WIC and Nutrition Manual 800 Policy Group Food Delivery

Table of Contents

Policy 801

Food Delivery Introduction and Overview

Policy 802

eWIC Card Ordering and Receipt

Policy 803

Issuance of Food Benefits and Assigning of Issue Date

Policy 804

WIC Food Benefit Replacement

Policy 805

Mailing and Uploading Benefits

Policy 806

eWIC Card Inventory and Security

Policy 807

Food Delivery in Disaster Situations

Policy 800

Appendices: Food Delivery and WIC Reports

Page 1 Food Delivery Overview Policy 801 December 2024 Policy 801 Food Delivery Overview POLICY Local WIC Agencies shall ensure WIC participants receive food benefits as appropriate.

PURPOSE To provide overall guidance for local WIC program staff on the food delivery portion of the WIC Program.

RELEVANT REGULATIONS 246.12 (r) – Issuance of food instruments, cash value benefits, and authorized supplemental foods. 246.7 (f)(2)(iv) – Processing Standards: Time frames for processing applicants

DEFINITION: Food Instruments (FIs): are defined in 7 CFR PART 246 as a voucher, check, electronic benefits transfer card (EBT or eWIC card), or any other document which is used by a participant to obtain supplemental foods.

Food Benefit: The foods a participant receives on WIC for a selected month. Depending on the participant category, food benefits provide specific amounts of WIC-authorized foods, formulas, and/or a fixed-dollar amount for participants to obtain WIC-authorized fruits and vegetables (referred to as a “Cash Value benefit” or “CVB”).

Food Benefit Balance: Unspent-issued food benefits which are available for purchase by a cardholder during the authorized benefit timeframe.

eWIC card: Magnetic stripe card used to purchase WIC-authorized foods or formulas from a WIC family’s Electronic Benefit Account (EBA). Each card has a 16-digit Primary Account Number (PAN).

PROCEDURES A. These procedures shall be in effect to prevent any conflict of interest. Employees must not issue food benefits for family/household members. B. Participants who move out of the geographic area served by the agency/site are eligible to continue their certification period and receive food benefits at their new agency/site. C. Each site must have an adequate supply of eWIC cards to serve the caseload. Security and accountability for all eWIC cards shall be ensured. D. Agencies/sites shall schedule issuance to serve their caseload in a timely manner. Appointments to pick up food benefits must be scheduled so there is no lapse in benefits and shall be coordinated with other services when possible. Appointments must comply with the Administrative Reference, Section: LHD Operations, “Appointment and Scheduling Requirements for Personal Health Services.” See WIC and Nutrition Manual Policy 202 Processing Standards and Policy 702 Caseload Management- Participation. E. Participants shall receive WIC foods free of charge. F. A food package must be prescribed for each participant by a health professional and must be appropriate for the participant’s status, age, and nutritional needs. G. Only foods approved by the State WIC Office shall be issued. Approved foods are organized into food packages. Food benefits shall be issued only for participants determined eligible and certified for the Program. H. All participants must receive food benefits at the time of certification, except the exclusively breastfed baby and the partially breastfeeding woman who, after six (6) months postpartum, has requested more than the maximum amount of formula for a partially breastfeeding infant. I. Benefits shall not be retroactive for new participants added to WIC.

Page 2 Food Delivery Overview Policy 801 December 2024 J. Eligible participants receive a food package for each month of eligibility in their certification period, provided all program rules are met. A maximum of three (3) months may be issued at one time. K. Participants/caretakers or their proxy shall personally pick up food benefits unless situations exist that justify mailing food benefits. L. Issuance must be clearly documented in the participant’s medical record at the time of issuance. Documentation must be reviewed prior to subsequent issuance. M. Participants/caretakers must be provided instructions on the proper use of food benefits. Food benefits can only be redeemed at authorized stores. Participants are provided with the approved Food List and a list of current authorized stores. Participants cannot be encouraged to shop at any specific store. N. When a participant becomes status ineligible, the participant is eligible to receive all food benefits with a “first day to use” prior to the date of ineligibility. O. Participants that fail to pick up food benefits for two (2) consecutive months are considered non- participating and are terminated from the Program. P. Participants shall not be denied WIC foods or food benefits for failure to attend or participate in nutrition education and/or other health services offered by the agency. Q. Food benefits that are replaced shall replicate the issue month and issue day of the original food benefits.

Security A. Web-Based Programs/Applications 1. Web-based programs/applications are secure and are only accessible by authorized participants. 2. In order to receive access to the programs/applications, a person must be authorized by the appointed person at the local health department, Local Health Operations, and CDP. See the procedures and forms on the Local Health website. 3. Web-based programs/applications include: a. CMS (Clinic Management System) b. eWIC (Electronic Benefits Transfer) c. Breastfeeding Peer Counselor B. E-Reports 1. Reports are accessible only by authorized personnel. 2. In order to receive access to the programs/applications, a person must be authorized by the appointed person at the local health department, Local Health Operations and CDP. See the procedures and forms on the Local Health website. C. Users will be deleted from web-based programs and applications after 60 days of non-use.

Page 1 eWIC Card Ordering and Receipt Policy 802 December 2024

Policy 802 eWIC Card Ordering and Receipt

POLICY Local programs shall be responsible for maintaining the inventory and security of all eWIC cards received from the contracted provider.

PURPOSE To ensure the WIC Program Integrity and eWIC Card security.

RELEVANT REGULATIONS 7CFR 246.12 (p) – Food Delivery Systems

PROCEDURES Ordering and Receipt of eWIC cards A. Ordering 1. New Clinic Site: Appropriate amounts of eWIC cards will be supplied based on the anticipated number of participants. Contact the State WIC Office for assistance in determining amounts. 2. Established Clinic Site: Agencies/sites are responsible for maintaining an adequate inventory of eWIC cards. 3. See the 800 Appendix for the eWIC Card order form.

B. Receipt of EBT Cards 1. Immediately upon receipt: Compare numbers on the eWIC Card Order Form with serial numbers on the eWIC cards received. If the serial numbers on your order form and the numbers on your cards do not agree, contact the WIC Help Desk for further instructions. 2. If correct, electronically acknowledge receipt of the eWIC card order in Portal. This must be done before any issuance from that series can be posted. 3. If the number of eWIC cards received or serial numbers do not match the eWIC Card Order Form, contact the WIC Help Desk for further instructions.

Page 1 Issuance of Food Benefits and Assigning of Issue Date Policy 803 December 2024 Policy 803 Issuance of Food Benefits and Assigning of Issue Date

POLICY Local WIC Agencies shall ensure WIC participants receive food benefits at their initial certification and at subsequent nutrition education and follow-up appointments. Benefit issuance must be scheduled so there is no lapse in benefits and shall be coordinated with other services when possible.

PURPOSE To ensure WIC participants receive food benefits in a timely manner and ensure household members’ issuance is coordinated.

RELEVANT REGULATIONS 246.12 (r) – Issuance of food instruments, cash value benefits, and authorized supplemental foods. 246.7 (f)(2)(iv) – Processing Standards: Time frames for processing participants

PROCEDURES Food Benefit Issuance A. General Policies 1. Food benefits shall be issued only for applicants/participants determined eligible and certified for the program. 2. Food benefits shall be issued when informing the participant or caretaker of eligibility and certification. a. Extenuating circumstances may exist that preclude the immediate issuance of food benefits. Information shall be documented in the medical record to support why food benefits were not issued at the time of certification. 3. For initial certification, the food benefit(s) shall be redeemable immediately and shall be valid for the current month or the remaining portion of the month if coordinating household members. 4. All eligible participants must be assigned an issuance date, and all household members must have coordinating dates. This date remains the same through the participant’s continuous participation in WIC. 5. Eligible participants may receive a food package for each month of eligibility in their certification period, provided all Program rules are met. A participant may receive a maximum of three (3) full month’s packages or a combination of one (1) partial package and up to two (2) full packages at one time, at issuance. A partial package is issued to coordinate/catch up with household members, so all household members have the same issue date. 6. Food benefits shall not be withheld in order to provide other services. 7. Participants coming to the clinic late to pick up food benefits may receive a partial/reduced food package. 8. Proof of identity of the person picking up food benefits must be presented and documented at issuance. Documentation of identity at issuance is entered into the system. The proof code will print on the issuance label, which is placed in the medical record. 9. Issuance must be documented in the participant’s medical record at the time of issuance and must include the months issued. For eWIC issuance, the system generates a label for placement in the chart. 10. The issuance label should be reviewed to ensure issuance is appropriate (food package assignment, months of issuance, etc.). 11. The Personal Identification Number (PIN) is the electronic signature for eWIC. a. Staff should never ask the participant for the PIN or write the PIN number down.

