April 25, 2016 Notes
MN WIC Advisory Group Meeting
ADVISORY GROUP (AG) MEMBERS PARTICIPATING: Jessica Allred (Winona County); Deb Boe
(Dakota County); Jill Bruns (Renville County); Julie Carroll (Brown County); Amber Converse (Dodge
County); Maggie Domski (Washington County); Rebecca Gruenes (Blue Earth County); Amy Lueck
(Southwest HHS CHB); Renee Lukkason (Cass County); Shari Nelson (Crow Wing County); Mary Peick
(Ramsey County); Liz Short (Aitkin County); Heather Thissen (Kandiyohi County); Kimberly Vickberg
(Anoka County); Lenora Yellow Bird (White Earth Reservation).
AG MEMBER ABSENT: Kris Klopp (Mille Lacs County), Jenifer Drill (Morrison County), and Stephanie
Olson (Polk County).
MDH STAFF IN ATTENDANCE: Rick Chiat, Food Delivery Unit Supervisor; Pat Faulkner, Nutrition Unit
Supervisor; Carol Rowe, Operation Unit Supervisor; Candy Wegerson, Interim Program Unit Supervisor;
and Rekha Dixit, Financial Analyst.
Welcome & Introductions
We had two new people attending the meeting – Lenora Yellow Bird, from the White Earth WIC
program, representing WIC Tribal Agencies, and Candy Wegerson, from the State WIC office, serving as
Interim Supervisor for the WIC Program Unit.
WIC Conference Update & Discussion
The state WIC conference will be May 3-5, 2017 at the Minneapolis Marriott NW. We are in the process
of executing the contract. In conjunction with the Conference, we will announce the fourth recipient of
the Sheila Farnan Award. (Information about the award and the timeline will be sent out in January
2017)
The AG members suggested the following speakers and topics:
• Speakers: Nils Bergman (skin-to-skin breastfeeding); Cathy Breedon (medical formula,
transitioning from the NICU to WIC, or any of many other possible topics); Molly Kellogg; Pam
McCarthy; Katy Smith (screen time); Ellyn Satter Institute; Michael Georgieff (feeding premies);
Anna Lynn (from MDH, on mental health in this population);
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Topics:
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Strategies for integrating & maintaining momentum w/ PCS & Baby Behaviors
Professional ethics: new requirement for RDs & DTRs to obtain 1 CPEU in Ethics in a 5-year
cycle CDR Continuing Ed Requirement
Adverse Childhood Experiences (ACES), and impact on health behaviors; building resilience
Substance use/abuse (meth; pain medications; suboxone) and the impact on
nutrition, and on families
Cultural diversity: feeding practices, health beliefs, histories for diverse groups; health
disparities (e.g., anemia, vitamin D status, etc.)
Outreach innovations, and using social media, effective strategies for retaining children
Quality Improvement (QI) – on QI process and/or a panel of LAs to share their QI projects;
Breastfeeding topics; offering CERPs; promote exclusivity; sessions BF peer counselors;
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Formula: basic and/or medical; working w/ HCPs regarding medical formula management;
PCS/Customer service topics
Poverty: the “culture of poverty”; experiential/simulations
Other related concerns: violence in the home, mental health, chemical dependency.
WIC ID Folder & Verification of Certification (VOC)
In MN WIC, the WIC ID Folder serves multiple purposes: a) form of ID in clinic; b) ID needed for
redeeming vouchers in the store; c) holds vouchers; d) calendar for managing WIC appointments; and e)
VOC for participants transferring to WIC in another state.
LAs have expressed concerns with how much time is required for filling out the ID folder, especially
when there are multiple participating members in a household, and ID Folders frequently have to be
replaced. So the questions are:
• What is required by federal regulations, and what isn’t?
• What information on the folder is helpful to LA staff and/or to participants?
• Are there ways, other than the ID Folder, to provide Verification of Certification?
