WIC Eligibility ‐ Road to Success 1 WIC Income Eligibility 2017/2018 Presenter: Heather Kahn, MS, RD Purpose The purpose of this training is to review USDA WIC policies and procedures determining WIC eligibility for income, residency & identity. A Medicaid review will be presented, as well. 2 Agenda 1. Policies to be updated 2. Medicaid Review 3. How do we Determine WIC Eligibility? 4. Examples 5. Questions 3
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WIC Eligibility ‐ Road to Success
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WIC Income Eligibility
2017/2018Presenter: Heather Kahn, MS, RD
PurposeThe purpose of this training is to review USDA WIC policies and procedures determining WIC eligibility for income, residency & identity.A Medicaid review will be presented, as well.
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Agenda
1. Policies to be updated2. Medicaid Review3. How do we Determine
2. Policy 2.04 Income EligibilitySimplified content & LanguageOrganized & grouped related informationUpdated references & websites
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POLICY UPDATE cont…
3. Policy 2.06: Adjunct Income Eligibility
Content Change: Incorporated MICHILD under the list of Adjunctive eligibility since now it is under the umbrella of Medicaid in Michigan.
Simplified content & Language
Organized & grouped related information
Updated references & websites
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POLICY UPDATE cont…
4. Policy 2.12: MigrantAdded the definition of a Migrant Farm Worker at the beginning of policy
DEFINITION: Migrant farmworker - An individual whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last 24 months, and who establishes, for the purposes of such employment, a temporary abode.
Edited Language
Updated References
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WIC Eligibility ‐ Road to Success
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Medicaid ReviewHow do
Medicaid Programs Differ from Each Other?
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MEDICAID: MA
100% FPL or Federal Poverty Level BENEFIT PLAN ID: MA PLAN NAME:
“Full Fee-For-Service Medicaid”
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MEDICAID Plan DescriptionMembers are generally assigned to thisbenefit plan upon approval of theireligibility information & remain activeeven if eventually assigned to Medicaid Managed Care [MA-MC].
Once assigned to a Managed Care Organization, the health plan is the primary payer.
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WIC Eligibility ‐ Road to Success
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APS: Ambulatory Prenatal ServicesThis program provides presumptiveeligibility for pregnant women limited toambulatory prenatal care services only.Covered services include physician visits forprenatal care, prescription drugs related topregnancy, and prenatal laboratory tests.
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HMP: Healthy Michigan Plan
133% FPL Benefit Plan ID: MA-HMP Adults: 19-64 years
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HMP DescriptionThis plan provides health care benefits toadults 19 through 64 years of age, notcovered by or eligible for Medicaid, withfamily incomes at or below 133% of thefederal poverty level (FPL) & who are noteligible for or enrolled in Medicare.Eligibility is determined through theModified Adjusted Gross Income (MAGI)methodology.
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Modified Adjusted Gross IncomeGenerally, your Modified Adjusted Gross Income (MAGI) is the total of your household's Adjusted Gross Income plus any tax-exempt interest income you may have.
It does not include assets.
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CHIP: Children’s Health Insurance Program
Provides health coverage to eligible children, through both Medicaid & separate CHIP programs.
Administered by states, according to federal requirements.
Funded jointly by states and the federal government.
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HK-EXP: Healthy Kids Expansion
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Full Fee-for-Service Healthy Kids Expansion 160% FPL Children under age 19 Funded by Children’s Health Insurance
Program (CHIP) Revised 7/1/2016
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MOMS: Maternity Outpatient Medical Services
195% FPL Immediate health care For PG Provides immediate health coverage for the
unborn child of an undocumented pregnant woman
Can be used during a Medicaid pending application
Must use Medicaid once it becomes available Also for non-citizens Can cover Entire Pregnancy & 2 Calendar Months
after pregnancy ends.
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MA-MICHILD (CHIP) CHILDREN UNDER AGE 19 212 % MAGI $10 monthly premium fee Non-emergency Transportation (NEMT) Under Medicaid Umbrella:
makes clients adjunctively eligible for WIC
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ESO: Emergency Services OnlyClients who do not meet citizenship requirements, but may be eligible for Emergency Services Only (ESO).
