Impact of 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.

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.

Objective: We aimed to examine the effectiveness of food service staff training on meals and menu quality across NA ECEs.

Conclusion: Implementing a best-practice menu with healthy recipes showed immediate improvements in meal quality. Although the change did not sustain, this study showed evidence of an opportunity to educate and train food service staff. Robust efforts are needed to improve both meals and menus.

By subsidizing a large share of a major operating cost, CACFP provides important financial support to the sector. In addition, the nonprofit sponsors directly administering the program can serve as an important source of information, advice, and morale. Although national figures are difficult to come by, in Illinois around three quarters of licensed family childcare providers participate in CACFP (author’s calculation from Illinois administrative data).

The relentless decline in the number of family childcare providers in the marketplace over the past several decades has reduced childcare options. Descriptive evidence on the association between CACFP participation and the continued operations of licensed family childcare providers during a period of intense financial distress indicates a strong positive association between CACFP participation and COVID-19-era resiliency. The estimated relationship is robust to controls for multiple background factors also associated with persistence in the childcare market.

The analysis in this report uses data from the 2019 National Survey of Early Care and Education (NSECE) to compare the general characteristics of childcare providers, both centers and day care homes, by CACFP participation status and eligibility. The NSECE is a nationally representative survey of childcare providers sponsored by the Office of Planning, Research and Evaluation (OPRE) in the Administration for Children and Families of the U.S. Department of Health and Human Services. The analysis also uses a follow-up data set to understand how the COVID-19 pandemic affected provider operations and CACFP participation.

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

Differences in child nutrition programs (NSLP, SBP, CACFP, CACFP-At Risk AfterSchool, SFSP, SSO, Summer EBT, SMP, FFVP). Most of the programs are "appropriated entitlements” meaning that funding is mandatory but given through annual appropriations acts depending on participation levels. The biggest programs are the National School Lunch Program (NSLP) and School Breakfast Program (SBP) operating in 90,000+ schools. Federal funding is primarily done through per-meal cash reimbursements which differ based on the child’s eligibility which depends if the meal price is free, reduced-price, or paid. Some programs also get "entitlement commodities” which are foods purchased by the USDA for distribution. Additionally, the USDA keeps up to 3.5% of annual funding for federal administration and each state also receives administrative payments. Spending has increased over time due to higher participation in free meal programs and the creation of new programs (eg: Summer EBT). Federal subsidies are highest for the meals given to children from low-income families and there are 2 main paths for certification. One is a household application which depends on the household income leading to either free or reduced-price means. Then there is the categorical eligibility where children are eligible if they participate in programs like SNAP or if they are in foster care, homeless, a migrant, or a runaway youth. The Health, Hunger-Free Kids Act of 2010 required the USDA to align school meal nutrition standards with the Dietary Guidelines for Americans creating certain standards for amounts of fruits, vegetables, grains, dairy, and meats/meat alternatives. During the summer there are different programs that provide free or reduced meals which are Summer Food Service Program, Seamless Summer Option, and Summer EBT.

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.

Study objectives: Study objectives were to document the prevalence of Tennessee child care programs screening for food insecurity, explore differences between programs receiving child and adult care food program (CACFP) funding and those screening for food insecurity, and understand possible burdens food insecurity places on child care families as perceived by child care program directors.

Conclusions: Child care programs receiving CACFP funds are more likely to screen families for food insecurity than programs who do not. Programs indicate a willingness to include food insecurity screening questions on child care paperwork.

GAO studies 6 federal nutrition assistance programs serving older adults, CACFP is one of them. They look at several states operations and menus.

The CACFP Sponsor and Provider Characteristics Study is focused on the child care component of the CACFP, which provides federal funds for meals and snacks served to children in public or private child care centers, Head Start programs, outside-school-hours care centers, afterschool care programs, emergency shelters, and day care homes. The study also covered centers that participate in the At-Risk Afterschool (At-Risk) component, which provides meals to children and youth through age 18.

Policymakers or advocates who see CACFP primarily to support employment of low-income mothers by subsidizing their caregivers may not be concerned about the low rates of participation among low-income children, especially among those in exclusive parental care. However, because many poor women use unlicensed care and such care is eligible for general childcare subsidies, making unlicensed providers eligible for CACFP should also promote employment among low-income women. The exclusion of unlicensed providers is even more problematic for those who emphasize CACFP’s nutritional goals because children in unlicensed homes and exclusive parental care miss out on a nutritional benefit provided to equally needy children in licensed care. Finally, CACFP may be seen primarily to supplement other childcare subsidy programs or other food assistance programs. In this case, it might be more efficient to increase assistance in these other programs directly (if they are inadequate), rather than through the CACFP program that fails to reach many low-income children.

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

Critical steps are needed to repair our nation’s fragile ECE system, including greater investment in CACFP, to ensure the nutrition, health, and development of young children during the COVID-19 pandemic and beyond. The findings show that in April 2020 there was a 35% nationwide decrease in CACFP reimbursed meals compared to April 2019. Other programs like school-based food programs and WIC could not bridge the gap left by CACP due to different food standards, administrative barriers,and eligibility restrictions. While federal waivers did allow for more flexible meal distribution factors like financial instability, workforce vulnerability due to age and health, and low reimbursement rates, ECE programs could not operate. The article offers recommendations for reform such as: improving emergency food access by expanding Pandemic Electronic Benefits Transfer to include all children participating in CACFP. Another recommendation is to strengthen CACFP administrative work. The last two recommendations they offer are to modernize data sets because there is no single comprehensive source for nationwide CACFP provider information and data and to also directly invest in early childhood education which will support centers, their staff, and parents.

The pandemic has challenged the ECE system, but has also drawn attention to the essential role of ECE in child nutrition and education. This study highlights potential opportunities for new policies to enhance efforts to promote child nutrition and quality care at ECE.