academy of Pediatrics.

Baby food meats for fully breastfed babies Only fully breastfed babies receive baby food meats. This is a value-added food. Infants 6 months and older need more iron and zinc. Infant food meats provide added iron and zinc in a highly bio-available form.

All that baby food! Many families would rather feed their babies homemade baby food. Homemade baby food can be a healthy option for infants. Jarred infant foods can offer some nutrition benefits to an infant, but are not necessary if table foods, or homemade baby foods, are used appropriately. It may be helpful to tell the parents that jarred baby foods can supplement homemade foods. There are key nutrients, like vitamin C in baby fruits or iron in baby meats, that the jarred foods can provide. The baby foods WIC provides can be used to supplement table foods. Suggestions include:

• Mix infant fruits and vegetables with regular fruits and vegetables or other table foods. • Mix infant applesauce or vegetable with finely-chopped meats to provide moisture. • Add infant fruits to infant cereal or cooked cereal. • Use the baby foods to supplement a family meal that don’t include many infant-

appropriate foods.

Practice Activity-C

1. Observe a CPA certify a breastfeeding mom/baby dyad. • How did the CPA assess the breastfeeding?

• What probing questions were used?

2. Observe food package assignment for the certification above. • How did the CPA work with the mom to assign a food package that

supports mom’s breastfeeding goals?

• Which food packages were assigned for the mom and baby?

Skill Check-#3

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1. Why is it important to carefully assess breastfeeding and give no formula

or the minimal amount of formula needed?

2. The amount of formula a Fully Formula-fed infant (non-breastfeeding) receives changes depending on baby’s age. What are the three age groups and amount of formula each age group receives? Base answers on Similac Advance powder formula can sizes.

3. Why do formula maximums decrease at 6 months of age?

4. Why are complementary foods added to the food package at 6 months?

5. Why do breastfed infants receive infant meats?

6. Why do breastfed infants receive larger quantities of infant foods?

7. Describe some ways to offer infant foods to older infants who may be interested in more textured foods.

8. For which situations might it be appropriate to assign a ready-to-feed formula?

9. In Food Package 2, two pounds of bananas replace ______ ounces of infant fruits and vegetables.

10. Mostly-breastfed infant receives how many jars of fruits and vegetables with no bananas? With bananas?

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Child and Woman WIC Food Packages

Objectives


List the foods included in food packages for children;

List the foods included in food packages for women;

State the milk options and milk substitutes available in the child and woman food packages.

FP 4: Food Package for Children)

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Children, 1-4 years old, receive Food Package 4. Food Package 4

Food Item

Maximum Monthly Allowances

Juice, Single Variety 128 fluid ounces juice 2 (64-oz.) containers* or 2 (11.5-12 oz.) frozen

concentrate Milk, Fluid Includes cow and goat milk Whole milk for children up to 2 years of age. Low-fat or fat free milk for children 2 years and older.

16 quarts milk

4 gallons OR

3 gallons + 1quart and 1 lb. cheese

Breakfast Cereal 36 ounces cereal Eggs 1 dozen eggs Fruits and Vegetables $6.00 Cash Value Voucher Whole Grains including bread, tortillas, oatmeal and/or brown rice

2 pounds

Peanut Butter or Dry/Canned beans One of the following: • 18 ounces peanut butter • 1 pound dry beans • 64 ounces canned beans

* 2 (64-oz) containers of juice provide the full nutrition benefit.

Issuance Guidance for Food Package 4 Milk The standard package for milk is 4 gallons of milk/month. This amount provides 2 cups/day, the amount recommended by the Dietary Guidelines for Americans. One pound of cheese may be substituted for 3 quarts of milk. The amount of cheese issued in a package is limited to just 1 pound to help decrease the amount of saturated and total fat in the child’s diet.

Cheese No cheese or 1 pound of cheese are the two cheese options in Food Package 4.

Whole milk is available for children up to second birthday. Whole milk is appropriate for most toddlers, 1 year of age. In some situations, physicians may recommend low fat milk based on a child’s weight status or family history of elevated blood lipids (fat).

Fat Free/Skim or Low Fat/1% milk for 2-4 year olds. CPAs will need to change the food package to fat free/skim or low fat/1% milk at the child’s second birthday. This change is made to lower dioxins and saturated and total dietary fat which is consistent with the Dietary Guidelines for Americans. Whole or 2% milk is available for children 2-4 years of age receiving Food Package 3, if deemed appropriate by the Health Care Provider on the Medical Documentation. Whole or 2% milk is not available for children 2-4 years of age in Food Package 4.

