8-29-2025 Connecticut WIC Program Manual

WIC 300-02 SECTION: Nutrition Services

SUBJECT: Food Package Prescription

Federal Regulation: §246.10 (e) (10)

Nutrition Services Standard: 13 The WIC Federal Regulations authorizes seven (7) food packages for WIC participants. A competent professional authority (CPA) on the staff of the local agency shall prescribe a food package for each WIC participant at certification and recertification, for an applicant who is an out of state transfer, or when a participant requires a food package change. The food package shall be based on the participant’s category, age, breastfeeding status or frequency (for infants and or women, nutrition assessment, health status, living accommodations, access to food storage/cooking facilities, and in some instances on basis of personal preferences (i.e. vegan families). The amount and types of foods prescribed for a participant shall not exceed maximum allowable quantities. Food packages shall not be tailored for cost reasons. Food Package Changes

If a participant’s nutritional needs requires a food package change or if the participant requests a change, a CPA shall prescribe a new food package, determining the types and quantities of food desired.

Selecting the Appropriate Food Package/Food Package Tailoring Guidelines A. GENERAL GUIDELINES

Infant formula and/or other supplemental food amounts must be individually tailored to the amount that meets the nutritional needs and other identified circumstances of women, infants, or children. 1. Start at the standard food package and adjust the amounts of individual food as necessary. 2. Address the specific needs (breastfeeding status or frequency, nutritional, homelessness, lack of cooking or refrigeration appliances) of participants in tailoring food packages. 3. Reassess the food package assignment at each certification, or more often, as participants need change (i.e. to preserve and support breastfeeding, it is common to change the breastfeeding dyads food packages often) and/or if they do not redeem all their benefits. 4. Review the benefit of the food package and reiterate that the food package is intended for use by the participant only. Violation of this agreement can result in disqualification from the program. Ensure that the participant and/or authorized person knows that there is an option to select/omit food items when a need is identified. 5. Food items should be tailored down or removed if the items cannot or will not be utilized appropriately by the participant, even if there is not an allowable substitution.

8-29-2025 Substitutions are available for certain food items. For more information on substitutions, see item C, SUBSTITUTIONS in this document. Documentation should reflect justification for this decision. Tailoring out all quantities of a food item should only occur after appropriate education and other creative ways for incorporating that food item into the participant’s diet has been explored. 6. Consider the current U.S. Dietary Guidelines when prescribing food packages, unless contraindicated by special nutritional needs. 7. For exceptions see item D, SPECIAL FOOD PACKAGE SITUATIONS in this document.

B. SPECIFIC GUIDELINES BY PARTICIPANT CATEGORY Description of Food Packages Federal regulations describe WIC food packages in numbers: I, II, III, IV, V, VI, and VII. Some food packages are offered with different food quantities based on the category and/or breastfeeding dyad. The Value Enhanced Nutrition Assessment (VENA) Guidance, updated in 2025, details the desired health outcomes for each WIC participant category. They are:

Prenatal participants: Delivers a healthy, full-term infant while maintaining optimal health status

Breastfeeding participants: Achieves optimal health during the childbearing years and reduces the risk of chronic disease

Postpartum Participants: Achieves optimal health during the childbearing years and reduces the risk of chronic diseases

Infant participants: Achieves optimal growth and development in a nurturing environment and develops a foundation for healthy eating practices

Child participants: Achieves optimal growth and development in a nurturing environment and begins to acquire dietary and lifestyle habits associated with a lifetime of good health

The tables below explain the participant category and breastfeeding dyad assigned to each food package and the supplemental foods allowed. To view allowed food maximums and proration amounts for each food package, see WIC Policy 300-02 Addendums I and II. Milk, breakfast cereal, juice, fruits and vegetables, whole wheat/whole grain products, eggs, legumes/peanut butter/nut-seed butter, and canned fish are the categories of supplemental foods authorized in the standard food package for women and children. For infants in Food Package I and II: • Only contract infant formula may be issued for infants. • The standard infant formula contains 20 Kcals/ounce.

