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State Plan Checklist - CERTIFICATION, ELIGIBILITY & COORDINATION OF SERVICES 8/14/2026 Page 13

b. The State agency authorizes local agencies to (check all that apply): [X] Conduct [X] Use medical referral data for [ ] Use data from a state Health Information Exchange (including access to medical referral data via a participant/physician portal) [ ] Use data from a trusted partner trained in taking accurate measurements Please list or attach partners the state agency accepts data from (list doesn t need to be all-inclusive)

Health Care Providers

c. The State agency uses only FNS-approved nutrition risk criteria, as referenced in Policy Memorandum 2011-5, WIC Nutrition Risk Criteria, and transmittal memorandum (dated December 17, 2020) that list the revised risk criteria requiring implementation by 10/1/2022, published on the FNS PartnerWeb, to document nutrition risk. (Note: A more recent transmittal memorandum was issued on November 17, 2022, however, the revised risk criteria included in this memorandum are not scheduled to be implemented until October 1, 2024)

Yes No Please append a list of the nutrition risk criteria used by the State agency in its entirety to this State Agency Plan.

Attachment - Nutrition Risk Criteria found in WIC Provider Guidance Manual

d. The State agency modifies nutrition risk criteria such that criteria definitions are more restrictive than nationally established definitions. Yes No

e. Hematological risk determination: CFR 246. 7(e)1(i)(A)

i. The State agency requires (check one of the following) Bloodwork data to be collected at the time of certification (Statewide). Bloodwork data to be collected within 90 days of certification, so long as the participant is determined to have at least one qualifying nutritional risk at the time of certification (Statewide), and the State has implemented procedures to ensure receipt of data.