WIC Operations Manual (WOM)


VII. Caseload Management

7.1.010 Outreach and Missouri WIC Logo

Authority: 2008 7 CFR 246.4(a)(7, 20), CFR 246.14(c)(3), 7 CFR 246.6(f), WIC Policy Memorandum #95-5: Allowability of Costs for Program Incentive Items

Issued: 01/1981

Revised: 10/2022

Policy:

The local agency (LA) shall have a written outreach plan appropriate to the population within the LA service area. The plan must include demographics for the area served and identify areas of potential need in the WIC-eligible population.

The LA shall have an active outreach and referral network within its service area that includes agencies and organizations which serve populations similar to WIC. The network must include the local Department of Social Services Family Support Division office. The LA will annually contact these community partners to provide updates about WIC, ensure the partner has the correct contact information to facilitate referrals to WIC and ask if the partner needs any additional WIC handouts or other information.

The LA shall update the outreach and referral network information at least annually to maintain accuracy.

The LA shall spend a minimum of 1% of their total FFY budget on WIC outreach.

The LA shall receive design and funding approval from the SA before purchasing any resources or printing materials. Approval of the outreach plan in the LAP does not include design approval unless the design is included in the LAP.

LAs operating in a hospital shall have a cooperative arrangement with the hospital that includes the permission to advise potentially eligible individuals that receive inpatient or outpatient prenatal, maternity or postpartum services or that accompany a child under the age of 5 who receives well-child services, of the availability of program services.

The nondiscrimination statement is required for all printed outreach materials. Refer to policy 11.1.020.

The LA shall use the Missouri WIC logo, provided by the WIC state agency (SA), on all resources (e.g., outreach or retention items, printed materials, signage, websites) paid for with WIC funds. 

Procedures:

  1. Creating the LA outreach and referral network.
    1. The network shall include the local Department of Social Services Family Support Division office.
    2. The network shall include other community agencies or organizations that serve similar populations.
    3. The network shall include other organizations and groups considered appropriate by the LA, such as local physicians, schools, religious organizations.
    4. The LA may request the SA to provide guidance and materials to assist with their outreach efforts.
  2. Providing community partners with up-to-date materials:
    1. Materials shall describe program benefits, potentially eligible participants and include the name, address, phone number, website or email address of the LA.
    2. Materials shall include the Missouri WIC logo.
    3. The nondiscrimination statement is required for all printed outreach materials. Refer to policy 11.1.020.
      1. Some outreach items may not have room for the statement, for instance, giveaway items like milk cups.
      2. Outreach resources must have the Missouri WIC logo and LA contact number, at a minimum.
        1. With smaller items, the LA name plus WIC or just WIC can be substituted for the logo.
  3. Outreach targeting:
    1. Outreach should target all eligible individuals.
    2. The LA shall use US Census, WIC management reports, WIC MICA data, community resources, geo-maps and other data bases.
    3. The LA may consult with the SA to ensure an appropriate target population and adequate methods.
  4. Funding:
    1. The LA shall request funding in the local agency plan (LAP).
    2. The LA shall charge the costs of conducting outreach in the following LAP locations.
      1. Personnel compensation of conducting outreach activities shall be included in program management hours. Refer to policy 5.1.020 and 5.1.030.
      2. Travel for outreach activities shall be labeled as outreach. Refer to policy 5.1.060.
      3. All other costs associated with outreach activities shall be listed under administrative office costs in the LAP. Each activity should be entered as individual line items to help with invoicing purposes. Refer to policy 5.1.090.
    3. Additional funding, when available, may be used for special outreach initiatives as appropriate and approved in the LAP. Refer to policy 5.1.140.
  5. Documenting Outreach:
    1. The LA shall provide a detailed outreach plan in the LAP.
      1. The plan shall be completed on the outreach plan template provided by the SA.
    2. The LA shall keep a file of all outreach materials used and document the completed activities on the outreach plan template in the fields provided. These shall be retained at the LA for monitoring and compliance verification.
      1. Monitoring and compliance verification shall be conducted throughout the FFY.
  6. Missouri WIC Logo:
    1. Items purchased with WIC funds: If LAs choose to include a logo on resources (e.g., outreach or retention items, printed materials, signage, websites) purchased using WIC funds, they must prominently use the current MO WIC logo. The item may have an individualized LA WIC logo as well, but the Missouri WIC logo must be prominently displayed. If there is not room for multiple logos, the Missouri WIC logo must be selected for printing. Prominent use of the Missouri WIC logo means that the Missouri WIC logo will be printed at least the same size as an individualized WIC LA logo.
    2. Items purchased with OTHER funds: If LAs are not using WIC funds for resources (e.g., outreach or retention items, printed materials, signage, websites), they may use an individualized LA WIC logo with or without the Missouri WIC logo.
    3. Items previously printed with individualized LA logos: If an LA has resources (e.g., outreach or retention items, printed materials, signage) without a prominent Missouri WIC logo, those items may continue to be used to depletion and do not need to be discarded. Reasonable attempts shall be made to use these resources prior to the end of FFY 2024.

