	Background

Established as a national program in the mid 1970s, the WIC program is  intended to improve the health status of low-income pregnant and  postpartum women, infants, and young children by providing  supplemental foods and nutrition education. 1). In Recent Years, USDA Has Further Aligned Formula Amounts with Current Nutrition Science and Infants’ Nutritional Needs

In the past decade, USDA has taken steps to better tailor WIC food  packages containing formula to the nutritional needs of participating  infants. Among other changes, the revised regulations reduced the  amount of formula provided to partially breastfed infants of all ages,  delayed when partially breastfed infants may begin receiving formula, and  reduced the amount of formula provided to older fully formula-fed infants. 2). 3). The National Extent of Online Sales of WIC Infant Formula Is Unknown, but Some Participants Attempt Them

USDA does not have data that can be used to determine the national  extent of online sales of WIC formula; however, officials in 5 of the 12  states we spoke to said that they have found WIC formula offered for sale  online by some participants. Consistent with these state accounts, our own monitoring of a popular e- commerce website for 30 days in four large metropolitan areas found few  posts in which individuals explicitly stated they were attempting to sell  WIC-provided formula. 2016.”
Through our monitoring efforts, and through interviews with USDA and  state and local WIC officials, we identified a number of key challenges  associated with distinguishing between WIC-obtained formula sales and  other sales:
Each state’s specific WIC-contracted formula brand is typically  available for purchase at retail stores by WIC participants and non- WIC participants alike, without an indicator on the packaging that  some were provided through WIC. Individuals posting formula for sale online are able to remain relatively  anonymous, so WIC staff may not have sufficient information to link  the online advertisement with a WIC participant. According to USDA, state, and local WIC officials, because of these  challenges, the return on investment for monitoring online sales of WIC  infant formula is low. However,  because the use of the Internet as a marketplace has substantially  increased in recent years and the national extent of online sales of WIC  food benefits is unknown, USDA and the states have insufficient  information to assess the benefits of broadening their oversight efforts to  include this participant violation, as discussed in more detail later in this  report. USDA Has Provided Limited Assistance to States for Preventing and Addressing Online Sales

USDA has taken steps aimed at clarifying that the online sale of WIC  benefits is a participant violation. In  our review of rights and responsibilities statements from 25 states’ WIC  policy and procedure manuals, we found that 7 did not require local  agency staff to inform participants that selling WIC benefits is against  program rules. Both USDA  officials and officials we spoke with from two states noted that some WIC  participants do not know that selling food benefits is a program violation. In addition, we found that states vary in the ways they identify attempted  sales of WIC formula through monitoring efforts. Without  general information on monitoring techniques—such as promising search  terms or online sites where states may want to focus their efforts—some  states may be missing opportunities to better target their limited  resources. 42 U.S.C. area. However, it is  clear that some participants are selling WIC formula online,  inappropriately using program resources. However, USDA has not  required state agencies to inform participants of this prohibition, and  some states are not requiring local staff to do so. Monitoring online classified advertisements for attempted sales of WIC  formula is another way to ensure program integrity. Recommendations for Executive Action

To better ensure that WIC participants are aware of the prohibition  against selling WIC formula, and to assist states’ efforts to prevent and  address online formula sales, we recommend that the Secretary of  Agriculture direct the Administrator of FNS to take the following three  actions:  Instruct state agencies to include in the rights and responsibilities  statement that participants are not allowed to sell WIC food benefits,  including online. We reviewed  relevant federal laws, regulations, and U.S. Department of Agriculture  (USDA) guidance to determine requirements related to the provision of  formula to infants receiving WIC, as well as to identify federal, state, and  local roles related to preventing and addressing online sales of WIC  formula. To determine the role USDA regulations  and guidance play in preventing and addressing online sales of WIC  formula, we reviewed a non-generalizable sample of 25 states’ WIC  policy and procedure manuals to determine how consistent states’  policies and procedures are in preventing and addressing online formula  sales. Specifically, the formula type and volume of  formula container advertised for sale were equivalent to a type and  volume of formula provided to WIC participants in the state in which the  posting was made, and the amount of formula advertised for sale  represented approximately 85 percent or more of the maximum amount of  formula authorized for fully formula-fed infant WIC participants each  month, averaged across all ages. Similarly, the other team used both an automated and  a manual approach to monitor the e-commerce website but found the  manual approach to be more effective—as measured by more postings  indicative of potential sales of these benefits—than the automated   Our monitoring was conducted to provide some information  approach.on the extent to which WIC participants may have attempted to sell WIC  formula in four metropolitan areas over 30 days.
Why GAO Did This Study

