Special Supplemental Nutrition Program For Women, Infants And Children (Wic) Participant Administration

Link to law: http://arcweb.sos.state.or.us/pages/rules/oars_300/oar_333/333_053.html
Published: 2015

The Oregon Administrative Rules contain OARs filed through November 15, 2015

 

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OREGON HEALTH AUTHORITY,

PUBLIC HEALTH DIVISION

 

DIVISION 53
SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS

AND CHILDREN (WIC) PARTICIPANT ADMINISTRATION

333-053-0000
Suspension of WIC Program
(1) Notwithstanding any other rules
in this division, all WIC program benefits are suspended if there is a government
or WIC program closure or if the government does not provide WIC funding. A suspension
shall remain in effect until such time as funding is approved or as soon as the
closure ends and only to the extent benefit issuance to participants is approved
by the federal government.
(2) Notice of suspensions
shall be made by the Oregon Health Authority by posting a notice on the WIC program
website and by notifying participants in writing. Notice of suspensions shall include
the suspension effective date. As soon as funding is restored or as soon as the
closure has ended, the Authority shall notify participants of the date that a suspension
is lifted.
(3) Benefits may not be issued
to participants and participants shall not redeem WIC food instruments they have
already received during a suspension.
(4) Participants who disagree
with a suspension are not entitled to continuing benefits or a contested case hearing
but may challenge a suspension through a rule challenge under ORS 183.335 or 183.400.
Stat. Auth.: ORS 413.500
Stats. Implemented: ORS 413.500
Hist.: PH 5-2014, f. &
cert. ef. 1-30-14
333-053-0030
Description of the WIC Program
(1) The WIC program is a federally funded
program established in 1972 by an amendment to the Child Nutrition Act of 1966.
The purpose of the WIC program is to serve as an adjunct to health care by providing:
nutrition education and counseling; nutritious supplemental foods; health screening
and referral services to pregnant and breastfeeding women, infants and children
in certain high-risk categories.
(2) Federal regulations governing
the WIC program, 7 CFR § 246, require adoption and implementation of standards
and procedures to guide the state’s administration of the WIC program. These
regulations also define the rights and responsibilities of participants.
(3) The Oregon Health Authority
administers the WIC program in the State of Oregon.
(4) Any participant who receives
benefits from the WIC program shall comply with these rules. Failure to comply with
these rules shall result in sanctions.
(5) WIC program participation
may include participation in the Oregon Farm Direct Nutrition Program (FDNP).
Stat. Auth.: ORS 413.500
Stats. Implemented: ORS 413.500
Hist.: PH 17-2008, f. &
cert. ef. 11-5-08; PH 10-2013, f. 11-6-13, cert. ef. 12-1-13
333-053-0040
Definitions
(1) “Adjunctively income eligible”
means an applicant or participant who is eligible for WIC because they are:
(a) Certified and fully eligible
to receive benefits for the:
(A) Food Distribution Program
on Indian Reservations (FDPIR);
(B) Supplemental Nutrition
Assistance Program (SNAP);
(C) Medicaid/Oregon Health
Plan (OHP); or
(D) Temporary Assistance
for Needy Families (TANF); or
(b) A member of a household
with:
(A) A SNAP recipient;
(B) A pregnant woman or infant
currently on Medicaid/OHP;
(C) A TANF recipient; or
(D) A FDPIR recipient.
(2) “Appeal”
means review of an agency decision by a neutral third party.
(3) “Applicant”
means any pregnant woman, post-partum woman, infant or child who is applying to
receive WIC program benefits, and a breastfed infant of an applicant breastfeeding
woman. Applicants include individuals who are currently participating in the program
but are re-applying because their certification period is about to expire.
(4) “Authority”
means the Oregon Health Authority.
(5) “Authorized food”
means any supplemental foods approved by the Oregon WIC program and listed on the
WIC Authorized Food List or food instrument.
(6) “Authorized shopper”
means:
(a) The participant or any
person designated by a participant who has been documented as such to act on the
participant’s behalf; and
(b) In the case of an infant
or child, the caretaker or the caretaker’s designee; or
(c) Any representative of
the Authority posing as a participant or participant designee as authorized by the
Authority.
(7) “Cardholder”
means the person authorized by the WIC program to use the eWIC card to purchase
WIC food benefits at WIC-authorized vendors.
(8) “Cash Value Benefit”
or “CVB” means a fixed-dollar benefit on a check, voucher, electronic
benefit transfer (EBT) card or other document which is used by an authorized shopper
to obtain WIC authorized fruits and vegetables.
(9) “Certification”
means the implementation of criteria and procedures to assess and document each
applicant’s eligibility for participation in the WIC program.
(10) “CFR” means
Code of Federal Regulations.
(11) “Claim”
means a demand for repayment for intentional misuse of WIC or FDNP benefits.
(12) “CSFP” means
the Commodity Supplemental Food Program.
(13) “Disqualification”
means termination of participation in the WIC program and cessation of WIC benefits
due to a participant violation for a specific amount of time.
(14) “Dual participation”
means simultaneous participation in more than one WIC program (more than one state
or more than one local agency within Oregon) or participation in the WIC program
and in the CSFP at the same time.
(15) “Electronic benefit
account” or “EBA” means an account established for a WIC household
administered by Oregon’s eWIC banking contractor and where food benefits for
all participants in the household are aggregated into that single account.
(16) “eWIC card”
means the electronic benefit transfer (EBT) card used by cardholders to purchase
WIC authorized foods or formulas from their electronic benefit account (EBA).
(17) “Fair hearing”
means a proceeding before an administrative law judge to review actions proposed
by the Authority.
(18) “Farm Direct Nutrition
Program” or “FDNP” means the Farmers’ Market Nutrition Program
administered by the United States Department of Agriculture (USDA), Food and Nutrition
Services and implemented by the State of Oregon, Oregon Health Authority.
(19) “First cardholder”
means the required cardholder for an electronic benefit account. The first cardholder
is either the woman participant or the parent or caretaker from the same household
as the infant or child participant therefore sharing the same address.
(20) “Food instrument”
means a WIC program voucher, check, coupon, electronic benefit transfer (EBT) card,
or other document which is used to obtain authorized foods.
(21) “Hearing request”
or “request for a hearing” means any clear expression by an individual,
or the individual’s parent, caretaker or representative, that he or she desires
an opportunity to present his or her case to a higher authority.
(22) “Local agency”
means:
(a) A public or private non-profit
health or human services agency that provides health services, either directly or
through contract with the Authority to provide services, in accordance with 7 CFR
? 246.5;
(b) An Indian Health Service
unit in contract with the Authority to provide services;
(c) An Indian tribe, band
or group recognized by the Department of the Interior that operates a health clinic
or is provided health services by an Indian Health Service unit; or
(d) An intertribal council
or group that is an authorized representative of Indian tribes, bands or groups
recognized by the Department of the Interior that operates a health clinic or is
provided health services by an Indian Health Service unit.
(23) “Notice of Non-compliance”
means a letter notifying participants, parents or caretakers of an infant or child
participant when they commit a program violation. This notice is an explanation
of the violation and a warning about repercussions of subsequent violations.
(24) “Participant”
means any pregnant woman, breastfeeding woman, post-partum non-lactating woman,
infant or child who has been certified to receive benefits from the WIC program.
(25) "Participant's caretaker"
means a person who has significant responsibility for providing food to the infant
or child. The caretaker is usually part of the family unit, for example the parent
or legal guardian of the infant or child.
(26) “Restitution”
means reimbursement to the Authority of the cash value of WIC program benefits received
by a participant as a result of a violation.
(27) “Sanction”
means a penalty imposed by the state WIC program because of a violation.
(28) “Second cardholder”
means an individual authorized on a WIC electronic benefit account who has been
issued their own eWIC card with the permission of the first cardholder.
(29) “Service area”
means a local program or subdivision of a local agency that encompasses a specific
geographic area.
(30) “Termination”
means a participant’s file is closed and WIC program benefits cease for any
reason including, but not limited to, lack of eligibility, no longer breastfeeding,
or transferring out of state, and participant violations.
(31) “Trafficking”
means the buying or selling of a WIC food instrument for cash.
(32) “Violation”
means any intentional action of a participant, parent or caretaker of an infant
or child participant, or any eWIC cardholder that violates federal or state statutes,
regulations, policies or procedures governing the WIC program.
(33) “WIC program”
or “WIC” means the Special Supplemental Nutrition Program for Women,
Infants and Children authorized by Section 17 of the Federal Child Nutrition Act
of 1966, as amended, 42 U.S.C. ? 1786.
(34) “WIC program benefits”
mean benefits a participant receives that includes but are not limited to food,
formula, and breast pumps.
Stat. Auth.: ORS 413.500
Stats. Implemented: ORS 413.500
Hist.: PH 17-2008, f. &
cert. ef. 11-5-08; PH 5-2011(Temp), f. & cert. ef. 7-1-11 thru 12-27-11; PH
11-2011, f. & cert. ef. 10-27-11; PH 10-2013, f. 11-6-13, cert. ef. 12-1-13
333-053-0050
Participant Eligibility
(1) In order to be eligible for the
WIC program, at the time of application an applicant must:
(a) Be a pregnant woman,
a breastfeeding woman less than one year after delivery, a non-lactating, post-partum
woman less than six months after delivery, or a child through the end of the month
