Peer-reviewed article
Trends in California Child and Adult Care Food Program Participation Among Family Child Care Home Providers: The Role of Tiered Meal Reimbursements.
Matias SL, Bacon KA, Lee DL, Marshall SK, Felix C et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how changes to meal reimbursement rates in California's Child and Adult Care Food Program affected whether family child care homes participated in the program. Using administrative data from 2017 to 2022, the researchers tracked participation before, during, and after the COVID-19 pandemic, comparing two categories of providers based on reimbursement levels. The findings suggest that when tiered reimbursement requirements were temporarily removed during the pandemic, participation remained stable or increased, but when these tiers were reinstated afterward, participation declined significantly.
Key points
- Before the pandemic, CACFP participation was slowly increasing among both tier 1 and tier 2 family child care homes
- During the early pandemic with tiered reimbursements in place, participation declined slightly for both groups
- When tiered reimbursement requirements were waived during the pandemic, tier 1 participation plateaued and tier 2 participation increased
- After tiered reimbursements were reinstated, participation dropped substantially for both groups, with tier 2 experiencing a steeper decline of -1.4% monthly
- Removing tiered meal reimbursement barriers could improve program participation and increase children's access to nutritious meals
Limitations
The study uses administrative data on program participation rates and cannot explain the mechanisms behind provider decisions or assess the actual nutritional outcomes for children. The analysis is specific to California's system and may not generalize to other states or regions.
Abstract
Objective To determine whether coronavirus disease 2019-related meal reimbursement changes were related to participation in the Child and Adult Care Food Program (CACFP) among family child care homes (FCCHs). Design Trend analysis of administrative data. Setting California. Participants Licensed FCCHs VARIABLES MEASURED: Child and Adult Care Food Program participation status, determined using start/enrollment and closed/drop out dates, was used to calculate monthly participation rates (number of FCCHs in CACFP/number of licensed FCCHs) by meal reimbursement tier (tier 1 or 2). Analysis Joinpoint regression was conducted separately for each tier. Average monthly percent changes (AMPC) over 4 predetermined periods were estimated. Results Prepandemic-period-AMPC indicated small upward CACFP participation trends (monthly 0.2% increase for tier 1, P = 0.001; monthly 0.1% increase for tier 2, P < 0.001). Pandemic-with-tiered-reimbursement-AMPC showed small downward trends (monthly -0.1% decrease for tier 1, -0.2% for tier 2, P < 0.001 for both). Pandemic with tiers waived AMPC detected a plateau for tier 1 FCCHs (0.0% change, P = 0.08), and a small upward trend for tier 2 FCCHs (monthly 0.2% increase, P = 0.003). Postpandemic-with-tiers-reinstated-AMPC revealed significant downward trends (monthly -0.4% decrease for tier 1, -1.4% for tier 2, P < 0.001 for both). Conclusions and implications Removing the tiered meal reimbursement system could increase CACFP participation among FCCHs, with likely positive impacts on young children's access to nutritious meals.