DC WIC POLICY & PROCEDURE MANUAL

Policy 9.005 1 | P a g e Title: Infant Food Packages Category: Food Delivery CFR Reference: 7 CFR 246.10 Policy Number: 9.005 Effective Date: 04/2022 Revised Date: 11/17/2025

POLICY STATEMENT: The State Agency will make available in the MIS infant food packages based on infant age and categories (see DC WIC policy 8.004 Categorical Eligibility) that allow up to the Monthly Maximum Allowance (MMA)* of authorized infant foods in accordance with 7 CFR 246.10(b)(2)(ii). Each infant will receive a tailored food package based on a breastfeeding and nutrition assessment conducted in accordance with DC WIC policy 2.003 Nutrition and Breastfeeding Assessment. Mother- infant dyads must have corresponding categories that best characterize the infant’s feeding status. *See DC WIC policy 9.004 Federal Food Packages for definition of MMA. DEFINITIONS Mother Infant Dyad – refers to the WIC participant category assignment of a mother to her infant based on infant feeding status. A mother infant dyad must have corresponding participant categories for a singleton birth (e.g. a PN category for a woman must have an infant assigned IPN). Standard Contract Infant Formula – refers to the milk-based and soy-based infant formulas offered in DC WIC as part of the program’s foods cost containment contracts in accordance with 7 CFR 246.16a. Noncontract Infant Formulas – refers to all other infant formula offerings in DC WIC intended to meet the nutritional and medical needs of WIC participants that are not included in the program’s food cost containment contracts in accordance with 7 CFR 246.16a. PROCEDURE The CPA or CPPA must provide each infant with a tailored food package based on the MMAs established for each infant age range and category: Infant Exclusively Nursing (IEN) (Fully Breastfeeding) For infants fully breastfeeding, the following food packages, including food items and amounts, are available based on the infant’s age at the time of issuance:

Federal Food Package I (0-5 Months) Federal Food Package II (6-11 Months) Infant Cereal N/A – infants fully breastfeeding do not receive any WIC foods 16 oz Infant Fruits and Vegetables* 128 oz Infant Meats 40 oz *CVB may be substituted in place of jarred infant fruits and vegetables at either 64 oz for $11 or 128 oz for $22. Monthly CVB amounts may be adjusted annually.

Infant Partially Nursing (IPN) (Mostly Breastfeeding) For infants partially nursing (mostly), the following food packages, including food items and amounts, are available based on the infant’s age at the time of issuance:

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Policy 9.005 2 | P a g e

Federal Food Package I (0-3 Months) Federal Food Package I (4-5 Months) Federal Food Package II (6-11 Months) Infant Formula May receive up to: • 388 fl oz reconstituted liquid concentrate, or • 384 fl oz RTF, or • 435 fl oz reconstituted powder May receive up to: • 460 fl oz reconstituted liquid concentrate, or • 474 fl oz RTF, or • 522 fl oz reconstituted powder May receive up to: • 315 fl oz reconstituted liquid concentrate, or • 474 fl oz RTF, or 522 fl oz reconstituted powder Infant Cereal N/A N/A 8 oz Infant Fruits and Vegetables* N/A N/A 128 oz *CVB may be substituted in place of jarred infant fruits and vegetables at either 64 oz for $11 or 128 oz for $22. Monthly CVB amounts may be adjusted annually.

Infant Partially Nursing (IPN+) (Some Breastfeeding) For infants partially nursing (some), the following food packages, including food items and amounts, are available based on the infant’s age at the time of issuance:

Federal Food Package I (0-3 Months) Federal Food Package I (4-5 Months) Federal Food Package II (6-11 Months) Infant Formula May receive up to: • 823 fl oz reconstituted liquid concentrate, or • 832 fl oz RTF, or • 870 fl oz reconstituted powder May receive up to: • 884 fl oz reconstituted liquid concentrate, or • 913 fl oz RTF, or • 960 fl oz reconstituted powder May receive up to: • 630 fl oz reconstituted liquid concentrate, or • 643 fl oz RTF, or • 696 fl oz reconstituted powder Infant Cereal N/A N/A 8 oz Infant Fruits and Vegetables* N/A N/A 128 oz *CVB may be substituted in place of jarred infant fruits and vegetables at either 64 oz for $11 or 128 oz for $22. Monthly CVB amounts may be adjusted annually.

