In New York State, nearly 13 percent of residents face food insecurity. The COVID-19 pandemic has only exacerbated social need, and a recent report estimates that at least 130,000 children may have become newly food-insecure between March and June 2020 alone. Food insecurity poses critical challenges to infant health, and people with Medicaid are disproportionately more likely than the general population to experience food insecurity and have low-birthweight babies, which lead to poorer health outcomes for the baby. Due to structural racism, Black and Hispanic/Latino communities are more likely to experience food insecurity and have low-birthweight babies among Medicaid members.
There are opportunities to support families enrolled in Medicaid by better leveraging the Special Supplemental Nutrition Program for Women, Infants, and Children (known widely as WIC). Through WIC, low-income pregnant and postpartum people, infants, and children under 5 receive vouchers to purchase foods from an approved list of nutritional items. People enrolled in WIC are more likely to have a healthy-birthweight baby. Given the significant overlap in people eligible for both Medicaid and WIC, the latter is an important part of the solution to the complex and intersectional problem of food insecurity.
All counties in New York have fewer families enrolled in WIC than births among Medicaid members. The underutilization of WIC for pregnant and postpartum people, infants, and young children with Medicaid creates an opportunity to harness an existing program more effectively to reduce food insecurity, low-birthweight births, and associated poor health outcomes.
WIC is most underutilized in counties with major urban areas: in these counties, Medicaid-financed low-birthweight births were higher and the ratio of WIC-enrolled pregnant people to Medicaid births was lower than the state median. These counties represent opportunities for targeted WIC programming. See map below; LBW stands for “low birthweight.”
New York Counties Where Intervention Might Yield the Most Value
Source: Scaffidi S, Gilman M, and Myers N. September 2021. Improving Nutrition and Infant Health Through WIC.
Stakeholders across New York have been applying a range of strategies for successfully improving WIC enrollment and utilization:
- A coordinated intake system for social need: Public Health Solutions, in partnership with a health plan, two NYC Health + Hospitals (H+H) locations, and several community-based organizations, created the Food and Nutrition Services bundle, a coordinated intake system to identify and refer food-insecure families to optimal food support. The coordinated intake system helped connect thousands of families struggling with food insecurity to consistent nutrition access through WIC and other available programs.
- Deploy community health workers to assist patients in accessing benefits: In a pilot run by Health Leads in collaboration with NYC H+H and the NYS Department of Health, community health workers were trained and deployed to assist community members with WIC enrollment. In addition to helping communities access nutrition benefits, such as WIC enrollment, data collected about frequent barriers will drive system redesign.
- Tailored care coordination through the Pathways Community HUB: Brooklyn Perinatal Network utilizes the Pathways Community HUB model, which begins with a health and social risk assessment, to identify one or more of twenty primary “Pathways” for targeted services. The model’s framework targets food insecurity on several levels. The Pathways are complete when the family has no food insecurity for 30 days or upon delivery of a healthy-birthweight baby.
- Leverage clinical-community partnerships: UHF’s Partnerships for Early Childhood Development grant initiative comprises partnerships between eight hospital-based primary care organizations and one or more community-based organizations (CBOs). All used a social needs assessment that included food insecurity and addressed the social needs identified in screening.
These stakeholders also described two additional challenges: COVID-19 and public charge. “Public charge” refers to an immigration rule changed under President Trump’s administration to restrict lawfully present immigrants who received public benefits from receiving immigration status. Although WIC and many immigrants (e.g., green card holders, refugees, asylees, etc.) were exempt, and the public charge rule has since been repealed, public benefits utilization among immigrants declined (frequently referred to as the chilling effect).
To overcome these challenges, stakeholders thawed the chilling effect with public education and medical-legal partnerships and adapted during COVID-19 to ensure consistent access to services, despite tremendous growth in food insecurity.
Some policy recommendations for reducing food insecurity, low-birthweight births, and associated poor health outcomes emerged from the research:
- Extend offering of remote WIC application and appointments beyond the COVID-19 crisis, easing structural barriers to program enrollment and participation.
- Develop automatic enrollment of pregnant recipients in WIC, making full use of the State’s adjunctive eligibility of Medicaid-enrolled pregnant people for WIC.
- Increase partnership with CBOs that understand the needs of the communities they serve and have established relationships with community members.
- Take proactive steps to restore trust with immigrant communities that are hesitant to enroll in government-funded programs after years of anti-immigrant rhetoric and harmful federal policy initiatives.
Addressing food insecurity has the potential to reduce the prevalence of low birthweight while improving infant health. Because improving WIC enrollment and utilization would have pronounced beneficial effects on immigrant communities, doing so would reaffirm the state’s commitment to the newest New Yorkers as well as the youngest.
Sarah Scaffidi, MSc, is a research manager at the University of Chicago Health Lab and formerly a research analyst at UHF’s Medicaid Institute.