us-ct/policy/wic-state-plan/fy2025

loading…

us-ct/policy/wic-state-plan/fy2025 · Axiom

(section-1-state-plan-for-program-operations)(page-3)Page 3#

A. INTRODUCTION

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is implemented by the United States Department of Agriculture (USDA-FNS) under public law 95-627, Section 17 of the Child Nutrition Act of 1966; final regulations were issued January 2002. Funds for Food and Administrative costs are transferred from USDA–FNS to the Connecticut Department of Public Health, Community, Family Health, and Prevention Branch, Maternal Child Health and Access to Care Section).

The State Plan for Connecticut’s WIC Program is the governing document that provides guidance and direction for the State agency and local agencies administering the program. In compliance with Federal regulations and State regulations and requirements, the plan is updated annually to ensure the inclusion of new and revised federal and state requirements and annual accomplishments and new goals and objectives. Although the State Plan is primarily based on Federal regulations, including requirements and guiding principles for best practices from the state perspective and that of the nation’s public health framework.

The WIC State Plan references a single document but has three major components.

Section I of the plan contains the State goals and objectives FFY2025 and the evaluation for FFY2024. To the extent possible, the goals address the core functional areas of the WIC Program. The functional areas are management and organization, nutrition services and breastfeeding support and promotion, food delivery and food instrument accountability, vendor/retailer management, management information systems, caseload management and outreach, coordination of services, civil rights, certification and eligibility, monitoring and QA, fiscal management and data quality, analysis, and reporting. The goals and objectives are State-specific and function as a guide for enhancing both State and local program operations effectiveness and efficiency. The WIC Vendor Agreement is included for review. The Connecticut WIC Program’s FFY2025 goals and objectives include upcoming program changes, such as the transition to a new MIS maintenance and operations contract and the conversion to a new EBT provider, but also include activities focused on preparing for required federal changes in the Food Package Final Rule, planning and implementing modernization efforts to improve the participant experience, and improving disaster plans and continuity of operations efforts as per the Access to Baby Formula Act (ABFA). The draft State Agency Internal Operating Procedures Plan is included as an attachment. Further, State Outcome objective reports continue to undergo a QI process which have impacted State agency targets for the FFY2025 State Plan. Close to completion, these changes to reporting will improve program outcomes tracking and evaluation in the future and allow the Connecticut WIC Program to better monitor and respond to trends.

Section II is the local agency operations manual and provides guidance to State and local staff about clinic level WIC policies and procedures. In addition to the State Agency Internal Operating Procedures Plan, included with this submission are updates to the previously approved Disaster policy for USDA review and approval.

Section III outlines the State level operations as Functional Format Checklists. See Appendix B for the relevant updates.

Approximately $52 million is allocated to Connecticut WIC for Food and Nutrition Services Administration funding and an additional $12 million rebated by Abbott Laboratories (in the process

(section-1-state-plan-for-program-operations)(page-4)Page 4#

of being extended through September 30, 2026, via NEATO), through a cost savings measure as part of the infant formula rebate program.

B. MISSION STATEMENTS

DPH Mission: To protect and improve the health and safety of the people of Connecticut by: • Assuring the conditions in which people can be healthy. • Promoting physical and mental health, and • Preventing disease, injury, and disability.

DPH Vision Statement: Healthy People in Healthy Connecticut Communities

Community, Family Health, and Prevention Branch Mission: The Connecticut WIC Program is in the Maternal, Child Health, and Access to Care Section, which is one of two sections in the Community, Family Health and Prevention Branch at the Connecticut Department of Public Health. The CFHPB is a positive and productive branch that creates and achieves optimal public health outcomes through strong, consistent, proactive and ethical leadership; a positive and productive workplace environment; results-based accountability; and, premier customer service to the public by valued employees through technical assistance, best-practice and research-based expertise, and clear and accurate communication.

WIC Program Mission: The Connecticut WIC Program is committed to improving the health of eligible pregnant women, new mothers, and children by providing nutrition education, breastfeeding support, healthy foods, and referrals to health and social programs during the critical stages of fetal and early childhood development.

Breastfeeding Statement: The Connecticut WIC Program endorses the American Academy of Pediatrics' Policy Statement on “Breastfeeding and the Use of Human Milk” (2022), which states, “Breastfeeding and human milk are the normative standards for infant feeding and nutrition. The short- and long-term medical and neurodevelopmental advantages of breastfeeding make breastfeeding, or the provision of human milk, a public health imperative. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately 6 months after birth. Furthermore, the AAP supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond.” The Connecticut WIC Program promotes exclusive breastfeeding as the normal infant feeding method through the first year of life and beyond, with the addition of appropriate complementary foods when the infant is developmentally ready, usually around six months of age. All WIC staff have a role in promoting and providing support for the successful initiation and continuation of breastfeeding.

(section-1-state-plan-for-program-operations)(page-5)Page 5#

WIC Program Vision: A WIC participant is the most important person to enter the WIC office. A participant is not dependent on us. We are dependent on them. They are the purpose for our work. We are not doing a favor by serving the participant. It is the participant who is doing us a favor by letting us serve them. A participant is a person who brings us their wants. It is our job to handle their needs, with professionalism and efficiency, always with each participant in mind. –Adapted from Hot Pots restaurant menu, Customer Service statement

C. STATE AGENCY ORGANIZATION

STAFF MEMBER PRIMARY RESPONSIBILITES

Marcia Pessolano, MPH, RDN, CD-N State WIC Director T: (860) 509-8101 F: (860) 509-8391 E-mail: marcia.pessolano@ct.gov

Federal grants management Contracts and budgets WIC program policy Program planning and evaluation Program management & administration Information Technology & Fiscal Units’ oversight Certification and Eligibility

Amanda L. Moore, MPH, CLC State Nutrition Coordinator T: (860) 509-8055 F: (860) 509-8391 E-mail: amanda.moore@ct.gov

Supervisor of Nutrition Services Certification and Eligibility Local agency monitoring and evaluation review lead Local staff training, liaison & technical assistance State Plan Management and policies Grant management activities Local agency RFP development Outreach MIS/EBT

Marilyn Lonczak, MEd, RD, CLC Nutrition Consultant 2/ State Breastfeeding Coordinator T: (860) 509-8261 F: (860) 509-8391 E-mail: marilyn.lonczak@ct.gov

Breastfeeding promotion and support, planning and evaluation Breastfeeding Peer Counseling (back-up) State Plan Management and policies Local staff training, liaison & technical assistance Nutrition Risk Criteria (back-up) on RISC WIC & Head Start Better Together Collaboration (sustainability) Operational Adjustment (OA) proposal coordination Representative for WIC-DPH on CBC, Food Policy Council, SEPI-CT, and other interagency workgroups

Pamela Beaulieu, CLC Nutrition Consultant 2 T: (860) 509-7138 F: (860) 509-8391 E-mail: Pamela.Beaulieu@ct.gov

MIS/EBT and CT-WIC coordination CT-WIC HelpDesk (scheduling and clinic modules) CT-WIC Nutrition Unit Reporting liaison Local staff training, liaison & technical assistance Update/provide input on Local Agency Plans/State Plan Outreach WIC Shopper Amy Botello, RD, CLC Nutrition Consultant 2 T: (860) 509-7656 F: (860) 509-8391 E-mail: amy.botello@ct.gov

Nutrition Services & Certification Reviews Issue written reports/respond to corrective action plans Provide technical assistance Nutrition Assistant II training coordination Update/provide input on Local Agency plans/State Plan Outreach Digital Nutrition education materials project lead

(section-1-state-plan-for-program-operations)(page-6)Page 6#

WIC Shopper and WIC Smart coordination One Call Now (OCN) and social media

Luz Hago, RD Nutrition Consultant 2 T: (860) 509-7662 F: (860) 509-8391 E-mail: luz.hago@ct.gov

WIC contract formula and eligible nutritional’s lead Formula approval and issuance Develop new food packages Local agency liaison, technical assistance Nutrition education Update/provide input on Local Agency Plans/State Plan

Mellessa McPherson-Milling, CLC Nutrition Consultant 2 T: (860) 509-7814 F: (860) 509-8391 E-mail: mellessa.mcPherson-milling@ct.gov

Local agency Program Operations Reviews Issue written reports/respond to corrective action plans Civil Rights Update/provide input on Local Agency Plans/State Plan

Lori Goeschel MS, RD, IBCLC Nutrition Consultant 2/ State Breastfeeding Peer Counseling Coordinator T: (860) 509-7755 F: (860) 509-8391 E-mail: lori.goeschel@ct.gov

Breastfeeding Peer Counseling Breastfeeding Peer Counseling contract management, program planning, technical assistance, and evaluation CDC 1807 cooperative agreement breastfeeding activities (back- up)

Kimberly Boulette Health Program Supervisor T: (860) 509-7845 F: (860) 509-8391 E-mail: kimberly.boulette@ct.gov Supervisor Food Resource & Vendor Mgmt.(FRVM) eWIC card stock and inventory reporting Food cost containment Farmers Market Nutrition Program liaison SNAP Collaboration/FNS Field Office/STARS Peer Group Pricing Management The Integrity Profile Report Vendor Advisory Council lead Rebate contract lead Vendor Training

Idamaris Rodriguez Health Program Associate T: (860) 509-7197 F: (860) 509-8391 E-mail: Idamaris.rodriguez@ct.gov

Contract liaison for all WIC contracts; local agency and vendor management Contract lead for Infant Formula Rebate contract and Compliance Investigation contract Compliance purchase report reviews Vendor agreement/Sign off on warning letters Provides technical assistance to WIC vendors State Plan updates Prepares Annual training document for vendors Arranges and provides vendor trainings

Rafael Lima Health Program Assistant 2 T: (860) 509-7815 F: (860) 509-8391 E-mail: Rafael.lima@ct.gov

Online Monitoring for trafficking of WIC foods Participant and Retailer Fraud Investigations Vendor monitoring Vendor technical assistance

Marangelie Ortiz Health Program Assistant 2 T: (860) 509-7526 Compliance Investigations Compliance Buys Vendor complaints

(section-1-state-plan-for-program-operations)(page-7)Page 7#

F: (860) 509-8391 E-mail: Marangelie.ortiz@ct.gov

Vendor training High Risk Criteria Vendor monitoring as needed

Eric Marszalek Health Program Assistant 2 T: (860) 509-8072 F: (860) 509-8391 E-mail: Eric.marszalek@ct.gov

