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The Oregon Administrative Rules contain OARs filed through June 15, 2014
 
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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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