7.1.020 Contracted Caseload Participation

Authority: 2008 7 CFR 246.16 (d)(2)

Issued: 03/1989

Revised: 10/2009

Policy:

The local agency (LA) shall contract to serve the state agency (SA) projected annual caseload budgeted in the local agency plan (LAP).

The LA shall provide a written request to the SA prior to a planned reduction in service for any purposes deemed necessary by the LA. Such request must be submitted sixty (60) days prior to the implementation and must include a plan for achieving the caseload reduction.

Procedures:

  1. The SA projects an annualized caseload of participants to be served for each LA based upon:
    1. Current rate of increase or decrease of LA participants served.
    2. LA's share of statewide caseload based on SA percent of historical LA performance projections, including projected growth or decline based on anticipated funding.
  2. The LA shall develop a LAP that describes how the agency will provide efficient, quality service to the allocated caseload.
  3. Each month the participant data system counts all of the following participants who receive program benefits.
    1. Women, infants, and children for whom a full or pro-rated food package is issued.
    2. Breastfed infants who did not receive a food package because their mothers requested no supplemental formula.
    3. Partially breastfeeding women, who requests after 6 months postpartum, more than the maximum of formula allowed for a partially breastfed infant will no longer receive a food package but continues to be counted as a WIC participant.
  4. The SA reserves the right to reallocate funds based on cumulative caseload of participants served documented in the WIC program data system and projected caseload of participants served. Caseload participation is defined as the number of program participants served during the contract year.
    1. The SA may adjust the annualized contract caseload participation with either an increase or decrease based on a review of participants served at the end of each quarter or more frequently.
      1. Any increase or decrease in caseload participation shall be communicated in writing.
      2. The LA will be allocated an annualized caseload and reimbursed based on actual expenditures during the month, not to exceed the per participant rate for each participant receiving service as stated in the contract.
      3. Reviews of the caseload served and projected may result in contract caseload funding adjustments.
    2. The LA shall provide a written request to the SA prior to a planned reduction in service for any purposes deemed necessary by the LA. Refer to 11.1.040.
      1. Such request must be submitted sixty (60) days prior to the implementation and must include a plan for achieving the caseload reduction.
      2. Upon written approval by the SA, the LA is responsible for notifying current WIC participants and other affected LAs of the proposed caseload reduction and completing the work to transfer participants.

7.1.030 No Shows: Follow Up

Authority: 2008 7 CFR246.6 (b)

Issued: 02/1991

Revised: 01/2011

Policy:

The local agency (LA) shall attempt, at least monthly, to follow up on no-show applicants and participants to reschedule missed appointments.

The LA shall attempt to contact each prenatal applicant who misses her initial appointment to apply for participation in the WIC program within five calendar days of the original appointment in order to reschedule the appointment and shall document such contacts or attempted contacts.

