State Benefit Issuance Systems and Prenatal WIC Participation Trends During the COVID-19 Pandemic

Background: Prenatal participation in the U.S. Department of Agriculture’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) improves maternal and infant health. To reduce administrative burden in WIC benefit redemption, the Healthy, Hunger-Free Kids Act required states to adopt electronic benefit transfer (EBT) systems by October 2020; however, the COVID-19 pandemic created a major disruption to this implementation and WIC service delivery. This study examines the impact of state WIC benefit issuance systems on prenatal WIC participation at the time of birth during the COVID-19 pandemic. Methods: We applied a quasi-experimental difference-in-differences approach using U.S. birth certificate data linked to state economic indicators (January 2019–December 2021). The sample included all Medicaid births (n = 4,564,705). States were classified by the type of benefit issuance adopted as of March 2020: online EBT, offline EBT, transitioning to an EBT system, and paper vouchers. Linear probability models were fit with interaction terms between each benefit issuance group and time (pre-pandemic and pandemic 2020 or 2021). Models adjusted for maternal and infant characteristics and state-level economic indicators. Results: Prenatal WIC participation declined during the pandemic in all benefit issuance groups. States transitioning to an EBT system (β = −2.76, 95% CI: −4.61, −0.91 in 2021) or remaining on paper vouchers (β = −3.17, 95% CI: −5.47, −0.87 in 2021) experienced the largest pandemic-related declines compared with online EBT states. We found no significant difference between offline and online EBT groups. Discussion: Adoption of either online or offline EBT systems mitigated WIC participation declines during the pandemic. These findings have implications for ongoing WIC service delivery modernization efforts to safeguard prenatal WIC access from future external shocks.