For the final project we were asked to identify a state level agency that delivers a federal program. The program this writer choose was WIC. She will identify where the program sits on the federal level, what department it is part of, any areas of concern, and of course identify its mission and any other pertinent information. We will attempt to explain how WIC interacts on all levels of government and the type of intergovernmental relations. This writer will write about the challenges currently facing the program and the challenges it may face in the future.
She will also try to apply the P A Dichotomy to a policy domain. She hopes she can successfully apply the facets of PA or Public management to the agency’s particular policy domain or problem. WIC Introduction The agency this writer chose to write about is a federal government program entitle Women, Infants & Children (WIC). It is this writers opinion that this government sponsored program, which partners with state government, is one that truly shows how well committed and jointly run government agencies should be run.
In her estimation WIC is one of the most successful government programs that has ever been sponsored. Background WIC stands for Women, Infants and Children and was started as a pilot program by the federal government in 1972 and was put into permanent service in 1974. The WIC program is managed by the Food and Nutrition Service (FNS) which is a division of the Department of Agriculture (WIC 2010). This department is dedicated to reducing hunger in America, in cooperation with various organizations, by providing access to food.
Their mission statement explains the agency’s goal which is “To safeguard the health of low-income women, infants, and children up to age 5 who are at nutrition risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care” (WIC 2010). The WIC program originally began under the name of the Special Supplemental Food Program for Women, Infants, and Children, but the name was later changed to WIC under the Healthy Meals for Healthy Americans Act of 1994.
The Healthy Meals for Healthy Americans Act of 1994 (P. L.103-448) reauthorized several important expiring programs, such as the school breakfast program, food stamps, school lunch program, homeless children nutrition program, and of course WIC to name a few of the programs this agency oversees. The act required that all federally subsidized meal programs match the food given to the Dietary Guidelines for Americans, permanently authorized the nutrition education and training program, and expanded the outreach and coordination of WIC, which changed its role as a nutrition program, instead of a social service program (Devaney 2007).
It also set new guidelines that were now required, that the meal programs were required to agree with. This is when WIC was changed to an entitlement program that would henceforth be permanently authorized. It expanded WIC’s outreach and coordination with other agencies. The WIC program currently serves about 8. 1 million participants each year at an estimated cost of over $5. 1 billion (WIC 2007). The agency provides foods rich in certain nutrients (iron in particular) to pregnant and breastfeeding women and children under 5 that have low income and are at nutritional risk.
The program tries to educate its participants in how to prepare good nutritious meals and supplies the reasons why this is so important for growing children. They will provide referrals, when necessary, to health care and other social service agencies to the participants at no charge. WIC serves low-income pregnant, postpartum and breastfeeding women, and infants and children up to age 5 who are at nutrition risk. This government program is eligible to most women who are pregnant or lactating, and along with their infants and children apply for a food supplement to help those below the poverty level.
The good thing about this program is that even if you are not low income you may still qualify if you have some sort of health problem. Like gestational diabetes, high blood pressure when pregnant, pre-term baby, jaundice at birth, low birth weight, being either over-weight or under-weight, to name a few. The FNS issues the rules and regulations for this program and monitors its compliance through its with its seven regional offices (Baydar, et el 1997).
The federal agency provides federal grants to the fifty States so that the state and local agencies can provide additional food, limited health care, and education on nutrition and its value for low income women, infants and children who are considered to be at risk in the general population. WIC is not an entitlement program, instead it is a Federal grant program for which Congress authorizes a specific amount of funds each year for the program’s use and the FNS provides these same funds as cash grants to the individual state agencies for their use in the program.
WIC is administered at the Federal level by FNS in partnership with 90 WIC state agencies, through approximately 47,000 authorized retailers (WIC 2010). WIC operates through 1,900 local agencies in 10,000 clinic sites, in 50 State health departments, 34 Indian Tribal Organizations, the District of Columbia, Northern Mariana, American Samoa, Guam, Puerto Rico, and the Virgin Islands (WIC 2010). Most State WIC programs will provide either vouchers or EBT cards to their clients, who in turn present the same for use at local area authorized food stores.
