Even as the COVID-19 pandemic intensified economic hardship and unemployment, Missouri saw one of the nation’s sharpest drops in participation in WIC, a federal benefits program for low-income women and children, according to a report released last week.
The steep decline, the report found, was associated with Missouri’s burdensome system of dispersing benefits. Missouri began transitioning to a less-burdensome system last year, the state Department of Health and Senior Services confirmed Friday, but it is estimated it will take another four years to complete.
Participation in WIC fell by nearly one-fifth in Missouri from February 2020 to February 2022, according to a report by the nonprofit advocacy group Food Research & Action Center.
The only state with a steeper decline in participation was New Mexico.
Roughly 80,000 low-income pregnant and postpartum women, infants and children under age 5 were enrolled in Missouri’s WIC program earlier this year, down by 20,000 participants since early 2020.
The pandemic “increased unemployment and economic hardship, making many families newly eligible for WIC,” the report noted, suggesting that declining participation was not a result of the declining need for public assistance.
The federal government has not released recent state-by-state data on coverage or eligibility rates over the pandemic.
States’ participation rates over the pandemic varied widely. There was a slight increase in WIC participation on average nationally, with some states like North Carolina witnessing double-digit increases.
One reason that some states like Missouri saw double-digit declines in the rate of WIC participation, the report suggests, might be related to administrative barriers, specifically, the burdensome way some states reload participants’ benefits.
Other states had systems that allowed them to shift away from in-person contact, but not Missouri.
Missouri is one of just nine states which uses a WIC system that requires participants’ benefits cards to be physically swiped when loading benefits. Missouri operates what’s called an “offline” system for reloading benefits onto participants’ electronic benefits transfer (EBT) debit cards. All other states operate “online” systems capable of remotely and automatically reloading benefits.
The majority of states over the pandemic adopted flexibilities from the federal government to waive requirements for in-person benefit issuance. Because Missouri didn’t have the technological capacity to issue benefits remotely, the state had to continue requiring in-person issuance.
The states with the most significant declines overall in WIC participation all had offline systems, meaning they couldn’t issue benefits remotely. They were: New Mexico (-19.7%), Missouri (-18.9%), Pennsylvania (-17.7%), Ohio (-14.5%) and Arkansas (-14%).
With federal flexibilities that are still in place, participants in most states do not have to travel to WIC offices to reload their benefits. The report advocates for those flexibilities to be extended beyond the public health emergency, arguing that the changes helped drive the modest increase in WIC participation nationally during COVID.
Participants in offline systems might have had health concerns going into the office during the pandemic, or may face general time and resources costs to going into a WIC clinic to reload benefits, the report stated.
‘I have to request off work just to come load the card’
One Missouri resident, Bethany Hanna, sometimes has to miss work to get her benefits loaded onto her EBT card in person.
Hanna, who lives in Joplin and is the mother of a three year old and an 8-month old, participates in WIC.
“I have to request off work just to come load the card,” she said in an interview. Nonetheless, she considers her situation lucky: “A lot of people don’t have a way to get there, or they have to work and can’t take off.”
Even when certain WIC services were provided virtually in Missouri, benefits were not. A WIC office in Joplin reminded participants in a Facebook post in October 2020, amid surging COVID infection numbers, that even though they could receive some services by phone, “after your phone call, you will need to bring card, pin [number], and mask into office to have benefits added as they don’t add automatically.”
The report argued, “it is imperative that state agencies with offline EBT systems begin the process to transition to online EBT to ensure remote benefit access as needed in the future.”
Other factors the report cited as potentially affecting participation levels include “varying levels of WIC outreach, promotion, and coordination with other sectors” as well as limited staff capacity at some state agencies.
States with offline systems, a Network for Public Health Law issue brief in May summarized, often argue the benefits of in-person reloading include accompanying nutrition education and health check-ins, and also cite the cost of switching to an online system.
But “these benefits are largely outweighed by the burdens associated with offline systems,” that brief argued, citing participants’ socioeconomic and transportation barriers to accessing in-person WIC benefits.
Network for Public Health Law concluded the pandemic “made clear that an online program better serves WIC beneficiaries” and proved “even minor barriers to accessing public programs may substantially reduce participation.”
A years-long transition
WIC is administered by the U.S. Department of Agriculture and operated by state agencies. In Missouri, the Department of Health and Senior Services (DHSS) oversees the program.
A spokesperson for DHSS, Lisa Cox, said “it is difficult to pinpoint a specific reason to the decline in Missouri WIC participation,” but added that “being an offline state made it more difficult to conduct WIC business.”
Other factors Cox said might have affected declining participation could include the state’s difficulties implementing the EBT system for the first time in 2020, “a challenge in itself without adding the complications brought on by COVID,” and increased benefits for other programs like unemployment and SNAP.
The reason Missouri elected to operate an offline system was based on an analysis conducted roughly a decade ago, Cox said.
In 2020, “it became apparent that an online system would be more user friendly,” Cox said, but “Missouri WIC was unable to change that decision mid-implementation.”
The state last year “began the steps” to transition to an online system, but the transition is expected to last around four more years, Cox said.
Cox added that the state has increased WIC outreach efforts and seen a bump of 3,000 participants in the last two months, bringing the latest average to around 87,000 participants — up from earlier this year, though still significantly below pre-pandemic levels.
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