WIC provides supplemental foods and assistance to low-income pregnant and postpartum women, infants, and young children. Approximately half of U.S. infants born each year receive WIC benefits, and infant formula is a key component of the food package many receive. Recent news reports suggest that some participants have attempted to sell WIC formula online, and the Internet has substantially increased as a marketplace in recent years. GAO was asked to provide information about online sales of WIC formula.
GAO assessed: (1) how USDA determines the amount of formula to provide to participants, (2) what is known about the extent to which participants sell WIC formula online, and (3) steps USDA has taken to prevent and address the online sale of WIC formula. GAO reviewed relevant federal laws, regulations, and USDA guidance; monitored advertisements to sell formula on one e-commerce website in four metropolitan areas; reviewed a non-generalizable sample of policy manuals from 25 states that as a group serve about two-thirds of WIC participants, and that were selected for their varied WIC caseloads and geography; and interviewed USDA and state and local WIC officials.

What GAO Found

In recent years, the U.S. Department of Agriculture (USDA) has more closely aligned the amount of formula it authorizes states to provide through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) with current nutrition science and the nutritional needs of participating infants. These changes were also made, in part, to encourage and support breastfeeding. Specifically, the agency issued revised regulations in 2007, finalized in 2014, that reduced the amount of formula authorized for partially breastfed infants and delayed the age when these infants may begin receiving formula. The regulations also reduced the amount of formula authorized for older fully formula-fed infants because they added infant fruits and vegetables for the first time.
USDA has not conducted any nationwide studies on the extent of online sales of WIC formula by program participants, but information gathered from state WIC officials and GAO's own limited monitoring suggest that some WIC formula is offered for sale online, though program rules prohibit such sales. In 30 days of monitoring one online classifieds website in four large metropolitan areas, GAO found 2 posts in which individuals attempted to sell formula specifically identified as WIC—among 2,726 that advertised infant formula generally. A larger number, 346 posts, advertised formula matching the brand, type, container volume, and amount provided to WIC participants, but did not indicate the source of the formula. Because WIC participants purchase the same brands and types from stores as non-WIC customers, monitoring attempted online sales of WIC formula can present a challenge. State officials GAO spoke with cited other challenges to monitoring online sales, such as the fact that individuals posting formula for sale online are able to remain relatively anonymous, and their posts may contain insufficient information to allow staff to identify them as WIC participants.
USDA has taken steps to clarify that attempting to sell WIC formula online is a participant violation but has provided limited assistance to states in preventing and addressing these sales. For example, USDA has not specifically directed states to instruct participants that selling WIC formula is against program rules, which could lead to participants making these sales unknowingly and using program resources inappropriately. GAO's review of 25 state policy and procedure manuals found 7 that did not require local agency staff to inform participants of the prohibition. Further, although states are responsible for controlling participant violations—including sales of WIC benefits—USDA is responsible for determining compliance with the WIC statute and regulations. However, because the department has not required states to describe their procedures for controlling these violations, USDA is unable to both oversee and assess state efforts to ensure program integrity in this area. The department is also unable to assist states' efforts because it has not assessed the national extent of these sales or techniques for addressing them. Through interviews with 19 state and local WIC agency officials from 12 states, GAO found that states vary in their approaches and the amount of resources devoted to monitoring attempted WIC formula sales. In addition, due to monitoring challenges, some officials expressed concerns about the return on investment for these efforts. Without information on cost-effective monitoring techniques—such as promising search terms or online sites where states may want to focus their efforts—some states may be missing opportunities to better target their limited resources.

What GAO Recommends

GAO recommends that USDA require state agencies to inform WIC participants that selling WIC formula is against program rules and describe in their state plans how they identify attempted sales. GAO also recommends that USDA assess online sales, including techniques states can use to monitor them. USDA agreed with GAO's recommendations.