Impacts of Pandemic-Era WIC Policy Changes on Participation Rates: A Quasi-Experimental Study

• In Event: Nutrition Assistance Policies: Changes, Participation, and Health Outcomes

Abstract

Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an important US safety net program for low-income households that provides food assistance and nutrition education for pregnant and postpartum women and children under 5. WIC is associated with improved health outcomes, but only about half of the eligible individuals participate in the program. State policy changes implemented during the COVID-19 pandemic aimed to increase WIC access, but few studies have examined the associations between these policies and WIC participation rates across US states. This study examined associations between state-level WIC policy changes and WIC participation rates among women, children (ages 1-4), infants, and overall.

Methods: We used national administrative data on WIC participation rates from January 2017 through March 2021 and a quasi-experimental difference-in-differences approach (N=2,550 state-months). The policy changes included allowing remote benefit issuance, extending certification periods, waiving medical documentation requirements, allowing fewer WIC staff members needed to approve eligibility, and expanding food substitution options. Models controlled for other social safety net program participation rates, state-level policies, whether the state used electronic benefit transfer cards, and other state characteristics (e.g, poverty rates).  

Results: Remote WIC benefit issuance increased participation rates for all groups (e.g., increases in total participation rates in states that allowed remote benefit issuance were 1.10 times higher [95%CI 1.05, 1.14] than in states that did not). No other individual policy changes were independently associated with participation rates. Results were robust to multiple sensitivity analyses, including using the d’Chaisemartin and D’Haultfoeuille difference-in-differences estimator that accounted for staggered implementation and reversal of some policies. 

Implication: WIC is an important safety net program that buffers the negative impacts of poverty leading to improved maternal and child health, but participation rates are consistently suboptimal. State policy differences contribute to different WIC participation rates, which may lead to health inequities across states. Findings from this study suggest that policymakers should consider removing barriers to safety net programs to increase participation rates among eligible individuals.

Author

• Emily Dore, Tufts University
  Presenting Author