There is not a specific requirement that participants be given or have an ID Folder. There are
requirement for VOC – but these can be met by printing off a VOC from HuBERT, which includes all of
the federally required information and can be done easily, quickly, and as needed.
AG members shared what information they find helpful to staff and/or to participants. The few items
everyone agreed were needed are on the front & back of the folder:
• Household ID
• Name & signature of participant and proxies
• Local agency name and phone number, and for larger agencies, clinic name;
The other information – certification dates, mid-cert due dates, names of all family members in WIC, the
calendar, DOB, etc. – might not be necessary on the folder, and/or always helpful.
The state agency will take this information, review the policy in MOM, and consider revising the policy
to better meet the needs of LAs. With implementation of e-WIC not too far off, and not yet knowing
what the need for ID folders will be, the state agency is not planning to revise the ID Folder, but instead
will notify LAs of what is required and what is optional.
Hunger Impact Partners
Hunger Impact Partners (HIP; a spin-off of Hunger Free MN) is a local non-profit organization
“that supports a breakthrough, statewide network of community-based initiatives and partners,
all of which have a common agenda: end child hunger.” They approached the State WIC staff
to propose working together to identify and implement strategies for promoting WIC
participation and retention, which HIP would then take to potential funders. Wendy Tai, from
HIP, presented some ideas for the group’s feedback.
Recognizing that MN WIC serves a high proportion of eligible people, but noting the drastic
“drop-off” between 12-18 months of age, HIP suggests focusing on:
• Increasing broad public awareness of WIC services;
• Increasing the proportion of women enrolling in WIC early in their pregnancy; and
• Increasing the proportion of 1-year-olds being recertified & continuing to receive WIC
services.
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The group believes that the “perceived” hassles encountered in participating in WIC may outweigh
perceived program benefits. The two most frequently mentioned hassles were: 1) getting to clinic (time
off from work, bringing infants & kids, transportation), and 2) challenges encountered shopping. People
also mentioned hearing that families “go off of WIC to give other families a chance”. Ideas suggested by
the AG include:
• Partnering w/ TPT; using social media, blogs
• Leveraging the goodwill/experience of current (or past) participants – especially local celebrities
or known community personalities -- to tell their story;
• Partnering w/ pharmacies & family planning programs to provide WIC brochures/info with
pregnancy tests, and other related materials;
• Birthday cards sent to kids as they turn 1, then 2, then 3 years of age – sent by US or e-mail, with
incentives (e.g., coupons for diapers, bus tokens, gas cards, visa debit cards)
• Showing participants how to prepare foods -- developing “recipe apps” or You-tube videos of
WIC recipes.
Wendy shared her contact information and encouraged AG members to contact her. Betsy will continue
working w/ HIP to prioritize and further develop some ideas/strategies.
Everyday Heroes Award
This award was proposed & developed by the Advisory Group, and last spring (2015) was the first time
the award was given out. The group discovered a number of “kinks” in the process, so at the 2016
January AG meeting, an ad hoc workgroup was formed to address the concerns. The revised materials
(process, nominating forms, timeline and ballot) were sent out to the AG members in advance of this
meeting. Maggie Domski reviewed with the group some of the changes made and the timeline.
The next awards will be presented in August 2016, in coordination with the WIC Regional meetings.
Information about the awards will be sent out in the WIC Wednesday Update on May 4th and included
in the CHS Mailbag. Nominations are due June 17th, and are to be sent to the AG regional
representatives. The group suggested that the new process be reviewed again after the August awards
are presented.
