Book Description

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is the third largest food assistance program in the United States and many studies have demonstrated positive health benefits from participation in WIC. However, several barriers prevent potential recipients from joining and fully utilizing available benefits. First, the participation rate is disturbingly low and has fallen in recent years to about 55 percent. Second, I have uncovered evidence of a high rate of partial or non-redemption of benefits by program participants, meaning the participant is obtaining none or only part of the food benefits that have been prescribed. Third, WIC is not anentitlement program, so its ability to serve clientele depends on cost efficiency, but many aspects of the program are ill-suited to achieving cost efficiency. This dissertation focuses on these major problems of the WIC program and investigates the impact of various WIC polices on WIC participants and WIC program cost. WIC has mandated changes to its food issuance and redemption method from paper vouchers to electronic benefit transfer (EBT) by 2020. In the first chapter of my dissertation, I study the changes in WIC program participation and program food costs after EBT transition. County level WIC enrollment data and WIC food issuance and redemption data in Oklahoma are used to perform the empirical analysis. The transition to EBT has been anticipated to increase participation and decrease food costs because it provides WIC participants more flexibility in redeeming food benefits, reduces the time cost and stigma cost of WIC participants, and prevents redemption of expensive, non-WIC-eligible food items. However, I find no statistically significant change in program participation after EBT transition. But EBT reduced average participant food costs about $8.24 per month in Oklahoma. Applying these savings to WIC participants in all the states generates $56 million in estimated cost savings annually. The second chapter of my dissertation focuses on partial redemptions and factors that affect WIC participants' redemption behavior. A partial redemption occurs when a participant redeems only a portion of the prescribed benefit, thereby not obtaining the full nutritional benefit. Partial redemptions are a major issue for the WIC program because considerable research has demonstrated the positive health benefits from WIC, but those benefits are mitigated if participants don't purchase and consume their prescribed foods. Using the transaction-level WIC redemption data, I study the probability that a household partially redeems its benefits in a given month, andthe factors that could affect this probability. The results identify WIC products that are most likely to be partial redeemed and household characteristics associated with partial redemptions, enabling targeted nutritional counseling. The third chapter of my dissertation focuses on WIC participants' food choices and explores the role that choice of WIC-authorized brands, package sizes, product types, etc. have in determining program food costs. State programs have discretion in designating foods eligible for the WIC program, subject to regulations set by the federal government. I combine WIC administrative data with IRI supermarket scanner data to simulate WIC participants' shopping behavior and compare the results with the actual food redemption data from California WIC. I find that the actual shopping patterns of California WIC participants closely resemble a situation wherein participants select the most expensive authorized products, brands, and package sizes. The policy implications from this study suggest that restricting participant product selection to least cost brands WIC foods leads to program cost savings between 4.6 percent and 9.5 percent, depending upon the food packages.