DEPARTMENT OF HEALTH

PARTICIPANT COMPLIANCE

The definitions in this section apply to this section through WAC 246-790-570 unless the context clearly indicates otherwise.

(1) "Appeal" means a formal proceeding where a participant who has received a notice of violation from the department has the opportunity to present his or her case in an impartial setting and be heard by the department.

(2) "Applicant" means any pregnant woman, postpartum woman, infant or child, or caregiver of an infant or child who is applying to receive WIC program benefits, and a breastfeeding infant of an applicant breastfeeding woman. Applicants include individuals who are currently participating in the program but are applying because their certification period is about to expire.

(3) "Authorized supplemental foods" means those supplemental foods authorized by the department for issuance to a particular participant.

(4) "Certification" means the implementation of criteria and procedures to assess and document each applicant's eligibility for participation in the WIC program.

(5) "C.F.R." means Code of Federal Regulations.

(6) "Claim" means a type of sanction demanding repayment for misuse of WIC/FMNP benefits by a WIC participant.

(7) "Deliberate" means acting intentionally, knowingly and voluntarily and not because of mistake or accident.

(8) "Department" means the Washington state department of health.

(9) "Disqualification" means the act of ending the WIC program participation of a participant whether as a punitive sanction or for administrative reasons.

(10) "Dual participation" means program participation in one or more than one WIC clinic.

(11) "Eligibility criteria" means the reasons people qualify for WIC program benefits as described in 7 C.F.R. Sec. 246.7(c).

(12) "Farmers' market nutrition program (FMNP)" means a program to provide fresh, unprepared, locally grown fruits and vegetables to WIC participants, and to expand the awareness, use of, and sales at farmers' markets.

(13) "Food instrument" means the method of payment used by a participant to obtain WIC approved foods. This method may include WIC checks, cash value vouchers, or electronic benefit transfer (EBT) payment.

(14) "Local agency" means:

(a) A public or private nonprofit health or human services agency that provides health services either directly or through contract with the department to provide services, in accordance with 7 C.F.R. Sec. 245.5;

(b) An Indian health services unit in contract with the department to provide services;

(c) An Indian Tribe, band or group recognized by the department; and/or

(d) An intertribal council or group that is an authorized representative of Indian Tribes, bands or groups.

(15) "Notice of violation" means a written document given to a participant, or caregiver of an infant or child participant, when the department determines a participant or caregivers of an infant or child participant, have not complied with WIC program requirements, federal WIC regulations, this chapter, or the participant rights and responsibilities form. This notice is a type of sanction which explains the violation and provides a warning about repercussions of subsequent violations.

(16) "Nutritional risk" means detrimental or abnormal nutritional conditions detectable by biochemical or anthropomorphic measurements; other documented nutritionally related medical conditions; dietary deficiencies that impair or endanger health; conditions that directly affect the nutritional health of a person, including alcoholism or drug abuse; or conditions that predispose persons to inadequate nutritional patterns or nutritionally related medical conditions including, but not limited to, homelessness and migrancy, as specified in 7 C.F.R. Sec. 246.2.

(17) "Participant" means a woman, infant or child receiving WIC benefits.

(18) "Participant violation" means any deliberate action of a participant, parent or caretaker of an infant or child participant, or proxy that violates federal or state statutes, regulations, policies, or procedures governing the WIC program.

(19) "Proxy" means an individual who is designated by a participant or a child or infant participant's parent, guardian, or caretaker to receive food instruments and to redeem food instruments for the participant and whose name is on file at the local agency.

(20) "Restitution" means reimbursement to the department of the cash value of the WIC program benefits received by a participant as the result of a sanction imposed for a violation.

(21) "Sanction" means a penalty imposed by the department of health WIC program because of a violation. The three types of sanctions are notice of violation, disqualification, and claim.

(22) "SNAP" means the federal Supplemental Nutrition Assistance Program. SNAP was previously known as the Food Stamp Program.

(23) "Vendor" means a sole proprietorship, partnership, cooperative association, corporation, or other business entity operating one or more stores authorized by the state WIC program to provide WIC approved foods to WIC participants.

