Q&A: Evaluating Changes to the WIC Cash Value Benefit During COVID-19

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The WIC Cash Value Benefit (CVB) is a component of the WIC food package that provides participants with a fixed dollar amount to spend on fruits and vegetables each month. Historically, the CVB for each family was only between $9-11 per person per month, an amount many nutrition experts and WIC participants deemed insufficient to meet fruit and vegetable intake requirements. In response to rising economic hardship and nutrition insecurity among families with low incomes during the COVID-19 pandemic, the United States Department of Agriculture temporarily increased the CVB from $9-11/person/month to $35/person/month during the summer of 2021. In October 2021, the CVB amount for children was changed to $24/month and extended through September 2022. In October 2022, the CVB was adjusted to $25/month and further extended through December 2022.

Healthy Eating Research funded several research teams to examine how the CVB increase affected participants’ fruit and vegetable consumption, and any facilitators and barriers to using the benefit increase. We discussed the findings with each of the research teams. McKenna Halverson, MS, is a Doctoral Student at the University of Delaware. Emily Duffy, MPH, RD, is a Doctoral Candidate at the University of North Carolina at Chapel Hill Gillings School of Global Public Health. Marisa Tsai, MS, MPH, is a Doctoral Student at the University of California, Berkeley and analyst at the University of California, Nutrition Policy Institute. Cristina Gago, PhD, MPH, is a Post Doctoral Fellow at NYU’s Center for Healthful Behavior Change and received funding for her project from NOPREN.

Each of your studies focused on how the WIC CVB increase impacted participants in a different state. What specific questions were you seeking to answer with your analysis?

McKenna Halverson: Our study sought to characterize how increases to the CVB during the pandemic impacted Delaware WIC participants’ perceptions of the benefit as well as their grocery purchases, food preparation, and fruit and vegetable consumption patterns. 

Emily Duffy: In this study, we wanted to understand North Carolina WIC participants’ perceptions and awareness of this unprecedented CVB increase, barriers and facilitators to using this higher CVB amount in different types of communities, and WIC participants’ perceptions of whether and how this increase changed their family’s dietary behaviors and nutrition security. We conducted 10 virtual focus groups (5 rural and 5 urban) with North Carolina WIC participants in March of 2022.

Marisa Tsai: In a previous analysis using longitudinal survey data, we found that access to fruits and vegetables, satisfaction with the CVB amount, and household food security increased significantly after 12 months of augmentation. With the current study, we aimed to build on these findings by examining whether the effects of the CVB augmentation were present in all racial and ethnic groups served by WIC, and whether it contributed to or reduced disparities. It was important to examine the effects of the CVB augmentation across racial and ethnic groups, as prior studies have shown that participants differ in their preferences regarding the composition of the food packages. The objective of this analysis was to compare the effects of the WIC CVB increase on redemption, satisfaction, household food security, and fruit and vegetable intake across racial and ethnic groups.

Cristina Gago: Through our study, we aimed to assess perceptions Massachusetts WIC caregivers held regarding the impact this CVB-increase posed on fruit and vegetable purchasing behaviors and satisfaction with the WIC food package in general. We also aimed to evaluate potential disparities in perceived impact by race/ethnicity, market access, and food security status, as a means of preliminarily assessing whether implementation and uptake of this enhanced benefit has been equitable.

What are the key takeaways readers should know about from your study? 

McKenna: We found that WIC participants strongly support the CVB increase and that higher benefit amounts positively affected perceived dietary quality. Specifically, participants reported that the higher CVB allotment allowed them to eat healthier by increasing their purchasing and consumption of fruits and vegetables. Additionally, participants reported consuming a greater variety of fruits and vegetables, which allowed them to better understand their children’s taste preferences.

Emily: This CVB increase was very positively received by WIC recipients in North Carolina, and, in fact, many WIC participants stated they need more CVB than they are currently receiving due to inflation. Participants stated that the pre-pandemic CVB amount was insufficient to meet their family’s needs and some stated that this amount was inconsistent with WIC nutrition advice to consume a lot of fruits and vegetables. Many participants were not notified about the pandemic-related CVB changes and this created uncertainty and challenges for WIC participants. Some barriers noted to using the higher CVB amount were inadequate supply of fruits and vegetables, particularly in rural communities, and issues identifying WIC-eligible fruits and vegetables in stores using things like shelf tags and the WIC BNFT app, which provides participants their benefit balance, transaction activity, store locator, and more. Participants consistently stated this CVB increase allowed them and their children to eat a wider variety of fruits and vegetables, something that is incredibly important for healthy taste preference development in early childhood.