MN Breastfeeding Coalition (MBC)
Deb Boe is a member of the MBC steering committee, and also on the nominating committee for Board
members. She announced that MBC is seeking a Chair Elect and an At-Large member. She also
encouraged local breastfeeding coalitions to join MBC. For more information go to MN Breastfeeding
Coalition
USDA Infrastructure Grant Opportunity
USDA is accepting proposals for Infrastructure Grants in 6 program priority areas: strengthen program
integrity; improve child retention; increase breastfeeding rates; enhance participant access; facility
renovation and purchases; and food package modifications. The grants are competitive and funds must
be spent by September 30, 2017. Management Team asked the group for their suggestions: many
suggested focusing on child retention and enhancing participant access; several encouraged greater use
of technology for increasing and/or reducing barriers to participation (e.g., the appointment reminder
app; integrating the Release of Information into the information system; using technology to minimize
the need for participants to come to clinic; etc.); one suggested purchasing a mobile clinic (e.g., like
blood mobiles, or food trucks). Management Team will consider the feasibility of these and other ideas.
Proposals are due May 6th.
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Breastfeeding Peer Program
The MN WIC Program currently has 14 peer programs, covering 30 counties and 1 reservation.
(Four current AG members have peer program grants.) As with the WIC grant, programs
operate very differently from each other, serve very different areas (metro, suburban, rural;
some sparsely populated, others densely populated, etc.) and demographics. Unlike the WIC
grant (which is funded by a formula, $14.75/participant served), peer program grants are
funded more like other MDH grants – local agencies submit a budget, state WIC staff work w/
them on adjustments and decide on a funding level. Consequently, funding for these programs
varies considerably. The process of “negotiating” each grant is time consuming for both state &
local staff, and results in huge differences, not necessarily associated with caseload, per se. The
state agency is considering moving toward a funding formula, and asked for input form the AG.
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State agency / funding constraints: peer funding is relatively limited & for many years flat;
rather than distribute the funds across all agencies, we have invested in a limited number of
agencies based on applications & funds available; peer funds can be used only for peer program
activities (but LA WIC grants can be used to supplement peer activities); most of the other
states in our region use a formula and distribute funds across all agencies.
• LA costs vary largely due to:
o salaries for lead staff, IBCLCs, and peers – which the LA has little or no control over;
o “efficiency of scale” that large agencies experience, but small agencies don’t; some
programs have proportionately higher administrative/peer direct service costs;
o Peer staff turnover – is big and costly;
• Comments/suggestions:
o Most support some kind of formula, based on caseload (preg & BF women); “having a
formula and limiting grants, forces agencies to live within their means” – LAs have to
prioritize and choose how they will spend their money;
o Consider creating 2 or 3 caseload “tiers”; factoring in program outcomes (giving more to
agencies which are succeeding or to agencies who have greater challenges?);
language/interpreter needs, number of “health risk” served; additional funds for
programs requiring travel for training or for providing services
o Some suggested focusing the limited funds on a very limited number of the highest
need agencies or groups (e.g., African American, American Indian);
o Some cautioned us against “punishing the programs which are more efficient and costeffective”, and not continuing to support financially agencies which might not be as
efficient as they maybe could be.
o Suggested state consider establishing recommendations on minimum # hours/peer
and/or number of participants served/peer; requiring that no less than 50% of grant be
used for direct service. Perhaps requiring a funding match.
o To build LA capacity and/or address turn-over – establish a career path or ladder,
providing opportunities for peers (and other staff) to advance to achieving IBCLC
certification – maybe establishing scholarships, paying for BFg course, and/or the exam.
Such opportunities might incentivize peers to stay, and increase their commitment to the
program.
The state agency will consider these suggestions and develop some formula options for further
discussion with peer program leadership and among WIC Management Team.
UPDATES
WIC Budget: Based on our current budget, the “per participant rate” of $14.75 is sustainable through
the end of FFY16. We have requested additional funds through the reallocation and the infrastructure
grant process. Group discussed possible reasons for the drop in participation.
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Nutrition Education:
• Mailing voucher policy – As follow-up to previous AG discussions about different options for
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providing nutrition education (including online education), the state agency is reviewing the
Mailing Voucher policy in MOM, and considering expanding the situations in which vouchers
may be mailed. Next steps – review policy and revise as allowable; submit to USDA for approval;
and revise State Plan. Any changes will be communicated to and discussed with LAs; until then
the current policy is in effect.
