WIC in Vermont
- A: EBT Card Use
- B: Food List and Food Packages
- C: Getting Ready for Ceres
- D: Transition to Ceres
- E: Training for Staff and Participants
- F: Using Ceres
- G: Grocers
For example, if the participant only wants baby formula, can they use all the $ on the card just for formula or will the card “know” she isn’t purchasing cereal, baby food, etc?
If a client does not use any juice, can that money that they would normally have on the card to buy juice, be available to buy fresh fruits and vegetables instead?
A: No to both examples. The new VT WIC EBT program will authorize specific quantities of specific foods in her food package(s). Think of it this way: The EBT food account and card REPLACE the POD. The EBT card allows purchase of specific quantities of specific items. Categories of food cannot be traded for each other. With EBT, the shopper makes her choices in the store, instead of in the clinic. Juice is a specific category of food, and fruits and vegetables are a separate specific category. The food benefit will continue to be “Cash Value” for any approved F&V, but specific quantities for things like juice.
And a reminder: benefits are not “on the card.” They are stored in an account on the EBT Host, just as they are stored now on the WIC mainframe. The card is a way of accessing the account (like a debit card accesses a bank account.)
A: Yes, if the store allows other shoppers to use them, then so must the WIC participants. This goes for "buy one get one free" and other promotions, also. In the “buy one get one free” scenario, the free item does not debit the participant’s benefit account. This is a federal requirement, and is in the agreement between Vermont WIC and authorized grocers.
A: The fruit and veggie benefit will still be a "dollar value" per month, and will be processed the way they are now. All food items will be rung up, then the WIC EBT system will "check" for which purchases are eligible for that household. Fruits and vegetables will be charged against the dollar value of the benefit loaded for that family.
A: Yes, WIC EBT is “use it or lose it.” All unused food benefits (which are stored on the Host, not the card) “expire” at 11:59:59 pm on the last day of the month, just as the current fruit and veggie cash benefit expires at month end. Eligible benefits for the next month then become available at 12:00:01am the first day of the next month.
It will be important to educate participants about this “use it or lose it” rule, especially because they may be used to SNAP benefits, which do carry over for three months. DOs will be able to view reports on Ceres showing which participants did not use up all their benefits, so they can be reminded.
A: Remember that the food benefits are not on the card; the card allows access to the benefits stored on the EBT Host Computer. And yes, the EBT Host can be queried at the store and the WIC clinic about what benefits are in the family account. Participants can also go online and log in to see their WIC account online. (Registering for this online card center is a task WIC staff can help participants with when cards are issued.) The cash register receipt will also print out what benefits remain, after a WIC purchase.
A: The call center will be run by our new contractor, a different contractor than the current center and will be a dedicated WIC EBT call center. The current center is actually a SNAP call center, so the system is not set up as well for WIC (e.g. SNAP uses social security numbers, which WIC does not use, making it more difficult for WIC participants to identify themselves to the call center and get help).
A: Federal rules state that if the shopper has the EBT card and PIN, no other identification would be requested, so a name on the card doesn’t matter. With the migration from home delivery to retail, whether EBT or paper voucher, Vermont WIC has to implement a strong investigation and compliance program. We will be issuing administrative rules to deal with fraud and abuse, and hiring contractors to conduct investigations as needed. With the good redemption data from EBT, we can also “spot check” for anomalies in purchasing/redemption.
A: Nutritionists Jackie Charnley and Carol Frary are coordinating the work. They collected APLs from surrounding states to try to align as much as possible, given overlap of chain stores, and shopping habits of some participants. We collected food inventory lists from wholesalers and chain stores, and conducted a survey of WIC participants – both in person interviews and an online Survey Monkey survey. We visited stores to conduct an assessment of what products are widely available. There are decisions to make, generally around the more “exotic” products, such as: will goat’s milk be on the APL, and if so in what forms? (e.g. powdered, shelf-stable, etc). Most noticeable change for participants will be in the Whole Grain category, as many more bread and cereal choices will be possible. Most states update their APL every October, so we’ll probably do what the surrounding states do. EBT provides real-time data on what exactly is purchased, so we’ll be able to make adjustments based on preferences (e.g. eliminating products that are rarely purchased).