MDHHS partners with:Michigan Fitness Foundation (MFF) Michigan State University Extension (MSUE).
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SNAP: Most FAP interviews are held by telephone. However, you may request an in-person
interview. If you are also re-applying for cash assistance,
you may be scheduled for an in-person interview.
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FIP: FAMILY INDEPENDENCE PROGRAM
o Provides FINANCIAL ASSISTANCE to families with children (Cash Assistance).
o Helps maintain and strengthen family life for children and the parent(s) or other caretaker(s) with whom they are living, and to help the family attain or retain capability for maximum self support & personal independence
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WIC Eligibility ‐ Road to Success
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Cash Assistance: Who Qualifies Children must be a part of your family and meet age
requirements: under 18 or 18 years old & attending high school
The family or legal guardians of that child are also evaluated as part of the eligibility process.
Pregnant women
Parents of a child in foster care who is expected to return home within one year
Must meet residency, income and identity requirements
2.02 Residency
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Proof of residency required at: Enrollment Each certification Transfer
Short certification if client did not bring proof: 60 days
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2.02 Residency
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Proof Allowed: Michigan ID/Driver’s license Voter registration Utility or rent/mortgage
receipt Passport/Visa Homeless shelter address Mihealth card Other records that the WIC
State Agency considers adequate to establish residency
This may include, but is not limited to:
Victim of theft, loss or disaster Homeless individual Migrant Person (transferring to Michigan) holding a
VOC card. Person who has recently moved into the
service area.
2.02 Applicants with NO PROOF of residency shall be fully certified with the completion of an Attestation Form.
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2.02 ResidencyApplicants who are unable to provide proof of residency during the initial enrollment onto the WIC program shall be required to provide proof at the next certification.
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How To Locate Attestation Form:
CLINIC MODULE:
Miscellaneous =>
Signature New
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2.03 Identity
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Proof required:
For NEW clients & Authorized Personsat initial enrollment
For transfers from Out of State & Overseas Visual personal recognition by WIC staff at
issuance of benefits or subsequent certifications is allowed once initial proof of identity has been established.
Identity Proof66
Hospital Record/Crib Card Health Insurance Identification Social Security Card Photo Identification Driver’s License Student Identification Card State Identification Card Work Identification Card Pay Stubs Voter Registration Card Mihealth card Michigan WIC Bridge Card WIC/WIC Overseas records
from other states/jurisdictions
Left Proof at Home… Short cert 60 days to bring in
proof Schedule next visit
within 60 days Immunization Record Birth Certificate
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2.03 Applicants with NO PROOF of identity shall be fully certified with the completion of an Attestation Form.
This may include, but is not limited to:
Victim of theft, loss or disaster Homeless individual Migrant
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2.03 Identity
Applicants who are unable to provide proof of identity during the initial enrollment onto the WIC program shall be required to provide proof at the next certification.
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2.04 Income DeterminationMaximum allowable is 185% of poverty unless…
Adjunctively eligible
Migrant, homeless or works for cash(Does not have verification/Proof) (No Proof of Income Attestation form)(ie. Has income, but cannot prove)
NO income (Client Agreement)-Policy 2.07(Has absolutely NO INCOME)
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2.04 Income Rules If client HAS proof of income, but did not bring it
to cert/recert appointment • SHORT CERT: 30 days of benefits
Migrant families have income determined every 12 months
IEVAL/CEVAL DO NOT evaluate income, Unless other family member is certified
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Definition of Income
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Income means gross cash income before deductions for income tax, social security, insurance premiums, etc.
