Impact of CHIP on WIC Adjunct Income Eligibility

This policy memorandum clarifies the impact of the new Children's Health Insurance Program (CHIP) on WIC adjunct income eligibility.

WIC Adjunct Income Eligibility

Section 17(d)(2)(A) of the Child Nutrition Act of 1966 (CNA) sets forth provisions whereby certain individuals are adjunctively income eligible for WIC. The CNA provides that an individual, regardless of income, shall be deemed income eligible for WIC if she/he is eligible to receive Food Stamp Program benefits, Temporary Assistance for Needy Families (TANF), assistance under the Medicaid program (Title XIX of the Social Security Act), or is a member of a family in which a pregnant woman or infant (not a child) receives Medicaid assistance. These individuals must meet all other WIC eligibility criteria, i.e., residency, category, and nutritional risk, to participate in WIC.

CHIP Options

Authorized by the Balanced Budget Act of 1997, PL 105-33, Title XXI of the Social Security Act created CHIP to provide health assistance to uninsured children (from birth up to age 19) who are not eligible for Medicaid benefits. Several options are available to states in implementing CHIP. A state may use its CHIP funds to (a) expand its Medicaid program, (b) establish a separate child health insurance program, or (c) create a combination of the two strategies. The option selected by a state will affect the WIC adjunct income eligibility for program applicants, as described below.

If a state chooses option (a), expanding its Medicaid program to provide health insurance to an expanded population of children, those children are considered Medicaid participants and are eligible to receive assistance under Title XIX of the Social Security Act. Children temporarily certified for the Medicaid program -- an option states can implement under the Medicaid program for pregnant women, infants and now children ;(commonly known as presumptive eligibility determination) -- are also considered Medicaid participants and eligible under Title XIX. Therefore, if WIC applications are submitted for these children and documentation is provided or obtained proving their eligibility for Medicaid, such children are adjunctively income eligible for WIC.

Under the authority of Title XXI, if a state chooses option (b) -- establishing a separate children's health insurance program -- children participating in that program are not adjunctively income eligible for WIC. WIC adjunct income eligibility does not convey to Title XXI child health insurance program eligible children.

If a state chooses option ( c ), a combination of options ( a) and (b ), only those children eligible to participate under the Medicaid program who apply for WIC are adjunctively income eligible for WIC. Those children who are eligible to participate in a separate child health program who apply for WIC are not adjunctively income eligible for WIC. The WIC state agency should coordinate with the Medicaid/CHIP state agency to ensure a system exists which identifies children eligible to participate in the federal Medicaid program and who will be deemed adjunctively WIC income eligible as a result. WIC agencies must be able to distinguish an individual eligible for the state's Medicaid program from a state's separate health insurance program in order to convey WIC adjunct income eligibility based on Medicaid eligibility to the appropriate individual.

Automatic Income Eligibility

A WIC state agency may still deem individuals automatically income eligible for WIC based on their or a family member's eligibility to participate in state-administered programs as permitted in Section 246.7(d)(2)(vi)(B) of the WIC regulations. Under this option, such state-administered programs must use eligibility guidelines at or below 185 percent of poverty and routinely require documentation of income. This option could also be used to determine a family member automatically income eligible for WIC based on a child's eligibility to participate in a state-administered program as long as the WIC income and documentation requirements are met.

Traditional Income Eligibility Screen

If an applicant is not adjunctively or automatically income eligible, WIC clinic staff need to determine income eligibility using traditional income eligibility screening procedures. These procedures include determining family income, family size and comparing this information to the maximum WIC income eligibility guidelines to determine if the applicant's family income is at or below WI C's income limit.

Potential Caseload Implications

Implementation of CHIP, particularly in states that are approved by DHHS to expand their Medicaid programs using eligibility guidelines above WIC's income guideline of 185 percent of poverty, may result in an increased demand for WIC services and benefits. If the demand for WIC exceeds available funds, WIC agencies may need to establish waiting lists of persons who cannot be served. When waiting lists are maintained, WIC agencies must use the nutritional risk priority system to provide WIC benefits first to those at greatest nutritional risk. Further, current WIC policy, FNS Instruction 803-2, Revision 1, permits WIC agencies, within the priority groups, to sub-prioritize based on income or other sub-priority levels. Sub-prioritizing based on income would ensure that WIC is provided first to those at greatest nutritional risk with the lowest incomes. Revised waiting list procedures must be approved by the appropriate regional office prior to implementation.

PATRICIA N. DANIELS
Director
Supplemental Food Programs Division