Milk Options for Food Package 4 Some foods are available in alternate forms, allowing participants to choose his/her preference. The following milk options may be issued without medical documentation:

Milk Option (up to 16 quarts) Substitution Rate Total

Evaporated Milk 1:2 (16 oz. to 32 oz. Fluid Milk) 21 (12 oz.) cans

Powdered Milk 1:1 (1 qt. to 1 qt. Fluid Milk)

5 (3 qt.) containers 2 (8 qt.) containers

Fluid Goat Milk

1:1 (1 qt. to 1 qt. Fluid Milk)

16 quarts

Lactose Free Milk 1:1 (1 qt. to 1 qt. Fluid Milk)

16 quarts OR 8 (½-gallons)

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Milk Substitutes for Food Package 4 The following milk substitutes may be issued when qualifying conditions are met and required medical documentation is completed:

Milk Substitute (up to 16 quarts) Substitution Rate

Medical Documentation

Required Maximum Allowed

Tofu 1 lb. tofu = 1 qt. fluid milk For any amount 16 lbs.

Soy Beverage 1 qt. soy beverage = 1 qt. fluid milk For any amount 16 qts.

8 (½-gallons)

See qualifying conditions and medical documentation requirements for Milk Substitutes are found in Food Packages with Medical Documentation.

NOTE A child with qualifying conditions requiring a medical formula receives Food Package 3 (medical formula) plus the foods from Food Package 4 that are appropriate for the child, depending on the medical conditions. Food Package 3 will be explained in Food Packages with Medical Documentation.

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FP 5: Food Package for Pregnant and Mostly-Breastfeeding Women

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The following women receive FP 5: • Pregnant with one infant • Mostly-Breastfeeding

Food Package 5

Food Item Maximum Monthly Allowances

Juice, Single Variety 144 fluid ounces 3 (11.5-12 oz.) frozen concentrate* or 2 (64-oz.) containers

Milk, Fluid Cow and Goat milk Low-fat or fat free milk only

22 quarts milk 5 ½ gallons

OR 4 ½ gallons + 1 quart and 1 lb. cheese

Breakfast Cereal 36 ounces cereal Eggs 1 dozen eggs Fruits and Vegetables $10.00 Cash Value Voucher Whole Grains including bread, tortillas, oatmeal or brown rice

1 pound

Peanut Butter or Dry/Canned beans

Two of the following: • 18 ounces peanut butter • 1 pound dry beans

• 64 ounces canned beans * 3 (11.5-12 oz.) cans frozen concentrate provide the full nutrition benefit.

Issuance Guidance for Food Package 5 Milk The standard in FP 5 is 5½ gallons of milk/month. This amount provides 3 cups/day and meets the Dietary Reference Intake (DRI) for calcium for adult women. Because teenage girls need about 4 cups/day, it is important to encourage them to eat or drink additional calcium sources. Like Food Package 4 for children, only fat free skim and low fat 1% milk are available for women. This is to reduce saturated and total fat, consistent with the Dietary Guidelines for Americans, as well as dioxins. Whole or 2% milk is available for women receiving Food Package 3, if deemed appropriate by the Health Care Provider on the Medical Documentation.

Cheese No cheese or 1 pound of cheese are the two cheese options in Food Package 5. The amount of cheese is limited in this food package to decrease saturated and total fat and dioxins for the woman.

Milk Options for Food Package 5 Some foods are offered as options or alternatives, allowing the woman to choose her preference. The following options may be issued without medical documentation:




7 (3 qt.) containers 2 (8 qt.) containers 1 (20 qt.) container

Fluid Goat Milk

1:1 (1 qt. to 1 qt. Fluid Milk)

22 quarts


22 quarts OR 11 (½ gallons)

Soy-Based Beverage 1:1 (1 qt. to 1 qt. Fluid Milk)

22 quarts or 11 (½ gallons)

Tofu 1:1 (1 lb. Tofu to 1 qt. Fluid Milk)

4 lbs. (> 4 lbs. requires Medical Documentation)

Milk Substitutes for Food Package 5 The following milk substitute may be issued when qualifying conditions are met and required medical documentation is completed:




Tofu 1 lb. tofu = 1 qt. fluid milk For > 4 lb. tofu 22 lbs.

See qualifying conditions and medical documentation requirements for Milk Substitutes in Food Packages with Medical Documentation.

NOTE A woman with qualifying conditions requiring a medical formula receives Food Package 3 (medical formula) plus the foods from Food Package 5 that are appropriate for the woman, depending on the medical conditions. Food Package 3 will be explained in Food Packages with Medical Documentation.