CT-WIC Vendor Portal Coordination Vendor Administrative Review Process A50 determinations WIC contact for EBT contractor Open enrollment and renewal process Technical assistance to vendors WIC webmaster

Beverley Daley Health Program Assistant 1 T: (860) 509-8076 F: (860) 509-8391 E-mail: Beverley.daley@ct.gov

Vendor monitoring Complaint follow up Vendor technical assistance

Barbara Quiros Health Program Assistant 1 T: (860) 509-7413 F: (860) 509-8391 E-mail: barbara.quiros@ct.gov

Competitive and Not to Exceed Pricing WIC Food Redemptions APL Maintenance Vendor training Technical assistance to Vendors and participants (transaction issues)

Maria Reyes Processing Technician T: (860) 509-7488 F: (860) 509-8391 E-mail: maria.reyes@ct.gov

Vendor application processing Vendor Authorizations Price Stock Survey updates Vendor correspondence/notification Tracks vendor penalties and prepares sanctions FNS/SNAP Collaboration/STARS

Susan Hewes Epidemiologist 3 T: (860) 509-7795 F: (860) 509-8391 E-mail: susan.hewes@ct.gov

Outcome objective analysis Program data analysis Produce results for quarterly objectives Internal/external data requests Adequate participant access determinations Lauren Kramer Secretary 2 T: (860) 509-7462 F: (860) 509-8391 E-mail: lauren.conroy@ct.gov State staff support Customer Service Order and maintain supplies Timekeeper Meeting minutes & training evaluations WIC Materials Management Basil Obute Technical Analyst 2 T: (860) 509-7690 F: (860) 509-8391 E-mail: basil.obute@ct.gov Systems development coordinator Local Agency technical support CT-WIC monitoring of automated processes CT-WIC data requests Waqas Farooq Technical Analyst 2 T: (860) 509-7429 F: (860) 509-8391 E-mail: waqas.farooq@ct.gov Development & maintenance Security Help Desk WICSmart WICShopper OCN

(section-1-state-plan-for-program-operations)(page-12)Page 12#

Objective Strategies/Activities Baseline Indicators Progress 1.1 Convene monthly meetings (in- person or virtual) for local agency coordinators to ensure on-going communication and feedback loop.

Schedule and facilitate at least 10 meetings with Program Coordinators to: • Review policies and procedures. • Discuss funding and staffing issues. • Review CT-WIC data availability and reports. • Other topics as determined. N/A Summary of meetings.

Improved compliance with policies and procedures.

Increased sharing of strategies regarding resource utilization and staff retention.

Improved use of data and discussions in LAP.

A total of 10 Program Coordinators’ meetings were convened via MS Teams in FY2024 to keep local agencies updated on funding; policies and procedures; formula availability; data management; the transition to electronic Farmers Market Nutrition Program benefits and more. Meetings provided an opportunity for local agency staff to share information on resource utilization, program operations, and other key topics.

State agency staff and partners presented at meetings on CT-WIC MIS system and other IT updates, partner referral opportunities such as CT Paid Leave, and on research partnerships such as Today’s Baby. 1.2 Actively participate in MyCT project in 2024 to improve ease of access for applicants and ensure compliance with confidentiality regulations. • Attend meetings. • Provide clarification and information regarding WIC Program Regulations and policies. • Develop MOU/MOA as needed N/A WIC Program successfully integrated into MyCT project and application. The WIC Director and State Nutrition Coordinator, as well as other relevant state agency staff attended regular meetings in FY2024 with the MyCT project team to finalize development efforts and prepare for launching the first phase of the site, which

(section-1-state-plan-for-program-operations)(page-15)Page 15#

Program Functional Area 2: Nutrition Services, Breastfeeding Promotion and Support* Goal 2: Improve the nutritional and overall health of WIC families in Connecticut. By September 30, 2024, Objective 2.1: At least 35% of pregnant women participating in the WIC Program for a minimum of 6 months gain appropriate weight. Objective 2.2: The incidence of low birth weight (LBW) among infants whose mothers were on the WIC Program for at least six months during pregnancy does not exceed 4%. Objective 2.3: The prevalence of anemia among children enrolled in the WIC Program for at least one year does not exceed 7.5%. Objective 2.4a: The prevalence rate of BMI > 85th percentile to < 95th percentile for children 2-5 years does not exceed 15%. 2.4b: The prevalence rate of BMI > 95th percentile for children 2-5 years of age does not exceed 10%. Objective 2.5: At least 80% of infants enrolled in the WIC Program (have mothers who) initiate breastfeeding. Objective 2.6: At least 60% of infants enrolled in the WIC Program are breastfed for 6 months or more. Objective 2.7: Monitor the maintenance of CT-WIC via policy revisions, provision of State and local agency staff training and technical assistance, update of CT-WIC user manuals/helpfiles and participant training materials. Objective 2.8: Local agency liaisons will make at least 1 in-person visit or phone call to each local agency to provide technical assistance in FY 2024.

Objective Strategies/Activities Baseline Indicators Progress 2.1 At least 35% of pregnant women participating in the WIC Program for a minimum of 6 months gain appropriate weight.

Through State MER chart audits and observations investigate baseline data for MWG indicators to determine areas for local agency improvement and recognize areas of local agency competence.

Review of local agency LAPs and show that few local agencies have implemented the Tell Me More (TMM) About You tool in prenatal appointments in FY23.

As a result, the State agency developed a required strategy for local agencies to use TMM About You in FY24.

A baseline will be established using results reported in FY25 LAPs.

The State agency will facilitate collaboration among Program Nutritionists in the last quarter of 2024 WIC Objective: ≥ 35%

FFY 2019 Target: ≥ 35% Average: 27.7% Range: 13.5% - 46.3%

FFY 2020 Target: ≥ 35% Average: 26.5% Range: 7.1%-40.2%

FFY 2021 Target: ≥ 35% Average 27.0% Range: 6.9-74.3%

2022 Target: ≥ 35%* Average 27.5% Range: 4.9-42.9%

2023 Target: > 35%* Average 28.3% Range: 11.6% - 47.5%

2024 data pending. Data Sources: FFY2019-2021: CT- WIC MIS (Management In- formation System).

CT-WIC Quarterly & Annual Outcome, Summary & Trend Reports.

MER chart reviews and Observations.

Improvement in trend data over time for low performing agencies.

There has been some steady improvement in the statewide average (28.3%) and range for the MWG objective. Prenatal weight gain recommendations were documented 70% of both charts reviewed and observations. One of three agencies reviewed in FY24 struggled with adequately discussing weight gain recommendations during observations and failed to appropriately document. In one local agency while staff reviewed weight gain recommendations there is limited evidence in documentation that staff partnered with participants to establish goals to ensure

(section-1-state-plan-for-program-operations)(page-16)Page 16#

FY23, and first quarter of FY24, to develop training, implementation, and evaluation process for the FY 2024 strategy.

When indicated, local agency liaison, may provide local agency management with feedback on CAP response and/or implementation via technical assistance visits, quality assurance activities (chart audits or observations) and/or training related to deficiencies in MWG indicators.

*Beginning with 2022 State Plan submission, we will report available complete calendar year data. appropriate maternal weight gain was achieved. One of the three agencies reviewed is utilizing the TMM prenatal tool as evidenced in both chart audit review and observations. Staff would benefit from continued training in the effective utilization of this tool to support healthy maternal weight gain. Overall, local agency staff would benefit from training on assisting participants in and documentation of a facilitated action plan for appropriate maternal weight gain.

2.2 The incidence of low birth weight (LBW) among infants whose mothers were on the WIC Program for at least six months during pregnancy does not exceed 4%.

Through State MER observations and review of documentation in chart audits, 80% of local agency staff incorporate prenatal weight gain guidance concepts in counseling, provide timely referrals and offer appropriate education materials that address applicable modifiable risk factors:  Smoking  substance use (including prescription drugs)  Prenatal weight gain  Mental health concerns (PMAD)

Investigate Local Agency Plan (LAP) community needs assessments to determine baseline of LAP’s that include data and/or add context to variables that impact LBW deliveries: 2024 WIC Objective: ≤ 4%

FFY 2019 Target: ≤ 6.0% Average: 2.5% Range: 0.0% - 13.6%

FFY 2020 Target: ≤ 6.0% Average: 2.7% Range: 0.0% - 13.8%

FFY 2021 Target: ≤ 6.0% Average: 3.1% Range: 0.0% - 9.5%

2022 Target: ≤ 4.0%* Average: 3.1% Range: 0.0% - 12.5%

2023 Target: ≤ 4.0%* Average: 4.7% Range: 0% - 17.2%

2024 data pending. CT-WIC Quarterly & Annual Outcome, Summary & Trend Reports.

Improvement in trend data over time for low performing agencies. This objective was not met this year, likely due to one quarter with unusually high result. Of the three agencies reviewed to date, 70% of records indicated some discussions on prenatal weight gain guidance. In 70% of observations/chart audits staff provided timely referrals for smoking cessation and other substance use programs. One local agency failed to document provision of referrals to participants who indicated substance use. 70% of records indicate the PMAD screen is

(section-1-state-plan-for-program-operations)(page-17)Page 17#

• teenagers • substance use • income • ethnicity • geographic location • mental health

Maintain relevant State agency collaborations that impact this outcome objective. (See Functional Area X)

FFY2019-2021: CT-WIC MIS (Management Information System). (*excludes pre-term & multiple births)

*Beginning with 2022 State Plan submission, we will report available complete calendar year data. conducted during the appropriate time frame and resources are provided appropriately. One of the three agencies reviewed had significant findings related to the administration of the PMAD screen. Findings included staff not asking staging questions to identify the appropriate screen (3 Question or 10 Question), staff failed to appropriately describe or introduce the screen to the participant, and PMAD screens were administered verbally over the phone.

2.3 The prevalence of anemia among children enrolled in the WIC Program for at least one year does not exceed 7.5%.

Through State MER observations and chart audits 90% of local agency staff effectively provide education to parents to reduce risk of development of anemia including:  Importance of timely blood work,  Risk of lead poisoning  Making appropriate referrals and follow-up.

Local agency liaisons will perform anemia QA chart audits in FY24. A total of 15 chart audits (sample to include 5 – 9-month infants; 5 – C1; and 5 – C2) to determine completeness of nutrition education documentation. Certain agencies will be selected based on outcome indicators.