For women: • Provide a food package with reduced fat to prenatal participants to meet appropriate weight gain goals. • Provide low fat 1% or skim milk to breastfeeding and post-partum non-breastfeeding participants to facilitate a return to a healthy weight.

8-29-2025 • Provide an energy rich food package to underweight women and encourage consumption of frequent nutritious snacks.

FOOD PACKAGE I

I-A Infants Birth to 3 Months I-B Infants 4-5 Months

CATEGORY SUPPLEMENTAL FORMULA Fully Breastfeeding Does not receive infant formula. Partially (Mostly) Breastfeeding Partially (mostly) breastfeeding from 0 to 5 months receives supplemental infant formula based on the nutrition assessment up to the maximum allowance described in Federal Regulations. Partially (Limited) Breastfeeding

And

Fully Formula Feeding Not breastfed or partially (limited) breastfeeding. The infant receives supplemental infant formula in quantities that exceeds those allowed for partially (mostly) breastfed infants.

FOOD PACKAGE II

For Infants 6-11 months (II)

CATEGORY SUPPLEMENTAL FORMULA SUPPLEMENTAL FOOD Fully Breastfeeding Does not receive infant formula. • Infant cereal • Infant fruits and vegetables* • Infant meats (Fully Breastfeeding ONLY) *Cash Value Benefit (CVB) to purchase fresh, frozen, or canned fruits and vegetables may be issued in place of half or all of the infant fruits and vegetables. Partially (Mostly & Limited) Breastfeeding

And

Fully Formula Feeding Partially (mostly or limited) breastfeeding or Not breastfed. The infant receives supplemental infant formula based on the nutrition assessment up to the maximum allowance for the assigned category described in the Federal Regulations.

8-29-2025 FOOD PACKAGE III *Requires Medical Documentation

For Women, Infants and Children who have a documented qualifying medical condition (ICD-10) that requires the use of a WIC formula (infant formula, exempt infant formula or WIC-eligible nutritional). Refer to State Policy WIC 400-10 for specifics of Food Package III issuance and qualifying medical conditions (ICD-10). Supplemental formula and food must be tailored based on a full assessment to meet the needs of the participant.

*Food Package III is not authorized for: • Infants whose only condition is a diagnosed formula intolerance or food allergy to lactose, sucrose, milk protein or soy protein that does not require the use of an exempt infant formula, or a non-specific formula or food intolerance. • Women and children who have a food intolerance to lactose or milk protein that can be successfully managed with the use of one of the other WIC food packages. • Any participant solely for the purpose of enhancing nutrient intake or managing body weight without an underlying qualifying medical condition. CATEGORY SUPPLEMENTAL FORMULA AND FOOD Infants • WIC infant formula or exempt infant formula • Infant cereal • Infant fruits and vegetables • Cash Value Benefit (CVB) to purchase fresh, frozen, or canned fruits and vegetables. It may be issued in place of half or all of the infant fruits and vegetables. Women And Children • WIC infant formula, exempt infant formula or WIC eligible nutritional • Infant cereal • Infant fruits and vegetables (when puree food is required) • Breakfast cereal • *Juice • *Milk or soy/plant-based beverage (whole milk for 2-4-year-olds and women with medical documentation for a WIC infant formula, exempt infant formula or WIC eligible nutritional) • *Eggs • Cash Value Benefit (CVB) to purchase fresh, frozen, or canned fruits and vegetables. • Whole wheat/whole grain foods • Legumes and/or peanut butter, nut & seed butters • Canned fish

*See Item C, Substitutes, for available substitutions.