25

FP 6: Food Package for Some-Breastfeeding and Non-Breastfeeding Women

26

The following women receive FP 6: • Some-Breastfeeding • Non-Breastfeeding

Food Package 6

Food Item

Maximum Monthly Allowances Juice, Single Variety 96 Fluid ounces

2 (11.5-12 oz.) frozen concentrate* or 1 (64-oz.) containers


16 quarts milk 4 gallons

OR 3 gallons + 1 quart and 1 lb. cheese

Breakfast Cereal 36 ounces cereal Eggs 1 dozen eggs Fruits and Vegetables $10.00 Cash Value Voucher Whole Grains including bread, tortillas, oatmeal or brown rice

NA

Peanut Butter or Dry/Canned beans

One of the following: • 18 ounces peanut butter • 1 pound dry beans • 64 ounces canned beans

* 2 (11.5-12 oz.) cans frozen concentrate provide the full nutrition benefit.

Issuance Guidance for Food Package 6

Milk The standard for FP 6 is 4 gallons of milk/month. This amount provides 2 cups/day, which is less than the DRI for calcium for adult women and teens. Because this amount does not meet the daily calcium need for these women, it is important to encourage them to eat or drink additional calcium sources. Like Food Package 4 and 5, only fat free skim and low fat 1% milk are available for women. This is to reduce saturated and total fat, which is consistent with the Dietary Guidelines for Americans, as well as dioxins.

Cheese A maximum of 1 pound of cheese may be substituted for milk. The amount of cheese is limited in this food package to decrease saturated and total fat for the woman.

Milk Options for Food Package 6 Some foods are provided as options or alternatives, allowing the woman to choose her preference. The following options may be issued without medical documentation:




5 (3 qt.) containers 2 (8 qt.) containers

Fluid Goat Milk

1:1 (1 qt. to 1 qt. Fluid Milk) 16 quarts



Soy-Based Beverage 1:1 (1 qt. to 1 qt. Fluid Milk) 16 quarts or 8 (½ gallons)



Milk Substitutes for Food Package 6

The following milk substitute may be issued when qualifying conditions are met and required medical documentation is completed:






NOTE A woman with qualifying conditions requiring a medical formula receives Food Package 3 (medical formula) plus the foods from Food Package 6 that are appropriate for the woman, depending on the medical conditions. Food Package 3 is explained in Food Packages with Medical Documentation.

27

FP 7: Food Package for Fully Breastfeeding; Mostly-Breastfeeding Multiple Infants; Pregnant with Multiple Infants; Pregnant and Fully Breastfeeding

28

The following women receive Food Package 7: • Fully Breastfeeding (baby receives no formula from WIC) • Mostly-Breastfeeding more than one infant • Pregnant with more than one infant • Pregnant and Fully Breastfeeding

Food Package 7

Food Item

Maximum Monthly Allowances Juice, Single Variety 144 Fluid ounces

3 (11.5-12 oz.) frozen concentrate* or 2 (64-oz.) containers


24 quarts milk 6 gallons

OR 5 gallons + 1 quart and 1 lb. cheese

Cheese 1 pound Breakfast Cereal 36 ounces cereal Eggs 2 dozen eggs Fruits and Vegetables $10.00 Cash Value Voucher Whole Grains including bread, tortillas, oatmeal or brown rice

1 pound

Peanut Butter or Dry/Canned beans Two of the following: • 18 ounces peanut butter • 1 pound dry beans

• 64 ounces canned beans Canned Fish 30 ounces Light Tuna or Pink Salmon

*3 (11.5-12 oz.) cans frozen concentrate provide the full nutrition benefit.

Issuance Guidance for Food Package 7 Milk The standard for FP 7 is 6 gallons of milk/month. This amount provides a little over 3 cups/day and meets the DRI for calcium for adult women. Because teenage girls need about 4 cups/day, it is important to encourage them to eat or drink additional calcium sources.

Like the other Food Packages for women, only fat free skim and low fat 1% milk are available. This is to reduce saturated and total fat, consistent with the Dietary Guidelines for Americans, as well as dioxins. Whole or 2% milk is available for women receiving Food Package 3, if deemed appropriate by the Health Care Provider on the medical documentation.

Cheese In addition to the pound of cheese provided in FP 7, a maximum of 1 pound of cheese may be substituted for 3 quarts of milk. The limited amount of cheese helps to decrease saturated and total fat for the woman.