A wide variety of State and local organizations cooperate in providing the food and health care benefits, and 46,000 merchants nationwide accept WIC vouchers (WIC 2010). Local government agencies, provide the various services to the participants, which include the initial screening for eligibility. After the participant has been certified the local agency is responsible for issuing the vouchers and other benefits. In some states, the local agencies are part of the State agency, while in other more populous states they are usually public health departments, community health care centers, or other community agencies.
In order to accomplish the purpose of Section 17 of the Child Nutrition Act of 1996 the United States Department of Agriculture along with the corresponding State Agency must agree on certain items to ensure the program is run correctly, fairly, and equally among its participants. The state agencies must certify each year in writing, that no one shall be denied or excluded from the programs because of their race, color, national origin, age, sex, or handicap. The state then must provide data, maintain records and submit reports as required, to allow enforcement of the nondiscrimination laws.
WIC has been proven to save lives and improve the health of many women, infants and children. This one government program has been proven time and time again that it does as it promises by continually improving the health and wellbeing of pregnant women, new mothers, and their infants. A 1990 study showed those who participated during their pregnancies had lower overall additional Medicaid costs for themselves and their babies than did women who did not participate (Devaney, B. 1992).
Those women who have participated in this program have been shown to have had longer gestation periods, coupled with higher birth weights and lower infant mortality rates than those that did not use this service. The results of studies conducted by FNS (Food and Nutrition Service) and other non-government entities have proven that WIC is one of the most cost-effective nutrition intervention programs (WIC 2010). They serve women who breastfeed up to infant’s 1st birthday and children up to their 5th birthday. This program provides the nutritious foods, education, counseling, and screening needed by both the mother and child (WIC 2010).
They will also refer the participants to other government agencies for assistant is asked or if the screener determines the need while examining them. They main objective is to ensure that each child in their program is given the best start to life that they are able to provide. The Nutrition Services Standards were put into place to allow both the State and local WIC agencies to gauge how well they were delivering these services to the participants and to assist them in improving the way these services are provided.
These standards embody a wide range of performance practices used to deliver quality WIC nutrition services and are adaptable so that they can be used in the many types of agencies that administer this program. The Nutrition Services Standards were developed through a joint effort between FNS, the National WIC Association and State WIC Nutrition Coordinators and Program Directors (WIC 2010). The standards provide state and local agencies a way to identify that which needs improvement such as staff training and technical assistance from various federal agencies.
Without this intergovernmental relationship, WIC would not be able to provide the services it currently extends to its citizens. Some of the different levels of government involved include state to local, federal to state; federal to local, local to tribe, tribe-to-tribe, tribe to the federal government and of course the many territories WIC serves. Without the Nutrition Services Standards guidelines, there would be no continuity in the services WIC offers. When looking into the roles the agencies play in ensuring the WIC program runs smoothly, one finds that the national and state governments are highly interwoven and interdependent.
The definition of intergovernmental literally means of, between, or involving different levels of government. WIC’s success depends on its cooperation with many different levels of government. States partner with the federal government and this ensures that the federal financial support and reasonable oversight when combined with state initiatives, flexibility, and accountability which ensures for the improvement of the lives of those Americans that are served by these programs. WIC has been successful with a high degree of reliability and accurateness.
WIC has a constant high performance level in their ability to serve customers and meet strict program requirements. They then partner with various local agencies in order to serve the citizens that are involved or enrolled with this program. Without cooperation from local government this program may not have had the desired outcome. The Problem Statements WIC currently has three distingue problems, two of which should be corrected before it can move on and one that it has started moving in the right direction on, in this writer’s opinion. The first problem would be the budget crisis it is currently facing.
