PENNSYLVANIA DEPARTMENT OF HEALTH

Policy Number: 5.07 WIC State Agency USDA Approval Date: November 8, 2023 State Effective Date: January 7, 2024

POLICY MANUAL ____________________________________________________________________________________ 5. NUTRITION AND BREASTFEEDING SERVICES.

5.07 Food Package Tailoring.

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A. POLICY OVERVIEW:

Pennsylvania Women, Infants and Children (WIC) program shall authorize Competent Professional Authorities (CPAs) and Competent Paraprofessional Authorities (CPPAs) to prescribe and tailor food packages to assure participants receive the maximum amounts of allowable foods.

B. POLICY:

1. Only CPAs and CPPAs who have been trained and authorized by the State agency (SA) may prescribe and tailor food packages. Refer to Policy 3.02, Local Agency Staffing, to determine qualifications for WIC staff.

2. Food package tailoring is based upon providing the maximum amounts of allowable foods and tailoring as needed. Food packages are based on participant WIC type, breastfeeding status, and age. Participants must be offered at least one food from each food category for which they are eligible on the first of the month. The exceptions to this requirement are:

a. The participant declines any of the foods offered in the food package; and b. The participant has medical and/or developmental problems, which warrant excluding a particular food category or item. c. Food may be reduced or eliminated based on assessment, including religious and cultural needs. See B.9 below.

All above exceptions shall be documented in the MIS.

3. When tailoring food packages, CPAs or CPPAs shall individualize the quantity of food provided from each WIC category and determine the specific types within food subcategories. One food category cannot be completely substituted for another. Any tailoring cannot exceed the maximum monthly levels established by Federal Regulations. For instance, additional juice above the maximum allowed cannot be substituted for milk in the case of milk intolerance.

4. Whole milk is the standard milk for issuance to 1-year-old children (12 through 23 months old). Fat-reduced (2%, 1% or nonfat) milks may be issued to 1-year-old children for whom overweight or obesity is a concern. The need for fat-reduced milks for 1-year-old children must be based on an individual nutritional assessment and documented in the MIS. For children receiving Food Package III, medical documentation must be obtained before tailoring to fat-reduced milks.

5. Lowfat (1%) or nonfat milks are the standard milk for issuance to children (24 months or older) and women. Reduced fat (2%) milk is authorized only for participants with certain conditions, including but not limited to, underweight and maternal weight loss during pregnancy. The need for reduced fat (2%) milk for children (24 months or older), under Food Package IV, and women, under Food Packages V-VII, must be based on an individual nutritional assessment and documented in the MIS.

PENNSYLVANIA DEPARTMENT OF HEALTH

Policy Number: 5.07 WIC State Agency USDA Approval Date: November 8, 2023 State Effective Date: January 7, 2024

POLICY MANUAL ____________________________________________________________________________________ 5. NUTRITION AND BREASTFEEDING SERVICES.

5.07 Food Package Tailoring.

Page 2 of 3

6. Food packages for children (24 months or older) and women may only be tailored to whole milk when issued Food Package III and with medical documentation.

7. The SA retains exclusive authority to make administrative adjustments to contain food package costs. LA staff shall not tailor food packages solely to lower cost.

8. The SA and LAs shall monitor all food package tailoring procedures through program reviews.

9. Prior to prescribing and tailoring food packages, WIC staff shall conduct a Value Enhanced Nutrition Assessment (VENA). Communicate with participant/caregiver/healthcare providers as needed. Gather the following information:

a. Participant’s personal preference and cultural eating patterns. b. Participant’s age and developmental stage. c. Available household food storage and preparation equipment. d. Ability of the participant or caregiver to prepare food/formula. e. Participant’s nutritional and medical needs (i.e. food allergies/intolerances).

10. Review participants’ food packages periodically using criteria in section B.9. above to determine if they are still appropriate. Review may occur:

a. At recertification and health evaluation appointments for all relevant WIC types; b. When infants reach 6 months of age; c. When infants turn one year of age; d. When pregnant women are certified as postpartum; e. When a pregnant breastfeeding woman stops breastfeeding her fully or partially (Part In) breastfed infant; or when that infant turns one year of age. f. When breastfeeding women request to receive infant formula; g. When breastfeeding infants are receiving supplemental formula; h. When a physician documents a need for change; i. At the request of a participant; and j. At the WIC staff's discretion.

11. When tailoring food packages for homeless participants, or those living in temporary accommodations such as shelters or other group residential settings, consider the cooking and food storage facilities available to the participant at the facility itself or elsewhere.

Reference(s): 1. WIC Regulations: 7 CFR Part 246.10. 2. USDA Food Package Policy & Guidance (March 2018)

Policy Status:

PENNSYLVANIA DEPARTMENT OF HEALTH

Policy Number: 5.07 WIC State Agency USDA Approval Date: November 8, 2023 State Effective Date: January 7, 2024

POLICY MANUAL ____________________________________________________________________________________ 5. NUTRITION AND BREASTFEEDING SERVICES.

5.07 Food Package Tailoring.

Page 3 of 3

1. This Policy supersedes Policy Number 7.03, dated June 19, 2015