Milk Options for Food Package 7 Some foods are provided as options or alternatives. The following may be issued without medical documentation unless otherwise indicated:




8 (3 qt.) containers 3 (8 qt.) containers 1 (20 qt.) container

Fluid Goat Milk 1:1 (1 qt. to 1 qt. Fluid Milk) 24 quarts



Soy-Based Beverage 1:1 (1 qt. to 1 qt. Fluid Milk)

24 quarts or 12 (½ gallons)



Milk Substitutes for Food Package 7 The following milk substitutes may be issued when qualifying conditions are met and required medical documentation is completed:


Medical Documentation Required

Maximum Allowed



29

NOTE A woman with qualifying conditions requiring a medical formula receives Food Package 3 (medical formula) plus the foods from Food Package 7 that are appropriate for the woman, depending on the medical conditions. Food Package 3 is explained in Food Packages with Medical Documentation.

30

Food Package for Fully Breastfeeding Multiple Infants (FP 7+)

Women who are Fully Breastfeeding more than one baby can receive Food Package 7+. (No formula is issued by WIC).

Food Package 7+ Women who are fully breastfeeding multiples receive 1½ times the food available in Food Package 7. For specific foods and quantities, refer to the MOM Section 7.13 for FP 7+. Since it is not possible to split some food items in half to give 1 ½ times the usual amount, those items are averaged over 2 months. In other words, the woman will receive the regular amount of food in the first month and twice that amount the second month. See the MOM Section 7.13 FP 7+ for specific averaging procedures.

NOTE A woman with qualifying conditions requiring a medical formula receives Food Package 3 (medical formula) plus the foods from Food Package 7+ that are appropriate for the woman, depending on the medical conditions. Food Package 3 is explained in Food Packages with Medical Documentation.

What are procedures for tailoring food packages?

1. The maximum amounts of food in each food package is set by federal regulation and may not be exceeded.

2. For most participants, issue all the foods in the food package to provide the full nutrition benefit.

3. Decrease or eliminate foods in the food package in the following circumstances: • Participant is not able to eat a certain WIC food. For example,

o The participant is exclusively tube fed; o A very premature infant is not ready for solids; o Participant is allergic to a specific WIC food

• Participant declines a specific WIC food.

http://www.health.state.mn.us/divs/fh/wic/localagency/program/mom/chsctns/ch7/sctn7_13.pdf



Skill Check-#4

31

1. Which food package provides 2 pounds of whole grains?

2. What is the Fruit and Vegetable cash-value voucher amount for FP 4? FP 5? FP 6? FP 7?

3. What is the maximum amount of cheese that may be issued to a child (1 through 4 years of age) in FP4?

4. Why is the amount of cheese limited in the food packages for children and women?

5. The food package for children 2 years of age and older allows only _________ or ________milk.

6. Which food package requires medical documentation for issuance of soy-based beverage?

7. What milk options are available to women in Food Package 5 & 6 that do not require medical documentation?

8. The substitution rate for tofu is ___ pound(s) of tofu for ___ quart(s) of milk.

9. Women pregnant with multiples are eligible for which food package?

10. Food Package 6 provides ____ pound(s) of whole grains.

Food Package Issues Related to Personal Preferences

32

Participants may not always want all the foods or the amounts that are available in the standard food packages. On the one hand, we want participants to get the most nutrition possible from the foods WIC provides and we want them to get foods they are most likely to use. On the other hand, we want to use WIC program resources wisely so that participants don’t purchase WIC foods they don’t need or want. The CPA can help the participant select foods that address both of these situations.

All participants are different and come from different backgrounds and situations. WIC staff can help the participant choose WIC foods he/she will use. If participants say they want to purchase a particular food, don’t use a particular food, won’t use as much as WIC provides, or have a religious or cultural concern about particular foods, the CPA has several options to offer:

• Use the WIC Shopping Guide to help find an option that works for their situation.

• Suggest that participants purchase only what they will need or use. Remind them of the rules around voucher use: They must buy everything they want from the voucher at the time it is spent. No rain checks or IOUs. No penalty for purchasing less than listed on the vouchers. Remind them to make sure the vendor charges only for the foods/quantities actually purchased with the WIC voucher.

Remember The foods WIC provides are for the participant and are not intended to be used by other family members. Do not recommend that a participant go ahead and purchase the food and allow other family members to use it. Possible Solutions to Participant Preferences

Prefers a particular type of milk other than fluid cow’s milk Situation: A pregnant woman prefers soy-based beverage and will not drink any cow’s milk. Solution: Select soy-based beverage in the Food Package. Soy beverage is available to women as a preference. Children require medical documentation. All other milk alternatives (evaporated milk, goat milk, dry/powdered milk and lactose-free milk) are available for participants without medical documentation.