Procedures:

  1. The LA shall send appointment reminders with information of the required documentation at the discretion of the Agency.
  2. Failure to Keep Appointment
    1. Responsibility for follow up lies with the LA staff at each agency. Follow up with phone calls/appointment notices will be conducted for all appointments as much as possible. The following steps will be taken for those failing to keep appointments for food instrument pick-up, certification or recertification.
      1. LA shall attempt to contact all prenatals who miss their appointment within five days to reschedule their appointment at the earliest possible date.
      2. LA will contact as many other participants as possible to reschedule their missed appointment. Missed appointment notices (letters or postcards) will be mailed to those who cannot be reached or do not have phones.
      3. Follow up activity will be documented in MOWINS in either the Appointment Follow-up screen after the appointment is missed or in the general notes of the participant folder to prove timeframes were met and follow-up was attempted. Refer to 8.1.110 for timeframes.
      4. When using the MOWINS scheduler, a list of missed appointments can be printed from the Missed Appointment Follow Up selection under the activities menu in the participant list. Categories can be selected to assure timeframes are met.
  3. End of Month Follow Up
    1. By the end of each month, the follow up report should be reviewed by the LA to identify further action needed. Appropriate contact will be made to those remaining clients who have failed to keep their appointments.
      1. Participants who do not pick up food instruments for two consecutive months or have failed to recertify for 31 days past their certification due date who are not in a new certification will be changed to inactive status from the active MOWINS files.
      2. If the participant returns for an appointment and is still within certification timeframe, the inactive status will be updated on the computer to reflect “reinstated” status and food instruments will be issued.

7.1.040 Waiting Lists

Authority: 2008 7 CFR 246.7(f) (1) & FNS Instr. 803-6

Issued: 03/1981

Revised: 10/2009

Policy:

The local agency (LA) shall establish waiting lists only when/if the contracted year-to-date caseload percentage equivalent is exceeded and when no contract amendment to increase the caseload allocation can be authorized by the SA.

The LA shall establish and maintain waiting lists in accordance with the priority ranking system.

The LA shall explain to applicants why placement on a waiting list is necessary and shall explain the realistic possibilities of receiving future benefits. This must be done within 20 days of the applicant's visit to the LA to request program benefits. LA may not refuse to place any applicant on a waiting list if the applicant requests to be placed on such a list.

For participants due for recertification, the LA shall reassess and determine eligibility status for current priority or sub-priority being served. The LA shall not place on a waiting list any transfer requests whether they come from another state with a valid verification of certification (VOC) or from another LA in Missouri.

When caseload opening occurs at the LA, the agency shall contact applicants on the waiting list to schedule certification appointments or food instrument issuance/nutrition education appointments.

Procedures:

  1. Waiting lists are not needed for any priority or sub-priority closed statewide unless placement on one is requested by a participant or applicant.
  2. Prior to requesting to establish a waiting list, the LA must:
    1. Track the contracted year-to-date caseload percentage equivalent on the Participant Totals Report.
    2. Determine the projected caseload for the remainder of the fiscal year.
    3. Consult with the state technical assistance (TA) team regarding available funds to reallocate caseload to the LA.
    4. Determine which priorities and/or sub-priorities the LA can continue to serve, based on factors including, but not limited to:
      1. Current caseload characteristics such as:
        1. Percentage in each priority and sub-priority.
        2. Percentage of women, infants and children served.
        3. Size of age groups served for children.
      2. Agency no-show rates.
      3. New and recertification appointments scheduled for the next thirty to ninety days.
  3. If funds for reallocation are not available, the state TA team will provide the LA written approval to establish a waiting list. Such approval will include which priorities and subpriorities will go on the waiting list.
  4. When approved to establish a waiting list, the LA shall:
    1. Screen the applicant for residency and income eligibility.
    2. Screen the applicant for anthropometric, biochemical, and physical/medical problems.
      1. If medical data (height, weight, and hemoglobin/hematocrit values) are available, the presence of an anthropometric, biochemical, or physical/medical risk can be assessed, which would place the applicant in a higher priority category than if only a dietary inadequacy were present.
      2. If the applicant applies for program benefits without the medical information necessary to determine an anthropometric, biochemical, or physical/medical risk, s/he will be placed on the appropriate lower priority waiting list for those persons having dietary risks only. Self-reported information on past or current medical problems may be accepted by the LA for purposes of assessing the applicant's potential priority.
      3. A dietary assessment may be performed, but is not required to determine the individual's potential priority.
    3. Place the applicant on a waiting list according to his/her potential priority in chronological order of application. For priority assignment, refer to the WIC priority ranking system in the federal regulations CFR 246.7(e) (4).
    4. Inform the applicant, either verbally or in writing, that s/he has been placed on a waiting list. This must be done within 20 days of the applicant's visit to the LA to request program benefits.
    5. For participants due for recertification, the LA shall reassess and determine eligibility status for current priority or sub-priority being served.
      1. If determined eligible for a priority or sub-priority being served, will continue to be served.
      2. If determined eligible for a priority or sub-priority not being served, will be placed next in line on waiting list.
    6. The LA shall not place on a waiting list any transfer requests with a valid VOC. Whether they come from another state or another LA in Missouri, the LA shall serve these persons regardless of priority or sub-priority.
  5. The following waiting lists may be established if authorized in the following order:
    1. Priority seven recertified participants. A health assessment is required to determine placement in this priority. Sub-prioritization shall be done in the following order (lowest to highest), as needed:
      1. Non-breastfeeding postpartum women with nutritional status regression.
      2. Children with nutritional status regression.
      3. Breastfeeding women with nutritional status regression.
      4. Homeless or migrant status.
    2. Priority six applicants and participants potentially eligible in this priority.
    3. Priority five certified or recertified applicants and participants. (A health assessment is required to determine placement in this priority). Sub-prioritization shall be done in the following order (lowest to highest), as needed:
      1. Children who have reached their fourth, but not their fifth birthday.
      2. Children who have reached their third, but not their fourth birthday.
      3. Children who have reached their second, but not their third birthday.
      4. Children who have reached their first, but not their second birthday.
    4. Priority four (4) applicants and certified or recertified applicants and participants. (A health assessment is required to determine placement of all except prenatal certified with risk factor 503 (presumptive eligible) in this priority.) Subprioritization shall be done in the following order (lowest to highest), as needed.
      1. Breastfeeding women.
      2. Infants.
      3. Prenatal.
    5. Priority three applicants and participants. Sub-prioritization shall be done in the following order (lowest to highest), as needed.
      1. Children who have reached their fourth, but not their fifth birthday.
      2. Children who have reached their third, but not their fourth birthday.
      3. Children who have reached their second, but not their third birthday.
      4. Children who have reach their first, but not their second birthday.
  6. The waiting list shall include, at a minimum, the following information:
    1. Name of applicant or participant.
    2. Name of guardian for infant or child.
    3. Mailing address.
    4. Phone number, message phone, or other method by which agency can contact applicant.
    5. Date(s) applied and/or placed on the waiting list.
    6. Category (i.e. woman & condition, infant, child).
    7. Date of birth.
    8. Expected date of confinement (EDC) for prenatal.
    9. Delivery date for postpartum.
    10. Potential priority.
  7. When caseload opening occurs at the LA, the agency shall contact applicants on the waiting list to schedule certification appointments or food instrument issuance/nutrition education appointments if prior health assessment already established eligibility.
    1. Contact applicants by telephone or letter, starting with those individuals on the highest priority waiting list.
      1. Telephone call must:
        1. Be received directly by the adult applicant, the participant or guardian of an infant or child.
        2. Schedule an appointment.
        3. Inform of removal from the waiting list if the appointment is not kept.
        4. If a message must be left for the responsible party, the LA shall follow-up with a second telephone call or with written notification.
      2. Written notification must:
        1. Include the LA return address and telephone number.
        2. Inform of the opportunity to schedule an appointment.
        3. Request a response either in writing or by phone within two (2) weeks of the date the notification is postmarked.
        4. Inform of removal from the waiting list if no response is received.
    2. After all applicants on the highest priority waiting list have been contacted, proceed to other lists in order of priority.