Indicators include anemia prevention, nutrition assessment, lab 2024 WIC Objective: ≤7.5%

FFY 2019 Target: ≤ 7.5% Average: 8.5% Range: 3.9% - 19.0%

FFY 2020 Target: ≤ 7.5% Average: 8.5% Range: 3.5% - 18.2%

FFY 2021 Target: ≤ 7.5% Average: 8.8% Range: 2.4% - 17.5%

2022 Target: ≤ 7.5%* Average: 8.2% Range: 2.9% - 12.7%

2023 Target: ≤ 7.5%* Average: 8.6% Range: 2.9% - 12.7%

2024 data pending.

CT-WIC quarterly and annual reports. Chart audits and observations.

Change in trend data over time for low performing agencies. The State agency did not meet the target for the anemia objective. The statewide average and range are stable.

90% of local agencies monitored are using effective educational methods and appropriate education materials to assist parents in prevention of iron deficiency anemia for their children. Of the two local agencies reviewed to date, one agency had a significant number of findings related to missing bloodwork. In the one agency reviewed, in 25% of charts audited there is missing bloodwork.

(section-1-state-plan-for-program-operations)(page-18)Page 18#

results, iron supplementation and type of anemia (if indicated).

FFY2019-2021: CT-WIC MIS (Management Information System).

*Beginning with 2022 State Plan submission, we will report available complete calendar year data. In addition, in 10% of charts despite bloodwork on file staff failed to enter results in CT-WIC. The State agency performed quality assurance (QA) using child charts from four local agencies and with a range of ages. Local agencies achieved the best results on the following indicators: accurately entering H/H into CT-WIC (53%) and scheduling and completing follow-up visits (66.7%). Local agencies partially met or completely met the standards for having a complete assessment note (78.6%). Local agencies did not meet the standards for setting an action plan/goal (60%) and identifying factors for anemia (80%). 2.4 a. The prevalence of BMI > 85%ile to < 95%ile for children 2-5 years of age does not exceed 15%.

b. The prevalence of BMI > 95%ile for children 2-5 years of age does not exceed 10%.

Review of local agency LAPs and show that few local agencies have implemented the TMM About Your Child tool.

As a result, the State agency developed a required strategy for local agencies to use TMM About Your Child in FY24. All child participants at risk of overweight or obesity will have the TMM questionnaire completed at their follow-up visits to assess behaviors and monitor progress.

2024 WIC Objectives: Overweight: < 15% Obesity: < 10%

a. OVERWEIGHT: BMI ≥ 85th%ile to <95th%ile

FFY 2019 Target: ≤ 15.0% Average: 15.1% Range: 10.1% - 20.1%

FFY 2020 Target: ≤ 15.0% Average: 15.1% Range: 9.1% - 20.8%

FFY 2021 Target: ≤ 15.0% Average: 14.7% CT-WIC Quarterly & Annual Outcome, Summary & Trend Reports.

Indicators of effective use include documentation of TMM, MI, Stages of Change and/or development of a plan.

The statewide target for the overweight objective was met, however, the obesity target was not met. Both overweight and obese targets show progress in the average and range. The State agency performed quality assurance on a total of 18 charts (2) for each local agency. Local agencies achieved the best results on the following indicators:

(section-1-state-plan-for-program-operations)(page-19)Page 19#

A baseline will be established using results reported in FY25 LAPs.

The State agency will facilitate collaboration among Program Nutritionists in the last quarter of FY23, and first quarter of FY24, to develop training, implementation, and evaluation process for the FY24 strategy.

The State agency will provide a presentation on the results of the FY23 TMM chart audits by December 2023 and identify areas for improvement in counseling and documentation for children at risk of overweight/obesity.

By the third quarter of FY24, the State agency will determine the need to update and convert the Child TMM tool to a fillable form.

Local agency liaisons will perform TMM QA chart audits in FY 2024.

A total of 15 chart audits (sample to include child participants with at risk for or with overweight or obesity risk) to determine completeness of nutrition education documentation. Certain agencies will be selected based on outcome indicators.

50% of local agencies continue to use WICSmart modules for obesity/overweight prevention. This will be assessed in routine monitoring. Range: 8.6% - 22.9%

2022 Target: ≤ 15.0%* Average: 14.4% Range: 10.0% - 18.6%

2023 Target: ≤ 15.0%* Average: 14.7% Range: 8.6% - 20.2%

b. OBESITY: BMI ≥ 95th%ile

FFY 2019 Target: ≤ 10.0% Average: 15.3% Range: 9.3% - 22.8%

FFY 2020 Target: ≤ 10.0% Average: 15.5% Range: 7.7% - 28.3%

FFY 2021 Target: ≤ 10.0% Average: 19.1% Range: 12.5% - 28.1%

2022 Target: ≤ 10.0%* Average: 16.7% Range: 8.8% - 23.1%

2023 Target: ≤ 10.0%* Average: 15.8% Range: 10.5% - 21.2%

2024 data pending.

FFY2019-2021: CT-WIC MIS (Management Information System).

*Beginning with 2022 State Plan submission, we will report available complete calendar year data. 28% of charts reviewed had documentation of TMM to start a conversation. 67% and 69% of charts audited assessed for snacks and sweetened beverages respectively. 70% of charts assessed for physical activity. 40% of charts assessed showed evidence of validating anthropometrics. 75% of charts audited had Care Plans that documented nutrition counseling. 36% and 16% of charts audited had specific nutrition or physical activity plans documented, respectively. The State agency provided a presentation on the FY 2023 chart audits for the Program Nutritionists. Another presentation will be provided in December 2024 with the results of current overweight/obesity chart audits.

To date in FY24 there was a 60% increase in WICSmart module completion over 2023 levels. Six of the nine local agencies have notable improvement in WICSmart

(section-1-state-plan-for-program-operations)(page-20)Page 20#

completion from FY23 to FY24. Of the three agencies reviewed to date, only one agency is utilizing WICSmart as an appointment option. However, there is little indication that WICSmart is provided as a strategy for the childhood overweight/obesity objective. Conversations continue with management to support assignment of WICSmart as 1.) an option for children with overweight/obesity and 2.) as a caseload management tool. 2.5 At least 80% of infants enrolled in the WIC Program (have mothers who) initiate breastfeeding.

Through State MER observations and chart audits 50% of local agency staff will incorporate and document concepts from breastfeeding Content Sheets into prenatal education and counseling.

Breastfeeding Unit to conduct 1-2 enhanced breastfeeding reviews at local agencies. (One review will include agency with peer program.) See 2.6.

2024 WIC Objective: ≥80%

FFY 2019 Target: ≥ 70.0% Average: 81.6% Range: 59.9% - 94.4%

FFY 2020 Target: ≥ 70.0% Average: 81.3% Range: 63.9% - 93.6%

FFY 2021 Target: ≥ 80.0% Average 79.8% Range: 61.1% - 94.3 %

2022 Target: ≥ 80.0%* Average: 79.6% Range: 62.8% - 94.9%

2023 Target: ≥ 80.0%* Average: 79% Range: 58.1% - 94.6%

2024 data pending.

CT-WIC Quarterly & Annual Outcome, Summary & Trend Reports, Chart Audits and Observations conducted during Enhanced Breastfeeding Reviews and Peer Counseling Monitoring.

Results of enhanced Breastfeeding MERs, show documentation of 80% compliance with CT Guidelines for Breastfeeding Promotion and Support.

The breastfeeding initiation objective was not met, with a statewide average of 79%. Six of the nine local agencies had breastfeeding initiation rates of over 80%. The remaining had initiation rates ranging from 68%- 79.4%. The State agency Breastfeeding Unit is hoping to see an increase in these rates based on implementation of Make a Plan strategies in FY 2023. Two of three local agencies reviewed to date in FY23 were observed utilizing effective and appropriate education materials to assist mothers in successful initiation of

(section-1-state-plan-for-program-operations)(page-22)Page 22#

documentation of preparing for hospital, family/friend support, skin- to-skin contact, rooming-in and community support.

A baseline will be established using results reported in FY25 LAPs.

The State agency will facilitate collaboration among Breastfeeding Coordinators in the last quarter of FY23, and first quarter of FY24, to develop training, implementation, and evaluation process for the FY24 strategy.

Breastfeeding Unit (State Breastfeeding Coordinator and State agency WIC Peer Counselor Coordinator (IBCLC)) continue to participate in Regional WIC Breastfeeding Curriculum training (CT, NH, ME, VI and VT) to train local agency staff and select community partners using the USDA/FNS DBE Curriculum.

If awarded, contribute to SPAN 0012 breastfeeding activities related to initiation: Ten Step Collaborative, Ready, Set Baby webpage. Diversity in Lactation, and update of It’s Worth it Campaign.

The Regional WIC Breastfeeding Training Curriculum continued for FY 2024. Most of the staff trained were from Connecticut WIC and staff from several community partners such the Community Health Network of CT (CHN-CT) and home visiting programs. Unfortunately, while CT- DPH’s SPAN 0012 application was approved, funding wasn’t available. Where possible, these breastfeeding strategies will continue with other identified funding sources. 2.6 At least 60% of infants enrolled in the WIC Program are breastfed for 6 months or more.

Through State MER observations and chart audits 50% of local agency staff will incorporate and document concepts from 7 duration focused breastfeeding content sheets, HUSKY breast pump access, and overview of CT breastfeeding 2024 WIC Objective: ≥ 60%

FFY 2019 Target: ≥ 50% Average: 65.2% Range: 37.5% - 90.7%

FFY 2020 Target: ≥ 50% Average: 64.4% Range: 42.6% - 88.9% CT-WIC Quarterly & Annual Outcome, Summary & Trend Reports. Chart audits and Observations.

During FY 2023-2024 the State agency has been conducting quality assurance (QA) on all data reports. The breastfeeding duration reports, and target will need significant changes based on the QA.

(section-1-state-plan-for-program-operations)(page-34)Page 34#

Program Functional Area 4: Vendor Management

Goal 4: To improve communication and effectiveness in Vendor Management.

Objective: 4.1 Improvements in reporting vendor data and producing the extracts for FDP. Objective: 4.2 Potential transition of EBT Processors Objective: 4.3 Develop policies and establish business processes for a Policy and Procedure Manual. Objective: 4.4 CTWIC Enhancements to streamline processes Objective 4.5 Training videos to supplement interactive vendor training Objective: 4.6 Improve investigation services through RFP process and inventory audits.