Page 2 Issuance of Food Benefits and Assigning of Issue Date Policy 803 December 2024 b. Participants are recommended to swipe and enter their PIN number before leaving the clinic at first card issuance or PIN change to ensure there are no issues with the eWIC card, PIN, or benefits.

B. Food Package Issuance Policies 1. Types and quantities of foods are organized into food packages with a code for each package. The code is entered into the system and indicates an entire food package prescription and distribution of foods. 2. Food packages must be prescribed by a health professional. 3. The prescribed food package must be appropriate for the age and status of the participant. 4. Infants must receive a standard contract brand formula package unless there is a documented medical reason. 5. Infant and child packages are age appropriate. The system automatically adjusts the package for the infant’s/child’s age based on the date of birth, first full package issue month/date, and status. a. Food benefits with a first day to use before the infant turns one (1) must be issued as an infant package. b. At 12 months of age, food benefits issued with a first day to use after age one (1) must be a child food package. This change is made in a recertification or an Infant/Child Transfer (ICT). 6. For all participants: a. Enter the identity proof for the person picking up food benefits. b. Verify the proper number of months and the proper food package was issued. 7. An issuance label will be generated to be placed on the participant’s CH-3 Progress Note or in the electronic medical record. If the label does not print, it can be regenerated for printing or electronic file saving through the CDP Report Viewer.

Assigning Issue Dates A. General Policies 1. All eligible participants must be assigned an issue date. 2. All household members must be placed on the same issue date so issuance can be done for all members at the same time. 3. The assigned issue date is the date desired for the first full food package. 4. An issue date of the 29th, 30th, or 31st can be used for first issuance. These dates are then automatically changed by the system to an issue date of 28th. This change is made since all months have at least 28 days and to accommodate issuance in all months. 5. When a member is added to an existing household and issue dates are being coordinated with other household members, using the current date, the system will issue a partial food package. The system calculates the number of days and issues the appropriate food quantities. 6. The issue date remains the same through the household’s continuous participation in WIC. For late pick up of food benefits, the system calculates the appropriate food quantities. B. Assigning Issue Dates 1. Issue Date for A New Household a. The issue date for a new household and new member(s) shall be the date the participant(s) is added to WIC. b. If there are other household members on WIC, issue dates must be coordinated. 2. Issue Date for A Transfer/VOC a. The issue date for a transfer/VOC from one Kentucky WIC clinic to another will be the existing issue date from the previous agency/site unless coordination with a household applies. b. Using the existing issue date for a transfer may result in the issuance of a partial food package. The system calculates the number of days and issues the appropriate food benefits and food quantity. c. The issue date for a transfer/VOC from out-of-state shall be the date the participant(s) is added at your site.

Page 3 Issuance of Food Benefits and Assigning of Issue Date Policy 803 December 2024 3. Issue Date for Exclusively/Partially Breastfed Infants a. The issue date is the same as the rest of the members of the household. 4. Issue Date for Partially Breastfeeding Woman beyond six (6) months postpartum a. A partially breastfeeding woman who continues to breastfeed after six (6) months postpartum and has requested more than the maximum amount of formula allowed for a partially breastfed infant will have the same issue date as the rest of the household. 5. Issue Date for Reinstatement a. The issue date for reinstatement to WIC is the participant’s existing issue date. b. Using the existing date for a reinstatement may result in issuance of a partial food package to catch up issuance for the participant. The system calculates the number of days and adds the appropriate food quantities to the eWIC card.

Putting Household Members on the Same Issuance When a new infant is added, or when participant(s) join a household, or additional household members qualify for benefits, issue dates within a household MUST coordinate. A. Initial Certification 1. Pull the medical record(s) of an existing household member to review the issue date assigned to the household. 2. Assign the new member to the household the same issue date as the household member(s) already on the program. 3. A partially breastfeeding woman who continues to breastfeed after six (6) months postpartum and has requested more than the maximum amount of formula allowed for a partially breastfed infant will have the same issue dates as the rest of the household. 4. Request at least two (2) months of food benefits. The first month is the appropriate quantity for the number of days to the full issuance and the second month is a full package. The appropriate amount of food will be calculated in the system to catch up the new participant to the other household member(s) full issuance date. a. The initial food package for a woman, child or infant will be provided as outlined below.

Partial and Reduced Issuance A. A participant’s assigned issue date, the actual date of issuance, and the participants status determines the quantity of food the participant receives. 1. Partial and Reduced Issuance Calculation a. Reduced or Partial issued food packages are based on the number of days until the next issue date and the status of participant. b. The following chart explains the number of days remaining in an issuance period and the quantity of food to be issued. See the food distribution, which appears in the Clinical Section, Food Package Distribution Charts. The issuance is in accordance with the category of the participant for partial or catch-up issuance, and reduced packages for late pick up: c. Infants Number of Days to the First Full Package Issue Month/Day/Year

System will issue

• 16 days or more • 15 days or less

• Full issuance • Partial issuance

d. Women and Children Number of Days to the First Full Package Issue Month/Day/Year

System will issue

• 16 days or more

• Full issuance

Page 4 Issuance of Food Benefits and Assigning of Issue Date Policy 803 December 2024 • 15 days or less • Partial Issuance

2. Issuance is not reduced for the breastfed infants receiving supplemental formula. 3. The participant’s assigned issue date remains the same through continuous participation in WIC. 4. In order to issue an appropriate quantity of food, adjustments will be made by the system in the quantity of supplemental food issued. The system will issue a reduced or partial food package for the following: a. To catch up a household member with another household member on WIC to coordinate issue dates. b. Late pick up/issuance of food benefits. 5. The system calculates the number of days for the issuance and issues the appropriate food quantity. 6. An issuance label is generated for placement in the participant’s medical record when food benefits are issued through eWIC and will indicate if a partial package is issued.

Issuance to Proxies A. Proxies are allowed to pick up food benefits with authorization from the participant or parent/caretaker. 1. In order to issue to a proxy, a properly completed WIC Proxy Authorization form must be in the Medical Record. 2. Proxies must present proof of identity at issuance of food benefits, and the type of proof must be documented. 3. See Policy 213 Proxy.

Page 1 WIC Food Benefit Replacement Policy 804 December 2024 Policy 804 WIC Food Benefit Replacement POLICY Issued and/or redeemed WIC benefits may be replaced only under limited circumstances, as described below.

PURPOSE To ensure WIC Program Integrity and provide guidance on when it is appropriate to replace issued and/or redeemed formula benefits.

RELEVANT REGULATIONS 7 CFR 246.12 (u) – Participant Violations and Sanctions 7 CFR 246.12 (u) – Claims against participants

PROCEDURES Replacing A. General Policies 1. Food benefits may be replaced for: a. A food package or formula change. b. Other situations that affect the participant receiving the issued food, such as a change in a child’s custody, i.e., mother’s custody to father, and move of infant/child to foster care. c. When an eWIC card is reported lost, stolen, or damaged, it is to be immediately deactivated and a new card issued to the participant. d. In the event of a Disaster. 2. Formula that was purchased and is no longer appropriate for the participant must be returned to the site. An inventory of returned formula must be maintained along with documentation of their destruction. See Policy 603 Handling of Returned Formula and Formula Benefit Replacement. 3. Replacement issuance shall replicate the issue month and issue date. All replacement issuances must be documented in the participant’s medical record. 4. See the CMS Manual for “Replacing a Food Package with the Same Food Package” and “Replacing a Food Package with a Different Food Package.” B. Replacing for Formula Changes 1. The system will not issue replacement food for an infant food package after the infant status has turned one year of age. 2. Only unused formula is returned: a. Document on the CH-3A in the participant’s medical record that the formula was returned, the quantity returned, and the reason for the return. b. A health professional must prescribe the food package for a formula change. Refer to Policy 603 Handling of Returned Formula and Formula Benefit Replacement and 600 Food Package Assignment Policies. If the replacement is done on a day other than the original issuance, report an issuance code of WO209 on the Encounter Entry Screen. c. The system will automatically calculate the appropriate quantity of formula to be issued. C. Replacing Food Benefits Lost, Stolen, Damaged or Destroyed 1. Document on the CH-3A in the participant’s medical record that the eWIC card was reported lost, stolen, destroyed and the reason for replacement. When an eWIC card is reported lost, stolen, or damaged, it is to be immediately deactivated and a new card issued to the participant as soon as possible, but no later than seven business days following the notice by the participant.

