For most of its history, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has relied on paper food instruments (checks or vouchers) for delivering healthy foods to pregnant women and families with young children. WIC provides a prescription of healthy foods to enrollees, requiring them to make purchases from authorized grocery stores based on a selection of approved healthy foods. The food instruments contain combinations of multiple foods; while WIC participants have numerous choices available, little has been known about the extent to which participants fully use their WIC benefits and the foods they choose to purchase or not purchase.

The Healthy, Hunger-Free Kids Act of 2010 incorporated changes to WIC, including a directive that all states implement Electronic Benefits Transfer (EBT) by October 1, 2020.¹ This policy (along with several other WIC policy changes, such as the 2014 FNS Final Food Package Rule²) has created an opportunity for WIC programs to modernize program management, improving both the efficiency with which the program is administered and its impact on WIC participants. By 2020, all 90 WIC state agencies (including tribal organizations and territories) must utilize EBT to implement WIC food benefits. To date, only 13 WIC state agencies have implemented EBT to deliver the food benefit using plastic debit cards.

The transition from a paper-based food instrument to EBT provides an opportunity to carefully examine the extent to which WIC participants fully use their benefits. A recent study conducted by Altarum Institute in three EBT states reveals interesting details on how WIC benefits are used, including the most popular foods, the groups that tend to fully use their benefits, and the foods that are likely not to be purchased.

“For years we have wondered what WIC participants have been purchasing, what foods are most popular, and, for participants not using all of their WIC benefits, which foods are not being purchased,” said study co-director Altarum’s Diane Phillips. “To date, there had been no comprehensive assessments aimed at understanding WIC participant behaviors. This study, funded by USDA’s Economic Research Service and in partnership with three WIC state agencies, provides information to inform decisions as all WIC state agencies plan and implement EBT by 2020.”

The study, “Transition to EBT in WIC: Review of Impact and Examination of Participant Redemption Patterns,” included qualitative and quantitative data analysis. Altarum conducted participant focus groups, interviewed authorized grocers and WIC state agency officials, and examined WIC family food benefit purchasing and EBT redemption patterns. Some of the highlights of the report follow:

• While it takes a long time for states to implement EBT, the overall benefits are significant. WIC EBT is a successful method for issuing WIC benefits and preferred by vendors and participants alike over paper. EBT data analysis reveals trends and patterns in participant food redemptions that were unknown with paper food instruments, as individual purchasing patterns could not be identified.
• EBT data can help state WIC programs address the nutrition education needs of WIC participants, particularly as the data relates to the value of purchasing all foods in the WIC benefit package. By knowing what foods are not being purchased, WIC programs can research the reasons why participants are not making these purchases and take steps to help increase WIC benefit usage.
• WIC participants have greater flexibility with EBT to make more shopping trips for WIC foods than they had under the old system; foods were combined on one food instrument, and the participant had to purchase all the foods at one time, even if they did not have storage room or need for the foods at that time. In addition, all the prescribed foods had to be purchased at one store. Under EBT, they can purchase individual foods at any time they wish during the month. The study revealed that, while WIC participants on average make just over three shopping trips per month to use their WIC benefits, the range of their shopping trips is 1–25 trips per month and they typically shop at about two different vendors.

As is noted by the study co-director Loren Bell, senior Institute fellow, “Clearly, WIC EBT provides this important public health nutrition program with more information to better manage the program. At the same time, it allows more flexibility for the participant, is easier for the grocer to process, and overall provides a more effective benefit delivery system than the old paper system. Because all WIC state agencies must use EBT by 2020, we hope this study helps them to understand how these new data can be used and the importance of this effort to participants and grocers alike.”

The full final report and executive summary are now available. Visit www.altarum.org/CFAN to learn more about the utilization of WIC benefits, the purchasing patterns of WIC participants, and the reactions of WIC participants and grocers to the new EBT systems.

Altarum Institute (http://www.altarum.org) integrates objective research and client-centered consulting skills to deliver comprehensive, systems-based solutions that improve health and health care. Altarum employs almost 400 individuals and is headquartered in Ann Arbor, Michigan, with additional offices in the Washington, DC, area; Portland, Maine; and San Antonio, Texas.

¹ http://www.fns.usda.gov/wic/special-supplemental-nutrition-program-women-infants-and-children-wic-implementation-electronic

² http://www.fns.usda.gov/wic/final-rule-revisions-wic-food-packages