Challenges Facing CACFP

CACFP Background: Licensed family childcare homes (FCCHs) in CACFP receive different reimbursement rates based on their income and location. Tier 1 FCCH providers receive higher rates. Tier 1 FCCH providers are those in low-income areas or who are, themselves, individuals with low incomes. Overall, FCCHs generally serve more children from families with low income than childcare centers.
Study context: The Child Care Nutrition Enhancement Act is a recently introduced piece of legislation that would eliminate tiered CACFP reimbursements. Due to COVID-19, tiering was temporarily suspended. Structured interviews were conducted with Tier 1 and 2 FCCH providers in California to better understand the impact of eliminated tiers.
Findings: With high reimbursement rates, providers reported that CACFP reduced the financial burden and concerns for families. FCCH providers from both tiers advocated for eliminating tiers and increasing the reimbursement rate overall as food costs increase.
Recommendations: Eliminate the tiered reimbursement system and provide higher reimbursement rates for all child care providers participating in CACFP. These recommendations support the Child Care Nutrition Enhancement Act.

Background: Family childcare homes (FCCH) are one kind of childcare environment that can receive support from Child and Adult Care Food Program (CACFP). In order to participate, FCCHs must work with a sponsoring organization. Sponsors oversee logistics of participation, including administrative and financial management and ensuring FCCH training and compliance with CACFP requirements. The number of sponsors in the United States is declining, as the number of participating FCCHs declines. The decrease in sponsors raises concerns for equitable access to CACFP. The brief performed semi-structured interviews with 15 California CACFP family home sponsors to understand their challenges.
Sponsor Concerns: A primary concern of sponsors is inadequate administrative reimbursement. The interviewed sponsors emphasized two main impacted areas. First, sponsors lack tools to support non-English-speaking childcare providers. Second, sponsors lack resources to hire staff needed to complete sponsor tasks. As a consequence, sponsors lack resources to work with new FCCHs. A second primary concern of sponsors is the challenges that accompany FCCH visits. Sponsors are required to visit FCCHs three times at least three times a year. Twice must be unannounced, and one must be during a meal or snack. Sponsors report that visits are time-consuming and expensive, can be difficult to coordinate at a time providers will be present, and present staff safety concerns. Recommendations: Sponsors must be adequately supported through funding and training resources, and virtual alternatives to in-person visits could be explored.

Currently CACFP participation rates among licensed child care centers point to program underutilization and unequal access, particularly in some states and regions. Work at the federal and state levels is warranted to expand participation in the program, above all in low-income areas, so that more young children could eat healthfully with the CACFP.

Very breif description of CACFP and then Lit review of barriers to participation, COVID-19 impact with examples of further research areas

Objectives: Child day care centers that serve low-income families may qualify to participate in the US Department of Agriculture Child and Adult Care Food Program (CACFP) and receive reimbursement for meals and snacks served. In 2017, day care sites were the present study will aim to determine how CACFP participation influences implementation of nutrition-related best practices and barriers in childcare settings.

Conclusions: While participation in the CACFP was related to higher prevalence of serving healthier food and beverages, few mealtime practices were affected. This could be attributed to CACFP regulations requiring participating childcare programs to serve nutritious food and beverages to children, but only recommend mealtime-related best practices. These findings could suggest that CACFP-related trainings should emphasize the importance of these practices with consideration of known provider-reported barriers.

Results indicate the need for the US Department of Agriculture to consider issuing and extending waivers, increasing ECE participation in CACFP, and ensuring timely communication and guidance on waiver tracking.

The two-tiered meal reimbursement system instituted in 1997 within the child care homes portion of the Child and Adult Care Food Program added new duties for sponsoring organizations. Is the reimbursement of sponsors' administrative costs adequate now that tiering has added income status determination and accounting to their duties? As the number of sponsors declines, is the CACFP readily accessible to family child care homes?

The attention to CACFP gets to the core of issues of equitable access. The program is meant to financially support centers and homes that provide care for the children of low-income parents who are likely to be working at one or more low-wage jobs. One of the great ironies of the US food system is its employment of some of the most poorly paid workers in America—those who work on farms or in meat-packing plants, food-processing facilities, fast food chains, restaurants, grocery stores, and grocery delivery services—many of them immigrants, perhaps undocumented.9 History tells us it is no coincidence that providers of childcare are also among these low-wage workers, are predominantly women of color, and may well qualify for federal food assistance themselves.

The authors recommended that CACFP-administering agencies (1) dedicate resources to support the translation of CACFP materials into multiple languages; (2) increase outreach to promote awareness and provide nutrition training to license-exempt providers who are likely to be unaware of CACFP; (3) increase reimbursement rates; and (4) reimburse providers for additional meals.