Page 2 WIC Food Benefit Replacement Policy 804 December 2024 a. If the replacement is done on a day other than the original issuance, report an issuance code WO209 on the Encounter Entry Screen. b. See the CMS User Guide for Replacing eWIC card. D. Other situations may occur after food benefits have been issued that will affect the participant receiving the food, such as removal of a child from the home into foster care or when another parent/caretaker other than the one who received the food benefits obtains custody of a child. These situations will be handled on an individual basis with consideration of the specific circumstances. E. Replacing Food Benefits in the Case of Disaster 1. Replace the eWIC card for unredeemed valid benefits for Kentucky participants from areas impacted by disaster when the card is lost or destroyed. 2. Emergency situations occur from time to time due to natural disasters such as ice storms, flooding, etc. Participants will report that they have lost WIC Food Benefits and/or WIC foods due to the weather situations. WIC Foods that have been destroyed or damaged due to the weather conditions may be replaced. See policy 807, Food Delivery in Disaster Situations. F. Returned Formula Requirements 1. Formula that was purchased and not used or is no longer appropriate for the participant must be returned to the site. 2. Returned formula is not safe for human or animal consumption and must be destroyed. Returned formula must be properly disposed of and may not be distributed or reissued in any way including another WIC participant, emergency food bank/pantry, charitable organization or another WIC agency. 3. An inventory of all returned formula must be maintained by each site. 4. The inventory shall include: a. Date the formula was received in the site b. Name of the formula c. Can size d. Quantity of formula received e. Type of formula (powdered, concentrate, ready-to-feed) 5. When formula is destroyed and discarded: a. Date the formula is destroyed/discarded b. Formula Name, Form and Size c. Quantity d. Initials of the staff discarding or destroying 6. There must be an inventory form to document the required information. A sample inventory form is included in this section in Food Delivery Appendix 800. 7. All returned formula must be kept secure and shall be stored in one location. 8. When formula is returned, the quantity returned and the reason for the return must be documented in the participant’s medical record. G. Voiding Voiding is the process to account for a good benefit issuance that is not usable. Benefits may be unusable for a number of reasons, such as a food package that is no longer appropriate, an EBT card that is lost, stolen, or damaged. Voiding ensures accountability and provides accurate participation counts. 1. For voiding of EBT benefits, see the CMS User’s Manual “Void Benefits.”

Page 1 Mailing and Uploading Benefits Policy 805 December 2024

Policy 805 Mailing and Uploading Benefits POLICY Food Benefits may be uploaded/mailed in certain circumstances as outlined below.

PURPOSE To ensure program integrity and timely issuance of food benefits to participants.

RELEVANT REGULATIONS 246.12 (r) – Issuance of food instruments, cash value benefits, and authorized supplemental foods. 246.7(f)(2)(iv) – Processing Standards: Time frames for processing participants

PROCEDURES Uploading/Mailing Benefits There may be instances when uploading benefits is desirable and/or necessary. A. Uploading of EBT benefits on an individual participant basis shall be permitted if: 1. The participant is eligible and has completed online nutrition education. 2. Upon Completion of a telephone nutrition education contact with a certifying health professional. 3. Food Package Changes a. Only after a full telephone assessment and assignment of a new food package by the certifying health professional. 4. The participant/caretaker cannot come to the clinic due to: a. Disability b. Illness c. Nearness to termination of pregnancy d. Inclement weather e. Distances to travel f. High cost of travel g. Inability to get to the agency during business hours h. Other 5. It is the health professional’s discretion as to how many months of benefits are provided (1, 2, or 3 months), but the number of months shall be taken into consideration and other service needs and/or appointments. B. Uploading of EBT benefits on a site/clinic-wide basis is permitted if the site/clinic’s computer system is not operational during clinic hours. C. Documentation requirements: 1. Confirmation of participant’s address. a. If the address in the system is not correct, the address must be updated in the system. 2. Issue benefits to the eWIC card, document proof of Identity Reason “Other” in the system, and document in the medical record “RBI” for “Remote Benefit Issuance,” reason for issuance, and sign and date. 3. Offer to mail the Household WIC Shopping List shall be mailed. To protect privacy, the WIC Benefit List shall not be mailed. 4. Remind participants of the availability of the WICShopper App. D. Refer to Policy 221 ARPA Waiver Remote Services for additional information on State Auto- issuance. E. Refer to Policies 220 Program Access in Disaster Situations, 807 Food Delivery in Disaster, and 221 ARPA Waiver Remote Services.

Page 1 eWIC Card Inventory and Security Policy 806 December 2024 Policy 806 eWIC Card Inventory and Security POLICY Security and accountability for all eWIC cards shall be ensured.

PURPOSE To ensure WIC Program Integrity and security/accountability of eWIC Cards.

RELEVANT REGULATIONS 7 CFR 246.12 (p) – Food delivery systems 246.12 (r) – Issuance of food instruments, cash value benefits, and authorized supplemental foods

PROCEDURES Inventory and Security Requirements A. Security and accountability for all food instruments (eWIC cards) and returned formula shall be ensured. B. Receipt of food instruments (eWIC cards) from the State WIC Office must be verified immediately. C. A physical inventory must be made of all food instruments monthly: 1. A person other than the person(s) that issues food instruments must do the inventory. 2. Any method which reflects the actual number of food instruments on hand from the last month plus additional food instruments received during the current month minus all food instruments issued during the current month is acceptable. 3. Account for all food instruments during this inventory by verifying that the food instruments on hand match the FI Range Search. 4. The actual number on hand, the name and signature of the person who did the physical count, and the date of verification must be maintained. All food instruments must be accounted for during this inventory. 5. Documentation of inventory must be retained for one (1) year. A suggested inventory format is provided. 6. Discrepancies must be reported to the State WIC Office as soon as possible. D. Issuance shall be performed accurately, and all required information must be recorded at the time of issuance. Benefits issued through eWIC cannot be issued in advance. 1. eWIC Cards Inventory a. A site inventory shall be established for the clinic. b. Cards must be kept in a locked room or file cabinet. c. Site inventory must be tracked. d. Cards received in a shipment must be logged received in Portal. i. Cards issued out to card issuers must be logged. ii. Cards removed from inventory for other reasons must be logged. e. When cards are received, count and bundle into stacks of 20. f. Site inventory totals and counts must be made once a month. g. Establish a minimum amount for reordering. h. One person that does not issue cards must be responsible for site inventory, with a backup person designated. 2. Card Issuers a. Each card issuer (or issuance location) must maintain a box of cards. b. Cards will be provided to card issuers from the site inventory with the total number of cards issued logged into the spreadsheet. c. Cards for issuers shall be maintained in a box, ideally a small lock box. d. Card boxes must be secured or returned to the site inventory location at the end of each day or end of issuance. e. Cards shall be allocated to issuers in a quantity for up to a maximum of one (1) week.

Page 2 eWIC Card Inventory and Security Policy 806 December 2024 f. Cards shall remain bundled in stacks of 20 to facilitate use in order. E. Lost, Stolen, Damaged, or Destroyed eWIC Cards 1. Food instruments (eWIC card) mailed from the State WIC Office and never received by the agency/site: a. If ordered food instruments have not been received in a reasonable time, contact the State WIC Office or the WIC Help Desk. b. The State WIC Office will investigate and advise the agency/site of appropriate action. 2. Food instruments (eWIC card) lost, stolen, damaged, or destroyed at the agency/site (stolen from agency/site, water/flood damage, fire, etc.) a. Identify and prepare a list of all food instrument numbers lost, stolen, damaged or destroyed. b. Contact the State WIC Office or the WIC Help Desk immediately and report the following: i. The situation (lost, stolen, damaged, or destroyed). ii. Card numbers of all affected eWIC cards iii. Total number of affected eWIC cards. c. For lost, stolen, damaged, or destroyed food instruments, enter the appropriate void reason code. d. If food instruments reported lost or stolen are located, immediately contact the State WIC Office or WIC Help Desk. The State WIC Office will advise the agency/site of necessary action. 3. Damaged Food Instruments a. An eWIC card that is determined to be damaged shall be replaced. 4. eWIC cards Reported Lost or Stolen a. It is the responsibility of the participant, parent/caretaker, or legal representative to report the eWIC card lost or stolen. b. Replacement and transfer of remaining food benefits to a replacement card must be done as soon as possible to afford time for the participant, parent/caretaker, or legal representative to obtain WIC benefits for the month. c. All participants, or their parent/caretaker or legal representative, must be informed of their WIC Rights and Responsibilities and the need to protect the card at all times and shall be provided information that selling or offering to sell WIC benefits including, eWIC cards, WIC issued breast pumps and/or supplemental foods in person, in print or on-line is a participant violation. d. The local WIC agency will need to determine if additional research is needed to rule out any program abuse concerns. See Program Integrity Policies 300 and 303. e. Upon receipt of a card reported lost or stolen: i. Perform a household search and deactivate the reported card assigned to the household; ii. Verify the cardholder’s address; iii. Issue the replacement card; iv. The agency must verify that the benefits have appropriately transferred to the replacement card; v. Print a current WIC shopping list; vi. Documentation of the card replacement and action taken must be maintained in the medical record. 5. System Reasons for eWIC Card Replacement/Deactivation: a. Damaged - A card that has been reported damaged and will be replaced or deactivated. b. Lost - A card that has been reported lost and will be replaced or deactivated. c. New Association - A new card assigned to a new Household. d. New Household - A participant or existing member that has been placed in a new household. e. Not Available - N/A (DO NOT USE)

Page 3 eWIC Card Inventory and Security Policy 806 December 2024 f. Replaced - N/A (DO NOT USE) g. Returned - An active/non-active card that is returned to the clinic or State WIC Office h. Stolen - A card that has been reported stolen that will be replaced or deactivated. i. Stop Access - N/A (DO NOT USE) j. Undeliverable - Card mailed to participant returned as unable to deliver. F. Replacing Food Benefits in the Case of Disaster 1. Replace the eWIC card for unredeemed valid benefits for Kentucky participants from areas impacted by disaster when the card is lost or destroyed. 2. Emergency situations occur from time to time due to natural disasters such as ice storms, flooding, etc. a. See Policy 807 Food Delivery in Disasters

Page 1 Food Delivery in Disaster Situations Policy 807 December 2024 Policy 807 Food Delivery in Disaster Situations

POLICY In a disaster, the WIC Programs shall work to maintain regular benefit delivery to participants.