Objective Strategies/Activities Baseline Indicators Progress 4.1 Improvements in reporting vendor data and producing the extracts for FDP. Utilize CTWIC data to improve reporting of high risk vendor criteria, transaction level redemption data, redemption patterns, and produce the redemptions template for FDP. June 2022 Refining reports in the SSRS reporting portal using the data from CTWIC to provide more comprehensive information. CT WIC staff worked with a consultant from 1/17/24-6/30/24 to complete several of these reports, including the high risk vendor report that is being used in Q4. CT WIC staff worked with IT staff and completed this FDP report. Utilize CTWIC data to improve tracking of compliance investigations and produce the investigations template for FDP. June 2022 Tracking the status of individual investigations and Key Performance Indicators. Revisions to high risk vendor report CT WIC staff worked with a consultant until 6/30/24 to build the parameters of this report. This report will be used for FY24 FDP reporting. Utilize CTWIC data to improve tracking of violations and produce the violations template for FDP. June 2022 Information is logged in CTWIC on the violations screen, and separate Excel spreadsheet is used for tracking purposes. CT WIC staff worked with a consultant until 6/30/24 to build the parameters of this report. This report will be used for FY24 FDP reporting.

(section-1-state-plan-for-program-operations)(page-37)Page 37#

Statement of Work, and updating NERO and SSO on the progress. Transition and Conversion plan for data, stand beside devices, retailer portal. July 2022 Transition to new provider or platform Expected to occur in FY25. 4.3 Develop policies and establish business processes for a Policy and Procedure Manual.

Document new processes in response to changes to current business practices.

March 2020 Changes to the WIC Vendor Agreement, access Documents are being updated. Revise policies and establish business processes for a Policy and Procedure Manual.

Policies and procedures in writing. Implementation of eWIC, utilization of CT-WIC, and the COVID-19 pandemic changed processes. Shared knowledge of processes. Documents are being updated. Modify the CT WIC Manual for the Vendor Module based on changes and enhancements made. April 2018 Vendor Module Manual updated last for version 1.9. Vendor Portal User Guide was updated in May 2024 and posted on website. Open the application portal multiple times per year for new vendors to apply for WIC authorization.

October 2023 Open enrollment now offered for new stores only in January each year. Vendor portal was opened in January 2024 for open enrollment and in February, May and June 2024 for multiple stores under the same ownership to apply for CT WIC authorization. Website language was updated on 2/14/24 to accept online applications outside of the January open enrollment period. 4.4 CTWIC Enhancements to streamline processes. Enhancements to Vendor Module training screens to increase the functionality and connection between training, monitoring and competitive pricing phases with selection criteria verification.

August 2020 Enhancements were delayed until the revised 3Sigma contract was in place. Currently the relationship between enrollment and routine operations are separate. The 3Sigma (now Voyatek) contract has not yet been approved but has been sent to USDA on 7/5/24 for review and meets determination.

(section-1-state-plan-for-program-operations)(page-39)Page 39#

Post on website for vendor use in training additional staff. October 2019 Assistance to vendors to train more employees on WIC policies and procedures. Video posting is postponed until attendance tracking can be achieved. In May 2024, CT WIC created a Training Documents section on the Retailers page of the WIC website and posted the current versions of the New and Renewal Vendor training presentations. Request from other states who utilize post-training tests, online assessments to test knowledge of training. October 2019 Training chapters will apply to different areas regarding minimum stocking requirements, transaction processing, violations, and sanctions. Information was obtained from other states in May 2024 on recorded trainings that meet the training requirements and vendor attendance surveys. 4.6 Improve investigation services through RFP process and inventory audits.

Re-Initiate an RFP for Compliance Investigation contract.

WIC timeline: RFP release date: 10/1/23.

Developed and issued an RFP for compliance buys investigation. No responses received in FY21; will revise and repost.

RFP was not initiated. CT DPH has experienced staffing shortages and significant backlogs in contracts management, fiscal and legal, which are areas that would be involved in the RFP and contracting process. Undercover investigations and inventory audits have continued to be conducted by State WIC Office staff. Screen and evaluate all proposals to determine if bidders meet the requirements of the RFP. WIC Timeline: Tentative 12/1/23. Reviewed RFP proposals.

RFP was not initiated, so activity was not conducted. Select a vendor to conduct compliance buys investigation services for the WIC program. WIC Timeline: Tentative contract award notification: 12/8/23. Screening team selected winner for the compliance buys investigation services. RFP was not initiated, so activity was not conducted. Develop a contract language for compliance investigation services.

WIC Timeline: Tentative 1/1/24. Developed new contract language. RFP was not initiated, so activity was not conducted. Submit paperwork to initiate contract process.

WIC Timeline: Tentative 1/1/24. Final contract paperwork submitted for review and approval. RFP was not initiated, so activity was not conducted.

(section-1-state-plan-for-program-operations)(page-43)Page 43#

refreshment and maintenance. 5.4 Increase staff knowledge and utilization of current Programming languages, tools and techniques.

Staff have access to training library Training on new version of Focus reports to leverage legacy reports with new dashboard technology. Staff have access to library as needed. Staff are utilizing training library. WIC IT Staff BITS is conducting some training for Power Apps and Power BI and LinkedIn trainings are available for all state staff now. 5.5 Implement new technologies to enhance productivity and system security.

Implement Office 365 for Local Agencies to access state resources. VPN connection to some resources, no access for others. Local agencies able to access applicable state resources and share files via Teams. WIC IT Staff All staff have now access to Office 365, that also provides self- service for password resets and file sharing with state staff. 5.6 Implementation planning for next EBT contract Complete state contract for EBT services. Convert from existing vendor to new vendor. Waiting on NY to vacate protest on award. NY completes master contract, contract awarded through DAS, conversion completed. State WIC Director WIC IT Staff FRVM Nutrition Unit Currently in negotiations with FIS, the selected contractor based on the Northeast Coalition of States bid. 5.7 Implement next MIS support contract The existing contract expires in 2023. Plan procurement strategy with FNS and start IAPD process. Have approval to use NASPO contract from DAS and have concurrence from FNS. IAPD created and statement of work published. State WIC Director WIC IT Staff

MIS maintenance and operations statement of work submitted to USDA for formal review and “meets determination” prior to execution. 5.8 Implement participant portal Add self service capabilities so participants can pre- enroll in WIC, upload documents, and make appointments New CT-WIC server configuration being updated to support applicable web services, and necessary security to support 40,000 users. Self-service portal implemented State WIC Director WIC IT Staff The participant portal is planned for FY2025- FY2026 pending the MIS M&O SOW execution. State WIC staff are currently developing surveys for participants and local agency staff as part of the planning phase to inform development.

(section-1-state-plan-for-program-operations)(page-44)Page 44#

Program Functional Area 6: Caseload Management/Outreach Goal 6: Effectively reach all eligible individuals as resources allow and achieve the maximum caseload capacity to serve the greatest number of women, infants, and children. By September 30, 2024: Objective 6.1: Target a 1% increase over 2022 first trimester enrollment rates. (14.0%-2022) Objective 6.2: Based on available funding, continue, or expand implementation of focused Outreach Campaign - WIC is MORE in FY 2024. CDC Health Disparity grant reporting is required. Objective 6.3: 25% of FY 2024 Local Agency Plans will include an Outreach Plan with measurable strategies. Objective 6.4: 100% of local agencies will review and use CT-WIC show rate tracking report to improve access to WIC services. Baseline/target for show rate is 80%.

Objective Strategies/Activities Baseline Indicators Progress 6.1 Target 1% increase over 2023 first trimester enrollment rates.

Review of local agency LAPs and show that few local agencies have implemented 1st trimester enrollment outreach strategies in FY23.

As a result, the State agency developed two strategies in FY24 to improve first trimester enrollment. Local agencies are required to select one for implementation.

2024 WIC Objective: ≥ 40%

FFY 2019 Target: ≥ 40.0% Average: 19.9% Range: 3.4% - 33.8%

FFY 2020 Target: ≥ 40.0%* Average: 17.4% Range: 4.3% - 38.6%

FFY 2021 Target: ≥ 40.0%* Average: 13.7% Range: 0.0% - 34.3%

2022 Target: ≥ 40.0%* Average: 14.0% Range: 0.0% - 42.1%

2023 Target: ≥ 40.0%* Average: 12.8% Range: 0.0% - 29.0%

Data Sources: FFY2019-2020: CT- WIC MIS (Management Information System).

*Starting with 2022 State Plan submission, we will report available complete calendar year data based on previous calendar year. CT-WIC Process Objective Report (FY 2023) 1st trimester enrollment of pregnant women is greater than or equal to 40%.

DPH/DSS exchange data at least quarterly on co- enrollment between WIC & HUSKY-A.

The State agency did not meet its target for this process objective. Some reasons for this drop in first trimester enrollment may be due to staff turnover and vacancies at the local level, coupled with an influx of enrollment requests. Looking at the 2024 calendar year data (Jan- Mar) the average is 14.9%, which is an improvement over the 2023 average.

The State agency has connected with a representative from Planned Parenthood Southern New England (PPSNE) to discuss updated contact information and strategies for more streamlined WIC enrollment. Local agencies have reported some issues with

(section-1-state-plan-for-program-operations)(page-48)Page 48#

Program Functional Area 7: Coordination of Services Goal 7: Strengthen coordination of information and resources with other Connecticut State Agencies to respond to the needs of the WIC clients. By September 30, 2024: Objective: 7.1 Maintain active coordination with at least 80% of identified key partners in 2024. Objective: 7.2 90% of reviewed charts/clinic observations during monitoring visits have appropriate mandated and targeted referrals.

Objective Strategies/Activities Baseline Indicators Progress 7.1 Maintain coordination with at least 80% of identified key partners.

Continue to actively participate in State level MCH Task Forces, Head Start, Oral Health, Lead Prevention and IZ programs, HUSKY (Medicaid Managed Care), Food Policy Council (FPC), DSS and OEC.

Continue to coordinate with DPH Food Protection Program, Consumer Protection Agency, and DPH Environmental Epidemiology.

Facilitate emerging collaborations and/or executed MOUs with the following: • DPH led-Maternal Mortality and Morbidity Review Committee (MMRC) interagency workgroup. • Pregnancy Risk Assessment and Monitoring System (PRAMS) collaboration Internal MOU executed. • CT Dental Health Partnership (DHP)- MOU draft in progress. • Substance Exposed Pregnancy Initiative or SEPI-CT and DMHAS and DCF Policy Academy Collaboration ongoing. • Office of Early Childhood and Home Visiting Collaboration ongoing. • CT Coalition Against Domestic Violence Collaboration ongoing. Letters of agreement or MOUs with Medicaid Managed Care (HUSKY), Immunization, SNAP-Ed, Department of Children and Families (DCF), and TANF.

Revise as needed policy and procedures on formula safety and recall.

Use existing Immunization Program MOU as a template for MOU or PSA with other programs as needed.