Additinal recommendations
Eliminate tiering
Monitoring flexibilities
Easy to use software
National Promotional Campaign
Address Research Gaps

Providers of child day care services operating out of their homes may be reimbursed for meals and snacks served to participating children through USDA's Child and Adult Care Food Program (CACFP). To participate, these homes must be sponsored by a public or private organization that recruits the homes, trains them to follow CACFP rules, monitors compliance with the rules, and handles meal reimbursement claims and payments. CACFP reimburses sponsors for the administrative expenses incurred in conducting these activities. In 1996, Congress instituted a meal reimbursement system to better target benefits to low-income providers and children. The system created new administrative tasks for sponsors and a need for more time to be spent on some of the tasks conducted previously. This situation has raised concerns as to the adequacy of reimbursements. The decline in the number of CACFP sponsors--a 6-percent drop between 1995 and 2001--has further added to the concern. To address the issue, this study explores the administrative cost reimbursement system for CACFP sponsors that oversee the family child care homes portion of the CACFP. Costs reported by sponsors on average were about 5 percent higher than allowable reimbursement amounts. The report also presents and discusses alternative administrative reimbursement systems used by other Federal programs.

The serious deficiency process is considered a barrier to CACFP participation. The serious deficiency process is intended to ensure integrity and make sure operators follow CACFP laws, rules, and regulations. Operator actions that are considered non-compliant can place them on serious deficiency. If operators cannot correct the errors, they are terminated from CACFP and cannot participate again for seven years.
Semi-structured interviews were conducted with 10 California CACFP sponsors to understand the challenges faced by family childcare center (FCCH) providers in CACFP. The sponsors reported three primary concerns. First, the regulations providers are expected to follow are too harsh. The ease of disqualification from simple mistakes paired with the severity of the consequences hinders participation. Second, limited technical and language resources create equity issues for providers who are less familiar with technology and whose first language is not English. Inadvertent discrepancies can put providers at risk of termination from the program. Third, sponsors report that the serious deficiency process is subjective, unclear, and time-consuming. The process cannot be upheld consistently without clarity and structure.

The paper looks at a cross-sectional study of 2,228 centers in Arizona among early childhood education centers with low participation rates in CACFP. The strongest predictors of participation are if centers are classified as enrichment sites, which is when they provide care for first responders and essential workers. Additionally, participation in the Quality First rating system(Arizona’s rating system for early childhood centers), having higher staff educational attainment, and eligibility for SNAP. There are geographic disparities in which certain counties are less likely to participate in CACFP like Maricopa County. The article notes the positive impact of CACFP as it allows significantly more nutritious meals and fewer unhealthy snacks compared to non-participating sites which positively correlates with lower risks of obesity, fewer days of illness, and improvement in educational outcomes, standardized test scores, and long-term social health. Finally, it discusses administrative barriers such as the complexity of the application process and the literacy levels needed for program management. Interestingly, CACFP-participating directors are less likely to report no barriers to serving healthy food so reimbursement value itself might not be the root cause. The article also mentions how lack of belief in the benefits of the program hinders implementation so they offer recommendations for expanding outreach in Arizona. They recommend that state agencies should identify non-participating centers in high-poverty areas to recruit, provide literacy and administrative support for centers with lower educational attainment, and focus outreach efforts in metropolitan centers that are not participating in CACFP.

Context: The child and adult care food program (CACFP) transitioned from the oversight of the California Department of Education (CDE) to the California Department of Social Services (CDSS) July 1, 2021. This project was intended to inform the CDSS of administrative challenges and potential improvements of the CACFP. CACFPR and the National Policy Institute (NPI) interviewed independent childcare centers across the administrative regions of the CDSS. Specifically, CACFP and NPI interviewed independent childcare centers that directly contract with the state, those that operate under sponsors, and sponsors themselves.
Findings: Benefits and Challenges: Key benefits included food reimbursement, ability to support low-income families and communities, and access to nutrition guidelines. Independent childcare centers that operate under sponsors reported benefits of administrative oversight and provision of software. Benefits also included having a reliable source to ask questions and help ensure compliance with nutrition guidelines. Key challenges spanned across administrative challenges, technological challenges, and the difficulty of offering adequate culturally responsive food options. Independent childcare centers directly contracting with the state identified more challenges than those operating under sponsors.
Findings: Recommendations: Primary recommendations involved online chat-rooms and telephone access to improve communication with CACFP staff, and online and streamlined paperwork to reduce paperwork load. Additional recommendations included further support for meeting nutrition standards, and in preparation for administrative reviews. Childcare centers also recommended additional CACFP materials to share with families, and further guidance for offering culturally responsive options. Sponsors recommended more consistent, program-specific report communication from the state. Sponsors also requested more supportive relationships from CDSS and analysts, and quarterly meetings with other sponsors.

