WIC Medical Formulas and Nutritionals
WIC provides medical formulas and nutritionals to participants who do not have Medi-Cal coverage or when the prescribed product is not covered by MediāCal. WIC participants must have a qualifying medical condition and complete medical documentation from their Health Care Provider (HCP) to receive the medical formula or nutritional from WIC.
Learn More
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WIC Medical Formula Request Process
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WIC Approved Formulas and Nutritionals
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WIC Qualifying Medical Conditions
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WIC Medical Documentation Requirements
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WIC Resources for Health Care Providers
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Policies and Procedures for WIC Local Agencies
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Contact Us
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Additional Resourcesā
WIC Medical Formula Request Process
Please see below on how the WIC medical formula process works:
WIC Approved Formulas and Nutritionals
The
WIC Formulas and Nutritionals List (PDF) is a listing of all the standard formulas, medical formulas, and nutritionals that are approved by WIC. Please contact
Formula@cdph.ca.gov to inquire whether a particular product can be approved by WIC and added to the WIC Formulas and Nutritionals List. ā
WIC Qualifying Medical Conditions
WIC qualifying medical diagnoses/conditions for a medical formula or nutritional include, but are not limited to:ā
- Premature birth.
- Low birth weight.
- Failure to thrive.
- Inborn errors of metabolism and metabolic disorders.
- Gastrointestinal disorders.
- Malabsorption syndromes.
- Immune system disorders.
- Life-threatening disorders.
- Diseases and medical conditions that impair ingestion, digestion, absorption, or the use of nutrients that could adversely affect the participant's nutrition status.
- Severe food allergies that require an elemental formula (allergy must be specified).
WIC will not approve a medical formula or nutritional for the following medical diagnoses/conditions:
- āNon-specific symptoms or diagnoses (e.g. colic, constipation, diarrhea, spitting up, picky eater, poor appetite, cramps, fussiness, gas, etc.).
- Condition that is solely for the purpose of enhancing nutrient intake or managing body weight.
- Non-specific formula intolerance or food intolerance.
- Preference or food dislikes.
WIC Medical Documentation Requirements
Health Care Providers with prescriptive authority must provide their patients complete medical documentation for any prescribed medical formula or WIC eligible nutritional to be approved by WIC. WIC requires participants to provide updated medical documentation every six months. The following includes, but are not limited to, acceptable forms of WIC medical documentation:
Complete medical documentation must include all the following information to be processed by WIC:
- āParticipant's first and last name.
- Qualifying medical condition.
- Name(s) of the medical formula or nutritional for the stated qualifying diagnosis.
- āFormula amount needed per day and duration prescribed in months.
- WIC authorized food restrictions, if applicable.
- Signature (or signature stamp) and contact information of the Health Care Provider.
- Date medical documentation was signed by the Health Care Provider.
WIC Resources for Health Care Providers
Policies and Procedures for WIC Local Agencies
For general inquiries, please contact us at
Formula@cdph.ca.gov.
Additional Resourcesāā