News Release

WIC Nutrition Program increased enrollment shifting from paper vouchers to electronic

Cards seen as more user-friendly, less stigmatizing

Peer-Reviewed Publication

University of Pennsylvania School of Medicine

PHILADELPHIA -- The U.S. government's Special Supplemental Nutrition Program for Women, Infants, and Children, usually abbreviated as WIC, saw a jump in enrollment of nearly 8 percent in states that implemented a federally mandated switch from paper vouchers to electronic benefit cards (EBTs), according to a study led by researchers at the Perelman School of Medicine at the University of Pennsylvania.

The finding, published in JAMA Pediatrics, supports the rationale for the switch, which was to increase participation by making it easier and less stigmatizing to obtain and redeem WIC benefits.

"The broad takeaway from this study is that making benefit programs more user friendly may be a good way to help these programs reach the children and families who need them," said study lead author Aditi Vasan MD, a postdoctoral fellow in the National Clinician Scholars Program at Penn Medicine, and a pediatric hospitalist and health services researcher at Children's Hospital of Philadelphia.

WIC is a federal welfare program, established in 1972, that offers money to states for nutrition education, health care referrals, and nutritious foods for low-income mothers or mothers-to-be, and to infants and young children who are at nutritional risk.

Initially, states gave WIC participants paper vouchers to be used to obtain food under the program. However, in 2010, Congress passed legislation mandating that states shift WIC benefits from vouchers to EBT cards by 2020. WIC participation at that point totaled only about 50 percent of eligible recipients, and the hope was that the shift to the more user-friendly cards could boost participation.

"One mother who lived in a state with the paper voucher system described it to me as a scavenger hunt, in which she goes to the store and tries to match the vouchers to the goods they cover, and then at checkout, hopes the cashier is trained to deal with WIC vouchers--because if not, she could be standing there a long time, with everyone in the line staring at her," Vasan said. "It can be a really stressful and stigmatizing experience."

In the states that have switched to EBT, a WIC participant can use his or her EBT like a debit card at store checkout counters, streamlining the process and making it far less stigmatizing.

In the study, Vasan and colleagues examined federal government data on state-by-state WIC participation from October 2014 through November 2019. Their main finding was that, on average, states that switched during the study window saw WIC participation increase by 7.8 percent in the three years after the switch, compared to states that didn't switch. That equates to about 220,000 more WIC beneficiaries in those EBT-switching states.

The analysis found that WIC participation increased by 7.22 percent among pregnant and postpartum women, 4.96 percent among infants less than a year old, and 9.12 percent among children ages 1-4 years.

Adjusting the results for state population changes, poverty rates and other potentially relevant factors did not alter the basic findings.

"These findings suggest that one small policy change aimed at making a program a little more user friendly can have a big impact," Vasan said. "And I think this points to an opportunity to implement similar interventions to reduce the administrative burdens that often prevent families from getting government benefits that could really help them."


Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $8.9 billion enterprise.

The Perelman School of Medicine has been ranked among the top medical schools in the United States for more than 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $496 million awarded in the 2020 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center--which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report--Chester County Hospital; Lancaster General Health; Penn Medicine Princeton Health; and Pennsylvania Hospital, the nation's first hospital, founded in 1751. Additional facilities and enterprises include Good Shepherd Penn Partners, Penn Medicine at Home, Lancaster Behavioral Health Hospital, and Princeton House Behavioral Health, among others.

Penn Medicine is powered by a talented and dedicated workforce of more than 44,000 people. The organization also has alliances with top community health systems across both Southeastern Pennsylvania and Southern New Jersey, creating more options for patients no matter where they live.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2020, Penn Medicine provided more than $563 million to benefit our community.

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