Rural child care providers missing out on higher reimbursement rate in federal food program

September 4, 2019

Rural child care providers missing out on higher reimbursement rate in federal food program


  • IGPA Staff

Note: This article was produced by the Institute of Government and Public Affairs as part of IGPA’s efforts to connect relevant, nonpartisan research and expertise from the University of Illinois System to the public policy discussion in Illinois.

University of Illinois researchers discovered that a federal program designed to give children access to healthy food through their child care may be inequitable for rural providers.

The Child and Adult Care Food Program (CACFP) is a federally funded effort that offers reimbursements to child care providers for food costs if they are eligible and meet the nutritional requirements of the program with the meals they serve. CACFP mirrors federal school breakfast and lunch programs and serves more than 4.2 million children across the country each day, according to the U.S. Department of Agriculture.

The new paper “Licensed Family Child Care Providers’ Participation in the Child and Adult Care Food Program (CACFP): Greater Benefits and Fewer Burdens in Highly Urban Areas?” published in the journal Early Education and Development, is focused on licensed family child care providers. These providers care for a small number of children in their homes.

The researchers surveyed providers in Chicago and central Illinois, so they could evaluate the different experiences of rural and urban providers. Among the providers surveyed, those in Chicago were more likely to receive the program’s highest reimbursement rate.

Brenda Davis Koester, assistant director of the University of Illinois’ Family Resiliency Center at the University of Illinois at Urbana-Champaign and one of the authors of the paper, said the group focused on family child care providers because they are an important support for low-income families and are often low-income themselves. She said that family providers are also a group that is “understudied” relative to larger child care centers because it can be more difficult to reach them for participation in a study.

Rachel Gordon, another author of the paper and professor and director of research training at the University of Illinois at Chicago’s Department of Sociology, said that it’s important that all eligible children have access to CACFP because of the program’s goal of providing nutritious meals to low-income children. One prior national study, for instance, found that young children who received care from CACFP-funded providers drank more milk and ate more vegetables than children in the care of providers not receiving CACFP. They were also less likely to be overweight or underweight.

“The goal of CACFP is to be sure that young children have access to the calories they need in as nutritious a package of food as possible,” Gordon said. “There is some evidence that this program gets kids more of that.”

In addition to putting an emphasis on nutrition, Gordon said CACFP reimbursements help family child care providers remain financially sustainable. “They will tell you that it has always been a really vital piece of the puzzle,” Gordon said. “It can make the difference in whether they can offer care or not.”

While the program is important to providers, the researchers found that the hurdles for participating and getting the highest level of reimbursement may be greater for rural providers.

Of the providers surveyed, 92 percent in the Chicago area were receiving the higher reimbursement rate. Providers in central Illinois were more likely to receive the lower rate, with 27 percent of them getting smaller reimbursements.

Geographic eligibility rules appear to be one cause of this disparity. Providers who live in school districts or census blocks where at least half of the children are low-income automatically qualify for a higher reimbursement rate, which applies to all of the children in their care. Providers can also receive the higher rate for all children based on their own low income.

If providers don’t meet these eligibility measures, they can ask the families of the children they care for to document their income. Their reimbursement rates are then based on the household income of each child, and they may receive the lower reimbursement level for some children in their care.

“It’s much harder to go child by child,” said Katherine Speirs, an extension specialist and assistant professor in the Norton School of Family and Consumer Sciences at the University of Arizona, who was a post-doctoral fellow at the U of I and lead author of the study.

Determining eligibility based on individual children is more intrusive and burdensome, and must be done more frequently than when eligibility is determined based on the local poverty rates, Speirs said.

The researchers found that of Chicago providers getting the higher rate, 99 percent qualified based on the poverty levels in their school district.

However, poverty can be less geographically concentrated in rural settings. A school district might encompass an entire community, including low-income and wealthy households. Of the providers who qualified for the higher rate in central Illinois, just 56 percent did so based on poverty levels in their school district.

“It would seem that for providers in rural areas, where people are more spread out, it may be harder for kids to qualify for the higher benefit,” Speirs said.

In the mid-1990s two tiers of reimbursement were introduced as part of the Personal Responsibility and Work Opportunity Reconciliation Act. At the time, all providers who participated in CACFP received the higher reimbursement rate and studies suggested that many of the children receiving benefits from the program were higher income. After the tiers were introduced, providers had to meet one of the new eligibility rules in order to receive the higher rate. Otherwise, they received the lower rate.

But after decades of observing how these rules play out in practice, Gordon said policymakers should consider the unique challenges that face urban and rural caregivers instead of defaulting to a one-size-fits-all approach.

“Areas of concentrated poverty may be broadly under-resourced in ways that justify all local providers and children being eligible,” Gordon said. “However, providers and families with fewer economic resources may also be challenged in rural communities where they are isolated from support networks and distant from grocery stores.”

Indeed, some rural providers who participated in interviews for the study reported lacking the professional network that urban providers said they found more readily available. These connections to other providers can offer support and practical help with CACFP, such as an opportunity to share tips on how to meet nutritional requirements with low-cost foods that children will actually eat.

“Being a family child care provider is kind of isolating because you’re in your home. You’re not out and about,” Koester said. But, she said, “There just seems to be a better network in more urban areas.”

The authors suggest that one option to address the divide between urban and rural eligibility might be to make it easier for children to be eligible for CACFP if they qualify for general subsidies to cover the cost of child care, like the Child Care Assistance Program (C-CAP) in Illinois.

Right now, individual children can qualify for CACFP if their families already receive certain forms of federal assistance, but it’s not automatic. Providers must proactively demonstrate that eligibility, and child care subsidies aren't always included because their income-eligibility levels vary across states and sometimes exceed the federal cutoff.

The authors say that making children who are eligible for C-CAP and other child care subsidies automatically eligible for CACFP would reduce burden, increase access and spread awareness about the CACFP program. It would also help harmonize the general and food-specific child care subsidies, which are typically administered by different agencies at the state and federal level.

Another possible strategy would be to increase outreach to rural providers to help them overcome some of their geographically specific challenges. A potential example of such outreach would be offering deliveries of nutritious foods, which could remove the burden of having to make trips to multiple, faraway stores.

Speirs said that the providers interviewed generally had good relationships with their sponsoring agencies. She said those relationships could be an opportunity to get more information on nutrition and health to family providers, who generally have fewer educational and training requirements than staff in child care centers. “CACFP could help reach these family child care providers to offer resources and strategies to support the important role they play in the lives of families and children,” she said.

The group hopes to continue studying the effects of CACFP on family child care providers and the children they serve. In the meantime, they agree that it might be time to look at the eligibility rules with fresh eyes and consider taking advantage of 21st-century technologies to help the program meet its goal of ensuring all low-income children have access to nutritious meals and snacks, even if their family or community lacks resources.



Research Area: Education, Learning, and Child and Family Well-Being

Policy Initiative: none