WIC Coordination With Medicaid and SNAP

Collaboration between the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Medicaid, and the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps) is an important way to give eligible low-income families with children access to a range of health, nutrition, and supportive services they need to become and stay healthy.^[2] By enrolling a greater share of Medicaid and SNAP participants in WIC, states can support healthier pregnancies, improve birth outcomes, and improve child health and cognitive development for low-income families, potentially reducing striking racial inequities.

By enrolling a greater share of Medicaid and SNAP participants in WIC, states can support healthier pregnancies, improve birth outcomes, and improve child health and cognitive development for low-income families, potentially reducing striking racial inequities.

This report draws on information the Center on Budget and Policy Priorities (CBPP) collected from WIC state agencies during the summers of 2021 and 2022 and updated in the fall and winter of 2023-2024. The report describes several ways that WIC state agencies are collaborating with their state’s Medicaid and SNAP programs and shows a promising trend of increased collaboration between WIC and Medicaid, and WIC and SNAP.

WIC provides nutritious foods, nutrition education, breastfeeding support, and referrals to health care and social services to low-income pregnant and postpartum people, infants, and children under age 5. A large body of research demonstrates that WIC improves participants’ health, developmental, and nutrition outcomes.^[3] Yet only about half (53.5 percent) of eligible people were enrolled in the program during 2022 (the most recent year for which U.S. Department of Agriculture, or USDA, estimates of WIC coverage are available).^[4]

WIC works alongside Medicaid and SNAP to help families weather financial distress, improve health and wellness, and boost economic prospects. To simplify eligibility determinations, a WIC applicant who already receives Medicaid or SNAP is automatically considered income-eligible, or adjunctively eligible, for WIC.^[5] Medicaid and SNAP enrollees can benefit from WIC’s nutritious foods and services, but many do not participate. Despite being adjunctively eligible, more than half of WIC-eligible Medicaid and/or SNAP enrollees did not participate in WIC in 2022. Only 20.2 percent of eligible pregnant people and 44.8 percent of children aged 1 through 4 who were enrolled in Medicaid participated in WIC. Similar percentages of pregnant people (15.1) and children (49.0) participating in SNAP participated in WIC.^[6] (See Figure 1.)

  

Interest in cross-program collaboration has grown in recent years. More state WIC programs not only collaborate with Medicaid and SNAP, but have entered into written cross-program agreements, which sometimes allow for sharing data that can be used for targeted outreach and streamlined enrollment. This report provides a state-by-state compilation of cross-program collaboration efforts involving WIC, Medicaid, and SNAP. CBPP collected information from states on coordination between WIC and Medicaid and/or SNAP during 2021 and requested updates from them in 2022 and again in late 2023 and early 2024.^[7] Responses from 49 of the 51 WIC geographic state agencies and the District of Columbia^[8] show positive trends, including:

• At least 36 WIC state agencies now meet periodically with Medicaid and/or SNAP officials, compared to only 24 state agencies that reported having periodic meetings with these programs in 2021.
• At least 36 WIC state agencies have a written agreement on coordination or data sharing with Medicaid or SNAP and five more are developing one, up from 2021 when only 27 states had agreements in place.
• At least 35 WIC state agencies periodically (anywhere from daily to annually) receive data on Medicaid and/or SNAP enrollees and six more are establishing processes to receive data, a notable increase from 2021 when only 22 WIC state agencies reported receiving data periodically.
• At least 23 WIC state agencies conduct targeted outreach to WIC-eligible individuals identified by matching WIC data with data on individuals or families enrolled in Medicaid or SNAP, a striking increase from 2022 (the first year WIC state agencies were asked about this) when only 13 used the data for targeted outreach; six more are establishing processes to conduct targeted outreach.

