“It’s just not worth it anymore”: A Mixed Methods Study Examining the Impact of Reinstating Reimbursement Tiers in the Child and Adult Care Food Program

OBJECTIVE: Assess impacts of the Child and Adult Care Food Program (CACFP) reinstatement of tiered reimbursements among family child care home (FCCH) providers, sponsors, and families. DESIGN: Mixed methods (survey and interviews). SETTING: California. PARTICIPANTS: Randomly selected FCCH providers surveyed (n = 277); purposively selected FCCH providers (n = 10) and sponsors (n = 5), and conveniently selected families (n=5) interviewed. PHENOMENON OF INTEREST AND VARIABLES: Perceptions of adequacy and impacts of tier reinstatement, and optimal amount and number of meals/snacks covered by CACFP. ANALYSIS: Linear and logistic regression for survey responses by tier; qualitative analysis using the framework method. RESULTS: Irrespective of tier, surveyed providers reported that the reinstated, tiered reimbursements were insufficient (92.4%), resulting in reduced food variety (39.1%) and quality (14.8%), and increased financial burden on providers (96.9%) and parents (24.0%). The ideal number of meals/snacks reimbursed was 4, and the ideal reimbursement amount for 2 meals/1 snack daily per child was $7.58 (currently $5.70 tier 1, $2.72 tier 2). Qualitative analysis identified 4 themes providing context on the challenges resulting from tier reinstatement: economic landscape, CACFP participation, food and care provided, and policy solutions. CONCLUSIONS AND IMPLICATIONS: Increases to CACFP reimbursements and meals/snacks covered is recommended to support healthy eating by FCCH children.