Chapter 01. Eligibility, Participation, and Benefits

Through local agencies at no cost to eligible individuals; and

To pregnant women, postpartum women, breastfeeding women, infants, and children, who are from families with income below a certain established amount and who are determined by a competent professional authority or a competent paraprofessional authority to be at risk with respect to their physical and mental health by reason of inadequate nutrition or health care, or both.

“Applicant” means an individual who has requested or on whose behalf another person has requested WIC benefits in person, either orally or in writing, under the provisions of this chapter.

“Benefits” means the foods prescribed and services provided to a participant by the Program.

“Breastfeeding woman” means a woman up to 1 year postpartum who is breastfeeding her infant.

“Caretaker” means an individual who is responsible for the care and welfare of a participant.

“Caseload” means the participation level that is assigned to a local agency by the State agency.

“Certification” means the implementation of criteria and procedures to assess and document an applicant's eligibility for the Program.

“Certification period” means the time period for which a participant has been authorized by a local agency as eligible for Program benefits.

“Child” means an individual who is 1 year old or older but is younger than 5 years old.

“Clinic” means a local agency facility where an applicant is certified.

“Competent paraprofessional authority” means an individual who:

Competent Professional Authority.

“Complementary feeding process” means a nutrition risk that applies to an infant or a child from 4 through 23 months old who has begun to or is expected to begin to:

“Day” means a calendar day.

“Disqualification” means the act of ending the Program participation of a participant, whether as a punitive sanction or for administrative reasons.

“Dual participation” means an individual's simultaneous participation in the WIC Program in more than one state, local agency, or clinic, or participation in the WIC Program and in the Commodity Supplemental Food Program funded by the USDA during the same period of time.

“Family” means a group of related or nonrelated individuals who are not residents of an institution but who are living together as one economic unit, except that residents of a homeless facility or an institution may not all be considered as members of a single family.

“Food delivery system” means the method used by a local agency to provide supplemental foods to a participant.

“Food instrument” means an electronic benefits transfer (EBT) card or other document that is used by a participant to obtain supplemental foods.

“Health services” means ongoing, routine, pediatric, and obstetric care or referral for treatment.

“HHS” means the United States Department of Health and Human Services.

Income.

“Infant” means an individual younger than 1 year old.

“Instream migrant” means a migrant farm worker or an individual accompanying a migrant farm worker who is traveling and currently employed or seeking employment in seasonal agricultural work that causes the migrant to move from the migrant's home.

“Local agency” means a public or private, nonprofit health or human service agency that provides health services, either directly or through contract.

“Migrant farm worker” means an individual:

“Nutritional risk” means:

“Nutrition education” means individual or group education sessions and the provision of information and educational materials designed to improve health status, achieve positive change in dietary and physical activity habits, and emphasize relationships between nutrition, physical activity, and health, all in keeping with the individual's personal and cultural preferences.

“Nutritionist” means an individual licensed in Maryland who has a bachelor's or master's degree in nutritional sciences, community nutrition, clinical nutrition, dietetics, public health nutrition, or home economics with an emphasis in nutrition.

“Participant” means a pregnant woman, breastfeeding woman, postpartum woman, infant, or child who is receiving benefits under the Program, and the breastfed infant of a breastfeeding woman participant.

“Participation” means receiving benefits under the Program.

“Participation data” means information concerning the number of:

“Postpartum woman” means a woman up to 6 months after the termination of her pregnancy.

“Poverty income guidelines” means the poverty income guidelines prescribed and adjusted annually by HHS.

“Pregnant woman” means a woman who is determined to have one or more embryos or fetuses in utero.

“Program” means the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) authorized by 42 U.S.C. §1786, the Child Nutrition Act of 1966, as amended.

“Proxy” means an individual who is designated by a participant or a child or infant participant’s parent, guardian, or caretaker to receive food instruments and to redeem food benefits for the participant and whose name is on file at the local agency.

“Special nutritional risk applicant” means a migrant farmworker or a migrant farmworker's family, a pregnant woman, or an infant.

“State agency” means the Maryland Department of Health's WIC Program.