Pilot programs have demonstrated that by matching data across programs to identify and conduct outreach to families enrolled in Medicaid or SNAP but not WIC, states can increase WIC enrollment, especially among Medicaid participants, which may improve health and developmental outcomes.^[9]

USDA is actively supporting WIC collaboration with Medicaid and SNAP. In 2023, the department issued a policy memorandum encouraging WIC state agencies to collaborate with Medicaid and SNAP agencies in their states to explore data sharing and outreach opportunities.^[10] USDA also entered into a cooperative agreement with the Johns Hopkins Bloomberg School of Public Health to launch the MORE WIC! Project that will provide grants and technical assistance to support WIC state agencies with data matching and outreach initiatives.^[11] The project team, including the National WIC Association, will assist WIC state agencies interested in launching or expanding data sharing and matching to identify WIC-eligible families enrolled in programs such as Medicaid and SNAP, but not enrolled in WIC.^[12] The project will also help states conduct outreach and streamline enrollment processes to increase these families’ WIC participation.

Examples in this report of how WIC agencies are collaborating with their state’s Medicaid and SNAP programs can help states that are interested in launching or expanding such collaboration identify other states undertaking similar work and confer with them or draw on the lessons they learned. There are additional opportunities within the Medicaid program to connect applicants and enrollees with WIC when they interact with the state Medicaid agency, managed care organizations, or health care providers. In addition to sharing data to facilitate targeted outreach, state Medicaid agencies can strengthen referrals by developing a standardized and streamlined mechanism for health care providers; build and define a community-based health workforce that can make linkages to WIC; and work with health care providers and Medicaid managed care organizations to include WIC enrollment as a strategy to improve quality and address health-related social needs.^[13]

Assessing the Extent of WIC Coordination With Medicaid and SNAP

Cross-program coordination can take many forms. One common approach is for WIC staff to meet periodically with Medicaid and/or SNAP officials. In addition to facilitating outreach, such collaboration fosters better coordination of services and supports for families participating in more than one program.

A growing number of WIC state agencies have a written agreement with Medicaid or SNAP (such as a data-sharing agreement or memorandum of understanding). A written agreement describing how these programs will coordinate and how to make referrals across programs can benefit both state and local WIC agencies.^[14] It may also allow data exchanges and describe the information that will be shared and how often. This allows WIC state agencies to periodically receive files with information about participants in the other program who are eligible for WIC. These files can then be matched with files of WIC enrollees to assess how many WIC-eligible individuals are not enrolled, and state or local WIC agencies can contact those individuals to offer to enroll them.

Though not the focus of this report, collaboration between WIC and Medicaid and/or SNAP also occurs at the local level. Local WIC agencies periodically meet with employees of the other programs to educate them about WIC’s eligibility requirements and services and how to make a referral to WIC. Some WIC local agencies send staff to Medicaid/SNAP offices to conduct direct outreach and help clients apply for WIC. Other local WIC agencies have agreements with the programs to receive contact information of clients who may be eligible for WIC to facilitate targeted outreach to them.

Since 2021, the Center on Budget and Policy Priorities has periodically collected information from states on coordination between WIC and Medicaid and/or SNAP. In our survey, 49 of the 51 WIC state agencies located in geographic states and D.C. responded to questions in 2021 and/or 2022 regarding coordination with Medicaid and SNAP programs in their states.^[15] Forty states provided updates to these questions during the winter of 2023-2024.

• Are there periodic (at least annual) meetings between state-level WIC representatives and representatives from Medicaid and/or SNAP programs?
• What information about applying for WIC does Medicaid provide to enrollees who may be WIC-eligible?
• What information about applying for WIC does SNAP provide to enrollees who may be WIC-eligible?
• Is there a state-level data-sharing agreement or memorandum of understanding between WIC and Medicaid and/or SNAP?
• Does Medicaid and/or SNAP share data on enrollees with WIC to identify enrollment gaps?
• If Medicaid and/or SNAP data are shared with WIC, are the data used for targeted outreach by mail, telephone, or text?
• If Medicaid and/or SNAP data are shared with WIC, how often are they shared?