Improvement of service delivery to mutual clients.

Ensure safety of food/formula provided to WIC participants. Current recommendations or guidelines relevant to WIC participants are sent to local WIC agencies.

The State agency maintains its engagement in many inter-agency workgroups. The bulk of the State agency efforts in FY 2024 included improving the process for dually enrolled participants in obtaining special formula through HUSKY and the development of a HUSKY/Medicaid & WIC Special Formula training for health care providers based on feedback from local agencies. WIC continues to have active MOUs with the Immunization (CT-WIZ) and PRAMS programs. Two MOUs, one between CT- DPH/WIC, DSS and CT-DHP and another between CT- DPH and OEC Home Visiting are in process (one awaiting final DSS review and the other, has been forwarded through CT-DPH for review and approval). In the absence of an MOU with OEC, the State agency

(section-1-state-plan-for-program-operations)(page-49)Page 49#

Objective Strategies/Activities Baseline Indicators Progress • MCH Block Grant Provide data and narrative for annual reports.

Continue to support WIC & Head Start Better Together Collaboration at 9 local agencies in FY24 via NSA funds and existing contracts.

• Sustaining State level activities include Liaison visits, bi-annual survey, and inclusion of Better Together objectives in LAP Outreach Plans.

• Sustaining local level activities include co-location, collaborative nutrition and outreach, monthly meetings and

As resources allow, continue SNAP-Ed/WIC Program Collaboration to complement WIC nutrition education efforts. Coordinate with SNAP-Ed as needed with local agency workshops that include taste testing and cooking demonstrations at selected sites. Incorporate routine use of SNAP-Ed recipes in WIC education/resources used.

Continue participation in both the Women and Children’s Health Committee and Connecticut Perinatal Quality Collaborative (CPQC). Work with both groups to better coordinate hospital and community messaging about breastfeeding to high-risk populations.

Executed updated MOU with OEC, CT-Head Start Association and 9 local grantees.

SNAP-Ed evaluations and feedback from SNAP-Ed/local agencies/students SNAP-Ed Recipes utilized at local WIC agencies.

Record of Women and Children’s Committee and CPQC meetings.

continues to work collaboratively (monthly check-ins) with OEC to pilot a centralized process for WIC and home visiting referrals in the Bristol/New Britain area. In FY 2024, local four new Head Start program signatories were added to Head Start data sharing MOU. A joint letter was sent to WIC and Head start Programs about reviving the WIC & Head Start Better Together Collaboration post pandemic. In FY 2025, State-level engagement is planned for those areas with new Head Start signatories.

See attached summary of SNAP-Ed/WIC activities.

The State agency did not participate in CPQC this year. Will remove this strategy in FY 2026.

(section-1-state-plan-for-program-operations)(page-50)Page 50#

Objective Strategies/Activities Baseline Indicators Progress Follow-up on implementation of Perinatal Mood and Anxiety Disorder (PMAD) self- directed online training (CT-TRAIN).

Continue collaboration with UConn’s Jennifer Vendetti, for technical assistance and training. Update post-tests to Microsoft Forms.

Perform QA on data tables, then, implement and monitor PMAD reports in 2024.

Maintain partnership with Doug Edwards from Real Dads Forever and other Fatherhood Advocates throughout the state. Doug Edwards will continue to provide training and serve as a support to the CT WIC Program in ensuring WIC services are family centered and encourage participation from dads and family men.

Local agencies will build relationships with local fatherhood advocates to find site Completion of PMAD training on CT-TRAIN and evaluation for new Staff.

Ongoing implementation of WIC PMAD Screening Protocol.

Improved engagement with dads and family men at local WIC offices. Local agencies will have identified father advocates in their service area to engage with for referrals and training/engagement opportunities. WIC Numbered Memorandum 24-011 was transmitted with relevant updates to the PMAD Protocols and Resources. The State agency through a local contractor with federal SAMHSA funding held 2- virtual 2-hour trainings on 6/24/24- Adult Mental Health Response for WIC staff to improve confidence in conducting PMAD screening. Post-tests for PMAD TRAIN- CT modules updated to Microsoft Forms and await posting through DPH Communications. The functionality of Microsoft Forms for reporting/analysis of data trends in not ideal and NSU continues to request access to Survey Monkey for better analysis. On 12/15/23 Doug Edwards provided training on ‘Partnering with Family Men: Why and How’ for all local agency WIC staff. Evaluation results show that there was a 50% increase in level of understanding on the importance of partnering with dads/family men. In addition, 78% said that they gained new techniques, skills and approaches they can apply to the jobs.

(section-1-state-plan-for-program-operations)(page-52)Page 52#

Program Functional Area 8: Civil Rights Goal 8: Establish and administer policies and procedures that ensure participant-oriented, customer friendly service environment for all applicants and participants and comply with Racial/Ethnic Federal mandate to ensure uniformity and comparability in the collection and use of data as required by OMB standards. By September 30, 2024: Objective: 8.1 Verify 100% of local agencies comply with use of revised nondiscrimination statement requirements and OMB racial/ethnic data collection standards. Objective: 8.2 Conduct annual civil rights training for state and local agency staff.

Objective Strategies/Activities Baseline Indicators Progress 8.1 Verify 100% of local agencies comply with use of non- discrimination statement requirements and OMB racial/ethnic data collection standards. During monitoring, request copies of LA developed brochures, handbooks, and/or other publications, webpages or social media accounts and review for proper usage of the nondiscrimination statement.

Monitor to verify that Racial/Ethnic Data Collection procedures are followed at local agencies during FY24 reviews. Ongoing Each brochure and handout and webpage will contain the current USDA non-discrimination statement.

Regulatory compliance as evidenced in monitoring reports. One of the three local agencies reviewed to date failed to ensure the current NDS is included on all publications.

Staff in the three local agencies reviewed follow the proper procedure for collection of Race/Ethnic data. 8.2 Conduct annual civil rights training for local agency staff.

Annually, update and train all State and local staff on revised nondiscrimination complaint procedures and forms.

The annual interactive Civil Rights applied session is incorporated into the annual Statewide Meeting.

Annual Civil Rights Training was presented by NERO/USDA on 9/27/2023 or 9/28/2023. All State and local agency staff attended or reviewed the recording.

(section-1-state-plan-for-program-operations)(page-53)Page 53#

Program Functional Area 9: Certification & Eligibility Goal 9: Improve and maintain program integrity in the areas of certification and eligibility. By September 30, 2024: Objective: 9.1 Investigate during MER (Nutrition Monitor) and State audits (Nutrition Consultant Formula Lead (NCFL)), local agency compliance with State WIC Special Formula and Eligible Nutritional policies. Objective: 9.2 Monitor local agency implementation of updated risk criteria.

Objective Strategies/Activities Baseline Indicators Progress 9.1 Investigate during MER (Nutrition Monitor) and State audits (NCFL), local agency compliance with State WIC Special Formula and Eligible Nutritionals policies.

For local agencies with MER scheduled, the Nutrition Monitor will use the CT-WIC Program Special Formula Review Form to determine if 80% of agencies reviewed comply with special formula procedures.  Select 5 (per permanent site) participant records with WIC Medical Documentation forms to determine frequency of insufficient “medical rationale” and if process was followed for HUSKY issuance of special formula.  Based on monitoring results, determine areas for improvement in staff training and clarify WIC formula policies and procedures and provide technical assistance as needed.

Established in 2018

Local agencies will demonstrate proficiency with:

Following policy and process in assisting participants in ordering of special formula received through WIC.

Following policy and process for assisting participants dually enrolled in HUSKY/Medicaid and WIC in obtaining special formula.

Local agency report of improved knowledge base and comfort-level in interactions with HCP’s.

In FY24, three agencies reviewed had special formula issuance findings. Most findings were related to missing documentation, inadequate follow-up tolerance or failure to assign risk factors/medical conditions identified on the medical documentation form. For one local agency there is no medical documentation form on file for participants who received special formula through WIC. 58% of completed WIC Medical Documentation forms were up to date and included information regarding HUSKY/Medicaid coverage. 80% of MER charts reviewed showed the CT-WIC Risk screen was updated based on medical conditions identified on medical documentation forms. The NCFL completed 21 chart reviews as required. The results show 84% Medical Documentation Forms Up to Date, 77% Medical Documentation Forms

(section-1-state-plan-for-program-operations)(page-54)Page 54#

Objective Strategies/Activities Baseline Indicators Progress

The NCFL will use the CT-WIC Program Special Formula Review Form to conduct a minimum of 5 chart audits per local agency, for those local agencies conducting an Off-Year Self Evaluation. per local agency. Approximately 20 charts per year will be evaluated by the NCFL. See indicators column, for performance standards for WIC Special Formula and Eligible Nutritionals’ issuance as well as HUSKY/Medicaid issuance.

Based on results, local agency liaisons will discuss areas for improvement and address questions or concerns during local agency TA visits. Outstanding formula issues identified will be topic for discussion during training sessions at local agency staff meetings, Program Nutritionists and/or statewide meetings.

Confirm baseline for compliance with special formula policies and practices for participants dually enrolled in HUSKY/Medicaid and WIC. (HUSKY as first payer). Determine useful tracking reports.

100% Medical Documentation Form Up to Date

70% Medical Documentation Form accurately completed by MD/HCP

90% Medical Documentation correlates with HUSKY and/or WIC prescription issuance on Family Benefit List (FBL)

80% Appropriate Growth Assessment/evaluatio n documented.

50% of verbal orders for medical documentation are obtained within 24 hours (WIC only).

25% of Nutritionists follow-up with MD/HCP when indicated. 60% CT-WIC Risk Screen updated based on new information.

accurately completed by MD/HCP, 73% Medical Documentation correlates with HUSKY and/or WIC prescription issuance on Family Benefit List (FBL), 25% Appropriate Growth Assessment/evaluation documented, and 41% CT- WIC Risk Screen updated based on new information.

Some of the above indicators show progress from last year. However, local agency staff need improvement in Care Plan documentation and consistency. Further, more focus is needed on confirming with HCP when HUSKY/Medicaid has covered special formula. Only 38% of charts showed that staff documented in CT-WIC when HUSKY/Medicaid covered special formula. The NCFL made some modifications to chart audit indicators in 2024 based on 2023 results. This process will continue to evolve.

(section-1-state-plan-for-program-operations)(page-57)Page 57#

Program Functional Area 10: Monitoring & QA Goal 10: Conduct on-site programmatic management and nutrition services reviews of local agencies to ensure compliance with Federal and State Regulations. By September 30, 2024: Objective: 10.1 Monitor five (5) service regions including satellites. Objective: 10.2 Evaluate applications of VENA principles in local operations and identify training and technical assistance needs.

