Guidance for providers on WIC Medical Referral Forms, blood work requirements, breastfeeding services, special or prescription formulas, and information about the WIC & Clinician: Partners in Good Health booklet.
Medical referral forms
The Medical Referral Form is a form you fill out that helps identify the medical or nutritional risk factor(s) needed for enrollment in WIC. Although the Medical Referral form is not mandatory, it helps WIC serve your patients better by:
- Documenting a medical or nutritional risk to facilitate WIC enrollment
- Avoiding duplicate bloodwork and anthropometric data collection
- Enabling WIC staff to conduct immunization screening
- Enabling WIC staff to provide nutrition counseling and referrals based on your concerns and recommendations
WIC blood work requirements
WIC follows the CDC recommended schedule for preventing and controlling iron-deficiency anemia in high-risk populations. WIC's bloodwork requirements are:
- Pregnant women: as early as possible in the current pregnancy
- Postpartum women: once during the postpartum period, ideally within 6 weeks after delivery
- Infants: between 9 and 13 months
- Children: between 15 and 18 months and, thereafter, every 12 months if blood values are normal, every 6 months if values are low
WIC breastfeeding services
The WIC program offers breastfeeding support services to women during and after their pregnancy. 'Mother to Mother' Peer Counselor support is available at all 31 local WIC clinics.
Special or prescription formulas
WIC offers approximately 30 special formulas for participants with special medical needs. To request a special formula, you will need to complete the Massachusetts WIC Nutrition Program Request for Special Formula and Food form 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.
Special or prescription formulas for WIC participants enrolled in MassHealth
MassHealth has primary responsibility for payment of special formulas for MassHealth members who are eligible to receive benefits through the WIC Program. WIC Participants, who are MassHealth members, will be guided to receive special formulas through their MassHealth insurance.
To assist families, Massachusetts WIC will provide 1 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 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: (800) 841-2900
- For Boston Medical Center Health Plan: (866) 802-6471
- For Fallon Health Plan: (508) 368-9138
- For Tufts Health Plan-Network Health: (888) 257-1985
- For Neighborhood Health Plan: (855) 444-4647
- For Health New England: (413) 233-3419
- For CeltiCare Health: (855) 678-6975
Some MassHealth plans require Medical Providers to submit a completed MassHealth Medical Necessity Review Form when prescribing special or prescription formulas.
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, including infant foods, that is appropriate for their nutrition and medical needs.
Download information for clinicians
The WIC & Clinician: Partners in Good Health booklet has all the material you need to know. You'll find information about helping patients receive WIC benefits, health outcomes research, WIC approved foods, and a whole lot more!