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.