Objective Strategies/Activities Baseline Indicators Staff Assigned 10.1 Monitor five (5) service regions including satellites.

By end of 1st quarter, develop FY24 monitoring schedule.

 Conduct monitoring visits, schedule exit conference within two weeks of completion of fieldwork, and complete exit conference within 30 calendar days.  Prepare program review reports to local agencies within thirty (30) calendar days of the program exit conference.  Respond to local agency CAP within 30 days. Two weeks as best practice.  Synthesize common review findings & responses to CAP in both nutrition services and program operations to update FY24 Goals and Objectives, training, and technical assistance plans.  During routine monitoring, collect data on satellite site operations to determine effectiveness: Location of satellite sites, # of participants served, and Hours of operation FY21 LA monitoring schedule (See Objective 10.3)

100% of scheduled monitoring visits and reports completed by Sept 2024.

80% of agencies will have their exit conference scheduled within two weeks of completion of onsite visits.

The monitoring schedule was developed at the beginning of the 1st quarter. Five agencies were scheduled for routine monitoring in 2024. In addition, one agency is scheduled for a follow up visit based on ME findings from 2023. Three agencies have been reviewed to date. One agency will not be reviewed due to contract termination. The last routine review and follow up visit will be conducted by September 2024. Common findings and CAP responses will be used to update FY25 Goals and Objectives, and training and technical assistance plans.

(section-1-state-plan-for-program-operations)(page-60)Page 60#

Program Functional Area 12: Data Quality, Analysis & Reporting Goal 12: Strengthen data outputs for improved program planning, monitoring, evaluation, and administration. Objective 12.1: Improve access to, and the utility and application of, WIC Program data: a. Build on current reports to provide enhanced, accurate and more accessible, data resources; b. Expand research/data analysis and reporting initiatives; and, c. Provide support in meeting other Program-related data needs. Objective 12.2: Contribute data inputs to help maximize strategic program coverage and effectiveness: a. Strengthen appropriate access to and delivery of program services; and, b. Ensure adequate access to vendor services and vendor capacity to meet demand.

Objective Strategies/Activities Baseline Indicators Progress 12.1 Improve access to, and the utility and applica- tion of, WIC Program data:

a. Build on current reports to provide enhanced, more accessible data resources. Prepare summary data tables & graphs to illustrate trends, and maps to compare the distribution of selected variables and other Program resources (e.g., participants, WIC sites, authorized vendors).

Post results or otherwise share selected data tables, graphs, reports, maps, and other data presentations as appropriate, including: • WIC participation and key demographics; • Process and outcome objectives; • Benefit issuance & redemption; and, • Authorized vendors; plus, • Current national WIC data and state population figures.

Coordinate with DPH attorney prior to sharing any personally identifiable information outside the WIC program (e.g., with DPH/Vital Records, Local Health Districts), to ensure state and federal con- fidentiality regulations are properly met; censor all public-facing data, as appropriate. Monthly Reports

Quarterly Out- come Reports

Annual Sum- mary Reports Enhanced analysis & data presentations meet USDA, state & local WIC agency data needs.

Data tables, graphs & maps facilitate the comparison of participant characteristics, outcomes, etc.

Data reports are posted to the shared Q drive for state & local agency staff; public-facing data posted to program website and DPH Dashboard are censored and periodically updated, as appropriate.

Improved data access results in less staff time being invested in responding to routine data re- quests, while protecting file security & participant confiden- tiality.

A solution to making WIC reports available to local agency contractors continues to be explored.

These reports are now available to State Staff via Teams WIC Reports.

USDA, State & Local data needs continue to be met b. Expand research/data analysis and reporting initiatives.

Select one program outcome to analyze in relation to potential risk/contributing factors (e.g., low birth weight: compare preterm/full-term birth outcomes in relation to mothers’ pre- pregnancy weight, weight gain during pregnancy, substance use behaviors, initiation of prenatal care, etc.). Prior DPH, WIC and other related studies

DSS Medicaid/ HUSKY A dataset More in-depth analyses help inform program decisions in sup- port of key interventions, with a focus on improved outcomes, and increased outreach, recruit- ment & retention.

Pending analysis of one program outcome in relation to potential risk/ contributing factors. The focus for 2024 has been the complete re- design of CT WIC’s six

(section-1-state-plan-for-program-operations)(page-61)Page 61#

• Identify and track risk factors contributing to poor birth outcomes. • Evaluate associations between WIC participa- tion and risk factors for poor birth outcomes. • New addendum to LBW outcome report will track prematurity data (current report excludes multiple and preterm births).

Support all efforts to procure DSS/Medicaid dataset, in order to: • Determine co-enrollment in WIC/Medicaid: • Use Medicaid data to identify and provide outreach to those eligible but not enrolled in WIC; map addresses to identify pockets of those not enrolled, enabling more targeted outreach efforts. • Map selected health, demographic and socio- economic Census variables at the local level; compare results with current program coverage.

U.S. Census Bureau data

Newly redesigned Outcome reports used to develop the methodology to: • Perform crosstab analyses of Outcomes to determine impact on results by, for example, race and ethnicity (e.g., breastfeeding initiation & duration); • Explore the impact of risk factors on Outcomes; and, • Map results.

Continued support of all efforts to procure DSS/ Medicaid dataset (unsuccessful to date).

Outcome Reports, to improve reliability, readability, and end user functionality.

Still no significant progress on efforts to procure DSS/Medicaid dataset.

c. Provide support in meet- ing other Program-rela- ted data and reporting needs. Respond to internal & external WIC data requests (e.g., DPH, Local Health Districts, FOI requests, universities, non-profits, ad hoc requests, etc.).

Identify/develop relevant reference & training resources: • Draft presentations for WIC Director, Nutrition staff, Vendor Unit, etc., when requested. • Prepare reports for use by state staff in local agency monitoring visits (e.g., staff-to- participant ratio analysis by race race/ethnicity; benefit redemption by Permanent Site, etc.). • Develop presentations for WIC staff; present on data-related topics as needed at statewide meetings, coordinators meetings, trainings. • Provide analysis, reporting and/or technical assistance as requested (e.g., adjust annual WIC outcome targets, calculate caseload, design surveys and new reporting forms, etc.). CT-WIC data reports

Ongoing colla- boration Timely response to internal and external data requests.

Data reports, surveys and presentations developed and/or technical assistance provided.

Committees successfully com- plete assigned tasks.

Ongoing.

(section-1-state-plan-for-program-operations)(page-62)Page 62#

• Contribute to preparing the Annual State Plan and yearly Operational Adjustment proposal; present midterm, and final reports. • Collaborate in DPH initiatives that benefit the State’s MICH population (e.g., MCH Block Grant, PRAMS Steering Committee, RFPs, Publication Review Committees, etc.).

12.2. Contribute data inputs to help maximize strategic program coverage & effective- ness:

a. Strengthen appropriate access to and delivery of program services.

Monitor Program services to help inform program planning and implementation efforts: • Identify service gaps, priorities & opportunities. • Track program outcomes, evaluate changes.

Use GIS mapping to help improve resource allo- cation (e.g., location of clinic sites, authorized vendors).

Target resources to improve outcomes for those at highest risk.

Identify specific populations to target for outreach promotional efforts and program services, where needed.

Develop new reports (e.g., identification of Risk Factors, Referrals/Counter-Referrals by local agency, and permanent WIC site, etc.).

Current pro- gram services & resources Decisions to increase/decrease or relocate program services and resources are based on objective inputs (e.g., trend analysis, per- centage change over “x” period of time, etc.).

Risk factors and other variables associated with a specific out- come or result(s) are identified, providing enhanced criteria for targeting program interventions.

Ongoing.

b. Ensure adequate access to vendor services, and vendor capacity to meet participant demand. Coordinate with the Vendor Management Unit to strengthen data collection, analysis and reporting functions, especially for vendor monitoring and TIP Report preparation.

Continue to identify priority data needs; perform needed analyses and build standardized queries and presentation formats to meet those needs. Vendor Unit data

Authorized Vendor lists

WIC Participation data Vendor locations, services and resources meet participant and program needs.

Analytical maps determine geo- graphic access and store capa- city to meet demand of WIC participants produced prior to adding or removing a vendor from the CT WIC authorized vendors list.

Ongoing, as requested.

(section-1-state-plan-for-program-operations)(page-64)Page 64#

Program Functional Area 1: Management and Organization Goal 1: Ensure program integrity, cost-effectiveness, quality of services and accountability in the delivery of nutrition services and the provision of food benefits. By September 30, 2025 Objective 1.1: Convene monthly meetings (in-person or virtual) for local agency coordinators to ensure on-going communication and feedback loop. Objective 1.2: Actively participate in statewide efforts to increase collaboration, referral, and data sharing, including continued work on myCT, the state’s health and human service portal and meetings with the CT Department of Social Services, Department of Agriculture, and State Department of Education. Objective 1.3: Convene at least one local agency management staff meeting, focused on emerging WIC topics, best practices, data management, and/or leadership. Objective 1.4: a) Update DPH and WIC Continuity of Operations Plan (COOP) to include recommended USDA components and ensure alignment. b) Finalize internal operating procedures and provide state and local agency training. Objective 1.5: Create a participant advisory council to support health equity and provide input on program modernization and improvement efforts. Objective 1.6: Conduct a cost-effectiveness study of local agency contractors.

Objective Strategies/Activities Baseline Indicators Staff Assigned 1.1 Convene monthly meetings (in- person or virtual) for local agency coordinators to ensure on-going communication and feedback loop by 9/30/25.

Schedule and facilitate at least 10 meetings with Program Coordinators by 9/30/25 to: • Review policies and procedures. • Discuss funding and staffing issues. • Review CT-WIC data availability and reports. • Other topics as determined. N/A Summary of meetings.

Improved compliance with policies and procedures.

Increased sharing of strategies regarding resource utilization and staff retention.

Improved use of data and discussions in LAP.