“Supplemental foods" means those foods containing nutrients determined to be beneficial for a pregnant woman, breastfeeding woman, postpartum woman, infant, or child, as prescribed by the Secretary of the USDA under 7 CFR §246.10, which is incorporated by reference in Regulation .03 of this chapter.

“USDA” means the United States Department of Agriculture.

“Verification of certification” means a document that provides proof of Program eligibility for the participant who is transferring from one WIC agency to another.

Shall reside, without regard to the length of residency, within the jurisdiction of:

Shall present documentation of identity for the application for benefits;

Shall be determined by the local agency to be income eligible pursuant to the specifications set forth in Regulation .07 of this chapter;

Shall be at nutritional risk pursuant to the specifications set forth in Regulation .08 of this chapter; and

May not engage in dual participation.

Dated correspondence documenting the applicant’s home address;

Maryland driver's license or identification card;

In the case of an applicant who was a prior participant, documentation that the applicant still resides at the same address that is on file with the WIC Program; or

Another item that confirms the residency of the applicant.

In order to determine whether an applicant is income-eligible for Program participation, a local agency shall determine the applicant's income, which is determined pursuant to family size as set forth in §B of this regulation.

Subject to the provisions of this regulation, a local agency shall determine an applicant’s income by adding together the sources of income for an applicant and the applicant’s family.

In determining an applicant’s family income, a local agency shall consider the family’s income to be the more accurate figure between the family’s income for the previous 12 months or the family’s current rate of income for the last 30 days.

If an applicant meets the income eligibility guidelines, a local agency shall declare the applicant income-eligible for WIC benefits based on the applicant's family income.

An applicant shall provide to the local agency documentation of the applicant's family income, as set forth in §E of this regulation.

In the case of a pregnant woman, the unborn child or children are counted only if this action allows the woman to meet income eligibility standards;

An infant or child is counted in the family size of the parent, caretaker, or guardian with whom the infant or child resides;

An infant, child, or other family member residing in a school or institution is counted in the family size of the parent, caretaker, or guardian who is providing economic support for that infant, child, or family member;

An infant or child who is a foster child living with a family, but who remains the legal responsibility of a welfare or other agency, is counted as a family of one and payments made by the agency or other sources to the family for the care of that foster child are the income of that foster child; and

An adopted child or individual for whom a family member has accepted legal responsibility is counted in the family size for that family with whom the individual resides.

A local agency shall document proof of income.

If an applicant claims to have no income, the applicant shall complete the form provided by the State agency declaring zero income.

After a local agency has recorded the family size information of an applicant, the local agency shall determine whether the applicant is income-eligible for Program participation.

To be considered eligible for the Program, an applicant and the applicant’s family shall have a gross income that is less than or equal to 185 percent of the poverty income guidelines issued by HHS, or shall provide documentation that the applicant is a recipient of:

A local agency shall determine an applicant to be automatically income-eligible for the WIC Program if a member of the applicant’s family is:

A local agency shall use the current poverty income guidelines issued by HHS and transmitted by the State agency in determining applicant eligibility.

The State agency shall adjust the Program income eligibility guidelines annually at the time the State implements income eligibility guidelines under the Medical Assistance Program.

Instream Migrant Farm Worker. A local agency shall consider that:

An applicant shall provide to the local agency documentation of the applicant's family income.

Except as provided in §E(3) of this regulation, a local agency shall accept any of the following as documentation of income:

If an applicant cannot provide a document cited in §E(2) of this regulation, a local agency may confirm the applicant's participation in another State-administered program by telephoning the appropriate staff person of that program and documenting the telephone contact in the applicant's record.

A local agency shall deny Program participation to an applicant who fails to provide income documentation within 30 days of the date that the individual applied for Program benefits.

Have the nutritional risk assessment completed by a specific medical provider; or

Receive ongoing medical care under the local agency.

Performing the measurements on each applicant;

Requiring documentation of each applicant's measurements from a health care provider; or

In its discretion, both §D(1) and (2) of this regulation.