he or she turns five years of age;
(b) Reside within the jurisdiction
of the State of Oregon and either reside within the local agency service area or
within the Indian State jurisdiction;
(c) Meet the state’s
income eligibility criteria at the time of application; and
(d) Be at nutritional risk
as defined by the Authority.
(2) In order to establish
eligibility, a state or local agency shall require proof of residency, identity,
and income and may require verification of pregnancy.
(3) Participants may only
be enrolled in one local agency or clinic within a local agency in Oregon at a time.
(4) Participants may be enrolled
in only one state WIC program at a time. If a participant moves to a new state they
are no longer eligible to receive Oregon WIC program benefits.
(5) A participant may be
terminated from the WIC program because they are no longer eligible.
(6) A participant may be
disqualified from the WIC program for violations of program rules.
(7) A participant may voluntarily
withdraw from participating in the WIC program at any time.
(8) A participant is eligible
to receive FDNP benefits if the individual meets all of the following eligibility
criteria on the date of FDNP benefit issuance:
(a) Is currently receiving
benefits under the WIC program; and
(b) Belongs to any eligible
WIC category described in subsection (1)(a) of this rule; and
(c) Is four months of age
or older.
(9) A participant will be
informed of and required to verify that he or she understands the rights and responsibilities
of WIC participation at the time of their eligibility certification.
Stat. Auth.: ORS 413.500
Stats. Implemented: ORS 413.500
Hist.: PH 17-2008, f. &
cert. ef. 11-5-08; PH 10-2013, f. 11-6-13, cert. ef. 12-1-13
333-053-0060
Participant Information
(1) Applicants shall provide accurate
information as part of the certification process.
(2) State or local WIC staff
may verify any of the information provided by the applicant, participant, or participant’s
caretaker.
(3) The WIC program may share
information about applicants and participants with other public health programs
and Oregon Head Start programs. This information will only be used to access other
health services and assess the effectiveness of those services.
(4) Information concerning
eligibility shall be shared with another WIC clinic or local agency if the participant
moves from one service area to another or to a different state.
(5) Applicants, participants
and the participant’s caretakers will be given the opportunity to register
to vote at the local agency, and they may decline to provide this information. Receipt
of WIC program benefits will not be affected by answers to voter registration questions.
Stat. Auth.: ORS 413.500
Stats. Implemented: ORS 413.500
Hist.: PH 17-2008, f. &
cert. ef. 11-5-08; PH 10-2013, f. 11-6-13, cert. ef. 12-1-13
333-053-0075
eWIC Cards
(1) At the time of certification, a
first cardholder will be identified and issued a eWIC card for the family.
(a) If a family requires
more than one authorized shopper, a second eWIC card for use by the family’s
second cardholder will be issued.
(b) Each family will have
no more than two activated eWIC cards at a time.
(c) No more than one activated
eWIC card can be assigned to a cardholder at a time.
(2) The Authority may issue
replacement eWIC cards at its discretion.
Stat. Auth.: ORS 413.500
Stats. Implemented: ORS 413.500
Hist.: PH 10-2013, f. 11-6-13,
cert. ef. 12-1-13
333-053-0080
Participant Violations
(1) During each certification visit,
participants shall be informed of their rights and responsibilities, program rules
and the sanctions issued should they intentionally violate a program rule.
(2) Whenever the Authority
assesses a claim of misappropriated WIC program benefits of $100 or more resulting
from a participant violation, assesses a claim for dual participation, or assesses
a second or subsequent claim of any amount resulting from a participant violation,
the Authority shall disqualify the participant for one year.
(3) A participant shall be
issued a Notice of Non-compliance for the first instance; a six month disqualification
from the program and issued a claim for the second instance; and a one year disqualification
from the program and issued a claim for the third and any subsequent instance of
the following violations:
(a) Simultaneously using
his or her own WIC benefits and acting as a store cashier for the transaction if
employed by or owns store;
(b) Destruction of vendor
or farmer property during a WIC transaction;
(c) Verbal abuse of store,
farmer, or farm stand employees or owners during a WIC or FDNP transaction;
(d) Verbal abuse of state
or local agency staff;
(e) Destruction of state
or local agency property;
(f) Altering a food instrument;
(g) Failing to notify local
agency staff of change of eligibility information;
(h) Returning foods purchased
with a food instrument to a WIC vendor in exchange for money or different food unless
they are receiving the identical item in exchange;
(i) Attempting to use a food
instrument reported lost or stolen; or
(j) Redeeming a food instrument
for unauthorized foods or formula.
(4) A participant shall be
issued a Notice of Non-compliance and issued a claim for the first instance; and