WIC is not an entitlement program like those that provide individuals with personal financial benefits that are administered by the government. Those programs that answer to and are controlled by the federal government are Social Security, Medicare, Medicaid, and the Veterans’ Administration to name a few. WIC is a Federal grant program and each year Congress sets a specific amount of funds for this program (WIC 2010). However like all federally funded programs, the new budget has affected the grant WIC typically receives. The new budget constraints imposed on WIC will alter the number of people WIC can help.
This will greatly impact on the future health of the children who will be left off the program due to the grant change. The other problem that this writer feels needs addressing is the “WIC only store”. Over the past decade, this new type of store has emerged. This entity is a store that only accepts |WIC vouchers as payment, and only stocks WIC approved items. This allows the recipients, who are on WIC, to use their vouchers and checks in one convenient location. When one looks at this idea, it seems like a very good, serviceable, customer orientated plan.
However this will severely hurt the associated food costs to the program, and severely hinder the number of people this program serves. The last issue is the change in the food allowed on the program. We will address the changes to the offerings; some in this writer’s opinion are a step in the right direction and some in the wrong. Analysis of problems The issue with the budget is simple, the political side wants to cut funding to the program while the administrative side knows that any cut to their grant will translate to helping less people.
The House proposed cutting this valuable service by more than $800 million below the current level and reduce their funding from $6. 73 billion this year to $5. 90 billion in 2012. This cut would mean that WIC would deny services to over 400,000 low-income women and children next year. This cut would break the 15-year commitment by Administrations and both houses of Congresses to provide enough WIC funding to serve all eligible women, infants, and children who apply to ensure that every child has a healthy start to life (Nueberger, Z. ; Greenstein, R. ; 2011).
WIC provides nutritious foods, counseling on healthy eating, and health care referrals to over 9 million low-income pregnant and postpartum women, infants, and children under the age five who may be at some type of dietary risk in the future (WIC, 2010). WIC, and many other government agencies, have had an overabundance of research and studies which have proven that WIC is highly successful in providing those citizens’ it serves good, solid nutrition and health.
The unfortunate thing is that unlike other key low-income nutrition programs, such as food stamps, TANF, aid to dependent children, and the school lunch programs, eligible WIC recipients have no entitlement to these benefits (Nueberger, Z.; Greenstein, R. ; 2011). If funds are insufficient, eligible applicants are put on a waiting list for services. If they can be helped, they will move from the waiting list to service. However, with the amount of monies that has been cut from their budget, they will not be able to service the same number of clients. The exact number of people that will be effected, of course, is difficult to determine to the exact number because of many contributing factors.
If food prices continue to increase, at its current rate, then the higher the prices for the foods that WIC provides will mean that there will be a fewer number of participants.
With the current rate of inflation this country has seen, it would not be unfair to state that food prices have been rising rapidly in the last year, and one can expect them to continue doing the same in the coming year. Looking to the second problem, the administrators of the WIC program, believed that WIC only stores would contain the rising food costs thus containing the amount of money used from the grants it receives from the federal Treasury, which would allow the program to help more clients. Since these stores operate outside the regular retail market, they tend to have higher shelf prices than regular competitive stores.
WIC participants rarely, if ever, shop around for the cheapest prices on these food items as they receive the same food items every month regardless of the price charged for these foods so they are not price-sensitive to the amounts that stores charge for WIC food items (Neuberger, Z. , Greenstein, R. , 2004). WIC participants seem to prefer to spend their vouchers in these stores, because they can get into and out of the stores quickly without having to stand in long lines like at supermarkets (Scribd. com 2005).
The stores are usually small, are customer friendly and the service they receive from the store associates is usually excellent when compared to the service they received at grocery stores. They’re seen as the equivalent of convenience stores, and charge accordingly. This increase spending means that the state does not have to return its excess funds to Washington, because it does not have any, while the states who do not have any specialty stores are required to return the unused portion of the federal subsidy to Washington so the amounts can be reallocated to other states that are asking for more funding.