In addition to the assessments set forth in §D of this regulation, a local agency, competent professional authority, or competent paraprofessional authority shall:

For applicants with a qualifying nutritional risk factor present at certification, a local agency, competent professional authority, or competent paraprofessional authority shall within 90 days of the certification:

The local agency, competent professional authority, or competent paraprofessional authority shall perform or require documentation of the hematological test as follows:

May determine a breastfeeding woman to be at nutritional risk if her breastfed infant has been determined to be at nutritional risk;

May certify a breastfed infant to be at nutritional risk if the infant's mother is determined to be at nutritional risk;

Shall place a breastfeeding mother and her infant in the highest priority level for which either is qualified;

Shall place an applicant exhibiting more than one risk factor in the highest applicable priority level; and

May not place an individual in successive certification periods whose only identified risk factor is possibility of regression of nutritional status.

Priority I. Priority I is a pregnant woman, a breastfeeding woman, or an infant at nutritional risk because of:

Priority II. Except for an infant who qualifies for Priority I, Priority II is:

Priority III. Priority III is a child or postpartum woman at nutritional risk because of:

Priority IV. Priority IV is a:

Priority V. Priority V is a child at nutritional risk because of:

Priority VI. Priority VI is a postpartum woman at nutritional risk because of:

To be placed on the priority waiting list in Priority levels I—V, an individual shall seek certification and be successfully certified by the local agency as eligible for Program benefits; and

To be placed on the priority waiting list in Priority level VI, an individual may request to be on the waiting list over the telephone, unless the individual's postpartum status is at issue, in which case the local agency shall place the individual on the waiting list only after the individual receives a personal assessment at the local agency.

A woman shall exhibit one or, where specified, two of the nutritional risk factors listed in Chart A, as shown in §B of this regulation; and

An infant or child shall exhibit one or, where specified, two of the nutritional risk factors listed in Chart B, as shown in §B of this regulation.

Verification procedures;

Certification interviews; and

Income computations.

Accept an application;

Arrive at an eligibility determination;

Notify the applicant of the decision made; and

Issue food instruments pursuant to the terms set forth in §E of this regulation.

Applicant's name;

Applicant's address; and

Date of the visit.

A local agency shall notify a special nutritional risk applicant of an eligibility or ineligibility determination within 10 days of the date of the application for Program benefits, except that the State agency may provide an extension of the notification period to a maximum of 15 days for the local agency that makes a written request which includes a justification of the need for an extension; or

A local agency shall notify other applicants of their eligibility or ineligibility within 20 days of the date of the application for Program benefits.

Inform the special nutritional risk applicant within 10 days of the certification visit, and other applicants within 20 days of the certification visit, of the:

Document the reasons for ineligibility; and

Retain this information on file at the local agency.

A pregnant woman for the duration of her pregnancy and up to the last day of the month in which the infant turns 6 weeks old or the pregnancy ends;

A postpartum woman up to the last day of the 6th month after the infant is born or the pregnancy ends;

A breastfeeding woman up to the last day of the month of the breastfed infant’s first birthday as long as the woman is breastfeeding;

An infant younger than 6 months old up to the last day of the month of the infant’s first birthday;

An infant from 6 months old to 1 year old up to the last day of the 6th month from the date of certification; and

A child 1 year old or older up to the last day of the month 1 year from the date of the certification or the month in which the child turns 5 years old.

The sale or exchange of food instruments or food obtained with a food instrument;

Dual participation;

Making false or misleading statements or intentionally misrepresenting, concealing, or withholding information in order to obtain benefits;

Verbal or physical abuse of or threat of physical abuse to Program or vendor staff;

Receipt from food vendors of cash or credit toward the purchase of unauthorized food or other items of value instead of authorized supplemental foods; and

Failure to pick up food benefits for 2 consecutive issue months.

If the State agency experiences funding shortages, it may discontinue Program benefits to participants, but only after exploring alternative actions.

The State agency may discontinue benefits by:

When the State agency elects to restrict benefits to a priority level of participants due to insufficient funds for a period of time:

Immunization record;

Birth certificate; or

Other record that the local agency considers adequate to establish the identity of an infant or child applicant.

The applicant may not engage in dual participation;

The Program violations and the sanctions applicable to a participant, a child or infant participant's parent, guardian, or caretaker, or proxy for committing those violations;

The importance of regularly picking up food benefits and food;

The disqualification policy for failure to pick up food benefits and the number of months of nonparticipation resulting from the disqualification;

The policy of not providing notification of disqualification to the participant when the participant fails to pick up food benefits;

The right to a fair hearing if the participant does not agree with the disqualification for failure to pick up food benefits;

How the local agency food delivery system operates and a list of authorized stores where food benefits may be redeemed;

The available health services, where they are located, how they may be obtained, and why they may be useful;

A participant or a child or infant participant’s parent, guardian, or caretaker shall notify the local agency of any change in life circumstances that would have an impact on Program eligibility; and

A participant or a child or infant participant’s parent, guardian, or caretaker shall advise any designated proxy of the proxy’s obligations under the Program, Program violations, participant and proxy sanctions, and the authorized food stores.

“The rules for applying for WIC are the same for everyone;”

“I can ask a WIC employee for a fair hearing if someone tells me I cannot be on WIC and I do not agree;” and

“I will get information about healthy eating and active living. WIC will help and support me with breastfeeding. I will get information about immunizations and other services I might need.”

“I understand what my rights and responsibilities are;”

“I agree to follow the rules below. I will:(i) not sell, give away or trade my eWIC card, foods, or formula for money, credit, rain checks or other items. If I have WIC items I can’t use, I will return them to the clinic; (ii) not post WIC items for sale or trade on the internet; (iii) not swear, yell, harass, threaten, physically harm WIC or store staff, or damage WIC or store property; (iv) not enroll a child who is not in my legal or designated care; and (v) not enroll in WIC in more than one state or get benefits from more than one WIC clinic each month;”

“The information I have provided for eligibility determination is correct, to the best of my knowledge;”

“The information that I provide to the WIC Program is being submitted in connection with the receipt of federal assistance;”

“Program officials may verify information provided to them;”

“I understand and agree that intentionally making a false or misleading statement or misrepresenting, hiding, or withholding facts may result in my having to pay the WIC Program, in cash, the value of the food benefits improperly issued to me and may subject me to civil or criminal prosecution under State and federal law and disqualification from the WIC Program;” and

“I agree to give true and complete information about changes in my life circumstances that would have an impact on my eligibility for WIC benefits (for example, I will notify WIC if I have changes in my income or family size or if I move).”

Issue a verification of certification to a participant who:

Ensure that each verification of certification contains the following:

Accept a valid verification of certification from a participant of a WIC Program whether within or outside of Maryland; and

Accept the verification of certification or the copy of the State-approved certification form as proof of eligibility for WIC Program benefits until the participant’s certification period expires.

Issue a verification of certification to an individual placed on the waiting list; or

Deny participation in the Maryland WIC Program to an individual with a valid verification of certification because of a difference between another state’s and Maryland’s eligibility criteria.

Ensure that nutrition education is offered every 3 months to the participant or the parent, proxy, guardian, or caretaker of an infant or child participant during each certification period;

Provide a nutrition care plan to the participant, based on the need for this plan as determined by a competent professional authority, and to a participant, parent, proxy, guardian, or caretaker who requests a nutrition care plan;

Ensure that a competent professional authority or competent paraprofessional authority determines the selection of the food package according to the category and nutritional need of the participant; and

Ensure that the food package is consistent with foods allowed under the provisions of 7 CFR §246.10, which is incorporated by reference in Regulation .03 of this chapter.

If a participant or a child or infant participant’s parent, guardian, or caretaker is unable to pick up or redeem WIC benefits, the participant or the child or infant participant’s parent, guardian, or caretaker may name a proxy to pick up benefits, redeem them, or both.

A participant or a child or infant participant's parent, guardian, or caretaker shall register the name of the proxy with the local agency before the proxy may perform any WIC-related activity.

The Program may remove an individual who violates Program standards from serving as a proxy.

A participant or a child or infant participant's parent, guardian, or caretaker may replace a proxy with another individual.

