Kansas WIC special issuance authorization for infant and child formulas
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Governs issuance of WIC-standard and special (exempt) infant and child formulas and related WIC foods in Kansas; affects Kansas WIC participants, health care providers completing special issuance authorization (SIA) forms, and coordination with KanCare (Medicaid).
No material clinical or coverage changes in this revision.
Formula Issuance and WIC Food Package Adjustments
WIC formula issuance criteria and food package adjustments
Covered with criteria — WIC issues contracted standard formulas for healthy infants and may issue special (exempt) formulas and adjust food packages when medical documentation supports the need, in coordination with KanCare when applicable.
Payor and KanCare interaction
- As of August 2025, KanCare (Medicaid) is the primary payor for specified exempt formulas for eligible KanCare members; providers should consult the member's MCO for procedures to obtain these formulas (e.g., ordering through DME).
- If KanCare covers the formula for the client, no SIA form is required; the client may continue receiving other WIC benefits and foods while KanCare provides formula.
- If a KanCare request is pending, WIC may provide formula one month at a time until KanCare accepts or denies the request; if KanCare denies the formula request or the client is not on KanCare, WIC may provide the requested formula up to maximum allowances.
Food package adjustments with special issuance
- Infants 6–12 months: All age-appropriate infant foods will be issued with the special issuance formula unless the provider/caregiver indicates 'No foods' on the SIA form; option to provide ONLY formula after 6 months if unable or delayed in consuming solids (may allow up to 29 fl oz for 6–11 months not receiving solids).
- Children 12 months and older: All appropriate WIC foods except milk will be issued with the special issuance formula unless the SIA form indicates otherwise; options include 'No foods', provide milk/soymilk in addition to formula and foods, or selecting specific foods to accompany formula as listed on the form.
ICD-10 Reference and Allowances
| E40-E46 | Malnutrition (ICD-10 range listed on form) |
Forms, Renewals, and Payor Coordination
Complete and renew the Kansas WIC SIA form for special formulas
Complete and sign the Kansas WIC Special Issuance Authorization (SIA) form whenever a client requires a special (exempt) formula and is not covered by KanCare, has a pending KanCare request, or KanCare denied the formula. The SIA must be renewed each WIC certification period or whenever the formula is changed; infants are usually certified until their first birthday and children typically for 12 months. WIC may temporarily provide formula during KanCare processing delays, but caregivers must notify WIC when KanCare coverage begins so WIC can stop issuing formula.
- Form is required to document the medical diagnosis that justifies a special (exempt) formula.
- Renew SIA each WIC certification period or when formula changes.
- WIC can provide formula one month at a time while KanCare decision is pending; if KanCare denies, WIC may provide up to maximum allowance.
Consult the MCO when KanCare is primary payor for exempt formulas
When KanCare is the primary payor for exempt formulas (effective August 2025 for certain diagnoses), providers should consult the enrollee's Managed Care Organization (MCO) for the procedures to obtain those formulas (for example, ordering through durable medical equipment vendors). If KanCare provides the formula, no SIA form is required and the client may continue receiving other WIC benefits.
- KanCare is primary payor for diagnosis-eligible exempt formulas for enrolled members; contact the appropriate MCO for ordering procedures.
- If KanCare provides the formula, WIC remains the second payor and SIA is not required for that formula; clients may still receive WIC foods.
Key Terms
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