Healthcare Providers

Letter for Healthcare Providers

from Megan Nason, MS, RD
Virginia WIC Program Manager

Effective June 1, 2021 Virginia WIC will no longer require approval from a Healthcare Provider (HCP) for Similac Sensitive or Total Comfort formulas and therefore a medical documentation form (WIC-395) will no longer be required for these formulas.

Resources

Virginia WIC Reports

Virginia WIC Local Agency Contact List

Virginia WIC FAQs

The Special Supplemental Nutrition Program for Women, Infants, and Children, commonly referred to as WIC, is a federal assistance program under the jurisdiction of the of the Food and Nutrition Service section of the United States Department of Agriculture. The WIC Program aims to safeguard the health of low-income women, infants, and children up to age 5 who are at nutrition risk.

WIC program benefits include more than just food!

WIC participants are provided nutrition education and counseling, breastfeeding educations and support, as well as screenings and referrals to other health, welfare, and social services in addition the nutritious foods to supplement their diets.

WIC participants must be either pregnant, breastfeeding an infant less than 1 year of age, had a pregnancy which has ended within the past 6 months (regardless of outcome) or be an infant or child under the age of 5. In addition they must also live in the state of Virginia and have a gross income less than 185% FPL or be currently enrolled in another program such as Medicaid, SNAP, TANF, etc. Lastly, participants must also have a diagnosed medical condition that may impact nutritional status or have a diet that does not meet current nutritional recommendations or that puts them at risk for decreased health or nutritional outcomes.

Less than half of those who are eligible for WIC are enrolled in the program so your referrals are important!

Children between the ages of 1 and 5 are the group with lowest WIC participation rate compared to the number of children who are eligible for WIC services in the Commonwealth.

According to USDA, WIC helps to improve health with benefits such as “longer, safer pregnancies with fewer premature births and infant deaths, improved dietary outcomes for infants and children, improved maternal mental health and improved performance at school”. In addition, individuals who participant in the WIC program consistently experience substantial reductions in healthcare related costs, improved immunization rates, and increased access to regular medical care. Each federal dollar invested in WIC benefits has an estimated return that is 3.5 times greater!

The Medical Referral Form is the preferred method to use when referring your patients to WIC and completed forms should be submitted to a WIC clinic via fax. Once the completed form is received by WIC, the patient/family will be contacted to start the enrollment process for WIC services.  A listing of contact information for all WIC clinics can be found HERE.

Participants can also be directed to the website www.myvawic.org to begin the enrolment process themselves.

Virginia WIC adheres to the American Academy of Pediatrics statement Breastfeeding and the Use of Human Milk. WIC encourages families to exclusively breastfeed until infants are 6 months of age, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for as long as mutually desired by mother and infant for a minimum of one year, unless it is medically contraindicated. Local WIC agency staff assist WIC participants with human milk feeding through education, peer support, provision of lactation education materials and supplies (including breast pumps) and referrals to advanced lactation support as needed.

Mothers participating in WIC are encouraged to breastfeed their infants if possible, but WIC state agencies provide infant formula to infant participants who are not exclusively breastfed. WIC state agencies are required by law to have competitively bid infant formula rebate contracts with infant formula manufacturers. This means WIC state agencies agree to provide one brand of infant formula and in return the manufacturer gives the state agency a rebate for each can of infant formula purchased by WIC participants. The brand of infant formula provided by WIC varies by state agency depending on which company has the rebate contract in a particular state.

By negotiating rebates with formula manufacturers, states are able to serve more people. For FY 2017, rebate savings were $1.74 billion, supporting an average of 1.55 million participants each month, or 21.25 percent of the estimated average monthly caseload nationwide.

The Virginia State WIC Office Nutrition staff are always more than happy to speak with healthcare providers, or representatives from their practice. Please reach out to Jennifer Madden Smith RD, CLC via email at Jennifer.Madden@vdh.virginia.gov (preferred) or by phone at (804) 864-7843 with any questions or concerns.

STANDARD WIC BENEFITS

The WIC food packages provide supplemental foods designed to meet the special nutritional needs of lower income pregnant, breastfeeding, non-breastfeeding postpartum women, infants and children up to five years of age. The WIC food packages align with the Dietary Guidelines for Americans and infant feeding practice guidelines from the American Academy of Pediatrics (AAP).

Priority nutrients found in WIC foods include vitamins C, D, and E, as well as magnesium, potassium, calcium, iron, zinc, folic acid, and fiber. A participant’s complete package of WIC foods is also designed to limit saturated fat, total fat, calories, and sodium.

The chart below details the food categories and associated issuance amount for all WIC participant categories:

WIC recognizes and promotes breastfeeding as the optimal source of nutrition for infants. For infants who are not fully breastfeed, WIC provides iron-fortified infant formula. Special infant formulas and nutritional products may be provided when prescribed by a healthcare provider for qualifying medical condition. It is important that both healthcare providers and participants understand that WIC is a supplemental program and the formula provided is supplemental and will not cover an infant’s full needs.

No, similar to other WIC foods formula is provided in supplemental quantities that are not intended to cover a participant’s full nutritional needs. The amount of formula provided will depend on several factors such as participant age, breastfeeding status, and formula form (powder vs. concentrate vs. RTF).

The chart below show the standard WIC maximum formula amounts

Formula Form Participant Category
Infants

0-3 months

Infants

4-5 months

Infants

6-11 months

Children

& Women

Powder 870 oz. 960 oz. 696 oz. Up to

910 oz.

Liquid Concentrate 806 oz. 884 oz. 624 oz.
Ready-to-Feed 832 oz. 913 oz. 643 oz.

WIC’s goal is to encourage mothers to breastfeed without supplementing with infant formula when it is not medically contraindicated. WIC staff complete full assessments before issuing formula to ensure that mothers are provided the resources necessary to meet their personal breastfeeding goals. When formula is provided to a breastfeeding infant, the amounts will be tailored to ensure the amounts are still supplemental and do not exceed the infant’s nutritional needs. During an infant’s first month of life, formula is not routinely provided to breastfeeding infants who are supplementing with formulas. In cases where WIC staff determine that supplemental formula is needed, the amount will be limited to a maximum of 1 can of powdered formula to minimize early supplementation and encourage the establishment of the mother’s milk supply.

MEDICAL DOCUMENTATION

Federal regulations require that medical documentation be obtained any time a non-contract infant formula is provided to infants participating in WIC. In addition, documentation is required when any type of formula is provided to child and women WIC participants or when changes to their standard food benefits are medically indicated.

Yes, WIC will only accept medical documentation that includes all of the requested information. If a request is received that is missing information, WIC staff will contact the prescribing HCP and alert them that new documentation will need to be submitted. Verbal orders or clarifications cannot be accepted.

Qualifying conditions include but are not limited to premature birth, low birth weight, failure to thrive, inborn errors of metabolism and metabolic disorders, gastrointestinal disorders, malabsorption syndromes, immune system disorders, severe food allergies that require an elemental formula, and life threatening disorders, diseases and medical conditions that impair ingestion, digestion, absorption or the utilization of nutrients that could adversely affect the participant's nutrition status.

No, medical documentation can be submitted in other written forms, such as on a standard prescription pad but the current WIC-395 form is always preferred. When an alternate format is used for WIC medical documentation it is still required to contain all of the information required on the WIC-395 form and must contain an original signature from the prescribing healthcare provider, electronic signatures and stamps are NOT allowable.

Yes, in some situations infant formula can be issued to participants after their first birthday although in many situations a pediatric formula may be more appropriate. Diagnoses related to prematurity are only applicable until children reach the age of 2.

Yes, WIC medical documentation must be updated at least every 6 months and is only valid for a single WIC certification period. The prescribing healthcare provider may also elect to request modifications to standard WIC benefits for a shorter about of time.

Due to the nature of the health conditions covered with medical documentation, close medical supervision is essential for each participant's dietary management. The responsibility remains with the participant's health care provider for this medical oversight and instruction and cannot be assumed by WIC personnel at the state or local agency.

No, provision of WIC benefits (to include specialty formula) is not dependent on a participant’s insurance coverage. Participants who have insurance coverage through a Virginia Medicaid plan may however be eligible for additional formula benefits through their insurance plan which WIC can assist in providing.

Per federal regulations, medical documentation requesting modifications to WIC benefits must be provided by a healthcare provider licensed to write prescriptions under state law. In Virginia this includes Medical Doctors (MD), Doctors of Osteopathy (DO), Physician Assistants (PA) and Advanced Practice Registered Nurses (NP, CNM, etc.). Medical documentation CANNOT be signed by other healthcare professionals such as Registered Dietitians (RD) or Registered Nurses (RN).

