For WIC Participants Enrolled in MassHealth

WIC Participants, who are MassHealth members, receive special or prescription formulas through their MassHealth insurance.

MassHealth has primary responsibility for payment of special or prescription formulas for MassHealth members who are eligible to receive benefits through the WIC Program.

To assist families, Massachusetts WIC will provide ONE month of benefits, in order to allow for the MassHealth Prior Approval process and will act as a safety net for families should the process take longer.

If you have questions regarding the MassHealth process for prescribing special or prescription formulas to MassHealth — WIC participants, please contact the following Customer Service Centers, depending on your patients MassHealth coverage type:

  • For MassHealth PCC or Fee for Service members: 1-800-841-2900
  • For Boston Medical Center Health Plan: 1-866-802-6471
  • For Fallon Health Plan: 1-508-368-9138
  • For Tufts Health Plan-Network Health: 1-888-257-1985
  • For Neighborhood Health Plan: 1-855-444-4647
  • For Health New England: 1-413-233-3419
  • For CeltiCare Health: 1-855-678-6975

Some MassHealth plans require Medical Providers to submit a completed MassHealth Medical Necessity Review Form when prescribing special or prescription formulas. Link to MassHealth web site here: pdf format of mnr-enteral.pdf
doc format of                             mnr-enteral.doc                .

MassHealth - WIC Participants will continue to receive all other WIC services including nutrition counseling and education, immunization screenings, health and social service referrals, Farmers' Market in the summer, as well as a WIC food package that is appropriate for their nutrition and medical needs.

For WIC Participants NOT Enrolled in MassHealth

For participants, NOT enrolled in MassHealth, with a medical diagnosis for a condition warranting a special metabolic formula, approximately 30 formulas are available through WIC. Click here for a complete list of Massachusetts WIC Formula List. For special metabolic formulas, you will need to consult with a local program nutritionist and complete the WIC Request for Special Formula and Food Form – Effective October 2016  pdf format of Request for Special Formula and Food Form – Oct. 2016
docx format of                             Request for Special Formula and Food Form – Oct. 2016                to document the diagnosis warranting a medical need for the formula. A thorough dietary assessment and counseling will be provided by a WIC nutritionist to resolve more common conditions not requiring special formulas such as constipation, spitting or loose stools.

WIC Formula Resources and Forms