The program is working so well, say administrators, that 97 percent of the federal funds are spent at stores that accept the vouchers, so no money goes back to Washington to help any other locality (Andrews, B. 2003). The third issue is the fact that for the first time in almost twenty years the USDA has changed the guidelines. Many nutritional experts, believe the 1992 pyramid does not reflect the latest research on dietetics. Some of the choices on the food pyramid were shown to possible cause medical problems in people.
With these changes to the nutrition guidelines, came changes to the foods allowed on WIC and the reasons behind the change. Many believe the changes came about because of outside pressure, and not from strictly dietetic reasoning. All one has to do is look at infant formula that is provided by WIC. WIC provides vouchers for the purchase of infant formula. The formula used is picked by a competitive bidding system that reduces federal costs by approximately $2 billion annually.
At least ten states so far this year have entered into a new contract for infant formula, and these costs have increased as a result of receiving a smaller discounts and higher infant formula prices, which will raise program costs and thereby reduce the number of people WIC can serve. One must also remember that not all infant formula is the same or carries the same ingredients. What may be fine for one baby may not be right for another. The new guidelines also attempt to encourage mothers to breastfeed exclusively for the first six months and disallow infant cereal or baby food for the first six months (Woods-Harris, S.2009).
This is a big change from the original WIC offering. Some babies actually do better if started on rice cereal at 4-5 months. One must also remember that breastfeeding is not an option for adoptive parents, so they are put back on the old WIC guidelines, meaning they are treating families differently. Recommendations The country will be cutting costs across the board and every agency will have less to use. But one wonders why the government cannot ensure that this program is not cut. It has a proven track record and the children it helps today, means less drain on the Medicare and Medicaid roles tomorrow.
This country needs to look at the budget and see where else the money can be cut. We cannot allow the children in this country to go hungry. Another recommendation would be to stop putting quarts of milk on WIC vouchers. The cost per an ounce of milk goes up dramatically when you start buying it in smaller containers. The cheapest way to buy milk is by the gallon, and unless it is a family of one, only gallons should be allowed. Another way to save money would be to remove any name brand cereals from the WIC approved food list if a similar cereal is available in store brand.
The same can be true of any food items on a WIC voucher. The clients should be buying the cheapest item available, in every food category. When looking at WIC only stores, one would say they are not needed. Many of these stores are run by larger grocery chains, but open these markets to increase profits they lose when one shops at the grocery storee instead of the WIC only store. The first way to improve this service would be to enforcing the law regarding what WIC vouchers are supposed to be used for. A WIC store does not need to attract additional WIC participants by offering incentives for shopping there.
Allowing customers to receive free diapers, strollers, bicycles and other non-food items, demeans the program. Since the owners of these stores are using the profit they garner from the WIC sales, they are, in essence, illegally using these federal WIC funds, and forcing other states to turn clients away, because they will not reallocate the funds as they are required to do. If the share of WIC sales that occurs in WIC-only stores continues to grow, the program will require substantially larger federal appropriations that will either expand the deficit or take funds from other worthy discretionary programs.
Another answer would be to ensure that state gets the same amount of funding. Then ensure that WIC only stores charge a fair price for its service, to compete with those stores that must abide by the guidelines one of which states that the item must be at the lowest profit margin for the company. This will ensure that each state can help the maximum number of clients that apply for WIC, instead of turning some away because of the lack of funds. State WIC programs must begin to regulate WIC-only stores.
However states are hesitant to take on this task because that no state funds are involved and they believe this should be a federal oversight. State WIC programs also are required to establish limitations on the amount that will be paid to vendors for approved foods, and they have flexibility with regard to how to design these limitations. The state should establish maximum pricing structures and requirements calculated to prevent these establishments from charging more than comparable competitive stores so that it does not cost the program increased amounts to provide the same benefits.
