Understanding Benefit Issuance

Benefit issuance is the process of issuing supplemental nutritious food benefits to a participant in the WIC program. Depending on the WIC program's policies, food benefits can be issued as any of the following:

• Checks -- redeemed by participants at approved retail grocery outlets (WIC vendors) for WIC-approved foods and processed through the federal banking system

• Vouchers -- redeemed by participants at approved retail grocery outlets (WIC vendors) for WIC-approved foods and processed by the WIC program itself

• Electronic Benefit Transfer (EBT) Cards -- redeemed by participants at approved retail grocery outlets (WIC vendors) for WIC-approved foods and processed through the federal banking system

• Direct Distribution -- WIC approved foods are distributed directly to participants at WIC food centers

The benefit issuance process can be started from the following application areas using the methods indicated:

• Work with On-site Group

• Select participants to whom to issue benefits in the Household Members On-site data grid, select the Issue Benefits check box, and activate the OK or Apply button.

• Participant Folder

• Activate the Issue Benefits toolbar button.

• Activate the Issue Benefits menu option on the Benefit Management menu.

• Certification Guided Script

• Activate the Issue Benefits guided script link.

• Activate the Issue Benefits menu option on the Guided Script menu.

Issuing Benefits

When the Benefits (Issue Benefits) process is started, the system analyzes each participant within a household and determines the members eligible for benefits and how many sets of benefits to issue for each person. The system takes into account the following factors when determining the benefits to issue to each household:

• Cycle Adjustment -- The system issues sets of benefits such that the participants of the household can pick up benefits at the same time.

• Issuance Frequency -- The system issues a number of sets of benefits to a household participant based on their follow-up frequency, which a CPA can specify on the CPA-Determined Follow-up screen.

• Late Pickup -- The system adjusts the package size for a household participant's current set of benefits if the household participant is late to pick up benefits.

• Certification End Date -- The system does not issue a household participant benefits with a first date to use beyond the end of the participant's current certification period.

• Previous Issuance -- The system does not issue a household participant a set of benefits for a participation month for which the participant has already received a set of benefits.

The internal steps necessary to issue the correct sets of benefits to print for the household are as follows:

• Determine which household members are eligible to receive benefits.

• Determine the first month of benefits for each eligible household member, validate each benefit as it is generated, and add it to a temporary benefit set.

• Cycle adjust the LDTU of each household member's first month of benefits according to the household's previous benefits and the first month of benefits generated for the household.

• Generate the rest of the benefits for each household member who received a first month benefit, as per their CPA-determined issuance frequency, and add them to a temporary benefit set.

• Validate the benefits in the temporary benefit set and add valid benefits to the final benefit set, deeming participants ineligible if at least one of their benefits is invalid.

• Prorate package sizes based on cycle-adjusted sets or late pickup.

• Display the suggested benefits.

Each step is defined in detail below.

Determine which household members are eligible to receive benefits.

A participant is deemed ineligible for benefits if any of the following conditions are true:

• The participant is not assigned to the current clinic.

• The participant is not in a current, valid, non-terminated certification.

• The LDTU of the latest benefit the participant was issued is more than [CLN_AllowFutureBenefitsWithinDays business rule value] days in the future.

• The participant is homeless and the Homeless Verified Date entered on the Demographics tabbed page of the Participant Folder screen is more than 30 days in the past.

• The participant is high risk and has less than the required number of education contacts (as determined by the EDCONTACTFORFI_INDIVCOUNT business rule value), and the participant's most recent education contact is more than 30 days in the past.

• The participant is breastfeeding and the Date Breastfeeding Verifiede entered on the Health Information tabbed page of the Participant Folder screen is prior to the current date.

• The participant requires Food Package III and the Date Food Package III Verified entered on the Health Information tabbed page of the Participant Folder screen is prior to the current date.

• The participant is on a waiting list.

• The participant is a breastfeeding mother, and her linked infant is more than six months old and receiving more than the maximum amount of formula.

• The participant is less than six months old and fully breastfeeding.

• The participant does not have a food prescription with a prescription date between the certification's effective and end dates.

Determine the first month of benefits for each eligible household member, validate each benefit as it is generated, and add it to a temporary benefit set.

For each participant member who is deemed eligible, the first month of benefits will be determined using the following calculations:

• If no previously issued benefits are present for the current certification period for the participant or the last certification ended more than 36 days ago, both the PFDTU and FDTU for the first set of benefits will be today's date.

• If no previously issued benefits are present for the current certification period for the participant and the last certification ended within 36 days, the system will attempt to keep the issuance cycle dates using the last benefits issued in the previous certification.

• If there are previous benefits issued for the certification that have established an issuance cycle and the latest issued benefit was not cycle adjusted, then the first day of the new benefit (Expected FDTU) is calculated by adding one day to the previous LDTU.