Pilot testing tablets – As part of an Operational Adjustment (OA) project, the state agency
received funds for pilot testing tablets in 4 local agencies to use for showing video clips as part
of NE (e.g., showing clips of infant behaviors or an effective latch). The agencies are: Le Sueur,
Quin, Sherburne, and Olmsted. Timeline: April/May – local agencies will purchase tablets; June,
July and August - pilot test and assess using videos as part of NE; September - evaluate the pilot
and submit a final report.
Federal ME: In response to the state’s 2015 federal ME, three policies were revised and submitted to
USDA for approval:
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Fair Hearing Policy (MOM 1.13): Since the primary responsibility for fair hearings is the
state agency’s (not local agencies’), we added applicable references to MN Statutes and
State Administrative Rules that explain the procedures we will use in the event of a Fair
Hearing, and clarified which decisions can and cannot be appealed.
Timeframes for Scheduling Certification Appointments (MOM 3.2): Current policy is not
changing, but we clarified when the 10/20 day timeframes apply, and added guidance on
documenting the initial contact and first appointment offered.
Voucher Stock Inventory and Security (MOM 8.5): To clarify the need for separation of
duties and LA oversight regarding voucher stock security and inventory control, we
added guidance on involving two staff whenever practical.
Data Privacy (MOM1.7): The need for a WIC-compliant Release of Information is not
changed. We are considering various options for how LAs can meet the requirement in
ways that might be less burdensome.
e-WIC:
• Moving ahead with USDA-required planning documents – awaiting approval from USDA on our
Implementation Advance Planning Document, which will be the basis for our funding request.
• Preparing 3 procurements: 1) for an e-WIC service provider; 2) for a Project Manager; and 3) for
a QA contractor. Securing the e-WIC service provider will be the real “launch”…only after the
service provider is on contract will we be able to establish a planning and implementation
schedule. We expect to begin piloting sometime between late-2018 and early-2019. Question
about which LAs might be selected to pilot e-WIC: the contractor will help determine that, and it
will likely be based on store readiness. The biggest change will be for participants in the store,
not at clinic.
• The state agency will form a “clinic readiness group”, comprised of LA and state staff, as we did
when implementing HuBERT.
• E-WIC final rule was issued March 1st – which stipulated that State Agencies are
responsible for both the implementation and on-going costs of vendor card-readers
Vendor Rule Revision: Announcement published in State Register May 2nd
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Timeline: May – publish announcement; Aug – publish specific rules being proposed, and solicit
input; late 2017 – rules become effective
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Opportunities for commenting: meetings with WIC Vendor Advisory Group (which includes
large & small, chain & independent, and metro/non-metro stores, as well as a few LA
representatives); WIC Advisory Group; WIC regional meetings; and written comments can be
submitted any time before we publish the proposed rule in August, 2016. After receiving
comments and suggestions from a variety of stakeholders, we publish specific proposed rule
changes (this should occur in August 2016). The rule revision process takes about 1½ years.
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General concepts being reviewed:
o Minimum stock requirements – currently a two tier system (metro vs all others);
considering basing requirement on store redemptions;
o Number of authorized stores – considering tightening up on eligibility requirements, such
as: a) establishing a std. based on % food sales (to eliminate stores whose primary focus is
gasoline and/or tobacco); b) establishing a minimum space (sq. footage) for food.
o Cashier training – currently, we require stores to participate annually in a “train the
trainer” and that all cashiers must be trained. Considering adding requirement that all
stores have a “training plan” which includes how & when cashiers will be/are trained.
July 25th Meeting - Proposed agenda:
• Wednesday Update – enhancing its effectiveness
• FFY17 State Plan goals proposed
• Vendor Rules
• Hunger Impact Partnership
• Tablet Pilot Update
• Infrastructure Grants
• Processing Standards – Follow-up on options for documentation
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