8-29-2025 FOOD PACKAGE IV

IV – A: For Children 12-23 months of age IV – B: For Children 2-4 years of age

CHILD AGE MILK STANDARD SUPPLEMENTAL FOODS 12-23 months • Whole milk is standard • Low-fat/non-fat milk issuance requires a thorough nutrition assessment to identify a nutrition risk. A progress note in CT-WIC must be documented by the nutritionist. • Breakfast cereal • *Juice • *Milk and Plant-based beverages • *Eggs • Cash Value Benefit (CVB) to purchase fresh, frozen, or canned fruits and vegetables. • Whole wheat/whole grain foods • Legumes and/or peanut butter, nut & seed butters • Canned fish

*See Item C, Substitutes, for available substitutions. 2-4 years • Low-fat/non-fat milk is standard • Whole milk issuance requires medical documentation AND a prescription for a WIC approved formula or eligible nutritional. • 2% reduced fat milk issuance requires a thorough nutrition assessment to identify a nutrition risk. A progress note in CT-WIC must be documented by the nutritionist.

FOOD PACKAGE V

V-A: Pregnant Women, Singleton V-B: Partially (Mostly) Breastfeeding Women up to 1 year post-partum V-B: Pregnant Women, Multiples

WOMEN CATEGORY SUPPLEMENTAL FOODS QUANTITY DIFFERENCES Pregnant • Breakfast cereal • *Juice • *Low-fat/non-fat Milk and Plant-based beverages • *Eggs • Cash Value Benefit (CVB) to purchase fresh, frozen, or canned fruits and vegetables. • Whole wheat/whole grain foods • Legumes and/or peanut butter, nut & seed butters • Canned fish *See Item C, Substitutes, for available substitutions. CVB Canned Fish Partially (Mostly) Breastfeeding

And

Pregnant with Multiples

8-29-2025 FOOD PACKAGE VI 1. Non-Breastfeeding Post-Partum Women (up to 6 months post-partum) 2. Partially (Limited) Breastfeeding Women WOMEN CATEGORY SUPPLEMENTAL FOODS Non-Breastfeeding Post-Partum, up to 6 months post-partum

and

Partially (Limited) Breastfeeding • Breakfast cereal • *Juice • *Low-fat/non-fat Milk and Plant-based beverages • *Eggs • Cash Value Benefit (CVB) to purchase fresh, frozen, or canned fruits and vegetables. • Whole wheat/whole grain foods • Legumes and/or peanut butter, nut & seed butters • Canned fish *See Item C, Substitutes, for available substitutions.

FOOD PACKAGE VII 1. Fully/Exclusive Breastfeeding Women (up to 1 year post-partum) 2. Partially (Mostly) Breastfeeding Women (multiple infants from the same pregnancy) 3. Pregnant Women, Fully or Partially (Mostly) Breastfeeding a singleton infant WOMEN CATEGORY SUPPLEMENTAL FOODS Fully/Exclusive Breastfeeding

And

Partially (Mostly) Breastfeeding multiple infants from the same pregnancy

And

Pregnant, Fully or Partially (Mostly) Breastfeeding a singleton infant • Breakfast cereal • *Juice • *Low-fat/non-fat Milk and Plant-based beverages • *Eggs • Cash Value Benefit (CVB) to purchase fresh, frozen, or canned fruits and vegetables. • Whole wheat/whole grain foods • Legumes and/or peanut butter, nut & seed butters • Canned fish *See Item C, Substitutes, for available substitutions.

FOOD PACKAGE VII 1.5X

Fully/Exclusive Breastfeeding Women (multiple infants from the same pregnancy)

Maximum quantities for FP VII 1.5X is 1.5 times the maximum quantities in the standard FP VII. Milk substitute quantities will not have the 1.5 multiplier. See Item C, Substitutions, below for more details.

8-29-2025 C. SUBSTITUTIONS

Federal Regulations allow some food items to be substituted for other food items. Below is a table describing the allowable substitutions.