The origins of CACFP being a result of the “war on poverty” and its important update in 2017 to coincide with the Health, Hunger-Free Kids Act of 2010. The nutritional standards are governed by federal regulations and include: at least 1 serving of whole grains a day. Sugar limits for breakfast cereals (>6g) and yogurt (>23g). Milk should also be unflavored, using whole milk for children below one and unflavored low-fat or skim milk for children 2-5 years old. Tier reimbursement: higher reimbursement for those in Tier I but highest among low-income childcare centers compared to daycare homes. The USDA Food and Nutrition service tracks participation, issues guidance, and creates tools like recipes and worksheets. State agencies like education and health departments approve sponsors, disperse the funds, and monitor compliance. Sponsors are entities that help center and family childcare providers with the administrative paperwork. The childcare providers, and sometimes the state auditors and sponsors oversee the menu planning and food sourcing. The article talks about how national participation is low and how most programs meet nutritional standards but compliance is still imperfect. Childcare providers constantly point to the burden of paperwork, understaffing, and inflexible nutritional standards as barriers to their participation. Finally, the reimbursements can cover food costs but generally don’t account for labor costs. The policy recommendations: streamlining of administrative paperwork, increasing reimbursements to account for labor and healthy food costs, and simplify communication between state agencies and food vendors so the burden does not fall on providers.

There is a 2-tiered reimbursement system within CACFP. Tier 1 is a higher reimbursement for providers in low-income areas, those serving low-income families, or providers who meet the low-income guidelines themselves. Tier 2 is lower reimbursement for providers who do not meet the criteria of economic vulnerability. There was a temporary elimination of tiers that led to nutritional improvements and economic stability for both providers and families. There are barriers to CACFP participation, like the high food costs that often exceed reimbursement rates. Also, for those in tier 2, the paperwork may be even more difficult and take longer. There is also a discomfort expressed by providers with the 3 annual sponsor visits (2 of which are unannounced). A final barrier is the strict nutritional requirements that providers struggle to meet. The article recommends policy shifts to eliminate the tiered system, simplify administration, and provide ALL providers with the financial means to meet the nutritional standard. Additionally, increasing reimbursement rates can improve nutritional adequacy. Virtual monitoring during the pandemic can be used to permanently improve the program.

Objectives
New Child and Adult Care Food Program (CACFP) meal patterns and best-practices were implemented nationally in 2017 to address the need to prevent chronic diseases. Young Native American children have disproportionately higher risk of chronic disease. Some Native American tribes operate early care and education (ECE) programs and have the opportunity to participate in the CACFP. The purpose of this paper is to describe a CACFP best-practice menu and training developed and implemented as part of the Food Resource Equity and Sustainability for Health (FRESH) study.

Conclusions
Efforts to improve menus in rural and low-income ECE programs must consider these issues in developing feasible intervention strategies. Collaboration with the site manager and cook is essential to fully understand perceived and actual barriers to provide training that can provide necessary background rationale for nutrition recommendations as well as beneficial and productive activities and hands-on training to effect change outside the training.

This Connecticut-based study of licensed child care centers aimed to identify facilitators and barriers to CACFP participation to expand the CACFP reach and improve the nutrition of young children. Using data from an online survey of licensed child care centers in Connecticut, the study analyzed predictors of CACFP participation, assessed program experiences, knowledge and challenges, reasons for not participating, and opinions about increasing the program appeal. The study's secondary goal was to estimate the amount of foregone federal funding because of CACFP underuse.

The program also indirectly supports the operational livelihood of program-enrolled facilities, which—through their care of children (and eligible adults)—provide an essential service and foundation for the community’s economic health by enabling workforce engagement among adults with dependents.

Fortunately, this issue has not gone completely unnoticed. Democratic and Republican senators recently came together to cosponsor the Expanding Childcare in Rural America Act of 2023, demonstrating this issue’s ability to overcome partisan politics. Unfortunately, the important connection between rural America’s childcare crisis and the documented underuse of CACFP has received minimal recognition in the literature and policy discourse to date (with Erinosho and colleagues’ conclusions regarding the dearth of rural CACFP sponsors being an exception11). With the White House working alongside federal agencies and local partners to rejuvenate rural economies via initiatives such as the Rural Partners Network and with Congress considering policies to address the national childcare crisis, the time is now to study and address rural disparities in the reach of CACFP.

Sponsor-perceived barriers to provider CACFP: eligibility (costs, background checks, fear/stigma, and delays in becoming state-approved providers); enrollment (lack of translated/low-literacy materials and cumulative systems requirements); and participation (challenges maintaining qualifying menus and documentation and accessing qualifying food, inadequate reimbursements, and unannounced visits). Sponsors suggested systems changes to improve provider support (eg, more assistance with becoming state-approved and for start-up costs and accessible, progressive nutrition training opportunities).

