No
Health Care Providers can play a pivotal role in ensuring families have access to the nutrition and services provided by WIC. WIC provides health screening, nutrition education, nutrient rich foods, breastfeeding support and referrals to other health and social services.
Infants and children on WIC and Medicaid will receive specialty formulas from Medicaid. Nebraska WIC provides contract and non-contract formulas for all infants and children. For WIC participants not on Medicaid and with qualifying medical conditions, WIC provides certain special formulas and food with authorization from a Medical Provider which is to be documented on the WIC Provider Authorization Form (PAF). If your patient participates in WIC and they are in need of a formula or food that requires a PAF, the completed form can be sent directly to their WIC clinic.
Nebraska WIC provides only the formulas and foods listed in the sections below.
Formula: Contract and *Non-Contract
*Non-Contract formulas require a PAF
During the appointment, a WIC CPA (Competent Physician Authority) considers the family's plan for breastfeeding and determines its formula needs, as they issue a formula benefit.
Exempt formulas and WIC Eligible Nutritionals (specialty formulas), require a PAF
During a WIC appointment, a WIC CPA (Competent Physician Authority) considers the family's plan for breastfeeding along with special needs identified by a Medical Provider, as documented on a PAF. Based on the received medical documentation, a CPA provides the participant's formula and/or food needs and issues benefits.
| Category | Medical documentation in a PAF is required: | PAF |
| Infants | - For non-contract formulas
- For specialty formulas
- For any change to standard six-month infant package
| Complete this form:
Provider Authorization Form for Infants
|
Children, ages 1 to 5 years
| - For contract formulas
- For non-contract formulas
- For specialty formulas
- For whole milk for children 2+ years (also requires additional prescription of a specialized formula)
| Complete this form:
Provider Authorization Form for Children
|
Women – pregnant, breastfeeding & non-breastfeeding
| - For contract
- For non-contract
- For specialty formulas
- For whole milk (also requires an additional prescription of a specialized formula)
| Complete this form:
Provider Authorization Form for Women
|
Nebraska WIC Approved Foods
New foods are frequently added to the approved food list. Model food packages provide a visual of the monthly food benefits a participant might receive. WIC staff review the food and formula package in detail with the family during their appointments.
Contact State WIC
For specific questions about WIC foods, formulas, or completing a PAF, please contact our Food Management Coordinator, Narissa Scales, PhD., RD, at narissa.scales@nebraska.gov or (402)-470-1634.
For other general questions, contact Nebraska WIC using the contact information below: