Food Package
g for
Qualifying Conditions
Presenters
Denise Gearhart
Gearhart, MS
MS, RD
Contractor, Michigan WIC Program
Kristen Hanulcik
Hanulcik, MPA
MPA, RD
Nutrition Consultant, Michigan WIC Program
Food Package for Qualifying Conditions:
O tline
Outline
•
•
•
•
•
Policy 7
7.03:
03: Food Package for Qualifying
Conditions
MI--WIC Implementation
MI
Staff, Client & Health Provider Resources
Break
Q
Questions
Food Package for Qualifying Conditions
Objectives
• Describe the food package for qualifying
conditions
• Describe the medical documentation process
• Understand the MIMI-WIC implementation
changes
• Identify and locate staff, client, and health
provider resources
p
Changes
g in Terminology/Process
gy
OLD
NEW
Prescription or
Medical Justification for
Medical
Alternative Formula form………..Documentation form
Di
Diagnosis
i ……………..…………Qualifying
…………….. …………Qualifying
Q lif i C
Conditions
diti
New Terminology
gy
Formula Types
Category of Formula
Class I formulas…………...Contract formulas
Class II formulas………......Exempt infant formulas
Cl
Class
III fformulas………….Exempt
l
E
t infant
i f t formulas
f
l
and WICWIC-eligible
medical foods
Why Do We Need Qualifying Conditions
and
dM
Medical
di l D
Documentation?
i ?

It is a federal requirement

To provide WIC formulas for specific medical
and developmental conditions

To improve communication and coordination of
client services between WIC staff and health
care providers
Policy 7.03: Food Package for
Qualifying Conditions

Women, infants and children who have:
• A documented qualifying condition that
requires use of a WIC formula because use of
conventional foods is p
precluded, restricted, or
inadequate to address their special nutritional
needs.
What are the Qualifying Conditions?










premature birth
low birth weight
failure to thrive
inborn errors of metabolism and metabolic disorders
gastrointestinal disorders
malabsorption syndromes
immune system disorders
severe food allergies that require an elemental diet
life threatening disorders, and
diseases and medical conditions that impair ingestion,
digestion, absorption or utilization of nutrients that could
adversely affect nutritional status
status.
What is NOT a Qualifying Condition?
This food package is NOT authorized for:
Any Client

S
Solely
f the purpose off enhancing nutrient intake or
for
managing body weight without an underlying qualifying
condition.
Women and Children

Food intolerance to lactose or milk protein that can be
successfully managed with the use of one of the other
WIC food
f d packages.
k
What is NOT a Qualifying Condition?
This food package is NOT
authorized for:
Infants

Only condition is a diagnosed formula
intolerance or food allergy to lactose,
sucrose,, milk protein
p
or soy
yp
protein
that does not require the use of an
exempt infant formula.

Non-specific formula or food
Nonintolerance.
Food Package for Qualifying Conditions
Clients can receive the same foods and
amounts of the maximum food package in
addition to WIC formula if prescribed by their
health care provider.
p
Michigan WIC Formulas
 Class I formulas (contract formulas)
• Enfamil AR LIPIL
• Enfamil LIPIL with Iron
• Gentlease LIPIL
• Prosobee LIPIL with Iron
Michigan WIC Formulas
 Class II formulas (exempt infant
formulas)
• Nutramigen
g
LIPIL
• Nutramigen LIPIL with Enflora
LGG
• Pregestimil LIPIL
• Similac
Si il Ali
Alimentum
t
Michigan WIC Formulas
 Class III formulas ((exempt
p infant formulas and
WIC--eligible medical foods)
WIC
• Refer to handout: Michigan WIC Authorized Formulas
(Effective August 1, 2009)
• List revised to remove discontinued products &
products not used,
used as well as add new products
• New products include:
- Boost Kid Essentials (retail version)
- Enfaport
E f
t
- Peptamen Jr. Fiber
p
Jr. 1.5
- Peptamen
Infants

With a qualifying condition may be
issued exempt infant formulas or
WIC--eligible medical foods (Class
WIC
II or III) with medical
documentation.

