Provider, Sponsor and Family Perceptions of CACFP Participation and COVID-19 Reimbursement Increases

Objective: Declining participation by family childcare home (FCCH) providers in the Child and Adult Care Food Program (CACFP) may stem from inadequate tiered reimbursements for nutritious foods. During the COVID-19 pandemic, federal waivers temporarily eliminated tiers and increased reimbursements. We evaluated provider, sponsor, and family perceptions of CACFP benefits and challenges in general, and regarding the temporary removal of tiers and increased reimbursement rates. Design: From September 2023 to February 2024, FCCH providers, CACFP sponsors, and CACFP family recipients in California participated in semi-structured interviews about CACFP benefits and challenges, perception of tiers and the COVID-19 waiver, quality of food, and business viability. Thematic analysis was conducted using the immersion crystallization method. Setting: Virtual interviews with California providers, sponsors, and families. Participants: FCCH providers (n=31), CACFP sponsors (n=10), and CACFP family recipients (n=6). Results: Providers and sponsors reported that the higher temporary reimbursement rate positively impacted food budgets and quality. Pandemic-era facilitators of CACFP participation included the higher reimbursement rate, tier removal, and a hybrid model for monitoring visits. Benefits beyond the pandemic included nutrition education and supporting child food security. Families valued CACFP for providing a variety of high-quality foods. However, barriers to CACFP participation persist, including administrative burden, inadequate reimbursements, strict regulations, and the impacts of the pandemic and inflation. Conclusions: Increasing CACFP reimbursements while reducing other participation barriers can better support FCCH providers’ and sponsors’ participation. Supporting FCCH CACFP participation and retention can enhance access to healthy and nutritious meals for children from families with low income.