Won’t buy the food Situation: Jane hates eggs and never buys them or even has them in her house.


Solution: Remove eggs from the food package. Similarly, other foods like peanut butter can also be removed by the CPA based on the participant’s dislike.

Has too much of the food or can’t always use the maximum Situation: Sandy says her son eats some peanut butter, but she already has 2 jars in her cupboard. Solution: Suggest Sandy try the beans or simply not purchase any more peanut butter with her WIC vouchers until she needs another jar. (Remind her of the rules around voucher use – she must buy everything she wants from the voucher at the time it is spent. No rain checks or IOU’s. No penalty for purchasing less than listed on the voucher. The vendor may only charge for the items actually purchased.)

Religious or cultural issues Situation: Amala is Hindu and is vegetarian. Solution: All the WIC foods in the women and child food packages could be considered vegetarian. WIC food packages are not vegan.

Situation: Katherine is a Russian Old Believer who does not drink milk during Lent. Solution: Remove milk from the food package for those months of Lent. Determine if she can drink soy-based beverage and if so, provide that during the months of Lent. Milk or a milk option may be issued for the other months of the certification as desired.

Organic foods Situation: Cindy is very concerned about what she offers her children and prefers to offer only organic food. Solution: Organic foods are allowed in the WIC food package when they are cost-neutral. That means that the cost of the organic version of a food item is similar to the non-organic version. Additionally, participants may use the Fruit and Vegetable Cash-Value voucher to purchase organic produce. Point out which organic food items are allowed in the WIC Shopping Guide. As always, a participant can decide to not receive or not purchase WIC foods they won’t use.

33


Skill Check-#5

34

Match the food package suggestions that you might offer when you hear the following statements:

Statements: ____ “I’d like my child to eat more vegetables, but I don’t buy them because they will

just go to waste.” ____ “I already have a lot of infant cereal in my cupboard.” ____ “He just doesn’t like peanut butter that much.” ____ “Cow’s milk doesn’t seem to set very well with my daughter. I’m not sure what

she should drink.” ____ “I really dislike fish of all types. I can’t stand the thought of having it in my house.” ____ “Brown bread doesn’t taste as good as white bread.” ____ “I only use organic food because it is so much healthier.” ____ “She’s my little vegetarian! She’ll eat anything other than meat.” ____ “Rice milk is the only type of milk that I serve my family. We try to stay as

close to a vegan diet as possible.” ____ “I rarely use eggs.”

Suggestions to offer: 1. There is no penalty for purchasing less than what is listed on the voucher. 2. We can create a food package without milk. WIC foods are not vegan but you are

welcome to pick foods from the WIC Shopping Guide that best match your diet. 3. Organic produce can be purchased with the fruit and vegetable voucher. Other organic

food options may be limited due to cost. 4. Beans are an option that can be selected instead of peanut butter. 5. We can assign a food package that doesn’t include fish. 6. Consider purchasing frozen vegetables with your fruit and vegetable voucher; then you can

prepare small amounts at a time. 7. Some mothers find that lactose-free milk works well as a milk alternative for the situation

you’ve described. 8. Whole grain and corn tortillas; oatmeal; and brown rice are other whole grain foods to

consider trying. 9. WIC foods work well for a vegetarian diet. 10. You can choose to purchase foods that you use occasionally only as you need them.

Food Packages with Medical Documentation


Objectives

Describe procedures for obtaining medical documentation for milk substitutes;

Describe procedures for obtaining medical documentation for medical formulas;

Understand when it is appropriate to issue Food Package 3.

FP 3: Food Package for Participants with Qualifying Conditions for Medical Formula

35

When a WIC participant has a qualifying medical condition which requires a special diet, WIC can provide special medical formula or foods if the participant has authorization and documentation from a licensed Health Care Provider. The form we use to collect this information is called the Medical Formula Documentation Form.

A qualifying condition is a medical diagnosis made by a licensed Health Care Provider that requires the use of a medical formula or food or a special diet to maintain good health or to improve health outcomes for a participant. Indication of a specific qualifying condition is a required element of medical documentation.