A: We will provide families with booklets that list and display (with photographs) the eligible foods. This will also be accessible online. (This link takes you to the Massachusetts guide, for example. http://www.mass.gov/eohhs/docs/dph/wic/food-guide.pdf ) Some grocers will use shelf tags (though not likely in border chain stores where multiple state WIC programs have authorized the store). This will be an important focus for participant education in clinic.
A: Grocers, wholesalers and manufacturers will be continuously updating VT WIC on their new products (new sizes, packages, products, UPC codes). When Vermont WIC decides to add that product to the Approved Products List and food packages (size, brand, etc), Ceres sends that updated information to the EBT Host, which downloads an updated list each grocer’s system. Also, when state staff notice that some foods on the APL are not being purchased, those foods can be removed. As part of our development process, we’ll figure out how/when to notify participants about changes to the list.
A: There will be far fewer food list changes for staff to make, because families will have many choices in each food category. For example, they won’t have to request a change from Cheerios to Kix – their food package will include authorization for an “eligible” cereal, and they can just choose which cereal they want each time they shop.
A: Not exactly. Some of the tailoring is in the Ceres system --- for example, the participant will be able to choose a food package that includes cheese instead of milk. But once someone chooses cheese for the food package, that’s what is stored in the EBT benefit file. In the store, the participant has multiple choices of the type of cheese to fulfill that item, and can choose when and how much to purchase at a given time.
A: We know that many participants prefer organic products. Authorizing organic foods is principally a cost issue for WIC. Some organics products will be allowed, but not those where there is a significant cost differential to the program. For example, milk, yoghurt, eggs and baby food are items where the organic product cost is many times that of conventional. We will probably authorize organic tofu and soy milk, because price differences are not significant for those products. Organic fruits and vegetables will be authorized, because it’s a cash value benefit, which limits WIC cost exposure. (And the “new” final food rules allow families to buy more fruits and vegetables if they want to make their own baby food from organic produce.)
A: No. States usually do this (require “lowest cost product” or store brands only) as a cost containment measure; for some states, it’s either impose this or impose a waiting list. We don’t anticipant having to do this. Our APL will have both national brands and store brand choices for the participants.
A: Yogurt was recently approved by USDA/FNS in the final food rule, and we will include it in our food packages for retail food delivery.
A: We believe retail delivery will allow more and better choices for all families. There will be a wider variety of breads and grains, yoghurt, cheeses and cereals. Even small stores specializing in Asian, African or other specialty foods should be able to participate if they carry a full market basket of products and are willing to meet WIC minimum stocking requirements; the state will provide the electronic equipment they need to accept the WIC card.
A: For fruits and vegetables, the benefit will still be a fixed cash value, so the lower the price, the more they can buy. For other approved foods, families will make food choices based on their own preferences within the approved foods. Some families prefer specific brands, others are used to coupon/bargain shopping (WIC allows families to take advantage of promotions such as “buy one, get one free”), and some prefer store brands for specific products due to ingredients, taste and familiarity.
A: Families will be able to use their card to purchase many of the formulas we now consider “special” but that are available in regular grocery stores. These include formulas such as Gentlease, Spit-up, Fussiness & Gas, Pediasure, Nutramigen, and Alimentum. For the really special items, we haven’t decided yet whether we should continue our district office pickup system, join a group of WIC states that has a contract for direct shipping these formulas to families, or special order the items through major grocery chain pharmacies for families to pick up at the store with their EBT card.
A: First, in clinic now, work on completing the whole certification, including writing your notes, before a participant leaves the room. In the new system, the notes need to be done before we can issue an EBT card – and we want people to leave clinic with their card! Practice recording information in the chart while you are talking with a participant. Start with just one simple visit, and work up to a full clinic session with no charts to finish up at the end of the day.
Second, brush up on your computer skills. Ask your RCN representative for the Computer Skills Self-Evaluation and find out how where you may want to spend some practice time or get help.
A: First, certifiers won’t have to look through paper files and write notes, saving everyone a lot of time during appointments. Any member of the family is accessible from another family member’s record. (For example, when posting measurements for two children, you’ll be able to click from one child’s record to another, from within the Anthropometric Measures screen.)
