Facilitators and Barriers to FCCH Enrollment in CACFP
Facilitators and Barriers to Family Child Care Home Participation in the U.S. Child and Adult Care Food Program (CACFP)
In December 2022, the Indiana University CACFP Project Team released a report describing the facilitators and barriers to CACFP participation by family child care homes (FCCHs). The report concludes with suggestions for potential strategies to promote participation in the CACFP by FCCHs. The study was conducted in two states, Arizona and New York, that have varying levels of CACFP participation. The study outlines the facilitators and barriers to FCCHs’ enrollment in CACFP and recommends a few strategies to increase participation.
Why it Matters
Eating habits developed in early childhood can have lifelong health impacts. FCCHs are important settings to promote healthy habits, as approximately 12% of U.S. children under the age of 6 are cared for in FCCHs (National Center for Education Statistics, 2019). Guidelines from the Academy of Nutrition and Dietetics recommend that children receive half to two-thirds of their daily calorie and nutrient requirements at full-day child care, but studies report the need to enhance the diet quality of foods/beverages provided at FCCHs. By participating in the CACFP, FCCHs are required to comply with specific nutrition standards, however participation by FCCHs varies widely among states. FCCHs are crucial for improving the nutrition and food security of the children in their care, as the meals/snacks FCCHs provide the nutrients children need for proper development that they may not receive at home.
Major Facilitators of CACFP Participation
1. Simple enrollment
- The simple processes for completing the initial enrollment in CACFP and subsequent annual renewal of enrollment were cited as facilitators for participation.
2. Technical assistance from sponsors
- Sponsors and stakeholder organizations helped facilitate initial enrollment in CACFP by providing support such as:
- providing technical assistance.
- conducting outreach to promote CACFP awareness,
- providing training about best practices,
- helping providers navigate challenges, and
- connecting providers with their peers to establish support systems and share ideas.
3. Software provided by sponsors
- Sponsors offered computer software programs that:
- helped providers comply with meal patterns,
- streamlined reimbursement paperwork processes, and
- eliminated the need to process reimbursement claims on paper or by postal mail.
4. Incentives from state agencies
- State agencies helped to promote CACFP by expanding funds available to sponsors to conduct program outreach and by including CACFP in Quality Rating and improvement Systems (QRIS).
Barriers to Participation
1. CACFP eligibility criteria
- The tiering system was a significant barrier to CACFP enrollment, as stakeholders and sponsors cited challenges with enrolling FCCHs that qualified for Tier II.
- The general decline in FCCHs nationwide resulted in fewer providers being eligible for CACFP. Sponsoring organizations described this situation as being due to:
- an aging population of providers,
- high costs of obtaining licensure,
- parental preference for enrolling children in formal center-based child care, and
- the pandemic.
2. Enrollment Requirements
- There is a perception that providers will have difficulties complying with the CACFP meal patterns and that it was easier to have parents provide their child’s meals.
- Given the limited resources of staff available and time constraints at FCCHs, there is a perception that the paperwork for CACFP enrollment would be too time-consuming.
3. Sponsor roles and requirements
- A general lack of sponsors in rural areas limits participation by rural providers
- Monitoring visits, especially unannounced visits, posed a concern for some providers.
- Many providers shared that there was a learning curve in getting started on computer software programs provided by sponsors.
4. Reimbursement challenges
- Reimbursement rates are low and inadequate, especially with current rising food costs.
- Individual states can further restrict reimbursement, where providers are only allowed to claim reimbursement for non-relative children in their care.
- Providers are concerned about non-compliance penalties, especially from unintentional errors, that could result in the disallowance of reimbursement for meals served.
Recommended Strategies to Promote CACFP Uptake
- Educating providers about CACFP paperwork requirements to eliminate perceptions that the paperwork to enroll is too cumbersome.
- Increase outreach to promote CACFP awareness, potentially by using state agencies to:
- disseminate CACFP information to new providers,
- inform them about its potential benefit,
- provide FCCHs with specific referrals to sponsoring organizations in their geographic location, and
- share information about new FCCHs with sponsoring organizations so that they can also conduct direct outreach.
- Expanding outreach to promote CACFP awareness among legally-exempt and alternately approved providers who typically do not go through licensure and may miss out on receiving information about CACFP.
- Increase CACFP reach in rural areas by:
- incentivizing existing sponsors to expand coverage to rural communities, or
- supporting the establishment of new sponsoring organizations in rural areas.
- Provide funding to supplement start-up costs for FCCHs and fees for obtaining licensure and home health/safety inspection approvals.
3. Resource provision
- Allocate more funding to support the work of sponsors.
- More opportunities to interact with and receive high-quality training about child nutrition and state/federal CACFP requirements from state CACFP agencies.
4. Reimbursement increase
- Extend the practice of reimbursing all providers at the Tier I rate.
- Generally, increase reimbursement rates, regardless of Tier, to offset rising food costs.
To learn more about the various factors that influence FCCHs’ CACFP enrollment, read the report on Facilitators and Barriers to Family Child Care Home Participation in the U.S. Child and Adult Care Food Program (CACFP).