The states are also required by federal regulations to automatically certify as income eligible those individuals who document their participation in the Food Stamp Program, Medicaid, and the Temporary Assistance for Needy Families Program. Efforts to Control Food Costs and Manage Vendors Have Reduced Costs, but the Program’s Structure May Discourage Wider Use

States’ initiatives to control food costs by limiting the types and package sizes of WIC foods and by more carefully selecting and regulating vendors have reduced the program’s costs by millions of dollars. These two practices include (1) contracting with manufacturers to obtain rebates on WIC foods in addition to infant formula and (2) limiting authorized food selections by, for example, requiring participants to select brands of foods that have the lowest cost. While all states have one or more food selection restrictions, 17 of the 48 WIC directors responding to our questionnaire reported that their states are considering the use of additional food selection limits to contain or reduce costs in the WIC program. According to Texas WIC officials, the state does not limit the number of vendors that can participate in the WIC program. Appendix II provides information on the states’ use of cost containment practices that affect the program’s costs. Thirty-two of the 48 WIC directors reported that their state agencies generally require documentation of income eligibility for these applicants. These states allow applicants to declare their income without providing supporting documentation. Finally, two directors reported that income documentation procedures are determined individually by the local WIC agencies. In addition, 20 state WIC directors reported that their states do not require applicants to provide proof of residency, and 12 reported that their states do not require applicants to provide proof of identity when they seek certification for program participation. Conclusions

A number of the states are making effective use of a variety of practices to contain the WIC program’s costs and to extend coverage to more women and children. Given such obstacles, and the states’ concern with how the program allocates the additional funds made available through cost containment initiatives, some states may be discouraged from adopting or expanding the use of cost containment practices. The states that base income-eligibility decisions on WIC applicants’ declarations of income without documentation may be allowing applicants who are not eligible to participate in the WIC program.
Why GAO Did This Study

Pursuant to a congressional request, GAO reviewed cost containment initiatives states are using to control the cost of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), focusing on the practices that the states use to: (1) contain costs by controlling the foods approved for use in the WIC program and by more closely selecting and regulating participating vendors; and (2) ensure that WIC applicants' incomes meet the program's eligibility requirements.

What GAO Found

GAO noted that: (1) the states are using a variety of cost containment initiatives to control the WIC program's costs; (2) for example, 10 states have contracted with manufacturers to obtain rebates on WIC foods in addition to infant formula, and some states have placed greater limits on WIC participants' food choices than other states; (3) separately, or in conjunction with efforts to contain food costs, 39 states use various practices to restrict the number of vendors or ensure that the prices vendors charge for WIC food items are competitive; (4) these and other practices to contain food costs have saved millions of dollars annually and enabled more individuals to enroll in the program, according to WIC directors; (5) while the use of cost containment practices could be expanded, certain obstacles, including the states' concern with how the program allocates the additional funds made available through cost containment initiatives, may discourage the states from adopting or expanding their use; (6) federal regulations provide that WIC program applicants who participate in the Food Stamp Program, Medicaid, and the Temporary Assistance for Needy Families Program automatically meet the income eligibility requirements of the WIC program; (7) the states use a variety of procedures to certify the income eligibility of the applicants who do not participate in these programs; (8) thirty-two of the 48 state WIC directors responding to GAO's questionnaire reported that their states generally require these applicants to provide documents, such as pay stubs and letters, to verify their income; (9) of the remaining 16 WIC directors, 14 reported that their states do not require documentation; (10) these states allow applicants to declare their income without providing supporting documentation; and (11) the other two directors reported that income documentation procedures are determined individually by the local WIC agencies.