Clinical Resource Guide

Infant Formula and Child/Adult Medical Foods

WIC provides supplemental foods designed to address the nutritional needs of low-income pregnant, breastfeeding and non-breastfeeding post partum women and infants and children up to 5 years of age. The USDA's interim rule states:

WIC was never intended to be a primary source of food, nor of general food assistance. The nutrition education provided by WIC enables participants to make informed decisions in choosing foods that, together with the supplemental foods contained in the WIC food packages, can meet their total dietary needs. The intent is to help participants continue healthful dietary practices after leaving the program.

USDA rules specify specific food benefits in seven "food packages," with each food package addressing the nutritional needs of a category of participants (infants, children, women). Food Packages I, II and III are the ones that impact WIC's provision of standard as well as medical formulas:

  • Infants from birth to 6 months receive WIC supplemental foods as specified in Food Package I.
  • Infants from 6 months to 1 year receive WIC supplemental foods as specified in Food Package II.
  • Women, infants and children with a qualifying medical condition receive WIC supplemental foods as specified in Food Package III.

WIC-eligible medical foods in Food Package III must serve the purpose of a food, meal or diet and provide a source of calories and one or more nutrients. These foods can only be provided when a licensed medical provider with prescriptive privileges in Maine authorizes their use. Close medical supervision is essential for individuals receiving these special medical foods and the responsibility for medical oversight and instruction lies with the participant's health care provider.

MaineCare and the Maine WIC Nutrition Program are adopting a 2001 federal regulation that identifies MaineCare as the primary payer of special/prescription formulas for individuals participating in both programs. Therefore, WIC participants that are also MaineCare members will receive their Food Package III special/prescription formulas through their MaineCare insurance. To help with this transition, MaineCare coverage of medical formulas and medical foods for WIC participants will be implemented January 1, 2010.

For WIC participants who also have MaineCare insurance, the Maine WIC Nutrition Program will provide one month of formula vouchers when a medical formula prescription is initiated, allowing for a smooth transition through MaineCare's Prior Authorization process. A completed WIC prescription form is required for prior authorization for the family to receive the special/prescription formula through MaineCare. WIC will issue a second month of formula vouchers, if necessary, for families experiencing a delay in MaineCare's Prior Authorization process. Please be aware that the Maine WIC Nutrition Program will continue to provide special/prescription formulas to WIC-enrolled participants that are not MaineCare eligible.

MaineCare members who also participate in WIC will continue to receive all other WIC services including nutrition counseling and WIC food packages appropriate to their nutritional and medical needs. Medical documentation is required for the prescription of any special/prescription formula or medical food as well as all regular foods for those participants with special health needs. The local WIC clinic must have written documentation of the:

  • qualifying condition
  • amount needed per day
  • length of time the special formula/medical food will be required
  • name of the authorized formula or supplemental food

The information required documenting medical need for the prescription of a medical formula or food is found on the Medical Documentation for WIC Medical Formula or Medical Food form. These forms can be obtained from any local WIC office, or from the State WIC Agency office. According to the Food and Nutrition Service rules, documentation of a WIC participant's medical need for a special/prescription formula must be kept on file at the WIC office.

The Food and Nutrition Service Rules and Regulations identify specific conditions that qualify for exempt special/prescription formulas or foods. In infants 0 to 12 months of age these conditions include:

Food Package III is not authorized for infants diagnosed with formula intolerance or intolerance to lactose, sucrose, or milk or soy protein. Colic or fussiness are not medical conditions that qualify as justification for medical special/prescription formulas.

The Maine WIC Nutrition Program is required by USDA to have a sole-source standard infant formula contract agreement. Currently, Enfamil Newborn, Enfamil Premium, Enfamil Prosobee, and Enfamil Gentlease are the standard contract infant formulas for Maine. Non-contract soy or cow's milk protein formulas do not qualify as medically exempt special/prescription formulas.

The Maine WIC Nutrition Program provides whole milk for children age 12 to 23 months. Recommendations of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents (National Cholesterol Education Program/NIH), The American Academy of Pediatrics Committee on Nutrition, and The American Heart Association Nutrition Committee state that fat and cholesterol should not be restricted during the first two years of life (AAP, Pediatric Nutrition Handbook, 1993, page 44; NIH, Report of the Expert panel on Blood Cholesterol Levels in Children and Adolescents, 1991, p

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