PURPOSE To ensure food benefits access to WIC Participants in disasters.

RELEVANT REGULATIONS 246.7 (o)(2)(i)(C) Certification of participants 246.7 (g) (3) Certification of participants WIC Policy Memorandum 95-9, WIC Disaster Policy and Coordination

PROCEDURES WIC’s Role in Disasters Ensuring access to nutrition assistance is a critical and immediate focus for disaster response teams. A. USDA Foods and the Disaster Supplemental Nutrition Assistance Program (D-SNAP) are the primary methods that the USDA uses to respond to the nutrition needs of disaster survivors. B. WIC’s role in responding to disasters is minimal, as the Program is neither designed nor funded to meet the basic nutritional needs of disaster survivors who would not otherwise be eligible to receive WIC benefits. 1. In a disaster, WIC Programs shall work to maintain regular benefit delivery to participants.

Emergency Situations Emergency situations occur from time to time due to natural disasters such as ice storms, flooding, etc. Participants will report that they have lost WIC Food Benefits and/or WIC foods due to the weather situations. The following procedures apply to these situations: A. eWIC Card Has Been Destroyed: 1. Void the card and reissue the unredeemed benefits for the current month and for up to two (2) months in the future, as appropriate. 2. Follow the guidance in the KY CMS User Manual for Food Package Replacement and Voiding Benefits. B. Foods that have been purchased and the foods that have been destroyed or contaminated: 1. Emergency situations occur from time to time due to natural disasters such as ice storms, flooding, etc. Participants will report that they have lost WIC Food Benefits and/or WIC foods due to the weather situations. See the Statement of Loss of Benefits Due to Disaster Form in Section 800 Appendices. Current month’s WIC Foods that have been destroyed or damaged due to weather conditions/disaster may be replaced. The following general guidance applies: a. Agencies may not issue a replacement of food benefits in areas where mass care relief organizations, such as The American Red Cross, Federal Emergency Management Agency (FEMA), or the Salvation Army, are providing feeding services. b. The system will not allow the prior month’s issuance to be replaced. Only current month’s redeemed, but damaged foods may be replaced. c. The quantity of replacement food benefits must be the portion of food benefits for which the participant would still be eligible. d. The participant/caregiver must sign a statement attesting to the fact that their food benefits have been destroyed as a result of a disaster. See the Statement of Loss of Benefits Due to Disaster Form in Section 800 Appendices. e. Contact the State Agency WIC Help Desk for assistance with the replacement of benefits due to a disaster.

Page 2 Food Delivery in Disaster Situations Policy 807 December 2024 2. Participants in this situation shall be directed to the local food distribution centers that are providing food. 3. The health professional must prescribe the package based on the individual needs (e.g. contaminated water supply and refrigeration) of the infant. C. Sanitation is a major concern in preventing outbreaks of illness during times of emergencies. 1. The health professional must prescribe the package based on the individual needs (e.g. contaminated water supply and refrigeration) of the infant. 2. Contact the Food Safety Branch for assistance regarding food safety issues. D. Other situations will occur during times of emergencies; contact the State WIC Office for guidance. E. Emergency situations can occur whenever WIC benefits or the WIC certification system is unavailable to a participant, clinic, or retailer for use to issue or redeem WIC benefits. 1. If a KY WIC clinic is unable to access the KY WIC certification system or issue WIC benefits because of a natural disaster or a prolonged system outage, the clinic shall follow their county’s health department disaster plan until a viable plan to access the WIC system is available. Remote Issuance is allowable. Refer to Policy 220, Program Access in a Disaster, and Policy 221, ARPA Waiver Remote Services. eWIC cards may be mailed due to a disaster. Refer to Policy 805 Mailing and Uploading Benefits. 2. Contact the State WIC Help Desk for assistance. a. In some instances, the state agency may be able to provide issuance remotely. Refer to Policy 220, Program Access in a Disaster. i New Participants to the program must be instructed to return to the clinic once the system is up to activate their eWIC card. ii Existing participants within a valid certification period may be issued benefits remotely via the state agency. Agencies with multiple sites may issue remotely from another site. iii Existing participants who are beyond the 30-day grace period for recertification must be recertified in the system in order to be eligible for WIC food benefits. 3. Each clinic, in conjunction with their health clinic, shall keep on file accessible for review by KY WIC Program a disaster/prolonged outage plan to ensure continued access to KY WIC benefits. a. It might include a plan to issue KY WIC from neighboring counties, KY WIC clinics, or mobile health clinics that have access to the KY WIC online system. b. A plan shall also contain continual contact with the KY WIC Help Desk for any assistance needed. The Help Desk number is accessible 24 hours a day at (877) 597- 0367, option 1. 4. If a KY WIC participant is unable to access benefits with the Food Benefits provided because of a natural disaster or a prolonged system outage issue, they shall be instructed to first contact the county from which benefits have been provided, or if their issuing county is unavailable, they shall contact the KY WIC Help Desk for further instructions to get access to KY WIC benefits. a. A clinic shall follow replacement procedures. See Policy 804 WIC Food Benefits Replacement. 5. If a KY WIC Retailer is unable to accept eWIC benefits because of a natural disaster or prolonged system outage, they shall be instructed to contact KY WIC’s EBT processor, Custom Data Processing (CDP) at (866) 237-4814 or contact the WIC Help Desk number for further instructions. F. Disaster-Related Out-of-State Evacuees and WIC Benefits 1. Out-of-State eWIC cards will not transact in Kentucky WIC Authorized Retailers. 2. Refer to Policy 220 for Disaster-related out of state evacuees for VOC, certification and food package assignment/issuance.

Page 1 Section 800 Appendices Food Delivery and WIC Reports December 2024

Section 800 Appendices Food Delivery and WIC Reports

Page 2 Section 800 Appendices Food Delivery and WIC Reports December 2024

FOOD DELIVERY FORMS AND FOOD INSTRUMENT SCREENS INDEX

eWIC order form 3-4 Monthly Count of Unused Food Instruments Inventory Form 5 Sample Notice to Participate Regarding Replacement Card Issuance 6 Example of eWIC Card 7 Example Statement of Loss Due to Disaster 8 WIC Approved Food List (WIC-40) 9 Formula Inventory Form 10-11 CMS/Portal Produced Labels Index 12-14 System Reports Index 15-49

Page 3 Section 800 Appendices Food Delivery and WIC Reports December 2024

eWIC CARD ORDER FORM

When To Use: Use form when requesting eWIC cards from the State WIC Office. Request an electronic fillable copy of the from the State WIC Office at WIC.HelpDesk@ky.gov. Instructions: 1. Clinic must complete the Clinic Name & Site Number.

2. Submitted by must be completed by the person submitting the order

3. Date Submitted must reflect the date the order is being submitted

4. Number of Cards Ordered. Please order in batches of 100 cards.

5. Email the eWIC Card Order Form to WIC.HelpDesk@ky.gov as a PDF. The State office will process and complete STATE WIC OFFICE Section.

6. Once the order has been processed the clinic will be notified via email by the Kentucky WIC Help Desk. Retention: Retain for reference for 1 year.

Page 4 Section 800 Appendices Food Delivery and WIC Reports December 2024 eWIC Card Order Form

Participation Cards On Hand Order 1-400 50 or Less 100 401-800 60 or Less 200 801-1500 70 or Less 300 1501-2000 80 or Less 400 2001-and up 100 or Less 500

**Recommended Inventory is a 3 month supply**

Please complete the order form and return via email to: WIC.Helpdesk@ky.gov

To be completed by LOCAL HEALTH DEPARTMENT

Clinic Name & Site Number:

Shipping Address: City, State, Zip (NO P.O. Box): Submitted By: Date Submitted: Number of Cards Ordered:

*To be completed by STATE WIC OFFICE ONLY*

Number of Cards Shipped: Shipped By: Date Shipped:

eWIC Card Range(s) *To be completed by State WIC Office ONLY*

Starting Card Number Ending Card Number

Revised: March 2022

Page 5 Section 800 Appendices Food Delivery and WIC Reports December 2024

WIC-31 MONTHLY COUNT OF UNUSED FOOD INSTRUMENTS INVENTORY FORM

Purpose: To account for all unused food instruments/cash value benefits and eWIC cards in inventory. Copy this form as needed.

