Food insecurity is a persistent national public health problem that affects one in eight children and can have negative effects on their short- and long-term development. The Child and Adult Care Food Program (CACFP) was created to help children in child care settings get nutritious meals and is a key federal program that supports children’s healthy nutrition and development. However, recent Urban Institute research highlights that CACFP has a major gap in its ability to reach children vulnerable to food insecurity.
Specifically, most states don’t allow small home-based child care providers, friends, and relatives who are legally exempt from state child care licensing requirements—also called license-exempt home-based providers—to participate in the program, even though their participation is allowed under CACFP. More children are cared for in license-exempt home-based settings (11.5 million children in 2019) than are cared for in the child care centers and the family child care homes that are listed with state licensing agencies and other agencies (10.5 million).
Who qualifies as a license-exempt home-based provider varies by state, with some states exempting only those caring for children they are related to, while others exempt home-based providers serving several children in their homes. Across the country, these providers disproportionately care for vulnerable children, including infants, toddlers, children with disabilities, children from immigrant families, families who face challenges affording child care, and families working nontraditional hours. Our findings suggest that state and federal policymakers have a remarkable opportunity to reduce food insecurity and support the healthy development of many children by allowing and supporting license-exempt home-based providers to participate in CACFP.
Unlisted Home-Based Child Care Providers Care for More Children Than Centers or Listed Home-Based Providers
Source: 2019 National Survey of Early Care and Education data, 2021a. Center-based Early Care and Education Providers in 2012 and 2019: Counts and Characteristics and 2021b. Home-based Early Care and Education Providers in 2012 and 2019: Counts and Characteristics.
Notes: Listed providers refers to home-based providers who appear in national or state lists of early care and education services, which can include licensed or regulated providers as well as license-exempt providers that may be part of a public system. Unlisted paid providers refers to providers who did not appear on state or national lists but were reported to care for children other than their own for at least five hours a week in a home-based setting and received payment for at least one child in their care. Unlisted unpaid providers are similar to unlisted paid providers, except they do not receive payment for children in their care and include caregivers who are family and friends who may live in the same household as the children they regularly look after.
What can be done to support license-exempt home-based child care provider participation in CACFP?
To explore how states that don’t currently include license-exempt home-based providers in CACFP could expand participation, we analyzed some states that do allow providers to participate. From this work, we found three key considerations:
- States have significant discretion to establish eligibility approval processes for license-exempt home-based providers. CACFP requires that states have some sort of approval process for providers who aren’t required to be licensed, leaving it up to states to determine what is “an acceptable care environment” within federal guidelines.
Of the relatively few states that do allow license-exempt home-based providers to participate in CACFP, most have chosen to rely on the child care subsidy system’s license-exempt provider approval process, allowing providers who go through that process to also be eligible for CACFP. While it is important that these states are allowing licensed-exempt providers to participate in CACFP, our review found this approach significantly narrows the eligible pool of license-exempt home-based providers when compared with the approach used by Louisiana and California. These two states have used the discretion allowed by CACFP to identify alternative approval processes—a fire marshal inspection in Louisiana and a criminal background check and self-certification checklist in California—that allow a broader spectrum of license-exempt home-based providers, including the many who are unpaid, to be eligible. If other states were to take similar steps to identify mechanisms that could make the broad spectrum of license-exempt home-based providers eligible for CACFP, they could provide nutritional supports to more of the millions of children across the country who are cared for by license-exempt home-based child care providers. - Funding, resources, and focused efforts by sponsor agencies could support providers’ participation overall and in underserved communities. Our review highlighted that making license-exempt home-based providers eligible for CACFP is an essential first step but is unlikely to significantly improve participation unless additional resources and supports are made available. CACFP sponsor agencies are responsible for recruiting, training, and monitoring providers enrolled in CACFP. Because license-exempt home-based providers include people who aren’t accustomed to dealing with government agencies or to meeting reporting requirements, they may require more intensive outreach and supports.
These challenges are even more evident for providers in underserved communities, including those with language or literacy barriers, who live in rural communities, who face technology barriers, who have immigrant status or family members who are immigrants, and who’ve had bad experiences with government agencies.
Yet the CACFP funding approach doesn’t provide sponsor agencies the resources needed to ensure license-exempt providers can enroll and meet program requirements. Making more resources and supports available to sponsor agencies is needed to facilitate their efforts to enroll license-exempt home-based providers overall and to ensure they reach providers in underserved communities. - CACFP’s policies and payment levels create significant barriers to participation. CACFP’s low payment rates for meals, extensive paperwork, reporting requirements, and unannounced monitoring visits can be challenging for all providers but can be even more difficult for license-exempt home-based providers. Because these providers may serve very few children, they will receive even less in total payment. And because they may not be caring for children as a business, they can find it more difficult to deal with the demands of paperwork, reporting requirements, and program rules. For example, providers are supposed to notify agencies if they won’t be home during a mealtime, so the agency knows not to conduct an unannounced visit that day. However, a grandmother that spontaneously takes her grandchildren out for a picnic may not remember to do so.
The federal government could support a review of policies and practices and ways to make them relevant for license-exempt home-based providers. CACFP agencies could also review their own policies and practices to identify the root causes of barriers that local providers face (e.g., language, literacy, internet access, trust issues) and take steps to address them.
By taking these key steps—making more license-exempt home-based providers eligible for CACFP, investing in the additional resources sponsors need to support the full range of providers, and addressing the barriers to participation that providers face in policy and practice—nutritional supports could become available to many more children. As a result, policymakers could better support the healthy development, nutrition, and safety of children across the country.