With a Health Care Provider’s Medical Documentation, participants with Food Package 3 are eligible for: • WIC-eligible medical formula (infants, children and women) • Standard contract infant formula (children) • Supplemental Foods (from the Food Package that they would receive if they

did not receive medical formula).

http://www.health.state.mn.us/divs/fh/wic/localagency/program/mom/exhbts/ex7/7d.pdf


Qualifying and Non-Qualifying Conditions for Food Package 3

Participant Category

Supplemental Food/Formula Requiring Medical

Documentation

Qualifying Medical Conditions Non-qualifying Conditions

Infants 0-5 months

Food Package 3

• Exempt infant formula • Medical food

• Premature birth • Low birth weight • Failure to Thrive • Metabolic disorders • Gastrointestinal disorders • Malabsorption syndromes • Immune system disorders • Life threatening disorders, diseases and

medical conditions that impair ingestion, digestion, absorption or utilization of nutrients that could adversely effect the participant’s nutrition status

• Non-specific formula or food intolerance

• Suspected or non-confirmed allergy

• Only condition is a diagnosed formula intolerance or food allergy to lactose, sucrose, milk protein or soy protein that does not require an exempt infant formula

• Participant preference

Infants 6-11 months

Food Package 3

• Exempt infant formula • Medical food

• As above. • As above.

Infants 6-11 months

Food Package 3 with foods

• Infant fruits & vegetables • Infant cereal

• Health Care Provider indicates complementary foods are appropriate

• Health Care Provider indicates complementary foods are not appropriate

Children 1 -4 years

Food Package 3

• Infant formula (contract) • Exempt infant formula • Medical food

• Premature birth • Low birth weight • Failure to Thrive • Metabolic disorders • Gastrointestinal disorders • Malabsorption syndromes • Immune system disorders • Life threatening disorders, diseases and


• Solely for the purpose of enhancing nutrient intake or managing body weight without an underlying condition

• Lactose intolerance • Participant preference • Food dislike

Children 1 -4 years

Food Package 3 with foods

• Milk/milk alternatives (includes Whole or 2%)

• Cheese • Cereal • Eggs • Fruits & vegetables • Whole grains • Peanut butter/beans • Juice

• Health Care Provider indicates supplemental foods are appropriate

• Health Care Provider indicates supplemental foods are not appropriate

36

Participant Category

Supplemental Food/Formula Requiring Medical

Documentation


Women Food Package 3 • Infant formula • Exempt infant formula • Medical food

• Metabolic disorders • Gastrointestinal disorders • Malabsorption syndromes • Immune system disorders • Life threatening disorders, diseases and


• Solely for the purpose of enhancing nutrient intake or managing body weight without an underlying condition

• Lactose intolerance • Participant preference • Food dislike

Women Food Package 3 with foods • Milk/milk alternatives

(includes Whole or 2%) • Cheese • Cereal • Eggs • Fruits & vegetables • Whole grains • Peanut butter/beans • Juice • Canned Fish (Fully

Breastfeeding)

• Health Care Provider indicates supplemental foods are appropriate • Health Care Provider indicates

supplemental foods are not appropriate

Medical Documentation Requirements for Food Package 3:

1. Obtain Medical Documentation from a qualified health care provider before issuing Food Package 3 vouchers. See Medical Formula Documentation Form to familiarize yourself.

2. Medical Documentation must be from a Health Care Provider licensed to write medical prescriptions.

3. The Medical Documentation must be in writing and kept on file. 4. Medical Documentation must include:

• Qualifying conditions • Name of formula or supplemental food • Prescribed amount/day • Length of time required • Health Care Provider signature, date and contact information

5. If you are unable to get written documentation in a timely manner, you may obtain an initial verbal OK from the Health Care Provider. Verbal confirmation must be received before any vouchers may be issued. Make sure that written confirmation is received within 1 month. Without it, a 2nd month of Food Package 3 vouchers can not be issued.

6. A new medical documentation form for medical formula & supplemental foods (Food Package 3) must be obtained at every certification OR when the prescription changes.

37


Issuance Requirements for Food Package 3: 1. Refer to the MN WIC Formula Amounts Guide for Medical Formula to

determine the allowed formulas and quantities. Each of the formulas and quantities are listed by WIC type.

• CPAs are responsible for issuing the correct quantities. • Make sure to adjust quantities to the amount prescribed and needed.

2. Infants 6-11 months receiving medical formula and no supplemental foods may receive increased quantities of formula.

• The increased amounts apply only to medical formula, not contract formula

• Increased amounts may be provided only when a medical condition prevents the infant from eating foods.

• Refer to the MN WIC Formula Amounts Guide for Medical Formula for increased quantities.

