Review of WIC Food Packages

1
Review of WIC Food Packages

• USDA Food and Nutrition Service
• Presentation to
• Expert Committee for Review of WIC Food Packages
• Institute of Medicine, Food Nutrition Board
• Washington, DC
• May 18, 2004

2
Committees Request to USDA

• Discuss overall methodology used in most recent
  food package review
• Discuss details regarding cost and nutrient
  analyses used in most recent food package review

3
Food package considerations

• Population needs assessment
• Administrative issues
• Nutritional guidance
• Food group and nutrient profile
• Cost

4
Population needs assessment

• CNPP study nutrients
• (Kremer-LeBlanc et al. Review of the Nutritional
• Status of WIC Participants, CNPP/USDA, 1999.)
• NHANES-III servings, dietary intake
• NWA recommendations stakeholder input

5
Administrative issues

• Policy memos
• Administrative complexity
• NWA - stakeholder input
• Tailoring
• Substitutions
• Cultural food preferences
• Food forms, sizes, brands
• Usage

6
Nutritional guidance

• Legislation and committee reports
• Dietary Guidelines for Americans
• Food Guide Pyramid
• Dietary Reference Intakes (DRIs)
• Current scientific publications
• American Academy of Pediatrics

7
Food group and nutrient profile

• University of Pennsylvania Food Package Study
• (Picciano et al. Technical Papers Review
• of WIC Food Packages, November 1991.)
• Servings comparison
• CNPP Study
• USDA nutrient database
• Nutrient analysis software (e.g., Nutritionist
  Pro)

8
Cost non-medical food packages

• Inputs
• Factors
• Sources prices
• Sources inflation
• Sources - usage
• Baseline estimate
• Proposed estimate
• Total cost

9
Inputs

• Average fiscal year unit prices
• Maximum package allowances
• Mean amount prescribed
• Participation by category

10
Factors

• Inflation
• Price weights (e.g., juice)
• Substitution rates
• Estimated prescription rates (e.g., soy-based
  beverages)
• Change in maximum allowance
• Ramp effect

11
Sources prices

• BLS average price series
• Scantrack/Nielsen and Infoscan/IRI
• State input
• Internet Pea pod, distributor

12
Sources inflation

• BLS CPI-U series
• ERS CPI projections

13
Sources price weights

• Food Stamp Purchasing Study
• (Cohen et al. Food Stamp Participants Food
  Security and
• Nutrient Availability Final Report, USDA/FNS,
  1999.)
• State input (e.g. evaporated milk)
• Scantrack/Nielsen and Infoscan/IRI (National
  market share)
• Research findings (e.g. Baydar et al. Final
  Report WIC Infant Feeding Practices Study,
  FNS/USDA, 1997.)
• Explicit reasonable assumption

14
Baseline estimate

• For each food, baseline cost
• ? i AP (mean amount prescribed)i FY
  inflation participantsi 12
• Notes
• Where i participant category
• AP Weighted Average Price
• Separate summations per FY

15
Proposed estimate

• For each food, proposed cost
• ? i AP (maximum amount)i FY inflation
  prescription rate participantsi 12
• Notes
• Where i participant category
• Separate summations per FY
• Prescription rate assumed is 100 if current mean
  maximum allowed
• Apply ramp effect in out years

16
Total cost

• ? i (Proposed cost) i - (Baseline cost)i
• Where i individual food

17
Special considerations

• Infant formula
• Disparate State impacts
• Medical food packages

18
Infant formula

• Rebates hold constant ( inflation)
• DHA enhanced formula
• Form allowable

19
Disparate state impacts

• Use national assumptions
• Cultural substitutions

20
Medical food packages

• Incidence PC02
• Package cost - state input
• ½ of FP-III formulas are standard
• 98 of FP-III participants are children
• Medically needy infants are now in FP-I
• Infants may be moved to FP-III for simplicity
• Large of medically needy infants receive OTC
  formulas
• Medicaid WIC State agreements