Any current or future changes should include a provision that will ensure that the retail prices in competitive stores are the basis for the price criteria that states use in approving WIC vendors and setting maximum reimbursement levels for WIC food items. The legislation that will be needed should include a method aimed at ensuring that the WIC program does not pay more for a monthly WIC food package if a WIC participant chooses to shop at a WIC-only store rather than at a comparable WIC-approved competitive store(Neuberger, Z. , Greenstein, R. , 2004).
Under such an approach, WIC-only stores would be able to continue to participate in WIC and to offer a shopping environment that appeals to some WIC participants. They simply would have to avoid taking advantage of their status as stores protected from normal market competition and funded entirely by federal taxpayer dollars to charge the Treasury excessive amounts (Neuberger, Z. , Greenstein, R. , 2004). WIC has also seen a change with regards from dietary adequacies to concerns about excessive intakes of calories, saturated fat, and inadequate consumption of fruits, vegetables, whole grains, and the entire country’s battle with obesity.
WIC has also changed by increasing the type of food it allows its participants to purchase. With this improved knowledge of nutrient requirements a new set standards and regular updates of the Dietary Guidelines for Americans have led to improved tools and guidance on how to eat a healthy diet (Devaney 1997). This change has forced the National Health and Nutrition Examination Survey (NHANES) to begin an ongoing annual survey conducted by the National Center for Health Statistics administered to a nationally representative sample of individuals of all ages.
Since the data collected by the participants is likely to be small number of people, the NHANES has elected to collect the summarizing the data over a set number of years so they could provide sufficient sample sizes for the research needs. If the goals of the proposed food packages are achieved, we would expect to see a stronger relationship between WIC participation and consumption of foods in the new WIC food package in the post-implementation model than in the pre-implementation model.
The revised food packages will include baby food for the first time. The inclusion of fruits and vegetables for infants 6 to 11 months of age is one of the biggest changes. It allows mothers who would normally buy these items to now purchase them on WIC, which amounts to a big savings for the parent, and better nutrition for the baby. Another change is the cash vouchers. A child between the ages of 1-5 will receive a six dollar voucher which is to be used to purchase a variety of fresh fruits and vegetables.
Women who are prenatal, breastfeeding, or postpartum will receive an eight dollar cash voucher. If fresh fruits and vegetables are of limited availability, State WIC agencies will allow canned, dried, or frozen fruits and vegetables instead. The only exception to the recommendation will be the simple white potato because white potatoes are already prevalent in the diets of WIC participants and are often consumed in forms that are high in calories and saturated fat (Oliveira, V. et al;2002).
To increase the nutrient content of WIC participants’ diets, as well as to address the increasing dominance of overweight and morbid obesity in the population, the proposed food packages emphasize eating whole grain cereals and breads and limit milk to reduced-fat forms for children older than two years of age and for prenatal, breastfeeding, and postpartum women. This idea is totally counterproductive to the new public administrator in a service provider fashion. Administrators are supposed to be dedicated to seeking good management and social equity as that which should be achieved, or motivated (Waldo, D.; (1968).
This system would try to change WIC only stores for the betterment of the people who use it. If one were to follow this principle than one would seek to make changes that would improve upon what the WIC store is trying to do. They must ensure that every entity involved is treated the same. Conclusion WIC is a hugely successful and highly popular program, because it serves a at risk section of the population and because of its comprehensive research record over the past 37 years.
At this critical time of budget woes for all levels of government coupled with the changes to the WIC food packages, we can only hope that this program does not end or lose its grant funding. The bottom line is that if WIC food prices continue to escalate along with the budget constraints then the only outcome will be a smaller amount of eligible women, infants, and children will be served. Therefore, having the most effective WIC program possible can have an important influence on the health of America. Over the past thirty-seven years the numbers of participants have changed considerably since it began.
Today one will find that the majority of the participants in the WIC program are Hispanics, African Americans, Native Americans, Alaskan Natives, Asian and Pacific Islanders. The demographics also show that among those participants reporting some income, the average income of the participants for 2008 was $16,535, an increase of $958 (6. 2 percent) since 2006 (FNS. USDA 2008). When one compares the income of the enrollees with the general US population, the WIC population is distinctly poor and live at or below the US poverty line.
The woman who participate in the WIC program usually have obstetrical risks and inadequate nutrient intake while the children showed inadequate nutrient intake and usually also suffered from low weight for height ratios. Three-quarters of WIC infants were recorded at risk because their mothers were at risk during pregnancy. Another interesting fact is that of the 50 states, the territories, and the district of Columbia, ten States serve 57 percent of all WIC participants. Two of these ten States, California and Texas specifically, provide services to 25 percent of WIC participants (FNS. USDA 2008).
The WIC community faces a number of issues that have been raised by policymakers, researchers, and WIC program managers at the Federal, State, and local levels about both the impact and the administration of the WIC program. The agencies should continue to do additional research to determine the optimal method of operating the WIC program to meet the needs of the current and future program participants. With the coming of the resource constraints due to the budget crisis just what services will be cut, and how many people will be turned away from this highly successful program is unknown.
While the USDA’s Economic Research Service and the Food and Nutrition Service are both currently conducting research studies related to WIC the results from these studies will help shed light on many of the issues currently facing the WIC program (WIC TRENDS 2008). When WIC was running a surplus the monies were returned to the federal governments for redistribution so that other states could help more people that were on a waiting list for assistance. This writer does not support cutting WIC funding.
Most of the women being assisted by WIC need far more than they receive. This is one government program that should never be cut because of the good it does. This writer believes that if this country can afford to extend tax cuts to the wealthiest Americans, and bailout big business, we can afford milk and formula for mothers and infants. The bottom line is we can pay now to ensure these children a healthy start to life, or we as taxpayers will pay ten-fold, through Medicaid, Medicare, welfare, food stamps and every other government service. References
Andrews, B. (2003); WIC shops glad to charge more; The Leader; September 3, 2003; Retrieved June 5, 2011; http://www. arkansasleader. com/sept0303/index. html#news Baydar, N. , McCam, M. , Williams, R. , and Vesper, E. (1997); The WIC Infant Feeding Practices Study. Alexandria, Virginia: Department of Agriculture, November 1997. Retrieved April 21,2011 Devaney, B. (1992). Very Low Birth Weight Among Medicaid Newborns in Five States: The Effects of Prenatal WIC Participation. Alexandria, Virginia: U. S. Department of Agriculture, September 1992.
Retrieved April 15, 2011. Devaney, B. (2007). WIC turns 35: Program Effectiveness & Future Directions; National Invitational Conference of the Early Childhood Research Collaborative; Minneapolis, Minnesota; December 7, 2007. Retrieved April 20, 2011 Neuberger, Z. ; Greenstein, R. ; (2011): Proposed WIC Cuts Would End Food Assistance for 325,000 to 475,000 Low-Income Women and Children: Center on Budget and Policy Priorities; May 23, 2011; http://www. cbpp. org/cms/? fa=view&id=3499; Retrieved May 28th, 2011 Oliveira, V. ; Racine, E. ; Olmsted, J.;
Ghelfi, L. M. ; (2002); The WIC Program: Background, Trends, and Issues. Food and Rural Economics Division, Economic Research Service, U. S. Department of Agriculture. Food Assistance and Nutrition Research Report No. 27; Washington, DC; September 2002; http://www. ers. usda. gov/publications/fanrr27/fanrr27. pdf ; Retrieved June 10, 2011 Website: WIC (2010); http://www. fns. usda. gov/wic/aboutwic/howwichelps. htm; Retrieved May 23, 2011; Website: FNS (2011); http://www. fns. usda. gov/fns/; April 20, 2011 W