Though more than 116,000 families in Nevada qualify for a federal program offering food, nutrition support and education to pregnant and postpartum women, toddlers and infants from low-income households, only about half of those families receive those benefits, state health officials told lawmakers earlier this month.

The low participation rates in the federal Supplemental Nutrition Program for Women, Infants and Children (WIC) program isn’t a Nevada-only problem — nationwide, enrollment in the social safety net program is around 57 percent, with individual state enrollment numbers ranging from 34.6 to 71.6 percent. Research indicates that WIC enrollment has resulted in fewer infant deaths, fewer premature births and increased birth weights.

Julia Peek, the deputy administrator of the community health services section of the Division of Public and Behavioral Health, told The Nevada Independent that a variety of factors contribute to lagging WIC enrollment — misinformation, lack of information about benefits, difficulty accessing services and restrictions when shopping with WIC benefits.

“It is always a gap we are working to close,” Peek said. “It means that families who need and could benefit from WIC are not accessing services that have shown to improve overall health and well-being.”

Similar to other states, WIC enrollment in Nevada actually jumped 5.4 percent between 2022 and 2023 — a trend seen nationwide and attributed to program changes implemented during the pandemic. However, advocates and state officials say the rates are still too low.

WIC has historically been supported across the aisle, though advocates and the Biden administration raised concerns earlier this year that a lack of government funding could turn away up to 2 million eligible women and young children from the program — though federal government funding bills passed in March ensured full funding for the program. In 2022, an analysis from the economic research service of the U.S. Department of Agriculture estimated that WIC served about 6.3 million participants each month, including about 39 percent of all infants in the United States.

Jamelle Nance is the early childhood policy director at the Children’s Advocacy Alliance, a nonprofit, nonpartisan organization that serves as an independent voice for Nevada's children. She said one of the largest barriers low-income families face when it comes to getting enrolled in programs such as WIC is the disjointedness among systems serving young children, lack of knowledge that these programs exist and the different application processes associated with them. 

She added that families often don’t fill out applications for the various programs aimed at helping them because they have to navigate unique, unfamiliar processes for each one.

“It is important for all the systems within the early childhood sector, whether it's in health care, food and nutrition, education, to work together to streamline those processes,” Nance said. “That really starts from the top down, really looking at who's governing these structures, how are they working together, and streamlining processes to make them more accessible for families.”

How it works

WIC is a federally funded program first established in 1972 that Peek and other experts say has been associated with a reduced risk of premature births and infant mortality.

To qualify for Nevada’s WIC program, families must have an income that falls within the qualifying limits, need help with health or nutrition and meet one of the following criteria: be pregnant, had a baby in the past 6 months, be breastfeeding a baby under the age of 1 or care for a baby or child younger than 5 years old. WIC can include caregivers, legal guardians, foster parents or anyone caring for a child under five years old who meets other criteria. WIC participants do not have to be U.S. citizens. 

WIC recipients receive a WIC card that operates as a debit or credit card, allowing families to purchase food that falls under a specific set of guidelines and is considered rich in protein, calcium, iron, vitamins A and C, and other nutrients. WIC food items often include milk, cheese, breakfast cereal, eggs, whole wheat bread, brown rice, peanut butter, and canned fish and legumes, while others are excluded, such as white bread, flour tortillas, most meats, certain package sizes of foods and baby food in pouches.

During an interim Health and Human Services Committee meeting in early April, officials with Nevada's Office of Food Security and Wellness said that even when people are enrolled in WIC, they redeem only about 57 percent of the benefits and leave the rest on the table — a rate officials said is lower than they’d like. The highest redemption rates for the 14 food categories available through WIC were infant formula (86.8 percent) and fresh fruits and vegetables (78.7 percent).

Households participating in the federal Supplemental Nutrition Assistance Program (SNAP) and WIC benefits can use both simultaneously, though each has unique application processes. WIC has a higher qualifying income limit than SNAP.

To qualify for WIC, applicants must not only meet federal income guidelines but also show that they have a medical condition or diet that puts them at “nutritional risk” — a requirement that is usually easily met. The process of enrolling includes a nutritional assessment, screening for height, weight and body mass index, a blood test to assess iron deficiency, food package tailoring, nutrition education, referrals and breastfeeding education and support. 

Officials said that all steps of the certification process are federally mandated and must be completed before enrollment, making auto-enrollment of eligible SNAP beneficiaries impossible. Many require in-person WIC clinic visits, which also create barriers for families. In contrast, SNAP, which has a less intensive application process, enrolls about 91 percent of eligible Nevadans.

Once a family is enrolled in WIC, the program requires quarterly follow-up appointments, though families are not penalized if they miss one. Families must recertify for the program once a year.

Peek said families enrolling in Nevada are given the option of holding their appointments online, but noted the “burden” associated with making time for appointments. She said automatic enrollment in the program would undercut the nutritional health education that is a key component of the program.

“WIC provides nutrition education, breastfeeding support and referral to health care and social services,” Peek said. “If enrollment were automatic, many families may miss out on these crucial WIC services.”

Federal regulations stipulate the amounts and types of food available to WIC participants, aligning with the Dietary Guidelines for Americans. Peek said those requirements could create a perceived barrier because participants can only shop for specific foods, unlike the broader SNAP, which provides eligible low-income families and individuals with a card, similar to a debit card, to purchase food. SNAP benefits cover a wide range of foods that can be prepared and eaten at home, but not items such as alcohol or hygiene products.

Improving enrollment

Peek said that the state is working to improve participation rates through agency collaboration, facilitating ongoing training between eligible programs and a new modernization effort. Specifically, she said WIC and the state agency that helps Nevadans sign up for other benefits such as Medicaid and SNAP, partner on efforts to improve “cross-program referrals.”

As part of that effort, state officials are using American Rescue Plan funding allocated by the federal government, to set up a two-way text message program and develop participant-facing tools and resources in 11 languages that can serve those with limited English proficiency. 

Peek added that federal waivers have allowed for remote appointments, which have helped streamline the enrollment and certification process for families, rather than requiring them to come to a WIC clinic in person. She said the modernization project, which is aimed at promoting the program to prenatal and postpartum breastfeeding people and expand access to the program, is in the early stages of development. The state has until 2027 to complete the work, but they anticipate many of the projects through the modernization grant will be completed before then. 

Nance said that creating an office of early childhood systems to centralize the locations of the programs and oversee funding for early childhood programs, among other changes, would help streamline processes and ease families’ burdens. It would also add a level of accountability at the executive level, she said.

“In a practical policy sense, it would have someone or a team of individuals at the executive level, really focusing in on those policies and practices that make things more accessible,” she said. “There are several different funding streams for several different early childhood programs that live within different departments. They all have different regulations, different grant cycles, and it really does impact the children and families we really want to serve.”

Nance said one example of a centralized system is the First 5 Nevada initiative, which is a portal that families can access, enter their information and get a list of services and resources that they are eligible for. The initiative, which includes an ad campaign, is supported, in part, with funding from the American Rescue Plan administered by the state.

“This is a huge step in the right direction, but we need to see that on a larger scale,” she said.