(24) "Violation" means any deliberate action of a WIC participant or caregiver of an infant or child participant, including actions listed in WAC 246-790-520 that violate federal or state statutes, regulations, policies or procedures governing the WIC program.

(25) "WIC" means the federally funded special supplemental nutrition program for women, infants, and children as described in 7 C.F.R. Sec. 246.

(26) "WIC benefits" means benefits a participant receives that include, but are not limited to, food, formula, and breast pumps.

(27) "WIC Participant Rights and Responsibilities form" means a document a WIC participant or proxy has signed showing she or he has been advised of and agrees to WIC program rights and obligations.

(1) The federal special supplemental nutrition program for women, infants, and children (WIC) provides supplemental foods and nutrition education to pregnant, postpartum and breastfeeding women, infants and young children from families with inadequate income through payment of cash grants to states that operate WIC food delivery systems. The department operates a WIC retail food delivery system in which WIC participants obtain authorized supplemental foods by submitting a food instrument to a retail business that has entered into a contract with the department to provide such service. The department's WIC operations comply with the most current version of 7 C.F.R. Sec. 246. Copies are available from the Department of Health, P.O. Box 47886, Olympia, WA 98504-7886, or by calling the WIC nutrition program at 800-841-1410.

(2) The purpose of this chapter is to establish:

(a) Requirements an applicant must meet to be certified as a WIC participant;

(b) Circumstances and process for verifying and sharing WIC applicant information;

(c) Participant violations and the sanctions that will be applied when violations occur;

(d) The circumstances in which a monetary claim will be imposed, the process for establishing a claim, and the consequences for failing to pay, or make arrangements to pay, a claim;

(e) The circumstances in which participants are disqualified; and

(f) The participant appeal process.

(1) To be eligible for the WIC program, at the time of application an applicant must:

(a) Be a pregnant woman, a breastfeeding woman up to one year after delivery, postpartum woman through six months after delivery, an infant up to one year of age, or a child from age one through the end of the month he or she turns five years of age;

(b) Reside within the state of Washington;

(c) Meet the department's income eligibility criteria as described in 7 C.F.R. Sec. 246.7; and

(d) Be at nutritional risk as defined by the department.

(2) At the time of enrolling in the WIC program, the applicant must:

(a) Provide truthful and accurate information to WIC agency staff;

(b) Present proof of residency, identity, and income; and

(c) Review and sign the department's "Rights and Responsibility" form acknowledging that the applicant has read and agrees to the rules governing WIC participants.

(3) WIC participants may participate in only one WIC clinic at a time.

(4) The department may remove a participant from the WIC program if the WIC participant no longer meets the WIC eligibility requirements.

(5) A WIC participant is eligible to receive farmers' market nutrition program (FMNP) food instruments if the participant meets all of the following eligibility criteria on the date the food instrument is issued:

(a) The WIC participant is currently receiving WIC pursuant to 7 C.F.R. Sec. 246 and this chapter.

(b) The WIC participant belongs to eligible WIC categories described in 7 C.F.R. Sec. 246.7 with the exception that the child must be four years of age or older.

(6) WIC participants must notify the department of any changes in status including, but not limited to, change in household income; change in eligibility status in an adjunct eligibility program, including basic food program, temporary assistance to needy families (TANF), food distribution program to Indian reservations (FDPIR), or medical assistance program; change of number in household; or change in breastfeeding status.

(7) The department will notify WIC participants of their program rights and responsibilities, program rules, and that there are sanctions should they deliberately violate a program rule.

(1) The department and local WIC agency staff may verify any of the information provided by any person applying for or receiving WIC benefits.

(2) When a WIC participant moves to a new service area or state, the WIC agency staff or state staff will share the participant's eligibility information with staff at the new WIC agency or the state.

(3) The department may provide information to law enforcement agencies when it is determined that a participant violated program rules.

(1) When any WIC participant or caregiver deliberately violates the federal or state statutes, regulations, policies or procedures governing the WIC program, the department will initiate appropriate enforcement action which may include establishment of claims under WAC 246-790-550 or disqualification under WAC 246-790-560. Violations and applicable sanctions are listed below:

(2) During each certification visit, participants will be informed of their rights and responsibilities, program rules and that there are sanctions should they deliberately violate a program rule.