No, a diagnosis of milk protein allergy would not be sufficient to show a need for formula for a child since WIC offers soy-based beverage (“soy milk”) as a substitute for regular milk. Even in situations where the soy-based beverage is not desired or appropriate, additional information would be needed to document an additional diagnosis that would reflect impaired ingestion, digestion, absorption, or utilization of nutrients. Milk protein allergy is however an approved diagnosis for the issuance of specialty formula for infants.

FORMULA TYPES AND SPECIFICS

The current Virginia WIC infant formula contract is with Abbott, the maker of Similac formula. The following infant formulas are available without medical documentation- Similac Advance, Similac Sensitive, Similac Total Comfort, and Similac Soy Isomil. Similac for Spit-Up is also offered as an infant formula option but does require medical documentation for issuance.

For participants with medical or nutritional needs that necessitate the use of specialty formula, the Virginia WIC program offers numerous exempt infant formulas and WIC-eligible nutritionals, which includes several modular products. This list is updated periodically and the current Virginia WIC Approved Formula List can be HERE.

Due to the infant formula rebate system, Virginia WIC is unable to provide infant formulas that are not included in the current infant formula rebate contract. Formula that are NOT allowable include Enfamil routine infant formulas, Gerber routine infant formulas, and generic or store-brand infant formulas. In addition, Virginia WIC is also not able to provide Similac Pro-Advance, Similac Advance for Neuro Support, Similac Pro-Sensitive, Similac Sensitive for Neuro Support, or Pro-Total Comfort due to these products not being available in WIC-approved container sizes. Exempt infant formulas and other nutritionals for children and women, to include modular products, are limited to products included on the Virginia WIC Approved Formulary. Even in cases where medical documentation is submitted, Virginia WIC cannot make any exceptions to allowable products.

RTF formula is not routinely issued to WIC participants due to its increased cost compared to powder and liquid concentrate forms of formula. Federal regulations restrict the issuance of RTF formula to the following situations-

  • Determination by WIC staff that the participant’s family has a restricted or unsafe water supply or that the parent/caregiver may have difficulties correctly diluting and preparing formula
  • When a specialty formula is prescribed, RTF can also be issued if the RTF form better accommodates the participant’s condition and/or helps improve compliance with consuming the prescribed product.
  • Contract WIC formulas cannot be issued in RTF form for reasons related to tolerance or compliance

While the WIC program itself is bound by federal maximum issuance amounts, Virginia WIC can assist participants who have insurance coverage through Virginia Medicaid with obtaining formula covered by their insurance when specific criteria is met. Federal regulations require that Medicaid be the primary payee of all non-contract formula issued by WIC to participants with Medicaid coverage. Through a unique partnership between Virginia WIC and Virginia Medicaid, WIC participants can obtain their full formula needs via their WIC benefits versus having to order any additional formula needed from a pharmacy or DME provider. Virginia WIC is then able to receive reimbursement from DMAS for the cost of the additional formula provided beyond the maximum WIC amount. In order for participants to be eligible for this service, they must be currently covered by a Virginia Medicaid plan that does not require the payment of co-pays and must also not have third party liability (TPL) coverage and must also have a diagnosis that support increased nutritional needs. In cases where WIC is not able to provide additional formula, providers and families are still encouraged to reach out to any applicable insurance providers to see if alternate coverage can be arranged.

In most cases, WIC food benefits are issued to participants as soon as they enrolled in WIC and any required documentation has been approved.

Only select WIC formulas are eligible for purchase at WIC-approved stores.  These include all contract infant formulas and other routinely issued products that are readily available at WIC-authorized stores. The current listing for formulas that participants can purchase at their preferred WIC-approved store can be HERE.

All other formula products provided by Virginia WIC are ordered from a distribution center in Pennsylvania that serve numerous other WIC programs. Formulas that are ordered may take up to a week to arrive and participants may need to obtain formula from another source to ensure needs are met while their current order is being shipped. This is especially important when participants are being discharged from an in-patient stay or are switching to a new formula and may not already have a supply on hand.