Infant Formula Fed (IFF) For infants’ formula-fed, the following food packages, including food items and amounts, are available based on the infant’s age at the time of issuance:

Federal Food Package I (0-3 Months) Federal Food Package I (4-5 Months) Federal Food Package II (6-11 Months) Infant Formula May receive up to: • 823 fl oz reconstituted liquid concentrate, or • 832 fl oz RTF, or • 870 fl oz reconstituted powder May receive up to: • 884 fl oz reconstituted liquid concentrate, or • 913 fl oz RTF, or • 960 fl oz reconstituted powder May receive up to: • 630 fl oz reconstituted liquid concentrate, or • 643 fl oz RTF, or • 696 fl oz reconstituted powder Infant Cereal N/A N/A 8 oz

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Policy 9.005 3 | P a g e Infant Fruits and Vegetables* N/A N/A 128 oz *CVB may be substituted in place of jarred infant fruits and vegetables at either 64 oz for $11 or 128 oz for $22. Monthly CVB amounts may be adjusted annually.

INFANT FORMULA ISSUANCE DC WIC authorizes several types of infant formulas in powdered, liquid concentrate, and/or ready-to- feed (RTU/RTF) forms that support the nutritional and medical needs of DC WIC participants. Authorized infant formulas are classified as one of the following: • Standard contract infant formulas • Non-contract infant formulas: o Includes DC WIC-authorized exempt infant formulas (see DC WIC policy 9.008 Qualifying Medical Conditions), and o Competitive infant formulas that may be available on a limited and temporary basis A listing of all currently authorized DC WIC formulas and their classifications can be found in the DC WIC Formula Guide. Standard Contract Infant Formulas Standard contract infant formulas authorized in DC WIC may be issued without a DC Medical Prescription Form to any infant with an assigned category of IFF, IPN+, or IPN in powdered or liquid concentrate form by a CPA or CPPA. Ready-to-feed (RTF) Formulas RTU/RTF formulas may only be authorized by a CPA and must meet one of the following conditions in accordance with 7 CFR 246.10(e)(1)(iv): • The participant’s household has an unsanitary or restricted water supply or poor refrigeration; • The person caring for the participant may have difficulty in correctly diluting concentrated or powdered forms; or • The WIC infant formula is only available in RTU/RTF. The CPA must document the justification for issuing a RTU/RTF formula in the participant’s record. Non-Contract Infant Formulas Non-contract infant formulas available in DC WIC may be assigned by a CPA when one of the following conditions applies: a. Religious Beliefs – a participant who cannot use a standard contract infant formula due to religious reasons or other circumstances may be issued a non-contract comparable infant formula. The CPA must contact the State Agency for approval and document the exception in the participant’s TGIF note.

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Policy 9.005 4 | P a g e b. Qualifying Medical Condition – a participant with a qualifying medical condition (see DC WIC policy 9.008 Qualifying Medical Conditions) may receive an exempt infant formula with the completion of a DC WIC Medical Prescription Form and approval by a CPA. Tailoring Infant Formula for Partially Nursing Infants Partially nursing infants (IPN or IPN+ categories) must have food packages tailored and issued that meet but do not exceed the infant’s daily formula needs. CPA/CPPAs must conduct a comprehensive nutrition and breastfeeding assessment that ensures the following: 1. The CPA/CPPA identifies the frequency of infant formula and breastfeeding intake in a 24-hour period and probes the infant’s caretaker on formula preparation methods (e.g. formula type and mixing ratios, bottle heating, bottle cleaning, formula storage, etc). 2. The CPA/CPPA identifies the mother’s breastfeeding goals and provides appropriate education, anticipatory guidance, and/or breastfeeding support to help her achieve these goals. Staff may reference the WIC Breastfeeding Check-In Tool to provide breastfeeding education and support information. 3. The CPA/CPPA calculates the total amount of formula the infant receives in a 24-hour period and determines the amount of formula to issue based on the DC WIC Formula Tailoring Guide (see below). 4. The CPA/CPPA tailors the infant’s food package to reflect the above formula calculation and provides food benefit education to the Authorized Representative (AR) in accordance with 9.001 Food Benefit Issuance Overview. MOTHER-INFANT DYAD CATEGORY CHANGES For a mother-infant dyad with a change in breastfeeding status, staff must ensure the following to complete the category change: 1. The CPA/CPPA probe to determine the change in breastfeeding and/or categorical status* and document this information accordingly on the infant’s Breastfeeding Surveillance Tab in HANDS. 2. The CPA/CPPA identify the new corresponding infant/mother categories that best characterize the infant’s feeding status and update the category on the Cert Tab in HANDS for the infant and mother**. 3. The CPA/CPPA reviews the category changes with the participants including updates to the certification period(s), appropriate risk codes, and food packages. Please note that food packages typically cannot be adjusted for mother-infant dyads during the current month’s benefit cycle if partial benefits have been redeemed. See DC WIC policies 9.001 Food Benefit Issuance Overview and 9.002 Replacement of Food Benefits for more details. *For a postpartum woman with an active certification that is now pregnant, staff must complete a new certification reflecting her pregnancy status in accordance with DC WIC policy 8.001 Certification Overview. ** For an infant 6 months or older who is no longer breastfed, staff only need to update the infant’s category, risk codes, and food package. The infant’s mother will no longer be considered categorically

