National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
JAMA Pediatr. 2021 Jun 1;175(6):609-616. doi: 10.1001/jamapediatrics.2020.6973.
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an important source of nutritional support and education for women and children living in poverty; although WIC participation confers clear health benefits, only 50% of eligible women and children currently receive WIC. In 2010, Congress mandated that states transition WIC benefits by 2020 from paper vouchers to electronic benefits transfer (EBT) cards, which are more convenient to use, are potentially less stigmatizing, and may improve WIC participation.
To estimate the state-level association between transition from paper vouchers to EBT and subsequent WIC participation.
DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation of state-level WIC monthly benefit summary administrative data regarding participation between October 1, 2014, and November 30, 2019, compared states that did and did not implement WIC EBT during this time period. Difference-in-differences regression modeling allowed associations to vary by time since policy implementation and included stratified analyses for key subgroups (pregnant and postpartum women, infants younger than 1 year, and children aged 1-4 years). All models included dummy variables denoting state, year, and month as covariates. Data analyses were performed between March 1 and June 15, 2020.
Statewide transition from WIC paper vouchers to WIC EBT cards, specified by month and year.
Monthly number of state residents enrolled in WIC.
A total of 36 states implemented WIC EBT before or during the study period. EBT and non-EBT states had similar baseline rates of poverty and food insecurity. Three years after statewide WIC EBT implementation, WIC participation increased by 7.78% (95% CI, 3.58%-12.15%) in exposed states compared with unexposed states. In stratified analyses, WIC participation increased by 7.22% among pregnant and postpartum women (95% CI, 2.54%-12.12%), 4.96% among infants younger than 1 year (95% CI, 0.95%-9.12%), and 9.12% among children aged 1 to 4 years (95% CI, 3.19%-15.39%; P for interaction = .20). Results were robust to adjustment for state unemployment and poverty rates, population, and Medicaid expansion status.
In this study, the transition from paper vouchers to WIC EBT was associated with a significant and sustained increase in enrollment. Interventions that simplify the process of redeeming benefits may be critical for addressing low rates of enrollment in WIC and other government benefit programs.
妇女、婴儿和儿童特别补充营养计划（WIC）是为生活贫困的妇女和儿童提供营养支持和教育的重要来源；尽管 WIC 参与带来了明显的健康益处，但目前只有 50%符合条件的妇女和儿童接受了 WIC。2010 年，国会授权各州在 2020 年前将 WIC 福利从纸质代金券过渡到电子福利转账（EBT）卡，EBT 卡使用更加方便，潜在的污名化程度更低，并且可能提高 WIC 的参与率。
估计从纸质代金券向 EBT 过渡与随后 WIC 参与之间的州级关联。
设计、地点和参与者：本研究对 2014 年 10 月 1 日至 2019 年 11 月 30 日期间州级 WIC 每月福利汇总管理数据进行了经济评估，比较了在此期间实施和未实施 WIC EBT 的州。差异中的差异回归建模允许关联因政策实施后的时间而变化，并为关键亚组（孕妇和产后妇女、1 岁以下婴儿和 1-4 岁儿童）进行分层分析。所有模型都包含表示州、年和月的虚拟变量作为协变量。数据分析于 2020 年 3 月 1 日至 6 月 15 日进行。
WIC 纸质代金券向 WIC EBT 卡的全州范围过渡，具体由月份和年份指定。
WIC 注册居民的每月人数。
共有 36 个州在研究期间之前或期间实施了 WIC EBT。EBT 和非 EBT 州的贫困和粮食不安全率基线相似。在全州范围内实施 WIC EBT 三年后，与未暴露州相比，暴露州的 WIC 参与率增加了 7.78%（95%CI，3.58%-12.15%）。在分层分析中，孕妇和产后妇女的 WIC 参与率增加了 7.22%（95%CI，2.54%-12.12%），1 岁以下婴儿增加了 4.96%（95%CI，0.95%-9.12%），1 至 4 岁儿童增加了 9.12%（95%CI，3.19%-15.39%；交互检验 P 值=0.20）。结果在调整州失业率和贫困率、人口和医疗补助扩张状况后仍然稳健。
在这项研究中，从纸质代金券向 WIC EBT 的过渡与注册人数的显著和持续增加有关。简化福利兑换过程的干预措施对于解决 WIC 和其他政府福利计划参与率低的问题可能至关重要。