WIC Director

State Nutrition Coordinator

(section-1-state-plan-for-program-operations)(page-67)Page 67#

Program Functional Area 2: Nutrition Services, Breastfeeding Promotion and Support* Goal 2: Improve the nutritional and overall health of WIC families in Connecticut. By September 30, 2025, Objective 2.1: At least 35% of pregnant women participating in the WIC Program for a minimum of 6 months gain appropriate weight. Objective 2.2: The incidence of low birth weight (LBW) among infants whose mothers were on the WIC Program for at least six months during pregnancy does not exceed 4%. Objective 2.3: The prevalence of anemia among children enrolled in the WIC Program for at least one year does not exceed 7.5%. Objective 2.4a: The prevalence rate of BMI > 85th percentile to < 95th percentile for children 2-5 years does not exceed 15%. 2.4b: The prevalence rate of BMI > 95th percentile for children 2-5 years of age does not exceed 10%. Objective 2.5: At least 80% of infants enrolled in the WIC Program (have mothers who) initiate breastfeeding. Objective 2.6: Define and develop breastfeeding duration report and target.

Objective Strategies/Activities Data Indicators Staff Assigned 2.1 At least 35% of pregnant women participating in the WIC Program for a minimum of 6 months gain appropriate weight.

Tell me More About You (TMM) strategies for prenatal participants to improve appropriate MWG were continued for the FY 2025 LAP. It will be determined if a baseline can be established with FY 2025 LAP results.

Local agency liaisons will perform TMM QA on prenatal charts in FY 2025.

A total of 20 chart audits (sample to include prenatal participants the 4 pre-pregnancy BMI classifications) to determine completeness of nutrition education documentation.

2025 WIC Objective: ≥ 35%

FFY 2019 Target: ≥ 35.0% Average: 27.7% Range: 13.5% - 46.3%

FFY 2020 Target: ≥ 35.0%* Average: 26.5% Range: 7.1%-40.2%

FFY 2021 Target: ≥ 35% Average 27.0% Range: 6.9-74.3%

2022 Target: ≥ 35%* Average 27.5% Range: 4.9-42.9%

2023 Target: > 35%* Average 28.3% Range: 11.6% - 47.5%

2024 data pending. Data Sources: FFY2019-2021: CT-WIC MIS (Management In- formation System).

CT-WIC Quarterly & Annual Outcome, Summary & Trend Reports.

MER chart reviews and Observations.

Improvement in trend data over time for low performing agencies.

Nutrition Monitor Local Agency Liaisons Epidemiologist IT Unit Nutrition Unit

(section-1-state-plan-for-program-operations)(page-69)Page 69#

2.3 The prevalence of anemia among children enrolled in the WIC Program for at least one year does not exceed 7.5%.

Local agency liaisons will perform anemia QA chart audits in FY24. A total of 15 chart audits (sample to include 10– 9-month IBE and IBP- (Mostly) infants; and 5- C1 to determine if anticipatory guidance and anemia prevention messages related to use of infant meat and cereals are documented at nutrition education visits. 2025 WIC Objective: ≤7.5%

FFY 2019 Target: ≤ 7.5% Average: 8.5% Range: 3.9% - 19.0%

FFY 2020 Target: ≤ 7.5% Average: 8.5% Range: 3.5% - 18.2%

FFY 2021 Target: ≤ 7.5% Average: 8.8% Range: 2.4% - 17.5%

2022 Target: ≤ 7.5%* Average: 8.2% Range: 2.9% - 12.7%

2023 Target: ≤ 7.5%* Average: 8.6% Range: 2.9% - 12.7%

2024 data pending.

FFY2019-2021: CT-WIC MIS (Management Information System).

*Beginning with 2022 State Plan submission, we will report available complete calendar year data.

CT-WIC quarterly and annual reports. Chart audits and observations.

Change in trend data over time for low performing agencies. Nutrition Monitor Local Agency Liaisons Epidemiologist Nutrition Unit

2.4 a. The prevalence of BMI > 85%ile to < 95%ile for children 2-5 years of age does not exceed 15%.

b. The prevalence of BMI > 95%ile for children TMM strategies for child participants at risk of overweight or obesity were continued for the FY 2025 LAP. It will be determined if a baseline can be established with FY 2025 LAP results.

The State agency will provide a presentation on the results of the 2025 WIC Objectives: Overweight: < 15% Obesity: < 10%

a. OVERWEIGHT: BMI ≥ 85th%ile to <95th%ile

FFY 2019 Target: ≤ 15% Average: 15.1% Range: 10.1% - 20.1%

CT-WIC Quarterly & Annual Outcome, Summary & Trend Reports.

Indicators of effective use include documentation of TMM, MI, Stages of Change and/or development of a plan.

Monitoring Staff Local Agency Liaisons Epidemiologist IT Unit Nutrition Unit

(section-1-state-plan-for-program-operations)(page-71)Page 71#

*Beginning with 2022 State Plan submission, we will report available complete calendar year data. 2.5 At least 80% of infants enrolled in the WIC Program (have mothers who) initiate breastfeeding.

Through State MER observations and chart audits 50% of local agency staff will incorporate and document concepts from breastfeeding Content Sheets into prenatal education and counseling. MAP strategies for prenatal participants interested in providing human milk were continued for the FY 2025 LAP. If feasible, a baseline will be established with FY 2025 LAP results.

Two of the FY 2025 monthly breastfeeding coordinators meetings will include discussions of the LAP initiation strategy and implementation best practices from local agencies.

The Breastfeeding Unit will conduct 1-2 enhanced breastfeeding reviews at local agencies. (One review will include agency with peer program.)

MAP strategies for prenatal participants interested in providing human milk were continued for the FY 2025 LAP. If feasible, a baseline will be established with FY 2025 LAP results. 2025 WIC Objective: ≥80%

FFY 2019 Target: ≥ 70.0% Average: 81.6% Range: 59.9% - 94.4%

FFY 2020 Target: ≥ 70.0%* Average: 81.3% Range: 63.9% - 93.6%

FFY 2021 Target: ≥ 80.0%* Average 79.8% Range: 61.1% - 94.3 %

2022 Target: ≥ 80.0%* Average 79.6% Range: 62.8% - 94.9%

2023 Target: ≥ 80.0%* Average 79% Range: 58.1% - 94.6%

2024 data pending.

FFY2019-2021: CT-WIC MIS (Management Information System).

*Beginning with 2022 State Plan submission, we will report available complete calendar year data based on previous calendar year.

CT-WIC Quarterly & Annual Outcome, Summary & Trend Reports, Chart Audits and Observations conducted during Enhanced Breastfeeding Reviews and Peer Counseling Monitoring.

Results of enhanced Breastfeeding MERs, show documentation of 80% compliance with CT Guidelines for Breastfeeding Promotion and Support.

Nutrition Monitor Local Agency Liaisons Epidemiologist IT Unit Breastfeeding Unit Epidemiologist

(section-1-state-plan-for-program-operations)(page-76)Page 76#

Promote nutrition education materials and collaborate with DoAg on messaging to participants about benefit issuance and spending FMNP benefits through the 2025 season. June 2024 Messaging begins in June on the issuance of eFMNP benefits

FRVM staff Nutrition staff

Distribute and promote the eFMNP participant surveys. November/December 2024 Responses to surveys accessed through WIC Shopper App, WIC website and One Call Now text messaging. FRVM staff Nutrition staff 3.3 Make changes to food packages and eligible foods in response to Final Rule for Revisions in the WIC Food Packages.

Assessment of tasks to be completed in the food resources and vendor management areas. Final rule published 4/18/24 Current functionality of CTWIC and processes. FRVM staff Nutrition staff Changes to minimum inventory, pricing and monitoring report screens.

Review submissions from manufacturers and distributors on product nutrition labels, statewide availability, and retail costs. Final rule published 4/18/24 Current redemption percentages for the highest redeemed food items

Emails and information submitted to the State WIC Office for approval in Connecticut. FRVM staff Nutrition staff Amendments to the vendor agreement and update the minimum inventory requirements. Final rule published 4/18/24 Agreements are revised and emailed to all authorized vendors. FRVM staff

Provide bulletin on new regulations or procedures. Final rule published 4/18/24 Bulletins sent to all WIC authorized vendors. FRVM staff

Communicate necessary changes in food packages to IT. Final rule published 4/18/24 Through the MIS contractor, Voyatek, requesting and testing system changes. Nutrition staff Provide updates to local agencies regarding any new policies, educational materials, etc. Final rule published 4/18/24 Numbered memos. Nutrition staff Notify wholesale distributors of updates to food packages, new food items, and minimum inventory requirements. Final rule published 4/18/24 Mailing list and communications through the WIC Vendor Advisory Group. FRVM staff

(section-1-state-plan-for-program-operations)(page-80)Page 80#

Refinement of the full monthly redemption report with EBT data through CT-WIC. Report captures data from multiple modules and redemption tables. Data had only been accessible through EPPIC and/or IT report requests. EPPIC access is not available to the local agency Coordinators, and data must be available as needed. FRVM staff Nutrition staff IT staff Access CT-WIC screens via SIM card technology on a tablet to allow real-time access to vendor information and provide electronic record of monitoring visits. Monitoring visits currently done on paper. Number of electronic documents available through the vendor portal to the MIS. Apple iPads can be used to access CT-WIC for in-store use. FRVM staff

Explore functionality for Adobe to integrate with Microsoft Teams and utilize for signing of training certificates and/or monitoring visits.

May 2024 Microsoft Office Hours and expanded use of Microsoft products FRVM staff 4.4 Training videos to supplement interactive vendor training Recordings through Microsoft Teams to develop training videos to incorporate into open enrollment and renewal interactive trainings.

March 2020 Consistent messaging for all training sessions. All trainings are now on Teams since the Covid pandemic. FRVM staff

Post on website for vendor use in training additional staff. March 2020 Assistance to vendors to train more employees on WIC policies and procedures. FRVM staff

Review information gathered from other states who utilize post- training tests, online assessments to test knowledge of training. March 2020 Training chapters will apply to different areas regarding minimum stocking requirements, transaction processing, violations, and sanctions. FRVM staff

4.5 Improve compliance investigation services.

Explore the use of summer interns and those seeking non-DPH internships for students to conduct compliance investigations. January 2024 Collaboration with criminal justice students or Connecticut Department of Emergency Services and Public Protection FRVM staff Explore the use of local agency WIC staff or non-WIC DPH staff to conduct compliance investigations. January 2024 Issued an RFP for compliance buys investigation. No responses received in FY21. FRVM staff

(section-1-state-plan-for-program-operations)(page-82)Page 82#

Program Functional Area 5: Management Information Systems Goal 5: To maintain and enhance the WIC IT infrastructure through 9/30/2025.