Instructions: • From the portal menu, select “FI Range Search.” Select appropriate clinic from the drop-down menu. Leave “Bank Account” drop-down menu blank and select Search. • Food instrument account numbers issued to the clinic will appear. • Verify the number of food instruments/cash value benefits in this inventory is correct by physically counting all food instruments/cash value benefits on hand. • Verify the number of eWIC cards on the Clinic Inventory Sheet. • Account for all food instruments/cash value benefits and eWIC cards. • Report discrepancies to the State WIC Help Desk. • Attach a copy of the Food Instrument Range Screen and a copy of the eWIC Card Inventory spreadsheet to this form for documentation.

Type of Food Instrument/ Cash Value Benefit # FI Range Screen # Per Physical Count # Difference

Action Taken Farmers Market Nutrition Program

Type of Food Instrument/ Cash Value Benefit # On Excel Spreadsheet # Per Physical County # Difference Action Taken eWIC Cards

Comments:

Count Done By:

This count must be done by someone that does not issue food instruments/cash value benefits.

Date of Count:

Page 6 Section 800 Appendices Food Delivery and WIC Reports December 2024

SAMPLE NOTICE TO PARTICIPANT REGARDING REPLACEMENT CARD ISSUANCE

NOTICE TO PARTICIPANT REGARDING REPLACEMENT CARD ISSUANCE

(Use local WIC agency letterhead) TO: (Cardholder Member Name, HH#)

(Address)

(City), Kentucky (Zip Code)

Date:

Enclosed is the replacement eWIC card for the card you reported as lost/stolen on

.

As a reminder, please be responsible with your card. The eWIC card shall be maintained in a safe and secure manner and the PIN number shall be kept private. Your card is reusable and shall not be thrown away.

If you have any questions, please contact:

.

Sincerely,

(WIC Coordinator or Local Official)

**Letter may be modified for local WIC agency needs.

Page 7 Section 800 Appendices Food Delivery and WIC Reports December 2024 EXAMPLE OF eWIC CARD

Page 8 Section 800 Appendices Food Delivery and WIC Reports December 2024

EXAMPLE STATEMENT OF LOSS OF BENEFITS DUE TO DISASTER Contact the State WIC Office at: WIC.HelpDesk@ky.gov for an electronic copy of the form and assistance with replacement. *Available in both English & Spanish

Page 9 Section 800 Appendices Food Delivery and WIC Reports December 2024 WIC APPROVED FOOD LIST WIC-40

Purpose: To inform participants of WIC approved foods. When To Use: At initial certification and issuance, when approved foods change and as needed. Instructions: Give to participant/caretaker. Language: English and Spanish versions are available. Ordering: Order from the Pamphlet Library. Effective Date: Target release date of October 1st. Revised when necessary.

Page 10 Section 800 Appendices Food Delivery and WIC Reports December 2024 FORMULA INVENTORY FORM

Purpose: For inventory of all formula returned to the site and issuance or disposal of returned formula.

When To Use: Ongoing for formula returned and formula dispensed. Instructions: It is recommended to use 1 sheet per Formula Brand, Type and Form

• Date: the date the formula was received or dispensed

• Action: Indicate if formula is being Received or Dispensed

• Formula Name: specific brand and name of formula being returned or dispensed, (ex. Gerber Good Start Gentle)

• Product Form (Type): Indicate the form of formula returned (Powder, Concentrate or RTF)

• Can Size: the size of the can, typically in ounces

• Amount: the amount of formula that is returned or dispensed

• Expiration Date: the expiration date on the can of formula

• Staff Initials: initials of the staff receiving or dispensing the formula.

NOTE: Copy Formula Inventory Form as needed.

Retention: Maintain documentation of formula inventory for one (1) year.

Page 11 Section 800 Appendices Food Delivery and WIC Reports December 2024 Formula Inventory Form Name of Formula____________________________ (Recommended: Maintain a separate sheet for each formula brand and type) Date Action Formula Name Product Form (Type) Can Size Amount Expiration Date Patients Name/ Identifier Balance On Hand Staff Initials

Received

Discarded

 Powder  Concentrate  Ready to feed

Received

Discarded

 Powder  Concentrate  Ready to feed

Received

Discarded

 Powder  Concentrate  Ready to feed

Received

Discarded

 Powder  Concentrate  Ready to feed

Received

Discarded

 Powder  Concentrate  Ready to feed

Received

Discarded

 Powder  Concentrate  Ready to feed

Received

Discarded

 Powder  Concentrate  Ready to feed

Page 12 Section 800 Appendices Food Delivery and WIC Reports December 2024 CMS/PORTAL PRODUCED LABELS INDEX

Page

Registration Label 13 Certification Label 13 Fully Breastfeeding Infant Certification Only Label 13 Reinstatement Label 13 Termination Label 13 Benefit Issuance Label 14 Income Assessment Label 14 Infant To Child Transfer (ICT) Label 14

Page 13 Section 800 Appendices Food Delivery and WIC Reports December 2024

1. Label as a result of new Registration:

2. Label as a result of a Certification:

3. Label as a result of a Fully Breastfeeding Infant Certification Only:

4. Label as a result of a Reinstatement:

5. Label as a result of a Termination:

Page 14 Section 800 Appendices Food Delivery and WIC Reports December 2024 6. Label as a result of Benefit Issuance

7. Label as a result of Income Assessment

8. Label as a result of Infant to Child Transfer (ICT)

Page 15 Section 800 Appendices Food Delivery and WIC Reports December 2024 SYSTEM REPORTS INDEX

Report Number

Title

Page

110, 111 7/30 Day Late Benefit Issuance Label 16 274 7 Day Late Benefit Issuance List 17 275 30 Day Late Benefit Issuance List 18 495 WIC Voter Registration Verification 19 562 Actions Due Listing 20 587 Automatic Terminations 21 588 Automatic Terminations Labels 22 1001 Possible Dual Participation in WIC 23 1596 Breastfeeding Statistics 25 1679 Patients on Breastfeeding Report 27 1902 Enrollment by Status and Priority 28 1925 Summary of Detail-Infants Prescribed Contract, Noncontract, Exempt Infant Formula and Medical Foods

29 1928 WIC Retail Volume 31 1930 WIC Participation Report by Priority/Status 33 1932 WIC Participant Detail Listing 34 1962 Medicaid and SNAP Recipients Not Enrolled in WIC 36 1964 Medicaid and SNAP Recipients Not on WIC Mailing Labels 37 1975 Waiting List by Priority 38 1976 Waiting List by Priority/Summary 39 1986 WIC Participation by Race/Status 40 1989 WIC Retailer Listing 42 2001 Breastfeeding Status Exceptions 43

Instructions for E-Reports 44

Web-Based System/Applications/E-Reports 46

WIC User Authorization Form 47

Autodialer 48

Page 16 Section 800 Appendices Food Delivery and WIC Reports December 2024 7/30 DAY LATE BENEFITS ISSUANCE LABEL

Report Title: 7/30 Day Late Benefits Issuance Label Report Number:

Report 110 – 7 Day Report 111 – 30 Day

Frequency: Weekly (available Thursday) Distribution: Obtain electronically through clinic site E-reports folder. Description: Label listing of all eligible enrollees that have not received benefits in the last seven (7) or 30 days. Labels are generated based on names that appear in the corresponding seven (7) and 30 day late reports.

Actions to be taken: Set printer properties compatible with label printer. Affix label to Reminder Postcard (WIC-51).

Explanation of Report: Label with address containing the name of WIC participant that has missed picking up WIC food instruments.

Retention/ Disposal Period:

N/A

063063

Test Label 275 East Main Street, HS2-EE Frankfort, KY 40621

Page 17 Section 800 Appendices Food Delivery and WIC Reports December 2024 7 DAY LATE BENEFITS ISSUANCE LIST

Report Title: 7 Day Late Benefits Issuance List Report Number: 274 Frequency: Weekly (available Thursday) Distribution: Obtain electronically through clinic site E-reports folder. Description: A detailed listing of all eligible enrollees that have not received benefits in the last seven (7) days.

Actions to be taken: This report is to be used to contact non-participants to urge their participation. Explanation of Report:

1. HH Num: the Household number 2. Participant ID: the participant’s identification number 3. Participant name: the participant’s name 4. FV Date of Last Benefit Issuance: the first valid date of the last benefit that was issued to the participant.