Second, all information about the family is entered one time.
Second, entering certification data into Ceres is mostly through the use of “drop down” menus, check boxes, etc. Everything related to the certification is in one place, on screen. There are no separate paper forms to find, fill out and organize.
While there is some “input” required for such items as participant responses to open-ended questions, certifiers are now writing those answers in long hand notes on paper – a time consuming task. With Ceres, the same task is done by typing instead. (Staff are encouraged to “brush up” on computer and typing skills to make it easier once everyone is using Ceres.)
Finally, the system we are implementing was selected in part because it is easy to use by anyone already using email, calendar, online purchasing, etc. Please take a few minutes to watch the brief (2 min) “Mini-Demos” we’ve prepared of the Ceres system. These are short PowerPoint presentations that show the screens and how many functions are performed (e.g. issuing a VOC, plotting growth charts.) You can view these at: \\Nessie\cph\Common\WIC\Ceres_Demos (access is limited to VDH district office staff).
A: It's the person behind the computer who makes it mechanical or makes it human. We can make it human. Mountain Plains states WIC staff recommended to us that training focus on how to be comfortable and remain fully engaged with the participant while conducting the interview and nutrition education. Think of all the times you interact with someone where there's a computer between you: at a store, checking into a hotel or airline, or at a doctor's office. It can be friendly and interactive and we’ll strive to do that.
Our "clinic enablement plan" includes WIC staff redesigning work-spaces to be comfortable with the lay out, and not create barriers.
Consider the upside: instead of going over a pamphlet with the participant, you can watch a video together, visit the CDC or other useful website together to research a question, or use a PowerPoint presentation for nutrition education. This is actually more like the WIC participant's "normal life" than a paper-based interview would be.
A: As soon as you’ve certified a household/family using the new system, the chart/folder can be readied for archiving. State office will manage the long-term archiving necessary to comply with FNS requirements.
A: Each clinic room and admin workstation will have a computer (PC), wide screen monitor that swivels, keyboard, card reader, signature pad, and mouse. Every local agency will also have a WIC-dedicated printer/scanner that is networked to all workstations.
Outreach clinics will have a laptop, card reader and signature pad. Any paper document that needs to be in the record will be scanned into the family record back in the district office.
A: The ideal is that all outreach clinics will have wireless connectivity to Ceres through laptops. If wireless is not available, Ceres has an offline function - family files are downloaded before leaving the office, and data and files will be synchronized between the laptop and Ceres when the staff return to the DO.
Each outreach site will be assessed for connectivity, reliability and a plan will be developed for how to best serve the site.
A: Families will continue to be certified for six months; the change is that benefits are issued for three months at a time. This requires a nutrition "check in" at three months. By reductions in paperwork during the certification period (e.g. by eliminating the PODs), this ought not to create a need for more staff, but will be a better use of staff time, which is freed up by the new MIS and EBT systems.
There is a subproject specifically to examine the impact of the move to Ceres on clinic flow and certification periods. This is one of the issues that will be addressed. WIC staff will be consulted before final decisions are made.
A: We don’t plan to reduce administrative staff because of Ceres. There may be opportunities for more outreach, work with retailers (many states have local grocer liaisons) and other activities. WIC and OLH will work together to redefine front office/admin tasks for WIC.
We can be confident that positions will not be cut because of the new WIC system & EBT. But there is never any guarantee that State positions will be where they are now, doing what they do now.
- Programs other than WIC may change.
- If population or program participation levels change staffing levels may need to change (up or down).
- State budgets affect how many state employees there are, where they are located and what their duties are, etc.
Those are all things that are beyond the control of a single program.
A: No specific role changes for certifiers are planned as part of the Ceres/EBT implementation.
A: One of the reasons pushing us to implement EBT quickly is that we’ve been notified several drivers want to retire in the next few years, and the trucks they drive aren’t easy to replace, either. We are keeping our drivers fully informed about the project, so they can make their own plans for 2016, when EBT is rolled out statewide. And we will plan a celebration to recognize their years of service to Vermont’s WIC families.