Includes OVERTIME PAY If self-employed or farm
income, net income is used for eligibility determination: 1040
Policy 2.04 Income Determination
Ways to Calculate Income…
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Current: The family’s current (past 30 days) rate of income
30 days worth of pay stubs: weekly, bi-weekly, semi-monthly, or monthly
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Annual: Families who qualify for this category include but are not limited to
Construction workers Farmers Seasonal agricultural farmworkers Self-employed persons Persons on extended leave
due to illness or childbirth. Income over the past twelve months (can use
“year to date income” annualized) Income as stated on the most current IRS 1040
tax form filed
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Temporary Low Income: Income for the NEXT 30 DAYS Income that is below a family’s normal level due
to infrequency or irregularity of employment (income available to the family in the NEXT 30 days), ie. Laid off
Families who qualify for this category include but are not limited to
Workers on strike Temporary or seasonal workers Unemployed workers
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Year to Date Income (YTD) Check stub has Year to date information MI-WIC feature calculates YTD based on
date of check stub and total amount YTD Will provide an annual income to be
entered into system.
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2.04 Income Sources Wages (including overtime), salary,
commissions, tribal “per capita” payments, can be electronic pay stub
Military Pay (see 2.04A) Net income from Farm or Self
Employment (IRS 1040 schedule F, C) Social Security benefits (SSI) Dividends, interest on savings or bonds,
income from trusts or real estate
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2.04 Income Sources cont… Public Assistance
DO NOT INCLUDE Food Stamp/SNAP benefits Government civilian or military retirement,
pensions or veterans’ payments Pensions or annuities Alimony or child support payments Regular contributions from persons not living in the
household Net royalties Other CASH income-can be on a regular basis
(baby sitting) or one-time (lottery winnings)
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2.04A Military Pay What DOES count:
Base pay Basic Allowance for Subsistence (BAS) Foreign Language Pay (FLPP) Family Separation Allowance (FSA) Jump Pay, Dive Pay, Sea Pay, Flight Pay Continental United States Cost of Living Allowance
(CONUS COLA) Allowed to Income Average over the year:
Clothing Maintenance Allowance (CMA) Bonus Pay (Bonus) Special Pay
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Military Pay: What DOES NOT count: Basic Allowance for Housing
(BAH or BAQ) Family Separation Housing (FSH) Family Subsistence Supplemental Allowance (FSSA) Overseas Housing Allowance (OHA) Overseas Continental United States Cost of Living
Allowance (OCONUS COLA or COLA) Combat Duty or Combat Zone Pay
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2.04 Income Exclusions The value of in-kind housing and other in-kind
benefits. Loans Payments or benefits from
Federal Programs or Acts:- See list 14e i-xxxv (page 4-7)- ie. VISTA, Foster grandparents payments,
Payments through Job training Partnership Act.
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2.04 Income Exclusions cont… School lunch benefits/child care feeding
programs Payments from Low Income Home Energy
Assistance Act Student financial assistance funded by Title IV,
including Pell grants… Value of child care payments under the Child
Care and Development Block Grant National Flood Insurance payments
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2.05 Income Guidelines
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MI-WIC POP UP
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2.06 Adjunct Income EligibilityMedicaid:
Healthy Kid’s Program Healthy Michigan Plan (HMP)MICHILD
Policy 2.08 Definition of Family…“A group of related or nonrelated individuals who are living together as ONE ECONOMIC UNIT (except that residents of a homeless facility or an institution are not considered as members of a single family).”
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Family or Household SizeWIC Policy 2.08
Family members share income, goods & services
More than one family can live in a house=> Shares apartment with sister, pays rent,
has own income Must have its own source of income
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2.11 Foster Child Eligibility
ONE PERSON FAMILY where DHHS is legally responsible for child
Payments made by DHHS or from any other source for the care of the foster childshall be considered the income for the child.
If adopted, the child becomes & is counted as a member of the family and WIC eligibility shall be based on the income of the adoptive family.
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2.11 Foster Child Eligibility
If custody changes, VOID Foster child’s benefits
Do Not Terminate Foster Child
Child will still be able to transfer to another family & receive benefits without having to
be recertified
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Foster child income processP-Cert Screen: Check Foster
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Income Tab: Select Foster Child & hit GO
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Enter rest of income data105
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Client Info Screen:106
2.12 Migrant FarmworkerAn individual whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last 24 months, and who establishes, for the purposes of such employment, a temporary abode.