3. Supplemental foods may be issued along with medical formula. • Issuance of supplemental foods in Food Package 3 requires Medical

Documentation from the Health Care Provider. • Make sure to adjust quantities to the amount prescribed and needed.

Use the certification assessment information to determine appropriate amounts.

4. For children under 2 years of age, infant cereal is available in Food Package 3 or 4. If the child is 2 years of age or older, infant cereal is available in Food Package 3 only. Issue 32 oz. plain WIC-allowed dry infant cereal in place of 36 oz. of cereal for children if appropriate.

Milk Substitutions for Food Packages 3 through 7

38

Participants who are eligible to receive a milk substitute must have one or more qualifying conditions determined by a health care professional licensed to write medical prescriptions. With this documentation, the following Milk Substitutes may be issued: • Whole and/or 2% milk (Available in Food Package 3 only.) • Soy-based Beverage (Medical Documentation not required for women) • Tofu (Medical Documentation not required for women unless a specific quantity is

requested. Quantities vary by food package.)

http://www.health.state.mn.us/divs/fh/wic/localagency/infosystem/hubert/info/amountsguide.pdf


Qualifying and Non-Qualifying Conditions for Milk Substitutions

Participant Category Milk Substitute Requiring Medical

Documentation


Children (FP 4) • Soy-based beverage • Tofu

• Confirmed Milk allergy • Vegan/vegetarian diet • Severe lactose maldigestion (cannot

tolerate lactose-free milk) • Medical condition requiring use of

soy-based beverage • Not able to drink milk due to

religious observance/practice (ex. Russian Orthodox)

• Cultural use of food item

• Participant preference • Food dislike • Suspected or non-confirmed

allergy

Women (FP 5, 6 & 7) • Tofu > 4 pounds for Food Package 5 & 6 or > 6 pounds for Food Package 7

• Confirmed Milk allergy • Vegan/vegetarian diet • Severe lactose maldigestion (cannot

tolerate lactose-free milk) • Medical condition requiring use of

soy-based beverage • Not able to drink milk due to

religious observance/practice (ex. Russian Orthodox)

• Cultural use of food item

• Participant preference • Food dislike • Suspected or non-confirmed

allergy

Medical Documentation Requirements for Milk Substitutions: 1. Obtain Medical Documentation from a qualified health care provider before issuing

vouchers for milk substitutes. See the Authorization of Milk Substitute form to familiarize yourself.

2. Medical Documentation must be from a Health Care Provider licensed to write medical prescriptions.

3. The Medical Documentation must be in writing and kept on file. 4. Medical Documentation must include:

• Qualifying conditions • Name of Milk Substitute • Prescribed amount/day • Length of time required • Health Care Provider signature, date and contact information

5. If you are unable to get written documentation in a timely manner, you may obtain an initial verbal OK from the Health Care Provider. Verbal confirmation must be obtained before any vouchers may be issued. Make sure that written confirmation is received within 1 month. Without it, a 2nd month of vouchers for a milk substitute can’t be issued.

6. A new medical documentation form for Milk Substitutes must be obtained at least yearly OR when the prescription changes. A Milk Substitute may be removed from the FP when no longer appropriate.

39

http://www.health.state.mn.us/divs/fh/wic/localagency/program/mom/exhbts/ex7/7e.pdf

Issuance Requirements for Milk Substitutes:

Refer to the Milk Substitutes tables by food package in MOM Chapter 7 for allowed milk substitutes and quantities.

• CPAs are responsible for issuing correct quantities. • Adjust quantities to amount prescribed and needed. Use assessment

information to determine appropriate amounts.

Why is medical documentation for soy beverages needed for children and not for women? USDA views vegan diets as a qualifying condition, not a personal preference. According to USDA, medical documentation for soy beverages for children

ensures that a child’s health care provider is aware that the child may be at nutritional risk when milk is replaced by other foods.

The Institute of Medicine states that while soy products may be an appropriate choice for children who cannot consume milk, soy should not be made available to satisfy participant preference in the absence of medical need.

Practice Activity -D

40

1. Talk to your WIC Coordinator about your agency’s procedures for managing

medical documentation requests.

2. Learn how Medical Documentation forms are scanned into records and who oversees this process.

3. Ask other CPAs how they handle a request for whole milk for a child over 2 years of age that does not receive Food Package 3.