A participant or a child or infant participant's parent, guardian, or caretaker shall advise a proxy of the:

Except as provided in §B(3) and (4) of this regulation, a participant or the participant’s proxy shall report to a designated site at designated times to receive food benefits prepared for that participant and to acknowledge receipt of the benefits.

When distributing food benefits, a local agency shall check a participant’s identification.

A local agency may mail or otherwise deliver food benefits to participants on a local agency-wide basis if the State agency approves this action on the basis of a hardship that may be encountered by the target population, such as seasonally inclement weather.

A local agency may mail or otherwise deliver food benefits to the participant or the participant’s parent, guardian, or caretaker who in writing requests this delivery and explains why it is necessary if a participant and the participant’s proxy are unable to report to the designated site to receive food benefits due to a hardship, including, but not limited to:

If the hardship cited in §C(4) of this regulation does not allow time for a written request to be made, a local agency may act on a verbal request for the upcoming benefit distribution period only and shall follow the procedure set forth in §C(4) of this regulation if the hardship continues.

When the hardship is resolved, a local agency shall continue with normal benefit issuance procedure.

To obtain WIC-authorized foods, a participant or proxy shall complete transactions at WIC-authorized vendors.

Only the participant for whom the food package was prescribed shall consume food obtained with a WIC food instrument.

Program shall disqualify the participant from the program for 1 year; and

Offending party shall pay to the State agency, in cash, the value of food benefits improperly received.

If the offending party is a participant or a child or infant participant's parent, guardian, or caretaker:

If the offending party is a proxy, the:

The Program shall counsel the participant or a child or infant participant’s parent, guardian, or caretaker, and disqualify the participant for 1 year; and

The offending party shall pay to the State agency, in cash, the monetary value of the items received.

Report the incident to the police;

Disqualify the participant from the Program for 1 year if the offending party is a participant or a child or infant participant’s parent, guardian, or caretaker; and

Remove the proxy if the offending party is a proxy.

For the first offense, disqualify the participant from the Program for 6 months;

Remove the proxy if the offending party is a proxy; and

For a subsequent offense, disqualify the participant from the Program for 1 year.

Program shall:

Offending party shall pay to the State agency, in cash, the monetary value of food or food instruments sold or exchanged.

Participant or a child or infant participant’s parent, guardian, or caretaker:

Proxy, the:

Program shall:

Program shall remove the proxy if the offending party is a proxy; and

Offending party shall pay to the State agency, in cash, the amount indicated on the food instrument with which the items were initially obtained, if the items were obtained.

Participant or a child or infant participant’s parent, guardian, or caretaker:

Proxy, the Program shall remove the proxy.

Participant or a child or infant participant’s parent, guardian, or caretaker, the Program shall disqualify the participant from the Program for 1 year; or

Proxy, the Program shall remove the proxy.

If a participant fails to return a hospital grade breast pump, the Program shall issue a warning letter to the participant.

If a participant fails to return a hospital grade breast pump after receipt of a warning letter, the participant shall pay to the State agency, in cash, the monetary value of the breast pump.

The reasons for the claim;

The value of the improperly issued benefits to be repaid to the Program;

That the participant shall pay to the State agency, in cash, the value of the improperly issued benefits; and

The participant's right to a fair hearing on the claim.

May appeal a State or local agency action resulting in the individual's being:

Shall appeal the action in accordance with COMAR 10.01.06.

To ensure that an individual may not, on the grounds of race, color, national origin, age, sex, or handicap, be excluded from participation in, be denied benefits of, or be otherwise subjected to discrimination under the Program, a local agency shall comply with the requirements of:

A local agency shall:

An individual may submit to a local agency a complaint that alleges an incident of discrimination pursuant to §A of this regulation.

The local agency shall forward to the State agency, within 10 days, the complaint which alleges discrimination.

The State agency shall refer the complaint, including a complaint based on sex or handicap, to the USDA for investigation and necessary action.

Take reasonable steps to provide Program information in the appropriate language; and

Ensure that the rights and responsibilities listed on the certification form are read to the applicant in the appropriate language.