Retention/ Disposal Period:

N/A

Page 18 Section 800 Appendices Food Delivery and WIC Reports December 2024 30 DAY LATE BENEFITS ISSUANCE LIST

Report Title: 30 Day Late Benefits Issuance List Report Number: 275 Frequency: Weekly (available Thursday) Distribution: Obtain electronically through clinic site E-reports folder. Description: A detailed listing of all eligible enrollees that have not received benefits in the last 30 days. Actions to be taken: This report is to be used to contact non-participant to urge their participation. Explanation of Report: 1. HH Num: the Household number. 2. Participant ID: the participant’s identification number. 3. Participant Name: the participant’s name. 4. FV Date of Last Benefit Issuance: the first valid date of the last benefit that was issued to the participant.

Retention/ Disposal Period:

If printed, shred or burn after report is worked.

Page 19 Section 800 Appendices Food Delivery and WIC Reports December 2024 WIC VOTER REGISTRATION VERIFICATION

Report Title: WIC Voter Registration Verification Report Number: 495 Frequency: Monthly (available 1st Thursday) Distribution: Obtain electronically through clinic site E-reports folder. Description: A detailed listing of all women participants age 18 years old or older that applied, transferred, or certified for WIC services during the month.

Actions to be taken: This report shall be used to verify that voter registration was offered to women 18 years old or older at WIC application, certification, and transfer. This report shall be compared to the Voter Registration Rights and Preferences Form (WIC-53) file to ensure the women completed a WIC-53 form when voter registration was offered.

Explanation of Report: 1. HH Num: the Household number. 2. Participant ID: the participant’s identification number. 3. Participant Name: the participant’s name. 4. DOB: the participant’s date of birth. 5. Certification Date: the date of certification. 6. WIC Status: the status of the women at the certification date.

Retention/ Disposal Period:

If printed, shred or burn after report is worked.

Page 20 Section 800 Appendices Food Delivery and WIC Reports December 2024 ACTIONS DUE LISTING

Report Title: Actions Due Listing Report Number: 562 Frequency: Weekly (available Thursday) Distribution: Obtain electronically through clinic site E-reports folder. Description: This report is a caseload management tool, which lists participant recertification and termination actions that are due and overdue. The report must be worked on a weekly basis to decrease inactive enrollment and increase participation. Overdue actions indicate an inactive caseload, which lowers the rate of participation to enrollment.

Actions to be taken: Use this report as a caseload management tool to investigate overdue actions. • Contact all inactive people on the Actions Due Listing and offer program services. • Educate all participants on the health benefits of WIC, remaining on the Program and keeping recertification appointments. • Send a reminder notice to all participants that missed their appointments.

Explanation of Report: 1. HH Num: the Household number. 2. Participant ID: the participant’s identification number. 3. Participant Name: the participant’s name. 4. WIC Status: the status of the women at the certification date. 5. Next Action Due: is the next action that shall be performed for the participant. 6. Next Action Date: is the date the next action is due to be performed. 7. Appt Date: is the date of the participant’s appointment. 8. Reasons: is the space for agency use to document resolution to the action due.

Retention/ Disposal Period:

If printed, destroy by shredding or burning after receipt of next report.

Page 21 Section 800 Appendices Food Delivery and WIC Reports December 2024 AUTOMATIC TERMINATIONS

Report Title: Automatic Terminations Report Number: 587 Frequency: Weekly (available Thursday) Distribution: Obtain electronically through clinic site E-reports folder. Description: The report is a listing of all participants whose next action due is termination and the action date is on or before the report date or those who have not received food benefit issuance for two (2) consecutive months (60 days) from expiration date (last day to use) of last set of food instruments issued. The reason for termination is listed on the report as non-participation or categorically ineligible.

Actions to be taken: Report shall be used to document the termination of the participant. Print the automatic termination label and pull the participant’s chart. Place the automatic termination label on the participant’s medical record.

Explanation of Report: 1. Patient #: the participant’s identification number. 2. Local User ID: clinics that assign chart numbers. 3. Participant Name: the participant’s name. 4. Birth Date: participant’s date of birth. 5. Reason: reason for the automatic termination. 6. Status: status of the participant. 7. Last Issuance: first valid date of the last food benefits issued to the participant. 8. Total Terminations: total number of participants automatically terminated.

Retention/ Disposal Period:

If printed, destroy by shredding or burning after receipt of next report.

Page 22 Section 800 Appendices Food Delivery and WIC Reports December 2024 AUTOMATIC TERMINATION LABELS

Report Title: Automatic Termination Labels Report Number: 588 Frequency: Weekly (available Thursday) Distribution: Obtain electronically through clinic site E-reports folder. Description: Label listing of all participants that have been automatically terminated due to non- participation or categorically ineligible. Labels are generated based on names that appear on the Automatic Terminations report.

Actions to be taken: Set printer properties compatible with label printer. Affix/save label to participant’s medical record

Explanation of Report: Label with participant’s information that has been automatically terminated.

Retention/ Disposal Period:

Label is retained in the participant’s medical record.

Page 23 Section 800 Appendices Food Delivery and WIC Reports December 2024 POSSIBLE DUAL PARTICIPATION IN WIC

Report Title: Possible Dual Participation in WIC Report Number: 1001 Frequency: Monthly Distribution:

Obtain electronically through clinic site E-reports folder. Report is produced only if there are participant matches.

Description: A detailed listing of potential dual participants in WIC. The participant’s name will appear as a possible dual participant if the system matches specific items. The items include local health department identification code, participant’s ID number, participant’s name, gender, birth date and status. The appearance of a person’s name on the Possible Dual Participation report does not mean that he/she is a dual participant.

Actions to be taken: Review all names appearing on the report. Investigate and take appropriate action as outlined in the Participant Abuse in the Certification and Management Section of the WIC and Nutrition Manual.

Document action taken in the participant’s medical record.

Explanation of Report: 1. HLS: local health department identification code. 2. Participant ID: participant’s identification number. 3. Participant Name: participant’s name. 4. Gender: gender of the participant. 5. Birth Date: participant’s date of birth. 6. Status: status of the participant. 7. Certification Date: date the participant was certified. 8. First Valid Date: first valid date of the most recent WIC issuance.

Retention/ Disposal Period:

If printed, shred or burn after report is worked.

Page 24 Section 800 Appendices Food Delivery and WIC Reports December 2024

Page 25 Section 800 Appendices Food Delivery and WIC Reports December 2024 BREASTFEEDING STATISTICS

Report Title: Breastfeeding Statistics Report Number: 1596 Frequency: Monthly (first Monday after the first weekend of the month) Distribution: Obtain electronically through clinic site E-reports folder. Description: The report provides breastfeeding statistics for infants enrolled in the clinic. The statistics are provided by the number of weeks, number of infants, percentage of infants and percentage of all infants enrolled. The tables relate to any breastfeeding, currently breastfeeding, and currently/ever exclusively breastfed. Any breastfeeding statistics are provided by primary race and ethnicity. Actions to be taken: This report shall be reviewed to determine current breastfeeding initiation and duration rates. Explanation of Report: 1. Total Number of Infants Enrolled: the number of infants enrolled in the WIC Program at the report site. 2. Any Breastfeeding: the number of infants that initiated breastfeeding and continued to breastfeed at least one (1) time per day. 3. Number of Weeks: the number of weeks the infant is breastfed. 4. Number of Infants: the number of infants that breastfed. 5. % of Infants Ever Breastfed: the percentage of infants that breastfed for the number of weeks based on the number of all enrolled infants. 6. % of All Infants Enrolled: the percentage of infants that breastfed for the number of weeks based on the number of all enrolled infants. 7. Currently Breastfeeding: the number of infants that are currently breastfeeding at this point in time. 8. Number of Weeks: the number of weeks the infant has currently been breastfeeding. 9. Number of Infants: the number of infants that are currently breastfeeding. 10. % of Infants Currently Breastfeeding: the percentage of infants that are currently breastfeeding, at this time, for the number of weeks based on the total number of infants that are currently breastfeeding. 11. % of All Infants Enrolled: the percentage of infants that are currently breastfeeding this point in time for the number of weeks based on all enrolled infants. 12. Currently/Ever Exclusively Breastfed: is the number of infants that currently or have ever only received breast milk with no supplementation of solid foods, formula, etc. 13. Number of Weeks: the number of weeks the infant has currently/ever been breastfeeding. 14. Number of Infants: the number of infants that are currently/ever breastfed. 15. % of Infants Exclusively Breastfed: is the percentage of infants that exclusively breastfed for the number of weeks based on total number of exclusively breastfed infants. 16. % of All Infants Enrolled: the number of infants exclusively breastfed for the number of weeks based on all enrolled infants. 17. Any Breastfeeding by Primary/Race/Ethnicity: the number of infants that initiated breastfeeding based on race/ethnicity. 18. Race: the race/ethnicity as categorized by USDA definitions and as entered into the system. 19. Number of Infants: the number of infants that are reported as any breastfeeding. 20. % of Infant Ever Breastfed: the percentage of infants that ever breastfed based on total number of infants that initiated breastfeeding.

