In the United States, 6.5 million children are food insecure, meaning they do not get enough food for an active, healthy life. This food insecurity has tragic health implications. These children are at higher risk for physical and cognitive development issues. Food insecurity also increases a child’s risk for mental health issues and chronic diseases like obesity, cancer, and cardiovascular disease.
The Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) is a highly effective collaboration between federal, state, local and tribal governments that helps address the food insecurity of young children. WIC provides nutrition assistance, education and health screenings and service referrals to pregnant women, postpartum mothers, infants (under a year old), and children up to their fifth birthday.
To qualify for WIC, individuals must come from low-income households and be at nutritional risk. In terms of income, the program serves people at or below 185 percent of the federal poverty level. Individuals can also meet the program’s income requirement through adjunctive eligibility. This process grants WIC income eligibility to individuals who are already enrolled in another means tested program like Medicaid, the Supplemental Nutrition Assistance program (SNAP), or Temporary Assistance for Needy Families (TANF). The nutritional risk requirement is unique among the major federal nutrition programs and a health professional conducts a nutritional risk assessment during the program intake process.
WIC nutrition assistance comes in the form of a food package. There are several categories of food packages, each tailored for the dietary needs of the participant. For example, infants under the age of six months are only eligible for formula, while children over one year are eligible for juice, milk, cereal, eggs, fruits and vegetables, and other nutrient-dense foods. Most jurisdictions provide participants with electronic benefits transfer (EBT), a benefit specific debit card, or vouchers to obtain these foods through approved retailers. However, federal law requires that all jurisdictions transition to electronic benefits by October of 2020.42 U.S.C. 1786(h)(12).
In 2017, WIC served an estimated 1.79 million infants and 3.76 million children. These young people are among the most vulnerable in the country with 74.2 percent of WIC participants coming from households below the poverty line and 37.8 percent of households reporting income at or below 50 percent of the federal poverty line (see page vi of WIC Participant and Program Characteristics Final Report).
Fortunately, WIC produces an array of positive results. These benefits include improved birth outcomes (fewer premature births, healthier birth weights, fewer infant deaths…), diet quality for participant children, cognitive development and academic performance, and growth rates.
Despite the tremendous success of the program, there is a critical gap. WIC allows children to receive benefits until their fifth birthday. At this age, if enrolled in school, children from low-income households can access nutritious meals through the National School Lunch Program and the National School Breakfast Program. However, not all children are in kindergarten or preschool by their fifth birthday. According to the most recent information from the Census Bureau, in 2016, approximately 10 percent of five-year-olds were not enrolled in nursery school or kindergarten, totaling approximately 401,000 children (see table 2 in the link). This dynamic allows children to age out of the program and exist in the gap between WIC and school nutritional services. As expected, research shows that this gap in services negatively affects the food security of families. The contours of this phenomenon are shaped in part by kindergarten enrollment age, which is generally dictated by state law and can vary between jurisdictions. For example, in Hawaii, a child must be five by July 31 to enroll in kindergarten but in Maine a child must be five by October 15.
During the previous Congress (the 114th Congress), a bill was introduced to address the nutrition gap that occurs when children age out of WIC. This bill, titled the Wise Investment in our Children Act, would have increased the age cut-off for WIC to six years of age. The bill did not make it out of committee. Currently, there is no legislation before Congress to address the food insecurity created by aging out of WIC.
Given the serious repercussions of food insecurity, it is important for the public health community to be aware of this service gap. We must work with government and private community resources to ensure that all children have the food they need to lead healthy-productive lives.
The Network for Public Health Law is ready to assist you in your efforts to address food insecurity and advance health justice for vulnerable populations. Our attorneys can provide strategic legal and policy technical assistance and substantive resources to help you navigate relevant legal landscapes and identify legal, regulatory and policy opportunities to improve public health.
As part of our work on these issues, our 2018 Public Health Law Conference programming will focus on our theme: Health Justice: Empowering Public Health and Advancing Health Equity and is designed for practitioners, policymakers, lawyers, advocates and researchers in public health and other sectors.
This post was prepared by Mathew Swinburne, J.D., Associate Director, Network for Public Health Law – Eastern Region. The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.