(3) Whenever the department assesses a claim of misappropriated WIC program benefits of one hundred dollars 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 department must disqualify the participant for one year.

(4) The department may decide not to impose a disqualification if, within thirty 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 eighteen, the department may approve the designation of a proxy in order to continue program benefits to these participants.

(5) Participants may reapply for benefits at any time after the disqualification period is over.

(6) The department must consider designating a substitute caregiver instead of disqualification for infants, children, and women under eighteen years of age.

(7) Second and subsequent instances of violations are assessed based on a twelve-month period from the first notice that a violation has occurred. Violations instances are household-based.

(1) If the department determines that a WIC participant has committed a violation listed in WAC 246-790-530 which involves the misuse of WIC benefits, the department shall establish a claim against the participant for the full value of such benefits.

(2) The department shall provide a written notice to the WIC participant of the claim, describing the violation, and demanding a specific repayment amount.

(3) If the WIC participant does not appeal the claim as provided in WAC 246-790-570, make full restitution, or agree to a repayment schedule within thirty days of receiving the letter, the department may take additional collection actions as authorized by law, unless the department determines that further collection actions would not be cost-effective.

(1) In addition to the disqualifications set forth in the table under WAC 246-790-530, whenever the department assesses a claim under WAC 246-790-550 of one hundred dollars or more, or assesses a second or subsequent claim of any amount resulting from a participant violation, the department must disqualify the participant for one year. In addition, a claim may be assessed for misuse of WIC/FMNP benefits.

(2) The department will count any violation occurring within the consecutive twelve-month period following the first notice of violation as a second or subsequent violation.

(3) The department will count any second or subsequent violation as a second or subsequent violation even if:

(a) Another member of the WIC participant's household commits the violation; or

(b) The violation affects the WIC benefits of another WIC participant in the same household.

(4) The department shall provide a written notice to the WIC participant describing the violations and specifying the sanction.

(5) For a violation involving a claim, the department may decline to impose a disqualification if the WIC participant makes full restitution, or agrees to a repayment schedule within thirty days of the date the notice of disqualification was sent.

(6) Where a parent or caregiver of an infant or child participant or a WIC participant under the age of eighteen has committed the violation, the department may designate a proxy to continue providing WIC benefits to the participant.

(7) Participants my reapply for benefits at any time after the end of the disqualification period.

(1) An applicant or WIC participant may file an appeal of the department's decision to deny an applicant, establish a claim, or disqualify a person from receiving WIC benefits.

(2) At the time the department determines an applicant ineligible, issues a disqualification, or establishes a claim, the department shall provide written notice of appeal rights informing the person of how to file the appeal and that the person may represent themselves personally or be represented by a spokesperson. The spokesperson does not need to be a member of the Washington state bar.

(3) The applicant or WIC participant must file the appeal within sixty calendar days of service of the notice of adverse action. Proceedings under WAC 246-790-500 through this section must be in accordance with 7 C.F.R. Sec. 246.9 and chapter 246-10 WAC including, at a minimum:

(a) A hearing conducted by an impartial official;

(b) A scheduling order that sets the time and dates of steps in the hearing process;

(c) A prehearing conference in which the hearing official explains the procedures and establishes the conduct at hearing;

(d) A hearing in which the appellant and the department's WIC program can present evidence and cross-examine witnesses.

(4) Participants who appeal the termination of benefits within fifteen days of service of the adverse action notice must continue to receive program benefits until the hearing official reaches a decision or the certification period expires, whichever occurs first. This does not apply to applicants denied benefits at initial certification, participants whose certification periods have expired, or participants who become categorically ineligible for benefits. Applicants who are denied benefits at initial certification, participants whose certification periods have expired, or participants who become categorically ineligible during a certification period may appeal the denial of WIC certification or disqualification within sixty days, but must not receive benefits while awaiting the hearing or its results.

(5) If a provision of chapter 246-10 WAC conflicts with 7 C.F.R. Sec. 246.9, federal regulation prevails.