disqualified from the program for one year and issued a claim for the second and
any subsequent instance of misrepresenting eligibility information to gain WIC or
FDNP benefits.
(5) A participant shall be
disqualified from the program for six months for the first instance and disqualified
from the program for one year for the second or any subsequent instance of the following
violations:
(a) Assaulting or using physical
force, actual or threatened, against store, farmer, or farm stand employees or owners
during a WIC or FDNP transaction; or
(b) Assaulting or using physical
force, actual or threatened, against state or local agency staff.
(6) A participant shall be
disqualified from the program for one year and issued a claim for the first and
any subsequent instance of the following violations:
(a) Collusion with local
agency staff to improperly obtain WIC program or FDNP benefits;
(b) Collusion with store
staff to use a food instrument for the purchase of anything other than specifically
indicated WIC program benefits;
(c) Theft of a food instrument;
(d) Buying, attempting to
buy, exchanging, attempting to exchange, selling, or attempting to sell food or
formula purchased with a food instrument for credit, merchandise, favors, or other
non-food items;
(e) Trafficking a food instrument;
or
(f) Collusion with store
staff to accept the return of food or formula purchased with a food instrument for
cash, credit, merchandise, favors, or other non-food items.
(7) The Authority may decide
not to impose a disqualification if, within 30 days of the date the letter was mailed
demanding repayment, full restitution is made or a repayment schedule is agreed
upon. In the case of a violation committed by the parent or caretaker of an infant
or child participant, or by a participant under the age of 18, the Authority may
approve the designation of a proxy in order to continue program benefits to these
participants.
(8) Participants may reapply
for benefits at any time after the disqualification period is over.
Stat. Auth.: ORS 413.500
Stats. Implemented: ORS 413.500
Hist.: PH 17-2008, f. &
cert. ef. 11-5-08; PH 10-2013, f. 11-6-13, cert. ef. 12-1-13
333-053-0100
Participant Claims
(1) If the Authority determines that
WIC program benefits have been obtained, sold, given away, traded, or otherwise
disposed of improperly as the result of a participant violation, the Authority shall
establish a claim against the participant for the full value of such benefits.
(2) For all participant claims,
the Authority shall issue a written notification demanding repayment.
(3) If the full restitution
is not made or a repayment schedule is not agreed on within 30 days of the date
the letter was mailed, the Authority shall take additional collection actions until
restitution is made or a repayment schedule is agreed on, unless the Authority determines
that further collection actions would not be cost-effective to pursue.
Stat. Auth.: ORS 413.500
Stats. Implemented: ORS 413.500
Hist.: PH 17-2008, f. &
cert. ef. 11-5-08; PH 10-2013, f. 11-6-13, cert. ef. 12-1-13
333-053-0110
Administrative Review
(1) The Authority shall provide a participant
with a fair hearing in accordance with the provision of ORS chapter 183 and 7 CFR
246.9 for the following:
(a) Denial of participation;
(b) Disqualification; or
(c) A claim against the individual
for repayment of the cash value of improperly obtained or disposed of WIC program
benefits.
(2) The Authority shall notify
the participant in writing of the right to a fair hearing, of the method by which
a hearing may be requested, and that any positions or arguments on behalf of the
individual may be presented personally or by a representative such as a relative,
friend, legal counsel or other spokesperson.
(3) The Authority shall not
limit or interfere with the participant’s freedom to request a hearing.
(4) Participants must request
a fair hearing within 60 days from the date the Authority notifies the applicant
or participant of an adverse action.
(5) The Authority shall not
deny or dismiss the request for a fair hearing unless:
(a) The request is not received
within 60 days;
(b) The request is withdrawn
in writing by the participant or participant’s representative;
(c) The participant or the
participant’s representative fails, without good cause, to appear at the scheduled
hearing; or
(d) The participant has been
denied participation by a previous hearing and cannot provide evidence that the
circumstances relevant to program eligibility have changed in such a way as to justify
a hearing.
(6) Participants may continue
receiving WIC benefits pending a hearing outcome or their certification period expires,
whichever comes first.
(7) Applicants who are denied
benefits at initial certification, participants whose certification periods have
expired, and participants who become categorically ineligible during a certification
period may request an administrative hearing to appeal the denial or termination
of WIC program benefits, however they shall not receive WIC program benefits while
awaiting the hearing or its outcome.
Stat. Auth.: ORS 413.500
Stats. Implemented: ORS 413.500
Hist.: PH 17-2008, f. &
cert. ef. 11-5-08; PH 10-2013, f. 11-6-13, cert. ef. 12-1-13

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