Skill Check-#6

41

1. Women, children and infants on a medical formula receive Food Package ___.

2. What are 2 qualifying conditions which allow an infant to receive a medical formula?

3. What are 2 qualifying conditions which allow a woman to receive a medical formula?

4. What are 2 non-qualifying conditions for issuance of medical formula to a woman?

5. What are 3 qualifying conditions which allow a child to receive soy beverage?

6. What are 3 non-qualifying conditions for issuance of tofu to a child?

7. How much tofu may a woman in FP 5 receive without medical documentation?

How much soy beverage?

8. What 5 criteria must be included in Medical Documentation?

9. What document should be used to identify the maximum amount of formula available in a food package category?

10. What is an option if the CPA is unable to obtain written documentation in a timely manner?

Homeless Food Packages

Objectives

42


Understand when it is appropriate to modify a food package with the “homeless” options.

Describe how to appropriately modify a food package for a participant with limited access to safe food storage and/or who lacks cooking facilities.

Food Packages for Homeless

A participant with limited access to safe food storage and/or who lacks cooking facilities may need a modified food package. In these situations it may be appropriate to use the “Homeless” food package choices to adjust milk and juice. The homeless choices allow for smaller packaging sizes of milk and juice.

• Milk is available in quarts. This smaller package size will be used more quickly than a ½ gallon or 1 gallon size. Also, a quart fits better in a small refrigerator.

• Juice is available in juice boxes. These boxes don’t need refrigeration and one box is usually one portion size that can be drunk at one sitting.

• For other food items in the package, select appropriate choices based on the participant’s access to safe food storage and/or adequate cooking facilities. See the suggestions listed below in “Other options”.

Other options: • If no refrigeration is available, evaporated or powdered milk may be a

better option than fluid milk. • On the WIC Shopping Guide, point out fruit and vegetable options

that do not require refrigeration. For example, fresh apples and oranges are a better choice than frozen berries.

• If cooking facilities are limited, suggest cold cereal rather than hot cereal. • Consider which whole grain option is best for the participant. Whole

grain bread and tortillas do not require any preparation, but brown rice and oatmeal require cooking.

• Ready-to-feed formula is available for infants if needed. If safe water is available, powder formula may be a better choice. With powder, a caregiver can make just the amount of formula needed for a feeding, eliminating the need for refrigeration.


Skill Check-#7

43

1. For homeless participants, milk is available in what size container?

2. Which whole grain options may be better for homeless participants?

Final Skill Check

44

Refer to the WIC Shopping Guide to answer the following questions:

1.

Canned fruit with added sugar is not allowed.

T F

2. Frozen fruit with an artificial sweetener like Splenda is allowed.

T F

3. No potatoes, except sweet potatoes and yams, are allowed.

T F

4. A 64-oz container of 100% apple juice must have 120% of daily vitamin C.

T F

5. Boil-in-bag brown rice is allowed.

T F

6. WIC-allowed whole grain cereal is defined as “more than 51% whole grain”.

T F

7. Whole and 2% milk are only allowed when listed on the voucher.

T F

Refer to the MOM Chapter 7 and the text of this module to answer the following questions 8. A mom of a Fully-Breastfed infant (receiving no formula) is eligible for Food

Package 7.

T F

9. An 8-month infant with no qualifying conditions is eligible for Food Package 3.

T F

10. A four-year-old child is eligible for Food Package 4.

T F

11. A mom of a 7-month infant receiving 3 cans of powdered contract formula is eligible for Food Package 5.

T F

12. All infants are eligible for infant meats.

T F

13. Only standard contract formula is available in Food Packages 1 and 2.

T F

14. Written Medical Documentation from a Health Care Provider licensed to write medical prescriptions is required for issuance of a medical formula.

T F

15. Participant preference is a qualifying condition for issuance of whole milk to a woman participant.

T F



Supplementary Materials

• WIC Shopping Guide – WIC Shopping Guide

• Food Packages Policy and Procedures - Food Package Policy and Procedures • Medical Formula Documentation - Medical Formula Documentation • Authorization for Milk Substitutes - Authorization for Milk Substitutes • MN WIC Formula Amounts Guide for Contract Formula - MN WIC Formula

Amounts Guide for Contract Formula • MN WIC Formula Amounts Guide for Medical Formula - MN WIC Formula

Amounts Guide for Medical Formula • MN WIC UPC listing – MN WIC UPC Listing

45




http://www.health.state.mn.us/divs/fh/wic/localagency/program/mom/exhbts/ex7/7e.pdf





http://www.health.state.mn.us/divs/fh/wic/vendor/fpchng/upc/index.html

Documents

Food Packages – Staff Roles - health.state.mn.us the steps involved in food package assignment ... The amount of breastfeeding the woman/baby pair does will determine the amount