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Kids and Health Care: Linking CHIPS to WIC

Still, most child welfare advocacy groups remain critical of the CHIP system as offering too little and making applications too difficult. They want children covered automatically.

The 100 Percent Campaign, a California group, has proposed that the state's Medicaid and Healthy Families programs be linked automatically with the state's Women, Infants and Children (WIC), school lunch programs and Head Start. A key characteristic that these other programs share: They don't ask any questions about immigration status.

WIC is a federally funded food and nutrition education program for low-income and nutritionally at-risk pregnant, breastfeeding and post-partum women, and children under age 5. Eligible households must have annual incomes at or below 185 percent of the federal poverty level (FPL); this meant an income of $33,930 for a four-person family in 2004.

Nutritional risk is indicated by such factors as low weight, obesity, anemia or an inadequate dietary pattern.

The purpose of WIC is to improve the health of participants during critical times of growth and development. WIC provides participants with nutrition screening and counseling, breastfeeding support and referrals for health care, social and community services.

Families also receive a check or voucher for nutritious food items that can be obtained at local grocery stores. The value of the vouchers depends on the participant but averages $32 per person per month.

The U.S. Department of Agriculture administers WIC through seven regional Food and Nutrition Service offices and 88 state and tribal WIC agencies, including the Department of Health Services in California.

California has the largest number of WIC recipients in the nation, with 81 local WIC agencies providing services to 1.21 million participants in all 58 California counties.

WIC does not have citizenship or permanent residency requirements.

In fact, California has tried periodically to link WIC and Healthy Families. The most ambitious effort took place in December 1998, when a letter was sent to all WIC participants in California -- who were not on Medi-Cal -- informing them that they could enroll in Medi-Cal or Healthy Families at their local WIC site.

The response and enrollment results were unexpectedly low. One reason: Lack of coordination. Families arrived at some sites with the state's letter in hand but WIC program staff members were unfamiliar with it and were unable to assist them.

Also, immigration status remained a problem. WIC program staff members reported that fear of retaliation from the Immigration and Naturalization Service was a prevalent problem among immigrant families. Many immigrant families eligible for Healthy Families feared repercussions on their immigration status or their ability to sponsor an immediate relative. This fear remains -- even though WIC programs have stated repeatedly that they don't share information with the INS.

Vermont has done more than any other state in coordinating its WIC and health programs by establishing a joint application for WIC and Medicaid/ Dr. Dynasaur -- its CHIP program serving children with family incomes up to 300 percent of the FPL. An applicant using the joint application can submit it to either WIC or Medicaid/Dr. Dynasaur. As a result, 97 percent of Vermont's kids on WIC had health insurance at the time of their most recent WIC visit.

When a joint application is received at a WIC clinic, it is reviewed for WIC eligibility and then forwarded, with an income determination worksheet, to Medicaid/Dr. Dynasaur. Since the income eligibility guidelines are lower for WIC than for Medicaid/Dr. Dynasaur, virtually all pregnant women and children found eligible for WIC are income-eligible for health coverage.

Each state handles its Healthy Family program in its own way; some are better at making access available than others. The main thing to keep in mind if you apply for Healthy Family coverage: Don't assume that the first person you talk to knows everything about the program. In many states, program staffers simply don't know all of the details about the programs.

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