To reveal students' experiences and perspectives related to Universal School Meals (USM) under the federal coronavirus disease 2019 waivers during school years 2021-22. Qualitative; 17 focus groups in June-July 2022. Virtual; students from 9 California regions in public and charter schools. 67 students (n = 31 in high school, n = 36 in middle school) from a racially and economically diverse sample. Students' perceived benefits and drawbacks of USM. Thematic analysis using an immersion-crystallization approach. Students appreciated USM for increasing school meals' accessibility, promoting food security by financially supporting families, reducing the stigma associated with school meals, simplifying the payment system, and enhancing school meals convenience. An increase in school meal participation was observed. However, concerns emerged regarding a perceived decline in food quality and quantity and increased food waste. Universal School Meals showed promise in increasing access to meals, reducing food insecurity, stigma, and increasing participation. Addressing food quality, quantity, and waste concerns is critical for its sustained success. Policymakers need to advocate for the expansion and continuous refinement of USM, prioritizing stakeholder feedback. Ensuring adequate funding to balance meal quality and quantity while minimizing waste is essential for an adequate school meal policy.

To evaluate students' perceptions of school lunches served when they were offered free of charge to all students. Cross-sectional qualitative study using focus groups. California students interviewed virtually. Middle school (n = 36) and high school (n = 31) students from a racially and economically diverse sample. Students' perceptions of school lunch. Thematic analysis using immersion-crystallization methodology. Students desire fresh and healthy school lunches. Students defined fresh as food prepared on-site, from scratch, and not prepackaged or frozen, and healthy as food that contains fruits and vegetables. Many students perceived the main entrees to be the least healthy and fresh part of school lunch and fruits and vegetables to be the most healthy and fresh; however, some students reported the fruits and vegetables were not always fresh or palatable. Students value fresh and healthy free school lunches, but they have somewhat limited definitions of what constitutes healthy. Schools can better meet student preferences for fresh and healthy foods to ensure that meals served free of charge are nourishing and palatable to all students while improving nutrition education such that students understand the components of a healthy meal.

Introduction: The U.S. Child and Adult Care Food Program (CACFP) provides tiered reimbursements for healthy foods for children at participating family childcare homes (FCCH). Higher tier 1 reimbursements are for providers who operate in low-income communities or who are themselves living on a low income. All FCCHs received a higher rate to address food insecurity during the COVID-19 pandemic. Methods: A survey was administered in the spring of 2023 to a randomly selected sample of licensed California FCCHs to assess the perceived impacts of the increased reimbursement on CACFP participation and anticipated challenges with reinstated tiered rates. A total of 518 surveys (261 tier 1, 257 tier 2) were analyzed using linear or logistic regression, adjusting for confounders. Results: Among tier 1 and tier 2 providers combined, over half reported lowering out-of-pocket spending for food (59%) and serving greater variety (55%) and quality (54%) of foods. Tier 2 providers reported experiencing more benefits (p < 0.05) and tended to be more likely to implement optional CACFP best practices (although not significantly different between tiers). Most FCCH providers found reimbursement rates were inadequate before (83%) the pandemic; this amount decreased to 54% post-pandemic for tier 1 and tier 2 providers combined. Conclusions: The temporary CACFP reimbursement positively impacted the perceived quality and variety of foods served to children, especially among tier 2 providers. Increased reimbursements for all FCCHs may ensure children have access to the healthy meals and snacks provided by the CACFP.

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). Trend analysis of administrative data. California. 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). Joinpoint regression was conducted separately for each tier. Average monthly percent changes (AMPC) over 4 predetermined periods were estimated. 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). Removing the tiered meal reimbursement system could increase CACFP participation among FCCHs, with likely positive impacts on young children's access to nutritious meals.

Objective: Declining participation by family childcare home (FCCH) providers in the Child and Adult Care Food Program (CACFP) may stem from inadequate tiered reimbursements for nutritious foods. During the COVID-19 pandemic, federal waivers temporarily eliminated tiers and increased reimbursements. We evaluated provider, sponsor and family perceptions of CACFP benefits and challenges in general and regarding the temporary removal of tiers and increased reimbursement rates. Design: From September 2023 to February 2024, FCCH providers, CACFP sponsors and CACFP family recipients in California participated in semi-structured interviews about CACFP benefits and challenges, perception of tiers and the COVID-19 waiver, quality of food and business viability. Thematic analysis was conducted using the immersion crystallisation method. Setting: Virtual interviews with California providers, sponsors and families. Participants: FCCH providers ( n 31), CACFP sponsors ( n 10) and CACFP family recipients ( n 6). Results: Providers and sponsors reported that the higher temporary reimbursement rate positively impacted food budgets and quality. Pandemic-era facilitators of CACFP participation included the higher reimbursement rate, tier removal and a hybrid model for monitoring visits. Benefits beyond the pandemic included nutrition education and supporting child food security. Families valued CACFP for providing a variety of high-quality foods. However, barriers to CACFP participation persist, including administrative burden, inadequate reimbursements, strict regulations and the impacts of the pandemic and inflation. Conclusions: Increasing CACFP reimbursements while reducing other participation barriers can better support FCCH providers’ and sponsors’ participation. Supporting FCCH CACFP participation and retention can enhance access to healthy and nutritious meals for children from families with low income.