Retention/ Disposal Period:

If printed, shred or burn after report is worked.

Page 26 Section 800 Appendices Food Delivery and WIC Reports December 2024

Page 27 Section 800 Appendices Food Delivery and WIC Reports December 2024 PATIENTS ON BREASTFEEDING REPORT

Report Title: Patients on Breastfeeding Report Report Number: 1679 Frequency: Monthly (first Monday after the first weekend of the month) Distribution: Obtain electronically through clinic site E-reports folder. Description: A listing of all infants that have ever breastfed, their status, race/ethnicity and length of time they have breastfed and whether they are currently breastfeeding.

Actions to be taken: This report shall be reviewed to ensure that breastfeeding data is being entered correctly and the status is consistent with whether the infant is currently breastfeeding.

Explanation of Report: 1. Patient Name: the patient’s name. 2. Patient #: the patient’s identification number. 3. Birthdate: the patient’s date of birth. 4. Status: the current status of the participant. 5. No. of Weeks: the number of weeks that the patient’s breastfed. 6. Cert Date: the date of the certification. 7. Race/Ethnicity: the patient’s race/ethnicity. 8. Currently Breastfeeding: whether the infant is currently receiving breast milk at least once per day.

Retention/ Disposal Period:

If printed, shred or burn after report is worked.

Page 28 Section 800 Appendices Food Delivery and WIC Reports December 2024 ENROLLMENT BY STATUS AND PRIORITY

Report Title: Enrollment By Status and Priority Report Number: 1902 Frequency: Monthly Distribution: Obtain electronically through clinic site E-reports folder. Description: This report indicates the number enrolled by priority and by status as of the report run date. If WIC priority and/or status is not known, the person will be assigned to the “unknown” category.

Actions to be taken: The report is to be used for caseload management and evaluation of enrollment.

Explanation of Report: 1. Reporting Period: timeframe for which enrollment is being reported. 2. HID/Clinic: identification of clinic. 3. Priority Assigned: highest priority assigned based on risk assessment. 4. Status/Category: status/category of the person enrolled. 5. Totals for Site: total number of enrollees for site.

*NOTE: Districts and multiple-site agencies receive enrollment reports by site with a cumulative total for the district.

Retention/ Disposal Period:

If printed, shred or burn after report is worked.

Page 29 Section 800 Appendices Food Delivery and WIC Reports December 2024 SUMMARY OF DETAIL – INFANTS PRESCRIBED CONTRACT, NONCONTRACT, EXEMPT INFANT FORMULA AND MEDICAL FOODS

Report Title: Summary of Detail – Infants Prescribed Contract, Noncontract, Exempt Infant Formula and Medical Foods Report Number: 1925 Frequency: Monthly (first Monday after the first weekend of the month) Distribution: Obtain electronically through clinic site E-reports folder. Description: This report is in three (3) parts:

Part 1: Provides the total number and percentage of infants by formula type (contract, noncontract, other noncontract, exempt infant formulas, medical foods and not receiving formula). Part 2: Provides the number and percentage of infants by food package and type. Part 3: Provides the names of the participant by agency and site who are receiving contract, noncontract, other noncontract, exempt infant formulas and medical foods.

Actions to be taken: This report shall be reviewed to determine current rates of contract, noncontract, exempt infant formula and medical foods. Use for quality assurance to ensure scripts are appropriate and challenge protocols have been followed.

Explanation of Report: Number and Percentage of Infants by Formula Type:

1. Formula Type: the classification of formula (i.e., Contract, noncontract). See the Clinical Nutrition Section for further definition. 2. Total # of Infants: the total number of infants receiving each type of formula. 3. Percentage of Total of Infants: the percentage of all infants enrolled receiving that type of formula.

Number and Percentage of Infants by Food Package and Type:

4. Formula Type: the classification of formula (i.e., contract, noncontract). See the Clinical Nutrition Section for further definition. 5. Package Code: the infant formula food package code. See the Clinical Nutrition Section for the food package codes. 6. Total # Infants: the total number of infants receiving each type of food package by code. Detail Listings of Infants Assigned Noncontract, Other Noncontract, Exempt, and Medical Foods. 7. Household: the household number. 8. Patient #: the patient’s identification number. 9. Participant Name: the participant’s name. 10. Birth Date: the participant’s date of birth. 11. Assigned Date: the date the participant was assigned the food package. 12. Food Package: the food package that the participant is currently assigned. 13. Rx Exp Date: the date that the current formula prescription expires.

Retention/ Disposal Period:

If printed, shred or burn after report is worked.

Page 30 Section 800 Appendices Food Delivery and WIC Reports December 2024

Page 31 Section 800 Appendices Food Delivery and WIC Reports December 2024 WIC RETAILER VOLUME

Report Title: WIC Retailer Volume Report Number: 1928 Frequency: Monthly (usually between the 15th and the 25th) Distribution: Obtain electronically through clinic site E-reports folder. Description: This report provides redemption amounts by month and year to date for each vendor. This information is provided for both in contracted agencies and outside contracted agencies.

Actions to be taken: This report is for information purposes. Review report for any unusual redemption patterns. Contact the State WIC Office to report any unusual redemption activities.

Explanation of Report: 1. Agency: the authorized agency number and name. 2. Retailer Number: authorized WIC retailer number assigned by State Agency. 3. Transactions Month: total number of transactions for the month. 4. Amount Month: Total dollar amount of EBT transactions for the month. 5. Transaction FYTD: total number of EBT transactions fiscal year to date. 6. Amount FYTD: total dollar amount of EBT transactions fiscal year to date. 7. In Contract Sub Total: total EBT transactions and dollar amounts redeemed with the contracted agency area. 8. Out of Contract Sub Total: total EBT transactions and dollar amounts redeemed outside the contracted agency’s area. 9. Retention/ Disposal Period:

If report is printed, destroy after receipt of next month’s report.

Page 32 Section 800 Appendices Food Delivery and WIC Reports December 2024

Page 33 Section 800 Appendices Food Delivery and WIC Reports December 2024 WIC PARTICIPATION BY PRIORITY/STATUS

Report Title: WIC Participation By Priority/Status Report Number: 1930 Frequency: Monthly (first Thursday after reconciliation) Distribution: Obtain electronically through clinic site E-reports folder. Description: The participation report is the number of participants reported as receiving food benefits for the reporting period. Participation is reported by priority and status. If WIC priority and/or status is not known, the participant will be assigned to the “unknown” category. The report is produced in two (2) phases: provisional and final.

Actions to be taken: This report is to be used for caseload management of active participation. Explanation of Report: Provisional: This report is produced the month following the report month. (Example: data for the month of October is produced in November and is the provisional report).

Final: This report is produced two (2) months following the report month. (Example: data captured on the provisional report for October is again produced in December for the October reporting period. This data is the final participation report for the October reporting period.)

1. Reporting Period: timeframe for which participation is being reported. 2. HID/Clinic: identification of clinic. 3. Priority Assigned: highest priority assigned to participant based on risk assessment. 4. Status/Category: status/category of the WIC participant. 5. Status Assigned: status assigned to the category of the WIC participant. 6. Priority Total: total of each column for all categories/statuses. 7. Totals for site: total number of participants receiving food benefits.

NOTE: Districts and multiple site agencies receive participation reports by site with a cumulative total for the district.

Retention/ Disposal Period:

If printed, shred or burn after report is worked.

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Page 35 Section 800 Appendices Food Delivery and WIC Reports December 2024 WIC PARTICIPANT DETAIL LISTING

Report Title: WIC Participant Detail Listing Report Number: 1932 Frequency: Monthly (first Thursday after reconciliation) Distribution: Obtain electronically through clinic site E-reports folder. Description: A detailed listing of participants enrolled in WIC at your agency.

Actions to be taken: This report is to be used as a reference for the participants enrolled in WIC at your agency.

Explanation of Report: 1. Reporting Period: timeframe for which enrollment is being reported. 2. HID/Clinic: identification of clinic. 3. Name: participants name. 4. ID Number: participant’s identification number. 5. Birth Date: participant’s date of birth. 6. Status: status of the WIC participant. 7. Priority: priority assigned to participant based on risk assignment. 8. Valid/Cert Date: n/a at this time. 9. Source: not applicable to clinic. 10. Report Totals: total number of participants enrolled for each status. 11. Total for All Categories: total number of participants enrolled.

Retention/ Disposal Period:

If printed, shred or burn after report is worked.