Their responses show an upward trend in WIC state agency collaboration with the Medicaid and/or SNAP programs in their state; over three-quarters have or are developing written agreements with another program; and three-quarters also currently receive enrollee data from Medicaid, SNAP, or both or are in the process of setting up procedures to receive such data.

Responses from WIC state agencies are summarized below, along with examples of ways WIC works with Medicaid and SNAP to coordinate, establish agreements, and use shared data. Table 1 shows each state’s response to each question.

Cross-Program Collaboration

WIC is usually administered by a different state agency than the agency that administers Medicaid and SNAP, while Medicaid and SNAP are sometimes administered by the same agency, but not always. Thus, coordination often must occur not only across programs, but across agencies. Regular cross-program meetings provide an opportunity to share information, develop referral processes, identify cross-enrollment opportunities, and coordinate outreach and service delivery.

Thirty-six of the 51 WIC state agencies have reported that they periodically meet with representatives of Medicaid and/or SNAP. In addition, many state agencies indicated that Medicaid and/or SNAP provide their enrollees with information about WIC, ranging from general program information, such as the WIC website or a toll-free WIC phone number, to a link to an online application. WIC state agencies that coordinate with other programs can recommend language for them to use in their communications with enrollees to ensure it is accurate and engaging.

Application processes for Medicaid and SNAP vary across states, with some emphasizing online service more than others. In all scenarios, there are opportunities to make referrals to WIC and provide information about how to apply.

One way to facilitate referrals from other programs to WIC is to incorporate online tools into the WIC certification process for families. These tools range from electronic forms that collect basic contact information or allow an applicant to request a certification appointment to online applications where families enter most of the demographic and basic health information needed for certification, upload eligibility documents, and read and electronically sign required forms.^[16] Links to online tools can then be included in the referral materials that Medicaid or SNAP provides to WIC-eligible families.

Several WIC state agencies indicated that they provide the other programs with a link to such an online tool to include in their outreach messages.^[17] This approach helps eligible families initiate enrollment in WIC without having to make a phone call or navigate a website to find information about how to enroll. By offering a unique link, WIC state agencies can also monitor whether Medicaid or SNAP enrollees are initiating WIC enrollment.

Including WIC in an online eligibility screener or program application is another way to connect families applying for Medicaid or SNAP with WIC. These are usually set up and operated by state agencies that administer Medicaid and SNAP. Some of these screeners and applications contain information about WIC, but families who may be eligible are often referred to a separate website for information about how to apply. Other applications automatically refer applicants who are categorically eligible to WIC or allow families to request that their relevant information be shared with WIC to initiate the enrollment process.^[18]

Agreements Between WIC and Medicaid and/or SNAP

A written agreement describing how WIC, Medicaid, and/or SNAP will coordinate, how to make referrals across programs, and how data will be shared and used can be beneficial for state and local WIC agencies.^[19] Federal law allows Medicaid and SNAP to share enrollee data with WIC, and states have demonstrated that data can be shared securely, protecting families’ privacy while improving their access to essential benefits and services.^[20]

Thirty-six WIC state agencies reported that they have a data-sharing agreement or memorandum of understanding with Medicaid or SNAP (an increase from 27 in 2021); an additional five reported that they are in the process of establishing an agreement.^[21] (See Figure 2.)

Developing a written agreement that includes data sharing involves staff from multiple programs with expertise in areas including program policy, law, data security, and technology. Thinking through in advance how shared data will be used, and how the impact of those uses will be evaluated, helps states craft strong, secure, and flexible data-sharing agreements.^[22] Consulting with states that have a data-sharing agreement in place or with national organizations with relevant experience can help states anticipate key issues and overcome challenges that arise.