6 thru 11 months may receive
formula ((Class II or III)) in place
p
of
supplemental foods at the same
maximum monthly allowance as
i f t 4 through
infants
th
h 5 months
th off age.
Food Package for Qualifying Conditions
Foods
Partially Breastfed Infants (IBP)
A: During the first month
B: 1-3 months
C: 4-5 months
Partially Breastfed
Infants (IBP)
6-11 months
WIC
Formula
A: Up to 104 fl oz reconstituted
powder
312 fl oz
reconstituted liquid
concentrate
or
320 fl oz RTF
or
384 fl oz
reconstituted powder
B: 364 fl oz reconstituted liquid
concentrate or 384 fl oz RTF or
435 fl oz reconstituted powder
C: 442 fl oz reconstituted liquid
concentrate or 448 fl oz RTF or
522 fl oz reconstituted powder
Infant cereal
0
24 oz
B b food
Baby
f d
fruits and
vegetables
0
128 oz (32
32--4 oz jars)
j )
Food Package for Qualifying Conditions
Foods
Fully Formula Fed Infants
(IFF)
A: 00-3 months
B: 4
4--5 months
Fully Formula Fed
Infants (IFF)
6-11 months
WIC Formula
A: 806 fl oz reconstituted
liquid concentrate or 832
fl oz RTF or 870 fl oz
reconstituted powder.
624 fl oz
reconstituted
li id
liquid
concentrate or
640 fl oz RTF or
696 fl oz
reconstituted
powder.
B: 884 fl oz reconstituted
liquid concentrate or 896
fl oz RTF or 960 fl oz
reconstituted powder.
Infant cereal
0
24 oz
Baby food fruits and
vegetables
0
128 oz (32(32-4 oz
jars)
Formula for Women and Children

Women and children with a qualifying condition
may receive a WIC formula and supplemental
foods with medical documentation.

910 fl oz of reconstituted liquid concentrate per
month in addition to supplemental foods.

Powder and readyready-to
to--feed formula may be
substituted for liquid concentrate formula at rates
that provide comparable nutritive value.
Food Package for Qualifying Conditions
Foods
Children (1 through 4 years)
Juice
128 fl oz
WIC Formula
910 fl oz reconstituted liquid concentrate
Milk
13 qt
Cheese
1 lb (maximum allowed without medical
documentation)
Breakfast cereal
36 oz
Eggs
1 dozen
Fresh fruits and vegetables
$6.00 cash value
Whole wheat bread/tortillas
2 lb
Legumes
Or Peanut butter
1 lb dry or 64 oz canned
Or 18 oz
Food Package for Qualifying Conditions
Foods
Pregnant Women (PG) and Partially
Breastfeeding Women (BP) Up to 1 Year
Juice single
Juice,
strength
144 fl oz
WIC Formula
910 fl oz reconstituted liquid concentrate
Milk
19 qt
Breakfast cereal
36 oz
Eggs
1 dozen
Fresh fruits and
vegetables
$8.00 in cash value
Wh l wheat
Whole
h t
bread/tortillas
1 lb
Legumes,
And Peanut butter
1 lb dry or 64 oz canned
And 18 oz
Cheese
1 lb (max. allowed without medical documentation)
Food Package for Qualifying Conditions
F d
Foods
P t t
Postpartum
Women
W
(NPP) and
d Breastfeeding
B
tf di
Women of Infants (BP) Receiving More Than the
Maximum Amount of Formula for Partially Breastfed
Infants (IBP) (Up to 6 Months)
Months).
Juice, single strength
96 fl oz
WIC Formula
910 fl oz reconstituted liquid concentrate
Milk
13 qt
Breakfast cereal
36 oz
E
Eggs
1d
dozen
Fresh fruits and
vegetables
$8.00 in cash value
Whole wheat
bread/tortillas
0
Legumes,
Or Peanut butter
1 lb dry or 64 oz canned
Or 18 oz
Cheese
1 lb (max. allowed without medical documentation)
Food Package for Qualifying Conditions
Foods
Exclusively Breastfeeding Women (BE) and Partially
Breastfeeding Women of Multiple Infants Up to 1 Year
Postpartum and Pregnant Women of Multiple Fetuses
Juice, single
strength
144 fl oz
WIC Formula
910 fl oz reconstituted liquid concentrate
Milk
18 qt
Breakfast cereal
36 oz
Eggs
2 dozen
Fresh fruits and
vegetables
$10.00 in cash value
Whole wheat
bread/tortillas
1 lb
1 lb dry or 64 oz canned
Legumes,
And Peanut butter And 18 oz
Tuna
30 oz
Cheese
3 lb (maximum allowed without medical documentation)
Whole Milk Substitution with
Q lif i Conditions
Qualifying
C diti

Women and children 24 months and older with a
qualifying condition that requires the use of a WIC
formula (Class II or Class III) may receive whole milk
in place of reduced fat or skim milks
milks.
Cheese Substitution with Qualifying
C diti
Conditions


Women and children with
lactose intolerance, milk
allergy, severe lactose
maldigestion or other
qualifying conditions
With medical
documentation, cheese
may be substituted up to
the maximum allowance for
fluid milk
Maximum Cheese Substitution with
Q lif i Conditions
Qualifying
C diti

Cheese may be substituted for fluid milk not to
exceed a monthly allowance of :
 5 lb for children and ppostpartum
p
women
 7 lb for pregnant and partially breastfeeding
women
 8 lb for exclusively breastfeeding women (9 lb
total)
 12 lb for women exclusively breastfeeding
multiple infants ((13.5 lb total).
)
Medical Documentation Requirements

A health care provider’s
prescription form will not
be accepted in place of
th required
the
i d medical
di l
documentation form.
Medical Documentation Requirements

Must be made by a licensed health care provider (MD or
DO).