Objective: 5.1 Implement solutions or new technologies to modernize participant experience and/or address state and federal requirements. Objective: 5.2 Move toward a self-service reporting environment for regular WIC information needs. Objective: 5.3 Develop a new MIS equipment obsolescence plan. Objective 5.4 Increase staff knowledge and utilization of current IT languages, tools and techniques. Objective: 5.5 Implement new technologies to enhance productivity or system security. Objective: 5.6 Implement next EBT contract and convert. Objective: 5.7 Implement next MIS support contract. Objective: 5.8 Implement Participant Portal.

Objective Strategies/Activities Baseline Indicators Staff Assigned 5.1 Implement solutions or new technologies to modernize participant experience and/or address state and federal requirements. Add additional functionality to CT-WIC. CT-WIC implementation project complete.

Timely update of changes to address needs or requirements. WIC IT Staff

5.2 Move toward a self- service reporting environment for regular WIC information needs. Implementing data dashboard to replace file distribution. Webfocus reports have been converted to SQL Server Reporting Services (SSRS) Begin discussions with agency data team on Power BI or other self-service option; provide additional access to local agency management for DPH Reporting Portal. WIC IT Staff WIC Epidemiologist Nutrition Consultant 5.3 Develop a new MIS equipment obsolescence plan.

Continuing equipment refresh every three to four years.

Current IT infrastructure is a client/server environment on windows platform using technical control is as follows: Routers are managed by DAS Bureau of Information Technology Solutions, while switches, servers, desktops, laptops, tablets and printers are Age and maintenance. WIC IT Staff

(section-1-state-plan-for-program-operations)(page-88)Page 88#

Program Functional Area 9: Certification & Eligibility Goal 9: Improve and maintain program integrity in the areas of certification and eligibility. By September 30, 2025: Objective: 9.1 Investigate during MER (Nutrition Monitor) and State audits (Nutrition Consultant Formula Lead (NCFL)), local agency compliance with State WIC Special Formula and Eligible Nutritional policies. Objective: 9.2 Monitor local agency implementation of updated risk criteria.

Objective Strategies/Activities Indicators Staff Assigned 9.1 Investigate during MER (Nutrition Monitor) and State audits (NCFL), local agency compliance with State WIC Special Formula and Eligible Nutritionals’ policies.

The NCFL will use the CT-WIC Program Special Formula Review Form to conduct a minimum of 3 chart audits per local agency with an Off-Year Self Evaluation. Approximately 20 charts per year will be evaluated by the NCFL.

Based on results, local agency liaisons will discuss areas for improvement and address questions or concerns during local agency TA visits. Outstanding formula issues identified will be discussed during Local agencies will demonstrate proficiency with:

Following policy and process in assisting participants in ordering of special formula received through WIC or assisting participants dually enrolled in HUSKY/Medicaid and WIC in obtaining special formula.

100% Medical Documentation Form Up to Date.

70% Medical Documentation Form accurately completed by MD/HCP.

90% Medical Documentation correlates with HUSKY and/or WIC prescription issuance on Family Benefit List (FBL).

80% Appropriate Growth Assessment/evaluation documented.

Nutrition Unit Nutrition Monitor NCFL Epidemiologist Liaisons

(section-1-state-plan-for-program-operations)(page-91)Page 91#

Program Functional Area 11: Fiscal Management Goal 11: Maximize the utilization of WIC NSA and food funds. By September 30, 2025 Objective: 11.1: Manage the infant formula rebate contract and utilize a new system to ensure accuracy in rebate amounts billed to Abbott Laboratories. Objective: 11.2: Manage internal systems for accuracy in recording and projecting expenditures to ensure proper 798 Report submission. Objective: 11.3: Implement enhanced CT-WIC Financial Module to allow local agencies to enter budget and expenditure information to improve timely reimbursements and expenditure review against approved budget.

Objective Strategies/Activities Baseline Indicators Staff Assigned 11.1 Manage the infant formula rebate contract and utilize a new system to ensure accuracy in rebate amounts billed to Abbott Laboratories. • Track and monitor monthly utilization of formula. • Utilize the new system to ensure accuracy of rebate amount. • Track billing and receipt of rebate amounts billed to Abbott. Manual reconciliation. Enhanced reporting capabilities to assist with tracking changes in pricing and ensuring accuracy of pricing and rebate billed. State WIC Director

Fiscal Unit

11.2 Continue to enhance and manage internal systems for accuracy in recording and projecting expenditures to ensure proper 798 Report submission. • Analyze WIC approved budget against expenditures monthly. • Maintain automated WIC accounting system. • Coordinate process for personnel charging the WIC Grant. Budget/expenditure reconciliation. Enhancements to accounting system will reduce posting inaccuracies. State WIC Director

Fiscal Unit

11.3 Implement enhanced CT- WIC Financial Module to allow local agencies to enter budget and expenditure information to improve timely reimbursements and expenditure review against approved budget. • Monitor information entered into CT-WIC Finance Module by local agencies. • Ensure that expenditures submitted by local agencies are approved in the budget. • Enhance reporting process for local agencies by utilizing an automated process. N/A The system tracks any revisions entered and has enhanced reporting capabilities. State WIC Director

Fiscal Unit

(section-1-state-plan-for-program-operations)Connecticut WIC State Plan Section 1: State Plan for Program Operations FY 2025#

(section-1-state-plan-for-program-operations)(page-1)

(section-1-state-plan-for-program-operations)Connecticut WIC State Plan Section 1: State Plan for Program Operations FY 2025#

(section-1-state-plan-for-program-operations)(page-1)

(section-1-state-plan-for-program-operations)(page-2)Page 2#

(section-1-state-plan-for-program-operations)(page-3)Page 3#

(section-1-state-plan-for-program-operations)(page-4)Page 4#

(section-1-state-plan-for-program-operations)(page-5)Page 5#

(section-1-state-plan-for-program-operations)(page-6)Page 6#

(section-1-state-plan-for-program-operations)(page-7)Page 7#

(section-1-state-plan-for-program-operations)(page-8)Page 8#

(section-1-state-plan-for-program-operations)(page-9)Page 9#

(section-1-state-plan-for-program-operations)(page-10)Page 10#

(section-1-state-plan-for-program-operations)(page-11)Page 11#

(section-1-state-plan-for-program-operations)(page-12)Page 12#

(section-1-state-plan-for-program-operations)(page-13)Page 13#

(section-1-state-plan-for-program-operations)(page-14)Page 14#

(section-1-state-plan-for-program-operations)(page-15)Page 15#

(section-1-state-plan-for-program-operations)(page-16)Page 16#

(section-1-state-plan-for-program-operations)(page-17)Page 17#

(section-1-state-plan-for-program-operations)(page-18)Page 18#

(section-1-state-plan-for-program-operations)(page-19)Page 19#

(section-1-state-plan-for-program-operations)(page-20)Page 20#

(section-1-state-plan-for-program-operations)(page-21)Page 21#

(section-1-state-plan-for-program-operations)(page-22)Page 22#

(section-1-state-plan-for-program-operations)(page-23)Page 23#

(section-1-state-plan-for-program-operations)(page-24)Page 24#

(section-1-state-plan-for-program-operations)(page-25)Page 25#

(section-1-state-plan-for-program-operations)(page-26)Page 26#

(section-1-state-plan-for-program-operations)(page-27)Page 27#

(section-1-state-plan-for-program-operations)(page-28)Page 28#

(section-1-state-plan-for-program-operations)(page-29)Page 29#

(section-1-state-plan-for-program-operations)(page-30)Page 30#

(section-1-state-plan-for-program-operations)(page-31)Page 31#

(section-1-state-plan-for-program-operations)(page-32)Page 32#

(section-1-state-plan-for-program-operations)(page-33)Page 33#

(section-1-state-plan-for-program-operations)(page-34)Page 34#

(section-1-state-plan-for-program-operations)(page-35)Page 35#

(section-1-state-plan-for-program-operations)(page-36)Page 36#

(section-1-state-plan-for-program-operations)(page-37)Page 37#

(section-1-state-plan-for-program-operations)(page-38)Page 38#

(section-1-state-plan-for-program-operations)(page-39)Page 39#

(section-1-state-plan-for-program-operations)(page-40)Page 40#

(section-1-state-plan-for-program-operations)(page-41)Page 41#

(section-1-state-plan-for-program-operations)(page-42)Page 42#

(section-1-state-plan-for-program-operations)(page-43)Page 43#

(section-1-state-plan-for-program-operations)(page-44)Page 44#

(section-1-state-plan-for-program-operations)(page-45)Page 45#

(section-1-state-plan-for-program-operations)(page-46)Page 46#

(section-1-state-plan-for-program-operations)(page-47)Page 47#

(section-1-state-plan-for-program-operations)(page-48)Page 48#

(section-1-state-plan-for-program-operations)(page-49)Page 49#

(section-1-state-plan-for-program-operations)(page-50)Page 50#

(section-1-state-plan-for-program-operations)(page-51)Page 51#

(section-1-state-plan-for-program-operations)(page-52)Page 52#

(section-1-state-plan-for-program-operations)(page-53)Page 53#

(section-1-state-plan-for-program-operations)(page-54)Page 54#

(section-1-state-plan-for-program-operations)(page-55)Page 55#

(section-1-state-plan-for-program-operations)(page-56)Page 56#

(section-1-state-plan-for-program-operations)(page-57)Page 57#

(section-1-state-plan-for-program-operations)(page-58)Page 58#

(section-1-state-plan-for-program-operations)(page-59)Page 59#

(section-1-state-plan-for-program-operations)(page-60)Page 60#

(section-1-state-plan-for-program-operations)(page-61)Page 61#

(section-1-state-plan-for-program-operations)(page-62)Page 62#

(section-1-state-plan-for-program-operations)(page-63)Page 63#

(section-1-state-plan-for-program-operations)(page-64)Page 64#

(section-1-state-plan-for-program-operations)(page-65)Page 65#

(section-1-state-plan-for-program-operations)(page-66)Page 66#

(section-1-state-plan-for-program-operations)(page-67)Page 67#

(section-1-state-plan-for-program-operations)(page-68)Page 68#

(section-1-state-plan-for-program-operations)(page-69)Page 69#

(section-1-state-plan-for-program-operations)(page-70)Page 70#

(section-1-state-plan-for-program-operations)(page-71)Page 71#

(section-1-state-plan-for-program-operations)(page-72)Page 72#

(section-1-state-plan-for-program-operations)(page-73)Page 73#

(section-1-state-plan-for-program-operations)(page-74)Page 74#

(section-1-state-plan-for-program-operations)(page-75)Page 75#

(section-1-state-plan-for-program-operations)(page-76)Page 76#

(section-1-state-plan-for-program-operations)(page-77)Page 77#