It is possible for the newly calculated LDTU to be before today's date (the participant hasn't picked up benefits for a few months and it was adding 29 days to an Expected FDTU that is several months ago). If this occurs, a month is added to the Expected FDTU and the above steps start over by adding 1 month to this new date, calculating the start of the next month's benefits, and adding one day at a time to the LDTU until it becomes a day before the start of the next month's benefits.

• The PFDTU is set to the Expected FDTU. If this date is before the effective date of the current certification (due to the participant recertifying before their current certification has ended), the PFDTU will change to be the same as the effective date of the current certification.

• If the PFDTU is before today's date, then the FDTU is today's date; otherwise the FDTU is the same as the PFDTU.

A participant's first month benefit is deemed invalid and results in the participant not being included in benefit issuance if one of the following is true:

• The participant is not homeless, does not have a VOC document and has at least one of the three proofs pending (Income Screening Contact on the Income History tab of the Participant Folder screen, or ID Proof or Residency Proof on the Demographics tab of the Participant Folder screen) and they have already received their one allowed benefit. Participants with pending proof are only allowed one benefit until all of the proof fields have been filled with valid values.

• The FDTU of the benefit is past the participant's current certification's end date.

• The FDTU of the benefit is past the participant's current certification's termination date.

• The FDTU of the benefit is past the participant's categorical ineligibility date.

• The participant is not an infant or pregnant, the month of the benefit is the same month as the participant's current certification's end date, and the month of the benefit is not the same month as the participant's categorical ineligibility date.

• The participant does not have a food prescription for the WIC status and/or age category as of the benefit's FDTU.

• The food prescription used for the current benefit has at least one food item that will expire by the PFDTU.

• The food prescription used for the current benefit has at least one food item that will not yet be active by the PFDTU.

• The food prescription used for the benefit has a special prescription and that special prescription has expired by the FDTU of the benefit.

Cycle adjust the LDTU of each household member's first month of benefits according to the household's previous benefits and the first month of benefits generated for the household.

All members of a household should be on the same issuance cycle; i.e. they should have benefits ending on the same date (where benefits issuance is valid). This is done for appointment scheduling reasons and check cashing reasons. For EBT this is required by the banking system used. When a set is cycle adjusted, only the LDTU can be modified. The LDTU cannot be 'stretched' forward to sync the household members. The maximum number of days on a benefit is 31. If the date used to do the cycle adjustment is before the FDTU of the benefit, the LDTU of the benefit will not be adjusted.

If there is a member in the household who already been issued at least one benefit with a FDTU after today, the cycle adjustment date is calculated differently. The system finds the earliest FDTU in the collection of the household's first month of suggested benefits (Date 1). The new members of the household are caught up to the first member's benefit cycle, and then they are synched to be on the same schedule.

If none of the household member benefits have a FDTU after today and the household has never been issued benefits, the LDTU to use for the cycle adjustment is earliest LDTU of the household's suggested first month benefits.

If none of the household member benefits have a FDTU after today and the household has previously been issued benefits, the system finds the latest LDTU of the household's previously issued benefits. If that date is later than today's date, it will be the date to use for the cycle adjustment. If that date is today's date or earlier, the date to use for the cycle adjustment is the earliest LDTU of the household's suggested first month benefits.

Generate the rest of the benefits for each household member who received a first month benefit, as per their CPA-determined issuance frequency, and add them to a temporary benefit set.

Using each participant's CPA-determined issuance frequency, benefits are issued for each household member using the following rules:

If the latest generated benefit (either the first month benefit or the latest subsequent benefit generated) was not cycle adjusted, then the first day of the new benefit (Expected FDTU) is calculated by adding one month to the FDTU of the latest generated benefit. If adding the one month results in skipping a month, then the resulting date is moved back to the last day of the previous month.

If the latest generated benefit was cycle adjusted, then the Expected FDTU is calculated by adding one day to the LDTU of the latest generated benefit.

The system starts calculating the LDTU of the benefit is calculated by adding 1 month to the Previous LDTU. It them figures out what the first day of the next month's benefit will be (varies from 28-31 days for given month). If the calculated LDTU is more than one day before the start of the next month's benefit, then one day is added to LDTU until it is one day before the start of the next month's benefits.

It is possible for the newly calculated LDTU to be before today's date (the participant hasn't picked up benefits for a few months and it was adding 29 days to an Expected FDTU that is several months ago). If this occurs, a month is added to the Expected FDTU and the above steps start over by adding 1 month to this new date, calculating the start of the next month's benefits, and adding one day at a time to the LDTU until it becomes a day before the start of the next month's benefits.

The PFDTU is set to the Expected FDTU. If this date is before the effective date of the current certification (due to the participant recertifying before their current certification has ended), the PFDTU will change to be the same as the effective date of the current certification.

If the PFDTU is before today's date, then the FDTU is today's date; otherwise the FDTU is the same as the PFDTU.

