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"It's just not worth it anymore": A Mixed Methods Study Examining the Impact of Reinstating Reimbursement Tiers in
Katharina C Fiedler1, Kassandra A Bacon1, Danielle L Lee1
1Nutrition Policy Institute, Agriculture and Natural Resources, University of California, Oakland, CA.
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.