This study explored barriers and facilitators of ECE participation in CACFP, and identified strategies to promote participation by eligible programs

Key barriers to CACFP participation included cumbersome enrollment and reimbursement paperwork, strict eligibility requirements, concerns about non-compliance penalties, strict meal patterns, low-reimbursement levels, and lack of on-site cooking facilities. Facilitators identified by participants were the outreach and technical assistance provided by stakeholders and sponsors, paperwork organizational systems established by sponsors, and trainings and nutrition education provided by stakeholders and sponsors

Background: U.S. Child and Adult Care Food Program (CACFP) provides tiered reimbursements for meals served in eligible family childcare homes (FCCH). Higher tier 1 reimbursements apply to providers who operate in low-income communities or are personally living on a low income. Tier 2 reimbursements apply to all other FCCHs. The tiered structure is intended to direct resources toward low-income families. However, the same program requirements apply to all FCCHs, which presents administrative burdens that can limit access to CACFP.
The Context of The Study: The USDA temporarily waived tiered reimbursements in response to increased food insecurity during the COVID-19 pandemic. The waving of tiers allowed all FCCHs to access higher reimbursement rates, and tier 2 providers’ reimbursements more than doubled. California FCCH providers were surveyed about their experiences with the higher reimbursement rates. 518 surveys were analyzed to understand providers’ perceptions of current impacts and future challenges of the reinstated tier system.
Survey Findings: Impacts of Higher Reimbursement Rates: Over half of the providers across tier 1 and 2 reported the following impacts: ability to pay less out of pocket for food costs, serve a greater variety of foods, and serve better quality foods. Additional reports included the following impacts: ability to serve more meals and snacks, choose more options children like, and not charge families more for childcare or food costs. The vast majority of providers across tier 1 and tier 2 also reported that it was easier to implement CACFP’s nutrition guidelines. Significantly more tier 2 providers reported benefits from the higher reimbursement rate, overall.
Survey Findings: Anticipated Changes After Tier Reinstatement: Providers across tier 1 and 2 reported that they would have to charge families more for childcare and decrease the variety of foods provided. Under half of providers reported that they anticipated withdrawing from CACFP or ending their childcare business after tiers returned.
Recommendations: Increased reimbursement rates for all FCCHs may support increased FCCH participation in CACFP, and ensure that more children benefit from nutritious meals and snacks.

CACFP Background: Licensed family childcare homes (FCCHs) in CACFP receive different reimbursement rates based on their income and location. Tier 1 FCCH providers receive higher rates. Tier 1 FCCH providers are those in low-income areas or who are, themselves, individuals with low incomes. Overall, FCCHs generally serve more children from families with low income than childcare centers.
Study context: The Child Care Nutrition Enhancement Act is a recently introduced legislation that would eliminate tiered CACFP reimbursements. Due to COVID-19, tiering was temporarily suspended. Structured interviews were conducted with Tier 1 and 2 FCCH providers in California to better understand the impact of eliminated tiers.
Findings: With high reimbursement rates, providers reported that CACFP reduced the financial burden and concern on families. FCCH providers from both tiers advocated for eliminating tiers altogether, and increasing the reimbursement rate overall as food costs increase.
Recommendations: The tiered reimbursement system should be eliminated, and higher reimbursement rates should be provided for all childcare providers participating in CACFP. These recommendations support the Child Care Nutrition Enhancement Act.

This study is the first national study to focus on reasons for CACFP participation by comparing current and former participants. The study spans 2019–2023, which coincides with the COVID-19 public health emergency, so it provides a unique look at FDCHs during that time. The study: (1) identifies challenges and barriers FDCH providers participating in CACFP face; and (2) shares recommendations from current and former FDCH providers to address these challenges. In addition to differences by CACFP enrollment status, the study also examines differences by urbanicity (urban/rural) and program size (large/small) among the former and current CACFP providers

This paper describes facilitators, barriers, and potential strategies to promote participation in the Child and Adult Care Food Program (CACFP) by family child care homes (FCCHs). 

The US Department of Agriculture have nutirtion assitance programs to combat food and nutrituon insecurity. However, they are under utlized by people who could benefit from them. The paper in interested in understanding the barriers between the people and their utlizations of these programs. In undertsanding the barriers, research and advocacy can be better aimed. Provides a framework to fit CACFP into for equitable access used by the Office of Management and Budget (OMB).

In pursuit of USDA’s goals, we note that the term equitable access is often not explicitly defined in the context of food and nutrition assistance programs. We propose conceptualization using the administrative burdens framework, which characterizes the burdens experienced by people seeking public services and benefits. Identifying administrative burdens, such as barriers to learning about program eligibility, can more clearly highlight the best strategies to enhance access to food and nutrition programs. This would give researchers a better understanding of these strategies and their implications (e.g., which strategies are equity-centered), enabling advocacy groups to develop more targeted policy agendas.