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Policy 9.005 5 | P a g e eligible and will be terminated from the program. Additionally, PN+ (Some Breastfeeding) participants are no longer eligible to receive a food package at 6 months postpartum but continue to receive breastfeeding support and participant-centered nutrition education, up to one year postpartum.

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Policy 9.006 6 | P a g e

DC WIC FORMULA TAILORING GUIDE The following tables can assist the CPA/CPPA in tailoring the amount of formula issued to Infants Partially Nursing (Some/Mostly). Maximum Monthly Allowance (MMA) per month for fluid ounces of infant formula: Standard Contract Formula Form Reconstituted Ounces per Container Infants Partially Nursing (Mostly) # of cans/containers to issue Infant’s Partially Nursing (Some) # of cans/containers to issue 0-3 mo. 4-5 mo. 6-11 mo. 0-3 mo. 4-5 mo. 6-11 mo. Similac Advance 20 calories per oz 12.4 oz Powdered 90 1-4 1-5 1-4 5-9 6-10 5-7 13 oz Concentrate 26 1-14 1-17 1-12 15-31 18-34 13-24 32 oz RTF 32 1-12 1-14 1-10 13-26 15-28 11-20 Similac Sensitive 20 calories per oz 12.5 oz Powdered 90 1-4 1-5 1-4 5-9 6-10 5-7 32 oz RTF 32 1-12 1-14 1-10 13-26 15-28 11-20 Similac Soy Isomil 20 calories per oz 12.4 oz Powdered 90 1-4 1-5 1-4 5-9 6-10 5-7 13 oz Concentrate 26 1-14 1-17 1-12 15-31 18-34 13-24 32 oz RTF 32 1-12 1-14 1-10 13-26 15-28 11-20 Similac Total Comfort 20 calories per oz 12.6 oz Powder 90 1-4 1-5 1-4 5-9 6-10 5-7

Standard Contract Formulas - Daily Formula Intake Amounts and Issuance Daily Formula Amount Powdered Daily Formula Amount Concentrate (13 oz can) Daily Formula Amount RTF (32 oz container) Up to 3 oz 1 can < 5 oz Not recommended to issue concentrate < 5 oz Not recommended to issue concentrate 4 to 6 oz 2 cans 6 oz 8 cans 6 oz 6 containers 7 to 9 oz 3 cans 8 oz 10 cans 8 oz 8 containers 10 to 12 oz 4 cans 10 oz 12 cans 10 oz 10 containers 13 to 15 oz 5 cans or up to MMA 12 oz 14 cans 12 oz 12 containers

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Policy 9.006 7 | P a g e

16 to 18 oz 6 cans or up to MMA 14 oz 16 cans 14 oz 14 containers 19 to 21 oz 7 cans or up to MMA 16 oz 18 cans 16 oz 16 containers 22 to 24 oz 8 cans or up to MMA 18 oz 20 cans 18 oz 18 containers 25 to 27 oz 9 cans or up to MMA 20 oz 23 cans or up to MMA 20 oz 20 containers or up to MMA > 28 oz 9 or 10 or up to MMA 22 oz 25 cans or up to MMA 22 oz 22 containers or up to MMA

24 oz 28 cans or up to MMA 24 oz 24 containers or up to MMA

26 oz 31 cans or up to MMA 26 oz 26 containers or up to MMA

28 oz 32 cans or up to MMA 28 oz 28 containers or up to MMA

30 oz 34 cans or up to MMA 30 oz

Noncontract Formulas – Daily Formula Intake Amounts and Issuance Refer to DC WIC policy 9.008 Qualifying Medical Conditions for formula tailoring amounts. REFERENCES 7 CFR 246.16a DC WIC policy 8.001 Certification Overview, 9.001 Food Benefit Issuance Overview, 9.002 Replacement of Food Benefits, 9.004 Federal Food Packages, 9.008 Qualifying Medical Conditions ATTACHMENTS & FORMS DC WIC Formula Guide DC WIC Medical Prescription Form