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2.12 Migrant Family Eligibility
Designate as migrant upon enrollment, verify migrant status at each certification
Give Priority appointments (within 10 days)
Do not need proof of ID or residency –Sign no proof of ID or Residency Attestation Form
Income completed every 12 months
Self-declaration allowed-No Proof of Income Attestation form
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2.12 Migrant Family Eligibility
VOC/Verification of Certification
Accept VOC for migrant family
Income eligible if verified in last 12 months
Provide VOC to migrant families so they have proof of WIC enrollment
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2.17 Certification Periods PG: Estimated date of delivery + 42 days
BF: one year past delivery date
NPP: 6 months past delivery or pregnancy end date
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2.17 Certification Periods Infants under 6 months of age:
one year past birth date
Infants 6 months of age & over shall be certified at the time of entrance into the Program for six (6) months.
C1-C4: 12 months past certification date
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2.17 Certification PeriodsTime Variations for Recertification
of Infants and Children:
In cases where there is difficulty in appointment scheduling due to illness or to synchronize
appointments with other family members, a time variation of +/- 30 days from the certification due
date is permissible.
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2.18 Notification of Client Rights and Responsibilities The Michigan WIC Client Agreement
shall be used to inform clients/authorized persons of their WIC Program rights and responsibilities.
Read by or read to the client/authorized person at each cert/recert in an appropriate language
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2.18 Notification of Client Rights and Responsibilities Sign & date the Client Agreement At each cert/recert When Authorized person changes When client transfers into Michigan
Copy of Client Agreement• At initial certification• Upon request at other certification/recerts
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2.19 Verification of Certification (VOC)
The local agency shall issue a VOC to each client participating in the WIC Program.
The VOC shall be issued to the authorized person at the time of each certification.
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2.19 Verification of Certification (VOC)
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Must have Signature & printed name of Local Agency Official
2.20 Ineligibility Notices Written notice is required when client is:
Ineligible at certification
Terminated at mid-cert for income ineligibility
Sanctioned, suspended or disqualified
BF woman who discontinues breastfeeding after 6 months
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2.20 Ineligibility Notices Written notification of ineligibility shall contain the following: Date of notice Client’s name Reason for ineligibility Client’s right to a fair hearing
Note: Automatically prints when Ineligibility Notice is printed
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2.20 NE: Nutrition Education Plan
Issuance of the NE Plan provides notification of the end of certification for each client/parent/caretaker.
Notification of Right to Fair Hearing IS NOT REQUIRED.
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2.21 Mid-Cert Income Determination Mid-certification income reassessment must be
done when a local agency receivesinformation that a client’s income or family size has changed.
If less than 90 days are left within the existing certification period, no redetermination of income eligibility is needed.
If more than 90 days are left in the existing certification period, determine current income based on the income documentation provided
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2.21: Mid-Cert Income Determination If the client’s income is determined to be over
income and the client/family does not have adjunct eligibility, the client/family shall be terminated with 15 days notice and benefits shall be issued during that period.
If client is no longer eligible, use the term reason of No Longer Eligible to end the certification period in MI-WIC.
Remember to give the client a notice of ineligibility.
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Special Cases Is a Deployed Husband counted in family size?
Yes
Parent is paying child support and is applying for WIC. Are they allowed to exclude their child support payments from their Gross Income?
No
Mom receives child support. Must mom count child support in her income?
Yes
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FAQ:Are they allowed to use “NO INCOME” AGAINif they had stated NO INCOME for their last certification period?
Currently, there is no Federal Guidance for this situation
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Answer:Questions to Assess current income status:
o How have they been able to support themselves & their family over the past year?
o If they are not on Medicaid, why or why not?
o Are they participating in any other MDHHS programs?
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Guidance Technically they could declare
NO INCOME again.
Be sure they understand the Client Agreement & consequences of fraud.