The benefits will continue to be generated for the participant and added to the temporary benefit set until [the total number of participation months in their generated benefits] + [the total number of participation months in previously issued benefits where the FDTU > today] is >= the participant's CPA-determined issuance frequency. The total number of participation months is based on the PFDTU, so there might be multiple benefits for the same participation month, if the first benefit was cycle adjusted.

If the participant is not homeless, does not have a VOC document, has at least one of the three proofs pending (Income Screening Contact on the Income History tab of the Participant Folder screen, ID Proof or Residency Proof on the Demographics tab of the Participant Folder screen), and their one allowed benefit has been generated in the above process, no more benefits will be generated, regardless of the participant's CPA-determined issuance frequency. Participants with pending proof are only allowed one benefit until all of the proof fields have been filled with valid values.

Validate the benefits in the temporary benefit set and add valid benefits to the final benefit set, deeming participants ineligible if at least one of their benefits is invalid.

After the set of benefits is generated for the participant, each benefit is validated. A benefit is deemed invalid if one of the following conditions is true:

• The participant does not have a food prescription for the WIC status and/or age category by the benefit's FDTU.

• The food prescription used for the current benefit has at least one food item that will expire by the benefit's PFDTU.

• The food prescription used for the current benefit has at least one food item that will not yet be active by the benefit's PFDTU.

• The food prescription used for the benefit has a special prescription and that special prescription has expired by the FDTU of the benefit.

• The participant is a breastfeeding mother, her linked infant is receiving more than the maximum amount of formula and the FDTU of the benefit is in a month after which the infant turns six months.

If the benefit is valid, it goes into the final benefit list for the participant. This is the benefit list that is displayed in the tree list on the Issue Benefits screen. If any of a participant's benefits is invalid, that participant will not be issued any benefits.

If the participant will turn one year of age (WIC status becomes Child) between the FDTU and LDTU of the benefit and the participant does not have a child food prescription by the FDTU, a message is issued to the user indicating an infant food prescription will be used for the benefit. The benefit is added to the final benefit list, but it does not process any more temporary benefits for the participant.

The generation of the benefit sets continues for each eligible participant in the household, validating the benefits for each participant and adding them to the final benefit list, before moving on to the next participant.

Prorate package sizes based on cycle-adjusted sets or late pickup.

Once sets of benefits have been determined for each household participant, the system determines the prorating of package sizes for the first set of benefits for each household participant by calculating the number of days between the FDTU and the LDTU for the set of benefits. The upper limit of days for each food package size is stored in the following business rules:

For infants, the following chart shows the partial month issuance:

For children, the following chart shows the partial month issuance:

For pregnant women, the following chart shows the partial month issuance:

For breastfeeding women, the following chart shows the partial month issuance:

For non-breastfeeding women, the following chart shows the partial month issuance:

Display the suggested benefits.

If the participant is picking up benefits on time or before the start of the issuance cycle, the PFDTU is the same and the FDTU, so the benefit dates display as "FDTU -- LDTU".

If the participant is late picking up a benefit late, the PFDTU is not the same as the FDTU, so the benefit dates display as "<PFDTU> FDTU -- LDTU".

While individual members of a household may have different CPA Follow-ups assigned to them, during benefit issuance, the system will use the shortest follow-up frequency of qualified household members, but will suggest optional issuances up to their individual CPA follow-up frequency. Benefits will be checked in such a way that they all benefits ending on the same date.

The user has the ability to remove possible sets from an issuance, so when required, issuance frequency can be overridden.

The system will determine the cycle adjustment required for a household automatically by default, but will allow for cycle adjustment to an arbitrary date with certain restrictions (see Cycle adjustment date range calculation below). The system will not allow cycle adjustment if any household members have future benefits already issued with a FDTU past today's date.

The default value in the Cycle Adjustment Type option group below the benefits tree list will be By "System Determined", but when "Selected LDTU of" is selected, the selection control will be enabled allowing the user to select a date to align the LDTU of the first set of benefits to. The range to select a date from will be limited based on a set of established guidelines to ensure it is valid (see below). Selecting "System Determined" will cause the system to cycle adjust back to the original dates.

• Cycle adjustment date range calculation

If the household has never been issued benefits,

Date Range Start = Today

Date Range End = Earliest LDTU of the future/suggested benefits for the household members.

• If the household has previously been issued benefits,

Date Range Start = Latest LDTU of the previously issued benefits for the household members. If this date is before today's date, the date is adjusted to today's date. If this date is before the earliest FTDU of all of the future/suggested benefits, the date is adjusted to that earliest FDTU.

Date Range End = Earliest LDTU of the future/suggested benefits for the household members.

If a new cycle adjust date is selected from the date picker, the system adjusts the LDTU of all the benefits it can, as long as the LDTU will not be adjusted forward or adjusted to be before the FDTU.