Page 36 Section 800 Appendices Food Delivery and WIC Reports December 2024 MEDICAID AND SNAP RECIPIENTS NOT ENROLLED IN WIC

Report Title: Medicaid and SNAP Recipients Not Enrolled in WIC Report Number: 1962 Frequency: Monthly (first Thursday) Distribution: Obtain electronically through clinic site E-reports folder. Description: Participants enrolled in the WIC Program are matched to the appropriate categories of Medicaid and SNAP recipients. Participants that do not appear to be in the WIC CMS System are listed on this report.

Actions to be taken: Use this report to outreach to the appropriate Medicaid and SNAP recipients that are not enrolled in the WIC Program.

Explanation of Report: 1. Patient Name: the patient’s name. 2. ID #: the patient’s identification number. 3. Birth Date: the patient’s date of birth. 4. Address: the patient’s address. 5. Prev. WIC Date/HIDLOCS: the previous date the patient was enrolled in the WIC Program and the local WIC agency where the participant was enrolled. 6. Matching Summary: lists the number of patients in the county that are enrolled on Medicaid and SNAP but not on WIC.

Retention/ Disposal Period:

If printed, shred or burn after report is worked.

Page 37 Section 800 Appendices Food Delivery and WIC Reports December 2024 MEDICAID AND SNAP RECIPIENTS NOT ON WIC MAILING LABELS

Report Title: Medicaid and SNAP Recipients Not WIC Mailing Labels Report Number: 1964 Frequency: Monthly (first Thursday) Distribution: Obtain electronically through clinic site E-reports folder. Description: Label listing of individuals who are on Medicaid and/or SNAP who are not currently enrolled in the WIC Program. Labels are generated based on names that appear on the Medicaid and SNAP recipients who are not on WIC report.

Actions to be taken: Set printer properties compatible with label printer. Affix label to outreach information in your area.

Explanation of Report: Labels are addressed with the names of individuals who are a recipient of Medicaid and/or SNAP that are not enrolled in the WIC Program.

Retention/ Disposal Period:

n/a

Page 38 Section 800 Appendices Food Delivery and WIC Reports December 2024 WAITING LIST BY PRIORITY

Report Title: Waiting List By Priority Report Number: 1975 Frequency: Monthly Distribution: Automatically printed overnight or obtained electronically through E-reports – Site and WIC Coordinator. Description: This report identifies all participants placed on the waiting list by the agency. The report is in priority and date placed on waiting list order.

Actions to be taken:

Use report to contact participants when benefits become available. Retention/ Disposal Period:

If printed, shred or burn after receipt of next report.

Page 39 Section 800 Appendices Food Delivery and WIC Reports December 2024 WAITING LIST BY PRIORITY/SUMMARY

Report Title: Waiting List By Priority/Summary Report Number: 1976 Frequency: Monthly – only when directed by the State WIC Office. Distribution: Automatically printed overnight or obtained electronically through E-reports – Site and WIC Coordinator. Description: This report indicates the number on the Waiting List By Priority and by status as of the report run date.

Actions to be taken: Use report for management of the Waiting List.

Retention/ Disposal Period:

If report is printed, destroy after receipt of next report.

Page 40 Section 800 Appendices Food Delivery and WIC Reports December 2024 WIC PARTICIPATION BY RACE/STATUS

Report Title: WIC Participation By Race/Status Report Number: 1986 Frequency: Upon request Distribution: After request, obtain electronically through clinic site E-reports folder. Description: The number of patients reported as receiving food instruments by race, ethnicity and status.

Actions to be taken: Use for caseload management, assessing clients served and outreach.

Explanation of Report: 1. Reporting Period: timeframe for participation of each race/status is reported. 2. Race: categories that can be selected on the Registration Screen. • White: participants having origins in any of the original peoples of Europe, Middle East or North Africa.

• Black or African American: participants having origins in any of the black racial groups of Africa.

• American Indian or Alaska Native: participants having origins in any of the original peoples of North or South America (including Central America), and who maintain tribal affiliation or community attachments.

• Asian: participants having origins in any of the original peoples of the Far East, Southeast Asia or the Indian subcontinent including, for example: Cambodia, China, India, Japan, Korea, Malaysia Pakistan, the Philippine Islands, Thailand and Vietnam.

• Native Hawaiian or Other Pacific Islander: participants having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands. 3. Native American/Indian – Hispanic or Latino and Hawaiian/Pacific Islander: Hispanic or Latino is the ethnicity of the participant. 4. Women, Infants and Children: the status of the participant. Unknown is used if the status is not known. 5. TOTAL: the number of participants by race, ethnicity and status.

Retention/ Disposal Period:

Retain as needed by agency/site.

Page 41 Section 800 Appendices Food Delivery and WIC Reports December 2024

Page 42 Section 800 Appendices Food Delivery and WIC Reports December 2024 WIC RETAILER LISTING

Report Title: WIC Retailer Listing Report Number: 1989 Frequency: Monthly (usually between the 10th and the 15th) Distribution: Obtain electronically through clinic site E-reports folder. Description: This report provides a listing of WIC Authorized retailers for each agency. Actions to be taken: This report is to be used to provide the WIC Participant with a contracted Vendor Listing for that agency. Explanation of Report: 1. Retailer Number: the authorized retailer number assigned by the State WIC Office. 2. Retailer Name: name of the authorized WIC retailer. 3. Retailer Address: physical address of the authorized WIC retailer. 4. Phone Number: area code and phone number of authorized WIC retailer. Retention/ Disposal Period:

Shred or destroy upon printing of next report.

Page 43 Section 800 Appendices Food Delivery and WIC Reports December 2024 BREASTFEEDING STATUS EXCEPTIONS

Report Title: Breastfeeding Status Exceptions Report Number: 2001 Frequency: Monthly (first Monday after the first weekend of the month) Distribution: Obtain electronically through clinic site E-reports folder. Description: This report provides the names of women and infants in the same household that have statuses that do not match, i.e., the women is listed as post-partum and the infant is partially breastfeeding.

Actions to be taken: Review the report and determine appropriate status of the women and infants in the same household. Document action to be taken in Action Taken column. Correct the information in the system to ensure the status of individual is appropriate and matches.

Explanation of Report: 1. Household Number: the household number. 2. Patient ID: the patient’s identification number. 3. Participant Name: the participant’s name. 4. Status: the current status of the participant in the system. 5. Action Taken: the place to provide comments about corrective action taken to ensure appropriate status are assigned.

Retention/ Disposal Period:

Retain report for one (1) year.

Page 44 Section 800 Appendices Food Delivery and WIC Reports December 2024 INSTRUCTIONS FOR e-REPORTS

E-reports allow local health departments to access their reports in an electronic format.

1. To sign into the reports system:

a. Enter user name as KY# and unique password assigned by CDP, Inc. b. Click BASIC button. c. Click OK button.

Page 45 Section 800 Appendices Food Delivery and WIC Reports December 2024

2. On the CDP E-reports screen:

a. Scroll and locate site number. b. Verify the month and click. c. On displayed reports, choose the desired report and click DOWNLOAD.

Page 46 Section 800 Appendices Food Delivery and WIC Reports December 2024 WEB-BASED SYSTEMS/APPLICATIONS/e-REPORTS

Web-based programs/applications/E-reports are secure and are only accessible by authorized participants. To access the web-based programs/applications/E-reports, a user must:

1. Be employed by a local health department. 2. Be assigned a KY number. 3. In order to access web-based programs/applications/reports a user will in some instances:

a. Need to have a VPN Contivity client.

b. Complete the CDP-Report Server – WIC User Authorization request form for local WIC agency staff requesting access to E-reports for the WIC Program. See CDP-Report Server – WIC User Authorization Request form in SYSTEM REPORTS.

i. If access is granted, the form will be forwarded to CDP. ii. The user will then be contacted by CDP via email with an attached excel document with active links to certain WIC folders. (ex: \\172.25.2.178\cdpreports\site000\wicky

c. If the user is not on the CHSDPHLHD domain, CDP will create a username and password.

4. For further help, contact the WIC Helpdesk at (877) 597-0367, Option 1.

Page 47 Section 800 Appendices Food Delivery and WIC Reports December 2024

Page 48 Section 800 Appendices Food Delivery and WIC Reports December 2024 AUTODIALER

Purpose: To contact participants through a call, text, or email for appointment reminders and benefit pick up.

When To Use: Ongoing

Instructions: The participant’s choice on how they prefer to be contacted is documented on the CMS Registration Screen.

If a method of contact is not chosen, the participant will not receive appointment reminders.

If a participant has chosen “no home contact”, they will not receive appointment reminders.

A daily Autodialer report is generated which will show message date, message day, start hour, end hour, status, type, messenger, source, deliveries, remain, delivered, unmatched.

Retention: Destroy upon printing of the next report.

Page 49 Section 800 Appendices Food Delivery and WIC Reports December 2024