  

Data Sharing Between WIC, Medicaid, and SNAP

Sharing data from Medicaid and SNAP with WIC allows state agencies to measure cross enrollment in the aggregate to assess the extent to which eligible families are missing out on WIC benefits. It also allows for direct outreach to families who are eligible for WIC but not enrolled. If these families enroll in WIC, the certification process may be streamlined because WIC already has information documenting adjunctive eligibility. States interested in launching similar efforts can learn how to effectively conduct data matches and targeted outreach from the states with experience or seek funding or technical assistance through USDA’s MORE WIC! Project.^[23]

State and local agencies use Medicaid and SNAP enrollee data for a variety of purposes, including documenting adjunctive eligibility. Most states have an automated telephone- or web-based system that allows them to check whether a WIC applicant is adjunctively eligible.^[24] States with such automated systems do not necessarily have a written agreement in place and do not need to receive batches of data to check applicants’ adjunctive eligibility.

Thirty-five WIC state agencies reported in 2022 or 2023-2024 that they or their local agencies periodically receive data on program enrollees from Medicaid and/or SNAP (as compared to 22 in 2021).^[25] The frequency of data sharing ranges from daily to annually. An additional six WIC state agencies are in the process of establishing procedures for receiving data from Medicaid and/or SNAP. (See Figure 3.) With nearly two-thirds of WIC state agencies having access to data from Medicaid and/or SNAP and more working toward that goal, there is an opportunity to identify and increase enrollment of WIC-eligible individuals. Once state and local agencies receive data, they typically use the data either to determine enrollment gaps or to conduct outreach to eligible low-income families.

  

By matching Medicaid and SNAP enrollee data with WIC enrollee data, state and local WIC agencies can assess the enrollment overlap and gap between programs. Measuring the aggregate enrollment gap allows states to measure progress over time in reaching more adjunctively eligible families. Analyzing which groups are more likely to be missing out on WIC allows states to develop more effective referrals and tailor outreach to underserved groups. Thirty-three state agencies report that they are using Medicaid and/or SNAP enrollee data to identify WIC enrollment gaps (as compared to 22 in 2021). An additional eight states are in the process of using data from the other programs for this purpose.

Matching Medicaid and SNAP enrollee data with WIC enrollee data also allows state and local WIC agencies to conduct targeted WIC outreach directly to eligible families who are not enrolled. Most states that use Medicaid and SNAP data this way have a written agreement in place that establishes the parameters for sharing and using data.

In 2021, state agencies were asked if the data use agreement or memorandum of understanding between WIC and Medicaid and/or SNAP permitted the data shared with WIC to be used for outreach. At that time, 20 state agencies indicated that the agreement allowed for the Medicaid or SNAP enrollee data to be used by the state or local agencies for targeted WIC outreach.^[26] Five additional state agencies were setting up agreements and procedures to use data from one or both of these programs for WIC outreach.

In 2022 and again in 2023-2024, states that are currently receiving Medicaid and/or SNAP data were asked if they are using the data to conduct targeted outreach. Of the 35 states that receive data from the other programs, 23 states indicated that they are using Medicaid or SNAP data for targeted outreach, employing a combination of text messaging, phone calls, and mail for outreach to Medicaid and/or SNAP enrollees who are not enrolled in WIC. An additional six states are preparing to conduct outreach to Medicaid and/or SNAP enrollees. Use of data for targeted outreach has greatly increased from 2022 when only 13 states reported doing so.

In some states, letters with information about WIC and how to apply are sent to families who are eligible for WIC but not enrolled through mass mailings. Other states provide lists with names and contact information for WIC-eligible families to their local agencies to contact by phone. Targeted outreach using text messaging has been successful in reaching and enrolling adjunctively eligible families in WIC.^[27] Regardless of the method, procedures for timely outreach and follow-up with respondents, and a mechanism for monitoring the results, are important for successful outreach.

Conclusion

By collaborating with Medicaid and SNAP, which have much more robust take-up by eligible families, state WIC programs can strengthen referrals, measure the extent to which WIC reaches adjunctively eligible families, conduct outreach to enroll more eligible families, and monitor progress over time. By working across agencies to ensure that low-income families with young children receive the full array of benefits and supports for which they are eligible, administrators of each program can help prevent short-term hardship and put children on a healthier course for life.