Impact of Increased Child and Adult Care Food Program Reimbursement Rates for Family Child Care Home Providers in California

Background

The federal Child and Adult Care Food Program (CACFP) serves over 4.2 million U.S. children. Participating family childcare homes (FCCH) receive tiered reimbursements (I/II) to serve healthy foods to children in households with low-income. CACFP participation can improve the quality and affordability of childcare. During the COVID-19 pandemic, federal waivers eliminated tiers and increased reimbursements. Tier-I/II rates were $4.78/$2.29 before July 2021, $5.67/$5.67 July 2021-2023 with the waiver, and $5.21/$2.72 after July 2023 post-waiver.

Objective

Assess the impact of pandemic-waiver and perceived impact of post-waiver CACFP reimbursement rates on FCCH financial viability and meal/snack nutritional quality in California FCCHs.

Study Design, Settings, Participants

From a random sample of all licensed FCCH in California on CACFP (n=1,000 per tier), n=261 tier-I and n=257 tier-II completed surveys in English (86%) or Spanish (14%) in May-September 2023, and a subset (n=30) were interviewed.

Measurable Outcome/Analysis

Binary and Likert-scale responses for benefits of pandemic reimbursement rates and perceived impact upon return to tiers in July 2023 were analyzed, comparing tier results after adjusting for potential confounders using linear and logistic regression. Qualitative data were coded into themes using immersion-crystallization.

Results

More tier-II than tier-I FCCH reported the increased pandemic rates resulted in lower out-of-pocket food costs (65% vs 54%, p<0.5), allowed for increased food variety (62% vs 47%, p<0.001), improved food quality (62% vs 47%, p<0.01), and facilitated CACFP best practices for serving lean proteins (p<0.05) and limiting processed meats (p<0.05). FCCH expected decreased food variety (71% somewhat or extremely likely) and increased childcare charges to families (70%), post-waiver. Interviews indicated CACFP ensures nutritious meals/snacks, but inflation impacts costs, and FCCH advocate for increased federal reimbursements and the elimination of tiering.

Conclusions

CACFP pandemic reimbursement rates improved FCCH financial viability and meal quality. Post-waiver return to tiers and lower rates may result in decreased food variety and increased childcare charges for families, highlighting the need for sustained support to ensure quality and affordable childcare for households with low-income.

Funding

Robert Wood Johnson Foundation