A: Families are currently getting their non-WIC groceries somewhere, somehow, and we are continuously adding stores to our network based on shopping patterns. Because the EBT card allows shopping anytime during the month at any time a store is open, families will have many opportunities to get their full WIC benefit. Difficulties in getting to a district office that may be many miles from home, during weekday business hours, is unlikely to be a predictor of problems getting to a grocery store.
A: No, DII and the MIS contractor will do that. We’ve started identifying the information that will need to be converted to the new system. Some information, such as racial/ethnic codes, will need to be entered in the new system when participants are recertified, because our complicated coding structure can’t easily be converted.
A: We are working very closely with DII to make sure the network can support this new system.
DII considers “today’s speed” the “baseline,” and will add capacity to bring “today” up to what is needed for Ceres. That means if “today” is already too slow, it’s important to contact Help Desk to report slow response, so we can all get the system working satisfactorily now. Then, the capacity added for Ceres will be enough to support it.
Our implementation includes a "clinic enablement plan," that assesses each location to make sure Ceres will work optimally there.
A: Yes, there are strict timelines required in the contract, with performance guarantees. WIC also has contracted for a Quality Assurance contractor, to make sure the work done by the MIS and EBT Contractors is complete and thorough. The most important key to keeping the project on time and on track is that WIC has assigned a full-time Project Manager, Nancy Rowell, PMP, who is supervising the project and the contractors.
Project Managers (PMs) for the contractors are in daily communication with our Project Manager, and there are weekly meetings of all the PMs. The project’s Steering Committee meets every week and is attended by representatives from WIC, DII, VDH IT and AHS IT. In other words, there is a strong project management component directing the program and closely overseeing the MIS and EBT contractors on a daily basis.
A: Even though we are transferring and installing an existing system, rather than writing new software, this is a very complex and expensive project. There are many checkpoints and review processes that add time, but are important to make sure it’s done right. For example, we finished writing the Requests for Proposals (RFP) for the contractors In the Fall of 2012, and it took from then until March 2013 for state agencies and FNS to review and approve the RFP. We selected the winning bidder in June 2013, but it took until late September before the contract had all required signatures. Once the contractors started working, the work does go quickly, as we planned. The pilot will happen in 6/2015, which is only one year and a couple of months after the work has begun in earnest.
With the very public news of failed IT projects recently, there is a lot of scrutiny. A lot of time is spent on planning and procurement --- kind of like the "measure twice and cut once" adage....
A: District Office staff will receive one full week of intensive, hands-on training using Ceres prior to roll-out in your office. This will include a full day of practicing intake, certifications, etc, using the equipment you’ll be using in your own offices.
During the second week of roll-out, state support staff, including training staff, will be in your office to help in the transition. Each DO will have a “super-user” on staff to provide ongoing help and support.
A: These are the kinds of topic that will be thoroughly covered in training and practice sessions, and in written manuals that will describe, step-by-step, how to process these changes.
The Colorado manuals use tables showing “Before, this was how you did this. Now, here’s how you do this.” Basically, a “cheat sheet” of sorts, or a cross-walk showing the changed process. We will use this in our manuals, and WIC staff will be involved in development of these materials to make sure they address functions clearly.
A: All clinic personnel, including clerical staff, will be fully trained for the tasks for which they are responsible, as well as any tasks for which cross-training needs are identified. WIC and the Office of Local Health will work together to look at how the Ceres/EBT affects the work of all staff disciplines, and to make changes in major job duties if necessary. Decisions about which staff person does which specific task at the local level will be a local decision, as it is now.
A: This is not just an issue for Burlington office. Our training plan will need to have a component for people whose first language is not English. Some states have set up “Let’s Play Store” training, used in group education or in one-on-one for ESL participants. This is the model at least one Vermont DO already uses to show participants how to use Farm to Family coupons.
A: No, Ceres will be located on the State of Vermont’s security protected Network. Your access to Ceres will be provided after your normal login to the State/AHS Network.
A: The new system can connect with the state auto dialer to make reminder calls.