Form DCH
DCH--1326 or DCHDCH-1327.

May be on an original written document or faxed copy.

May be telephoned to a CPA only when absolutely
necessary.

W itt confirmation
Written
fi
ti mustt be
b provided
id d att the
th local
l
l clinic
li i
within two weeks.
Medical Documentation Must Include
 WIC formula, including amount needed per day
 Authorized
A h i d supplemental
l
l ffoods
d and
d their
h i prescribed
ib d
amounts
 Length of Use
 Qualifying
Q lif i conditions
diti
 Signature, date and contact information of the health
care provider
Medical Documentation Requirements

Scanned into the clients record.

Amounts prescribed not to exceed the maximum
allowance.
allowance

Renewed at least everyy 6 months.

Include authorized supplemental foods allowed or
milk
ilk substitutions
b tit ti
(i.e.
(i cheese
h
and
d whole
h l milk).
ilk)
Coordination of Services

For WIC clients also
enrolled
ll d iin CSHCS or
Medicaid and the formula is
one which may be
authorized by these
programs
p
g
under certain
conditions, then WIC
should collaborate with
them to ensure the
nutritional needs of mutual
clients are met
met.
Medical Documentation Forms
& Approvals
pp
Needed
WIC Formulas and Milk
Substitutions
CPA
Approval
Class I Formula (children)
X
Class II Formula (infants)
X
Class II Formula (children and
women)
X
Class III Formula (women,
infants, and children)
Whole Milk Substitution with
Class II Formula
X
X
Whole Milk Substitution with
Class III Formula
Maximum Cheese Substitution
Local Agency Authorized
RD or MDCH RD
X
X
MI--WIC Implementation
MI

Required Fields: Expiration Date
– For Class I ((if child),
), II,, and III formulas

Alert
– For infant 66-11 months old receiving Class II or Class
III formula and not receiving infant foods.
 Option to assign the maximum formula allowed for
a 44-5 month old

Validation
– To
T assign
i a food
f d package
k
with
ith whole
h l milk
ilk tto a
woman or child 2 years or older, a Class II or Class
III formula must be included in the package
MI--WIC Implementation
MI

MI-WIC will calculate formula maximums in each
MIfood p
package
g according
g to the infant’s age
g
range and category and based on the
manufacturers reconstituted amount for powder
formula.
MI--WIC Implementation
MI

BP Woman
• When a BP woman with an IBP 11-5 months
old is assigned an NPP package, the infant
can receive more formula than the IBP
maximum.
maximum
• When a BP woman with an IBP 66-11 months
old does not receive food benefits, the infant
can receive more formula.
Staff Resources
•
•
•
•
Spotlight:
p g
Improved
p
Services to Clients with
Qualifying Conditions
WIC Policy 7.03 (Food Package for Qualifying Conditions)
Dujour, MIMI-WIC Helpline
Forms and Information on WIC website:
www.michigan.gov/wic
Click on “New WIC Foods” and scroll down to Local
WIC
C Agencies
• Medical Documentation Forms for Physician, including
Instructions
• List of Authorized WIC Formulas
Client Resources
Shopping List
• Food Card and vignettes on WIC website:
(Go to “New WIC Foods”, WIC Families)
•
• Overview
O
i
video
id vignette
i
tt – English
E li h on website,
b it
Spanish & Arabic will be posted and sent on
DVDs to Local Agencies
• Video vignettes on Fruits & Vegetables and
Whole Grains will be posted on website and
sent as DVDs to Local Agencies
•
wichealth.org
Health Providers Resources

Forms and Information on WIC website
(Go to “New WIC Foods”, scroll to Medical
Providers)
– New Medical Documentation requirements
(including forms and instructions)
– List of Authorized WIC Formulas
– Qualifying
Q lif i Medical
M di l Conditions
C diti
Health Provider Communications




WIC
C Division
s o information
o at o to be se
sentt to Family
a y
Physician, Pediatric, and Primary Care
Associations for their member e
e--newsletters.
Ph i i memo and
Physician
d forms
f
posted
d on WIC
website
Local agencies may direct physicians to website
if needed
Physicians will be directed to contact WIC
Division or local WIC agency for more
information
Reminder…....
Reminder

Do not schedule WIC clinics on Saturday,
Saturday
August 1, 2009.

If you already have a clinic scheduled on
th t S
that
Saturday,
t d
please
l
contact
t t clients
li t tto
reschedule.
WIC provides improved coordination of
services
i
to
t clients
li t with
ith qualifying
lif i conditions
diti
15 Minute Break – Will Return Shortlyy
Food Package for Qualifying Conditions