Food Item Substituted Food Item Allowable Substituted Amounts Milk Cheese, Yogurt, Tofu Cheese: 1 pound of cheese (dairy and/or plant- based) may be substituted for 3 quarts of milk; For children and women in Food Packages IV through VI, no more than 1 pound of cheese may be substituted. For women in Food Packages VII and VII 1.5X, no more than 2 pounds of cheese may be substituted. Yogurt: 1 quart of yogurt (dairy and/or plant- based) may be substituted for 1 quart of milk with a maximum of 2 quarts of yogurt that may be substituted for 2 quarts of milk. Whole fat and low fat yogurt are the standard issuance for 12- 23 month olds. Low fat and non-fat yogurt are the standard issuance for 2-4 year olds. Tofu: May be substituted for milk at the rate of 1 pound of tofu per 1 quart of milk up to the total Maximum Monthly Allowance (MMA) of milk. Juice Cash Value Benefit (CVB) Maximum of $3 CVB for 64 oz juice Eggs Dry/Canned Legumes, Peanut Butter, Nut & Seed Butter* Dry Legumes: 1 LB of dried legumes for 1 dozen eggs. Canned Legumes: 64 oz of canned legumes for 1 dozen eggs. Peanut Butter, Nut & Seed Butters: 18 oz of peanut butter or nut & seed butters for 1 dozen eggs. Tofu: 1 LB of tofu for 1 dozen eggs. *If these food items are substituted, the amount listed would be in addition to the issued in the Legumes, Peanut Butter, and Nut & Seed Butter category.

Participants must be informed of all available options. Staff should educate participants on the standard food package and the allowable substitutions and adjust amounts of individual foods as necessary.

Staff must educate participants on how to purchase their full maximum benefit. When a food package is tailored to meet the individual’s needs, staff must clearly document the rationale for tailoring.

8-29-2025 D. SPECIAL FOOD PACKAGES SITUATIONS

Ready-To-Feed Formulas for Infants

Local agencies must issue all WIC formulas (WIC formulas refers to all infant formula, exempt infant formula and WIC-eligible nutritional’s) in concentrated liquid or powder physical forms. Ready-to-feed WIC formulas may be authorized when the competent professional authority determines and documents one or more of the following conditions: • The participant's household has an unsanitary or restricted water supply or poor refrigeration. • The person caring for the participant may have difficulty in correctly diluting concentrated or powder forms; or • The WIC infant formula is only available in ready-to-feed. In Food Package III two additional conditions are: • If a ready-to-feed form better accommodates the participant’s conditions; or • If it improves the participant’s compliance in consuming the prescribed WIC formula. Refer to CT State WIC Policy 400-10 for more details on ready to feed formulas in Food Package III. Food Package for Developmental Delay at 6 months of age Food Package III must be issued. A completed medical documentation by the HCP indicating a medical diagnosis of developmental delay, is required to issue an increased amount of infant formula in the 6-month package. The nutritionist should contact the HCP/pediatrician for an appropriate diagnosis when the WIC nutrition assessment indicates inadequate caloric intake and/or developmental delay affecting the infant’s ability to eat solid infant foods. Since the identified reasons for developmental delay may vary; for example, prematurity, malabsorption requiring semi-elemental formula, esophageal obstruction requiring liquids only, etc. contact with the HCP can help the Nutritionist to verify the rationale for the diagnosis and the increase in infant formula. Cash Value Benefit (CVB) 1. *Inflation Adjustments *The CVB will be adjusted annually for inflation for all eligible categories. Table 2 Footnote 19 from 7 CFR 246.10(e)(10) of the WIC Federal Regulations states ‘19 The monthly value of the fruit/vegetable CVV will be adjusted annually for inflation using fiscal year 2022 as the base year as described in § 246.16(j)’.