Due to federal regulations, WIC is unable to provide formula directly to participants and therefore WIC clinics do not have sample formula available. In addition, WIC is a supplemental program and the benefits provided (to include formula) are not intended to cover a participant’s full nutritional needs and additional amounts cannot be provided. All participants, especially those needing formula, should anticipate needing to either purchase or obtain additional product from another source each month or in emergency situations.

Yes, HMF products are available for breastfed infants who were born prematurely and require additional nutrients. WIC can provide up to 104 packets/vials monthly for infants who are under 1 month old (actual age, not adjusted or corrected age) and then greater quantities as needed for infants up to 4 months of age (actual age, not adjusted or corrected age). HMF is not approved for infants 4 months and older.

Yes, Virginia WIC offers both preterm and post-discharge preterm formulas and all require medical documentation.

Post-discharge preterm formulas, such as Similac NeoSure and Enfamil EnfaCare, can be issued to participants until they have reached the corrected age of 1 year and when medically indicated may be approved for longer use.

Preterm formulas, such as Similac Special Care and Enfamil Premature products, can only be issued to participants under 4 months of age (actual age, not adjusted or corrected age). This restriction is to reduce the risk of vitamin toxicities and other concerns that may occur when these products are consumed in quantities above what the manufacturers recommend.

MODIFICATIONS TO WIC SUPPLEMENTAL FOOD BENEFITS

Yes, WIC participants are eligible to receive all regular category-specific supplemental foods as long as they are not medically contraindicated. When medical documentation is received for a specialty formula, the prescribing healthcare provider must also select which other WIC foods the participant can receive.

No, infants cannot be issued regular milk or other foods offered by WIC to children and women even if a healthcare provider submits medical documentation.

No, WIC does not issue complementary foods to infants prior to 6 month age.

For children 12-23 months of age, only whole milk is provided.

For children age 2 and older and all women participants, both 1% and skim milk are provided and participants can select which option they would like when shopping.

Participants are also able to substitute a portion of their liquid milk for cheese and/or yogurt if they wish.

For participants with an allergy or sensitivity to lactose, lactose-free milk is also offered. This does NOT require medical documentation.

For participants who are unable to or elect not to consume dairy, soy-based beverage (“soy milk”) is also offered. This does NOT require medical documentation

Whole milk is the only dairy option available for children 12-23 months of age. 2%, 1%, and skim milk cannot be issued until 2 years of age. For children unable to consume dairy, soy-based beverage (“soy milk”) can be substituted for whole milk. When children under age 2 are provided soy-based beverage, additional education will also be provided to ensure alternate sources of fat are added into the child’s diet.

In addition to offering regular dairy milk, federal regulations also allow the issuance of lactose-free milk and soy-based beverage (“soy milk”) as an option for WIC participants over the age of 1. Other milk substitutes, such almond, oat, rice, etc., do not have a nutritional composition that is comparable to dairy and therefore are not eligible for WIC approval.

Although WIC food benefits are standardized, there are some customizations that can be made to ensure that participants receive foods that are medically appropriate and that they will utilize as well as options that are already built into the standard benefits provided that allow flexibilities for those with allergies. WIC foods that a participant cannot consume are removed from their benefits and when an appropriate substitution is not available WIC staff will provide additional nutritional counseling on alternate ways to obtain the nutrients similar to the food(s) that must be removed.

Milk allergy - Soy-based beverage (“soy milk”) is offered as an alternative

Gluten allergy - Gluten free cereals are labeled on the allowable foods list; rice and corn tortillas are offered as options in the whole grain category

Peanut allergy - Dried and canned beans are offered as another option in the legume category

Yes, but only when specific conditions are met and when medical documentation is provided. Children age 2 and older and all women participants are routinely only provided 1% and skim milk by WIC. Higher fat milks can only be issued in cases when it is requested by a HCP and the participant is also receiving a specialty formula from WIC and has a diagnosis that support increased nutritional needs.

No, pregnancy itself does not indicate that a woman would require a higher fat milk.

No, additional formula cannot be provided in place of infant foods for infants age 6 months and older (WIC does not provide infant foods prior to 6 months of age). However in cases where an infant is medically unable to consume solids, medical documentation can be provided to document the infant’s inability to consume solids and in those cases the infant can continue to receive the higher amount of formula provided from 4-5 months of age and the infant foods will not be provided.