216 R.I. Code R. 216-RICR-20-05-3.4

Current through December 26, 2024

Section 216-RICR-20-05-3.4 - Application of Eligibility and Determination

A. WIC applicant income screening will be determined by USDA WIC Income Poverty Guidelines, incorporated above at § 3.2(A) of this Part. WIC participants must be either eligible under the USDA WIC Income Poverty Guidelines or be adjunctively eligible.

B. All WIC applicants must sign an applicant agreement form that gives the WIC Program permission for coordination of services, describes rights and responsibilities of both the client and the program and indicates agreement that the information provided is accurate.

C. To be eligible to receive available benefits of the WIC Program, a person must be:

1. A resident of the State of Rhode Island; and

2. A pregnant, breastfeeding or postpartum woman; an infant; or a child up to his/her fifth birthday; and

3. A member of a household with an income at or less than 185 percent of the poverty level guideline or be adjunctively eligible (based on enrollment in SNAP, Medicaid, TANF, Katie Beckett); and

4. Be at nutritional risk.

D. A Competent Professional Authority (CPA) determines nutritional risk by performing a complete nutritional assessment on an individual basis. Each individual seeking certification or recertification for participation in the program shall be physically present at the clinic site for determination of program eligibility. This applies to all new applicants for their initial certification as well as those applying for a subsequent certification.

1. The following assessment tools must be considered in determining the individual's nutritional status:

a. WIC Medical Information Form (if applicable);

b. Prenatal Weight Gain Grid (if applicable);

c. Infant/ Child WHO growth standards for children birth to 2 years (if applicable);

d. Child Growth Charts, for children over two years, measuring stature (if applicable);

d. Client Centered Survey tool for Infants, Children and Women

2. An individual history must include a Client Centered Assessment.

a. A Client Centered Assessment must include:

(1) An understanding of and response to the clients major concerns to build rapport and provide referrals and support that is most important to the client.

(2) A nutrition assessment: Understanding and description of food preferences, family mealtime dynamics, nutritional supplements, fads, or any factors that impact nutritional status.

(3) Medical history related to nutrition: The history may be obtained through a review of the applicant's medical record or referral information from a competent professional not on staff of the local agency.

(4) Socioeconomic factors that affect nutrition including: resources available for food purchase, availability of food storage and cooking facilities and educational level of the participant.

(5) Anthropometric Measurements: The consistent and accurate use of pregnancy weight gain grids, or growth grids as a recording and evaluation tool for the heights, weights, and BMI following measurements is necessary.

(6) Laboratory Analyses: A blood test for anemia such as a hemoglobin, hematocrit, shall be performed and/or documented at certification or within 90 days of certification. Review of Lead results that was performed within the past 12 months, provided by the client's doctor.

E. Nutrition Education and Follow up

1. At the first nutrition education meeting, contact staff must create obtainable nutrition goals with the client and the client's child.

2. At the first nutrition education appointment contact staff must explain to clients/guardian:

a. Why the client qualified for WIC Program benefits and what is provided by the program and that the nutrition and food benefit is for the individual that has applied whether it be a child, pregnant woman, or breastfeeding woman;

b. WIC Program procedures pertaining to the appointment, anthropometrics, hematological, counselling, check pick up and cashing WIC checks and follow-up appointments;

c. The fact that the WIC Program is a supplemental nutrition program, that does not provide the complete nutritional needs for the client;

d. The current nutritional standing of the client; and

e. What the client's nutritional risks are; and

f. The importance of regular physician checkups; and

g. Counseling on breastfeeding (if applicable);

e. The importance of STD testing and the risk of transmission to their child (if applicable);

f. The detrimental effects of drugs, alcohol, and tobacco; and

g. The nutrition goals set with the client or the client's guardian.

2. The Second Nutrition Education Contact (SNEC)

a. SNECs are to be provided by CPA's only.

b. Routine nutrition education contact:

(1) The Local WIC site must provide group information sessions which can count as a SNEC or schedule a SNEC on an individual basis. The client can refuse the SNEC education and still receive the remaining benefits.

(2) This secondary contact is the time in which individual goals must be discussed and adjusted as necessary.

b. High risk nutrition education contact: All clients designated as high risk, according to state and local agency criteria, will receive a high risk care plan outlined in the client notes. It will include a plan designed by the local agency nutritionist and client/guardian. Each high risk client will receive a minimum of one follow-up visit. An individualized care plan can also be provided to any non-high risk participant at his/her request.

3. Breastfeeding Education and Support: Ongoing support and rapport building for Pregnant and Breastfeeding Women

a. Prenatal Clients: At least 1 contact at each trimester ( 1-3 months, 3-6 months, 6-9 months) and again at 2-4 weeks before anticipated due date.

b. Postpartum: Follow-up contacts within 2-3 days or as requested by participant. Follow-up on problems within 24 hours (see Problem Referrals). After first 2 weeks postpartum: contact at 2-3 weeks, 4-8 weeks, and 3-4 months postpartum. Maintain contact as needed or as requested for entire breastfeeding duration.

c. Breastfeeding Problems: Follow-up is required referrals by WIC staff within 24 hours of receiving referral of breastfeeding problems. Follow-up contact with client must be within 24 hours of problem discussion.

4. Referrals and Coordination: Local Agencies shall refer WIC participants to additional services provided by other health and human resources to avoid duplication of effort.

216 R.I. Code R. 216-RICR-20-05-3.4