2. For Infants 6 months to 11 months This package can be offered after an individual nutrition assessment is performed for signs of readiness for solids, food acceptance and feeding preference method. The options are as follows: • The maximum allowance of jarred infant fruits and vegetables is assigned and issued OR • Infants may receive either $11 CVB and 64 oz (16 jars) jarred infant fruits and vegetables OR • Infants may receive $22 CVB and no jarred infant fruits and vegetables

8-29-2025 Food Package requiring Infant Formula at 12 months of age and beyond Food Package III must be issued. All formula provided to a child based on chronological age (regardless if the corrected age places them as an infant) requires a doctor’s prescription and will require a completed WIC Medical Documentation form. In Food Package III child participants with qualifying conditions receive both WIC formula AND all appropriate WIC supplemental foods that are not contraindicated by their medical condition. Also, if a participant is an infant by developmental age but child by chronological age, they will need to be recertified at one year of chronological age. This requires an updated WIC Certification and Medical Documentation form from the health care provider (HCP). Issuance of Whole Milk The issuance of whole milk to a woman or child over 2 years of age requires medical documentation. The woman or child must be issued Food Package III, with a qualified medical condition that also requires a WIC Special Formula or a WIC eligible medical nutritional. In a circumstance in which only whole milk is prescribed the nutritionist must contact the HCP to clarify the prescription. The Nutritionist should connect with the HCP to see if 2% milk would be an appropriate/acceptable option, due to the negligible difference between the fat content of 2% milk and whole milk. When it is determined that a woman or child is underweight, provide the adequate food package and encourage inclusion of frequent nutrient-dense snacks. Refer to CT State WIC Policy 300-14 Issuance of Milks (Whole Milk, 2%, 1%, Skim) and Yogurt.

Refer to CT State WIC Policy 300-14 Issuance of Milks (Whole Milk, 2%, 1%, Skim) and Yogurt.

Issuance of Lactose-Reduced or Lactose-Free Milk A medical documentation form is not required to provide Lactose Reduced or Lactose Free milk in place of regular cow’s milk. The nutritionist must communicate with the child’s healthcare provider the request for lactose free, or lactose reduced milk to ensure accurate implementation of healthcare provider’s recommendations. It is important to verify that intolerance is due to lactose intolerance and not milk allergy, as treatment for milk allergy is different than for lactose intolerance. A Medical Documentation form can be used for this purpose. Proper documentation of the action steps taken by the nutritionist is also advisable. In CT-WIC, the default food packages for women and children will include milk and soy or other plant based beverages/milks (whole, low-fat/non-fat) with the words ‘All Authorized’. ‘All Authorized’ means that the participant has a choice of the type of milk that can be purchased. For example, if a 1-year-old is issued ‘Milk – Whole All Authorized’, the participant is able to purchase lactose reduced or lactose free milk, evaporated milk, dry milk, and/or goat’s milk. They may purchase all the same type of milk or a combination of these milk products. Soy or Other Plant Based Beverages/Milks

For children and women, soy or other approved plant-based beverage/milk may be issued without medical documentation. For children, issuance of soy/plant-based beverage/milk (or tofu) does not require a qualifying medical condition or ICD-10 code. The determination of soy/plant-based beverage/milk is based on individual nutrition assessment and if needed, in consultation with the health care provider. Rationales may include milk allergy, lactose intolerance, severe lactose mal- digestion, vegan diets and religious preference.

8-29-2025 Children ages 12 months to 23 months are eligible to receive regular soymilk (which contains 5 grams of fat per 8 ounces cup). Since regular soy milk has less fat than whole milk, Nutrition staff should discuss this with parents or caretakers of these children as they may need to include additional fat to the diet. Additional fat can be added in the form of oil or butter of slightly more than 1 teaspoon (5 grams of fat) to compensate for the reduced fat in soy milk (2 cups of soy milk has 10 grams of fat, but 2 cups of whole milk has 16 grams of fat). Women and children 2 years old and older must receive fat free/non-fat, low-fat soy or other plant based beverages/milk. Refer to CT State WIC Policy 300-14 Issuance of Milks (Whole Milk, 2%, 1%, Skim) and Yogurt. Issuance of UHT Milk In Connecticut WIC, the issuance of shelf stable/UHT Milk is assigned by the CPA when it is determined that the family is facing special situations such as inadequate storage, homelessness, disasters, and to meet participant’s preference for consuming milk.