A: Ceres has nearly 200 reports built in. WIC staff may have different levels of permissions for reports. However, almost all of them will be accessible by District Offices without requesting reports from State Office. Ceres automates production of these kinds of reports, on demand. This means that authorized personnel will be able to produce these reports at the District Office level, whenever they are needed. We have a subproject to figure out the roles of each type of staff, including who has access in Ceres to which reporting functions.
To see a demonstration of the powerful reporting functions in Ceres, look at the mini-demo posted on the RCN Resources website: Ceres Demonstrations. You can find the Demos in the Nessie folder: \\Nessie\cph\Common\WIC\Ceres_Demos. Select the Ceres Demonstration called “Run Reports.” (Access to the demos is limited to VDH district office staff).
A: Every Ceres user will have a user ID and name in the system. Ceres creates an audit trail, using the log in from each staff person, creating a record of who does what – who created a record as well as who last modified the record. If data integrity becomes a problem, finding out who needs more training and support will be possible.
When WIC staff log in to Ceres to handle any clinic activity, that staff member’s activity is identified with the action taken, and displayed by Ceres system. Thus, anyone checking the participant’s record (for example, the record of a pregnancy appointment) can see all staff who saw that participant before.
A: Appointments may take longer for a few weeks while everyone gets used to the system. As people develop confidence, their appointment schedules can go back to normal. If people need more training, we'll make sure they get it. The point is to help staff be able to provide better service using the new MIS. One of the MPSC states, during implementation, scheduled every other appointment slot for the first few weeks, until the staff was comfortable with the system and their skills. If an appointment took longer, it wasn't a problem. The extra time before the next appointment can also be used to do a "practice run" of what will need to be done for the next family.
Ceres automates virtually all of the processes needed to run a WIC office. Therefore, it will be significantly easier and faster to do the work that is done now, without requiring more staff, and allowing existing staff to better and more quickly serve WIC participants.
A: For out of state transfers, Ceres will print a VOC document that contains all of the necessary information for an out of state transfer, ready for a staff signature. To see how simple Ceres makes the VOC, look at the mini-demo posted on the RCN Resources website: Ceres Demonstrations. You can find these in Nessie at this location: \\Nessie\cph\Common\WIC\Ceres_Demos. Select the Ceres Demonstration called “VOC.” (Access to the demos is limited to VDH district office staff).
A: There are no current recommendations. We will add this to the clinic enablement plan.
A: Ceres won’t have a direct connection (interface) with Medicaid. It will still be necessary to check Medicaid eligibility the way it is done now. Having that interface is on a list for future enhancements, but it’s probably a long ways off.
A: We’re not sure yet. Both Utah & Colorado WIC (who use the system we are transferring as Ceres) use wichealth.org, so we can learn how they are using it for nutrition recalls.
A: While outages do happen, the State’s servers and networks are being made more secure and stable with the consolidation of state resources by DII. (For example, the servers are no longer located in flood plains.) In the case of a long-term disaster outage, the WIC program’s own Disaster Recovery plan would take effect. That process would most likely be a paper process, similar to what you use now.
A: We have already certified additional border stores, based on a survey of WIC participant shopping habits. We will also probably authorize Wal-Mart superstores for the retail delivery roll-out.
A: We have been working with grocers for a couple of years to prepare them, and make sure if they install new IT systems that they plan for WIC EBT. If they don’t want to incur costs for a WIC-compliant system, can use a state-provided EBT card device. We now know that the major chains – Hannaford, Price Chopper and Shaws, will be WIC EBT-ready by the time of our pilot in 2015.
A: The grocers will be grouped into Peer Groups by their size and whether they are part of a chain, because that has an impact on the prices they have to charge. NTE is set for each food product at the average price charged in the Peer Group, plus a “cushion” for price increases. The NTE for a chain store will be different than the NTE for a small neighborhood store. If a grocer’s system charges VT WIC more than the NTE, the system will cap the WIC payment at the NTE and notify the grocer. The federal rules and grocer contracts prohibit the grocer from charging the participant for the overage. The grocer has to “eat” the loss. Because the EBT system will be collecting actual pricing in real time, the VT NTE will always be up to date for all peer groups. This is the way WIC operates now in all other states that use vouchers or EBT.
Page updated 11/07/2014