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OCR for page 159
10
Summary
This report has reviewed the current methodology used by USDA to
estimate, on a national basis, eligibility and participation for the WIC pro-
gram. Our review first described the two basic purposes for which the esti-
mates are being made: to develop budget estimates for the upcoming fiscal
years and to gauge how well the program is reaching the population it
intends to reach, that is, program coverage. To a lesser extent, the estimates
are also used to estimate how program changes affect eligibility and partici-
pation and how external influences, such as economic conditions, affect
eligibility and participation. The panel has argued that if the purpose of the
estimates is to understand program coverage and evaluate the effectiveness
of program characteristics, then it is essential to estimate the number of
people eligible for WIC and the Percentage of those who may narticinate in
WIC.
1 ~
ESTIMATING ELIGIBILITY
, . 1
The panel concludes that current estimation methods result in a sub-
stantial underestimate of eligibility because monthly income and adjunc-
tive eligibility are not adequately addressed. Panel estimates show that a
significantly greater number of people would be determined eligible for
WIC if a monthly income measure were used instead of an annual income
measure. Using Survey of Income and Program Participation (SIPP) data,
159
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160 ESTIMATING ELIGIBILI>~D PAR TICIPATION FOR THE ~CPROGR~
the use ot monthly income (and accounting for WIC certification periods
and adjunctive eligibility through reported enrollment in food stamps,
Medicaid, or Temporary Assistance for Needy Families TANF) resulted
in a 46 and 54 percent increase in the number of income-eligible infants in
1997 and 1998, respectively, and a 34 and 36 percent increase in 1997 and
1998 for children, compared with the current USDA estimates.
The panel also determined that current methods used to estimate eli-
gibility do not adequately account for adjunctive eligibility. With expan-
sions in the Medicaid program that raised the income limit for eligibility
well over 185 percent of federal poverty guidelines in many states, some
people with annual incomes over 185 percent of poverty could be eligible
for WIC because they were enrolled in Medicaid, but they would not be
counted as such in the eligibility estimates. Using SIPP data and reported
participation in Medicaid and other public assistance programs that con-
fer adjunctive eligibility (TANF and food stamps), the panel estimates that
an additional 18 percent of infants are eligible for WIC and an additional
10 percent of children are eligible compared with estimates based on the
current USDA methodology, which uses an annual income measure. The
panel concludes that current estimation methods result in an underesti-
mate of eligibility because monthly income and adjunctive eligibility are
not addressed.
Options for Estimating Eligibility
The panel proposes two options for USDA to consider using in order
to estimate income eligibility for WIC. One option maintains the March
Current Population Survey (CPS) as the base survey from which eligibility
estimates are derived, but it uses multipliers to make appropriate adjust-
ments. The second option relies on SIPP, which has a longitudinal design
and collects monthly data on income and program participation. An out-
line of these two options is given below:
CPS with multipliers: Use annual income to estimate the number of in-
fants and children eligible for WIC. Count those who report receiving
Medicaid, food stamps, or TANF as adjunctively eligible. Use a con-
stant multiplier to increase the estimates to account for monthly in-
come and certification practice and underreporting of participation in
means-tested programs in the CPS. This multiplier could be based on
the estimates from the Transfer Income Microsimulation (TRIM)
OCR for page 161
SUMMARY
161
model (a multiplier of 1.20 for infants and 1.05 for children), or on a
SIPP-based multiplier. These core estimates for infants and children
would then be used to estimate the number of eligible pregnant and
postpartum women.
SIPP option: Use monthly income and account for WIC certification prac-
tice to estimate the number of income-eligible infants and children.
Count those who report receiving Medicaid, food stamps, or TANF as
adjunctively eligible. Directly estimate the number of eligible pregnant
and postpartum women.
Both of these options have benefits and limitations. The major limitation
of the SIPP data is that their public release is not as regular or as quick as
the CPS. The major limitation of the CPS-based option is that month-to-
month income variability that differs from the panel's estimate would in-
troduce error in the constant multiplier proposed to correct for the use of
annual income. Either option is better than the current method because
they both account for income variation across the year and adjunctive eligi-
bility.
Accounting for monthly income and adjunctive eligibility are high pri-
orities for improving CPS-based estimates of eligibility. The panel also
makes recommendations about the methods used to infer the number of
income-eligible pregnant and postpartum women from the number of in-
come-eligible infants, to estimate breastEeeding rates among postpartum
women, and to estimate the prevalence of nutritional risk. These recom-
mendations can be summarized as follows:
1. To correct for CPS undercounts of infants and overcounts of chil-
dren, use adjusted weights (Chapter 41.
2. To estimate the number of income-eligible postpartum women
from CPS-based estimates (both breastEeeding and nonbreast-
feeding), continue to use the current adjustment factor of 0.9844
to account for multiple births and infant and fetal deaths (Chapter
61.
3. To obtain the number of income-eligible pregnant women, apply
an adjustment of 0.533 (instead of the 0.75 factor) to the number
of income-eligible infants to account for income variability during
pregnancy (Chapter 61.
4. Use more recent data to estimate breastEeeding rates and duration
among income-eligible postpartum women less than 12 months
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162 ESTIMATING ELIGIBILI>~D PAR TICIPATION FOR THE ~CPROGR~
postpartum. Apply them to the estimates of income-eligible post-
partum women to determine the number breastfeeding and
nonbreastSeeding (Chapter 61.
5. The percentage of the income-eligible population also at nutri-
tional risk is very close to 100 percent. Methods used to screen for
nutritional risk are not accurate enough to precisely identify the
small percentage of those who are income eligible but not at nutri-
tional risk. As a result, the panel concludes that a nutritional risk
screen is not useful for determining eligibility. If the USDA drops
this aspect of eligibility determination, no adjustment for the
prevalence of nutritional risk is needed to estimate eligibility
(Chapter 71.
The first three recommendations apply to the CPS-based option for
estimating eligibility. The last two recommendations apply to both the CPS-
based and SIPP-based options for estimating eligibility.
ESTIMATING FULL-FUNDING PARTICIPATION
The full-funding participation rate (FFPR) is the percentage of indi-
viduals eligible for WIC who choose to participate, if funds are sufficient to
serve them. The panel makes the claim and illustrates that changes in pro-
gram administrative practice or changes in program outreach can increase
or decrease the number of WIC participants. The FFPR is a level of partici-
pation that policy makers could set a goal to achieve. Based on the premise
that the full-funding level of WIC participation is a policy goal, the panel
recommends a strategy to predict the number of participants each year for
the purpose of making budget estimates. The strategy the panel recom-
mends depends on whether the goal FFPR has been achieved or not. If the
FFPR has been achieved, then the method to estimate participation levels
is simply to use last year's participation levels. However, if the FFPR has not
been achieved, then the method multiplies the desired FFPR by the esti-
mated number of eligible persons in the eligibility category. The assessment
of whether each category of eligible persons has met the desired rate of
participation should be made each year. Furthermore, because it is likely
that not all eligibility categories will meet the full funding level, separate
assessments and estimation strategies should be made for each eligibility
category.
Representative terms from entire chapter:
monthly income