      Example: A LA which has been maintaining waiting lists for priorities six and seven now has 25 spaces available for enrollment. The LA would begin contacting applicants from the priority seven waiting list. After all priority seven applicants had been contacted for a certification appointment, the LA would proceed to priority six (6) waiting list.
    3. If a LA does not have sufficient caseload available to enroll all applicants within a priority, the LA may enroll applicants on a first-come, first served basis or on the basis of the severity of the risk factors, as determined by the LA nutritionist/CPA.
    4. If an applicant fails to keep the scheduled certification appointment, s/he shall be removed from the waiting list.
  8. A current participant whose priority is lower than applicants on the waiting list shall be disqualified at the end of the current certification period in order to make space available for higher priority applicants. The participant shall then be placed on the appropriate waiting list for his/her priority ranking if the agency reasonably expects to serve that priority in the future.

7.1.050 Clinic Access

Effective: 10/2025

Issued date: 10/2003

Authority references: 2025 7 CFR 246.4(a)(22) and (23); 246.7(b)(2) and (b)(4); 246.7(f)(2)(iii)(A); WIC policy memo 92-1A; ARPA Physical Presence Waiver 2023

Policy:

The local agency (LA) must ensure that employed applicants, participants, authorized representatives, alternate representatives and proxies have access to clinics that require minimal time expenditures.

The LA must ensure that applicants, participants, authorized representatives, alternate representatives and proxies who live in areas with little or no public transportation have access to clinics that require minimal travel distance.

The LA must implement one or more of the practices detailed in the procedures below to minimize time and distance.

The LA must evaluate and address clinic access annually.

Procedures:

  1. Providing clinic access.
    1. When scheduling appointments, the LA must inform all applicants, participants, authorized representatives, alternate representatives and proxies of appointments that:
      1. Minimize loss of employment time.
      2. Minimize travel distance and transportation barriers.
      3. Meet processing time frames. Refer to policy 8.1.110.
  2. Providing additional clinic access options.
    1. The LA must have in place one or more of the following practices to minimize time and distance:
      1. Schedule and serve individuals by appointment, even if the LA normally does not give appointments.
        1. This does not prohibit serving those without appointments (i.e., walk-ins), but places scheduled appointments ahead of walk-ins.
      2. Allow individuals to be served at the LA of their choosing.
      3. Allow participants who are not high risk to receive food benefits on a bi-monthly or tri-monthly basis.
      4. Allow the authorized representative to send an alternate representative for certification of an infant or child. Refer to policy 8.1.190.
      5. Provide clinic opportunities outside of normal business hours, such as:
        1. Before 8 a.m.
        2. Between noon and 1 p.m. (i.e., coverage over lunchtime).
        3. After 5 p.m.
        4. On a Saturday once or twice a month.
      6. Have clinics no more than 30 miles from any part of the service area.
      7. Have clinics near or on public transportation lines, if applicable or available.
      8. Provide WIC services at specific locations that may include, but are not limited to, major employers, daycare centers or schools.
      9. Implement mobile units that allow clinic access at various locations.
      10. Offer remote certification appointments and services.
      11. Refer to policy 8.1.280.
      12. Other options as approved by the state agency (SA) technical assistance (TA) staff.
  3. Maintaining clinic accessibility.
    1. The LA must maintain routine clinic hours to ensure applicants, participants, authorized representatives, alternate representatives and proxies are aware of when they can receive WIC clinic services.
      1. The LA must notify the SA of unexpected changes to the clinic hours (e.g., clinic closings due to inclement weather, structural building issues, WIC staff training or lack of WIC staff).
      2. The LA must notify the SA administrative TA staff of all other clinic changes. This may include but is not limited to, street name changes without a change in physical location or increases to clinic days or hours.
        1. The LA must complete the appropriate Civil Rights Impact Analysis Form. Refer to policy 11.1.040.
      3. The clinic hours must be the same every month unless the SA is notified of unexpected changes, or the appropriate Civil Rights Impact Analysis Form is approved.
  4. Evaluating clinic access.
    1. The LA may use the following methods to evaluate clinic access:
      1. Survey applicants, participants, authorized representatives, alternate representatives or proxies to reevaluate clinic access and more effectively meet their needs.
      2. Survey public sites, population sites and public transportation to see what services are available to reduce barriers to WIC services.
      3. Survey city/county census data and/or the public to identify areas of need that should be considered for clinic access in the future.

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