Maternal & Infant Health
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Lessons of Two Years of COVID-19: Impacts of an Offline System for WIC Beneficiaries in Ohio

March 21, 2022
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By: Hope A. Lane-Gavin, Fellow, Health Equity, The Center for Community SolutionsKatherine Ungar, Policy Associate, Children’s Defense Fund - Ohio  

In our first blog of this series highlighting our research into the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and how it operates in Ohio, we outlined many of the program’s key components (such as eligibility, referrals, and how to apply) as prescribed by the United States Department of Agriculture’s (USDA) Food and Nutrition Service (FNS). However, like other benefit programs managed by the federal government but administered by individual states, there are crucial programmatic differences in the way WIC operates across the country, and this is reflected in enrollment rates among eligible participants.

 Now, two years into a global pandemic, an online system appears to have better served WIC beneficiaries. Ohio should heed the lessons of two years of COVID-19 by transitioning to an online system.

One integral element that USDA FNS left up to states was whether or not their programs would operate online (Electronic Benefit Transfer (EBT) cards reloaded remotely) or offline (requiring beneficiaries to either mail or physically present their EBT cards at their local WIC office). Ohio was one of the first states to use an EBT card, and therefore, had to make the decision of offline versus online earlier than many others. At the time, Ohio’s decision between offline or online was not as obvious as it might seem today, given that both methods had clear benefits. Now, two years into a global pandemic, an online system appears to have better served WIC beneficiaries. Ohio should heed the lessons of two years of COVID-19 by transitioning to an online system.  

WIC delivery online and offline map

Recertification is more difficult in-person versus online

Similar to other benefit programs, WIC requires participants to recertify their enrollment in and need for the program every so often. In Ohio, this time period is every six months, which, depending on participation in other public benefit programming, may require a participant to gather and present proof of income, proof of identity, and other essential documentation to their local WIC clinic in-person. Certification and recertification generally require participants in both online and offline states to physically come into the WIC clinic. The distinction between online and offline states focuses on the ability to issue benefits remotely. However, some online states were approved to offer remote certification and nutrition education through COVID-19 waivers, in addition to remote benefits reloading.

EBT Cards are safer and easier to reload remotely

Ohio is one of just nine offline states requiring that WIC beneficiaries either mail or present their EBT cards at their local WIC office every four months (three months during non-pandemic times) to reload their benefits onto their EBT card.ii This is in contrast to online states where EBT cards are automatically reloaded remotely each month and WIC beneficiaries are not required to physically go to the WIC clinic.  

Risks of in-person contact, delays in mail processing and delivery, as well as increased socioeconomic and transportation barriers resulting from the pandemic underscore the challenges faced by offline states that require in-person EBT card reloading. In other words, offline benefits reloading may mean families have limited access to WIC benefits at a time when they needed them most. Between April and June 2020 at the start of the COVID-19 pandemic, 29.5 percent of children in the United States, predominately from low-income families and racial and ethnic minority groups, experienced household food insecurity.iii  

Since WIC serves a population that’s challenged by Social Determinants of Health (SDOH) combined with the unpredictability and stress of pregnancy and subsequent newborn care, requiring participants to have reliable transportation to simply access their benefits – not to use them – runs counter to the program’s intentions and goals.

 Ohio is one of just nine offline states requiring that WIC beneficiaries either mail or present their EBT cards at their local WIC office every four months (three months during non-pandemic times) to reload their benefits onto their EBT card. This is in contrast to online states where EBT cards are automatically reloaded remotely each month and WIC beneficiaries are not required to physically go to the WIC clinic.

Offline reloading decreases WIC participation

WIC offline benefits drop in Ohio

Research published in in The Journal of the American Medical Association (JAMA) in August 2021 assessed whether WIC participation differed before and during the pandemic in offline versus online states. They noted that online and offline states had similar baseline poverty and unemployment rates and similar unemployment rates during the pandemic and that there was no statistical evidence of differing trends in WIC participation across these states prior to the pandemic. Researchers found that offline EBT reloading systems were associated with significant decreases in WIC participation during the COVID-19 pandemic. Specifically, the research showed:

  • During the pandemic, the mean number of WIC beneficiaries decreased 4.43% in offline states and increased 3.49% in online states.
  • WIC participation was 9% lower in offline states relative to online states. As a falsification test and to test the validity of their underlying variables (i.e. WIC), the researchers also looked at participation in the Supplemental Nutrition Assistance Program (SNAP or food stamps where EBT cards are loaded remotely in both WIC offline and WIC online states) and found that there was no significant relative change in SNAP participation in WIC offline states.  

In addition to the card reloading barrier faced by WIC participants in Ohio, other administrative burdens that families face accessing the WIC program, such as the lack of option to apply online, shopping experiences, and vendors available, may also contribute to the declines experienced prior to the pandemic.

Next Steps for Ohio’s WIC Program

We know the Ohio WIC program works hard to effectively serve its clients, and we appreciate that Ohio applied and was approved for the waiver that allowed participants to reload their EBT cards less frequently (every four months as opposed to three). However, with declining participation rates, the program must continue to consider the administrative barriers that keep people out, such as offline benefit reloading. The challenges of the pandemic have made clear that an online program better serves WIC beneficiaries and meets people where they are. Therefore, it is also important that our state works towards adopting online benefits reloading systems.

 The challenges of the pandemic have made clear that an online program better serves WIC beneficiaries and meets people where they are.

In our next Blog of this series, we will be diving deep into Ohio’s WIC participation rates by eligibility categories, both prior to the pandemic and now. We will also be proposing additional strategies that Ohio can explore to improve the WIC utilization rate.  

i Arkansas, Louisiana, Missouri, New Mexico, Ohio, Pennsylvania, Texas, Utah, and Wyoming are the nine offline states.  

ii In light of the pandemic, FNS allowed WIC agencies to issue up to four months of WIC benefits on EBT cards at one time for those state agencies with offline systems. Ohio’s waiver to issue four months of WIC benefits was approved on April 15, 2020.    

iii https://www.ipr.northwestern.edu/documents/reports/ipr-rapid-research-reports-pulse-hh-data-10-june-2020.pdf

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