Trends in California Child and Adult Care Food Program Participation Among Family Child Care Home Providers: The Role of Tiered Meal Reimbursements.

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.