Marisa: We found that the temporary CVB augmentation was associated with improved fruit and vegetable access for all racial and ethnic groups served by WIC. Household food security also increased in all racial/ethnic groups. Additionally, all groups reported substantial increases in satisfaction with the CVB amount. Increases in satisfaction were greater among those with lower baseline satisfaction with the CVB, such as Asian, non-Hispanic White, and non-Hispanic Black participants. Participants from groups with lower baseline CVB satisfaction were more likely to indicate that a future reduction in the CVB would decrease the likelihood of continued program participation.

Cristina: We found that most caregivers reported that they perceived the CVB increase reduced their out-of-pocket fruit and vegetable expenses and allowed them to buy better quality and greater quantity of fruits and vegetables. Caregivers also reported perceived increases in the amount fruits and vegetables they offered their children and consumed personally. Though high satisfaction with the WIC food package was reported both pre- and post-CVB-increase, over one-in-three (37.1%) still reported an increase in satisfaction following benefit enhancement, which could ultimately pose huge implications for redemption and retention over the long-term. Finally, probability of reporting improved outcomes was not found to differ by race/ethnicity or market access. 

Where do we go from here? What are the top policy implications or steps needed to facilitate change or progress?

McKenna: Our top policy recommendation is to permanently extend increases to the CVB. Amounts of $25/month/child, $44/month/pregnant or postpartum participant, and $49/month/breastfeeding participant have shown improvements in dietary purchasing and consumption. Permanently extending the enhanced CVB could help to increase fruit and vegetable consumption among children, which is an important goal because many children are not meeting the consumption recommendations in the Dietary Guidelines for Americans.

Emily: Our findings and similar results that have been replicated in other contexts show that this CVB increase has been a step in the right direction for aligning the WIC food package more closely with dietary guidance and WIC participants’ needs. This higher CVB amount is still a temporary change and is slated to end in December. We think that our study and others can be used in efforts to decide whether and how to make this higher CVB amount permanent. Additionally, this was not the primary objective of our study, but we frequently heard in our focus group discussions of other desired changes to the WIC food package such as including more culturally-relevant items, allowing WIC benefits to roll over for at least one month, and building in more flexibility in the sizes and types of foods received through WIC. Participants felt these changes would allow them to use more of their WIC benefits and would make the WIC food package work better for them and their children. We are hopeful this information will be useful in the comment period when USDA releases the proposed rule for the revised WIC food package later this year.

Marisa: The findings support that the CVB augmentation improved access to fruits and vegetables through greater redemption, improved satisfaction with the CVB amount, and increased household food security. We found that these benefits are experienced across diverse participant groups and provide support for continued investment in the augmented CVB, as well as other efforts to increase nutrition access for low-income children. Additionally, this study was a collaboration between WIC researchers at an academic institution and a WIC provider. The combined expertise and ownership of the project was invaluable to the development of policy- and practice-relevant research questions and allowed increased evaluation capacity. We are hopeful that other researchers and WIC providers would consider similar models to support WIC and identify approaches to continue improving the program.

Cristina: More studies on the impact of this important policy change are necessary so that we can understand not only the perceived impacts of this change (as we assessed in our study), but also the objective impacts posed on redemption and retention, for example. Through these future research initiatives, we need to encourage interstate collaboration and comparison, to better understand how both implementation and uptake of this enhanced benefit may have differed by context. Our findings and those of others in similar states add to a growing body of literature in support of making this temporary benefit enhancement permanent, as a means of improving WIC caregiver satisfaction and experience, as well as promoting optimal retention and full redemption of benefits. We also recognize the need for continued efforts at the local clinic level to ensure that caregivers know this enhanced benefit exists and is available to them. These communications occur both with local clinic staff (whose efforts have been monumental in scale and impact), social media, as well as through other technology like the WIC Shopper App (in states where available). Understanding how to best get the word out and keep caregivers informed — through these means and others — is an important area of future research.

Thanks to McKenna Halverson, Emily Duffy, Marisa Tsai, and Cristina Gago for discussing their findings with us. To learn more, see their published work (below). McKenna, Emily, and Marisa will also be presenting on these studies at APHA’s annual meeting during a session on “Understanding Perceptions and Utilizations of the WIC Cash Value Benefit.”