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CACFP Administrative Manual Section 4.3

Child and Adult Care Food Program Administrative Manual Section 4.3: Meal Benefit Form for Providers.
Important Notice: CACFP Program Moved to CDSS

The Early Childhood Development Act of 2020 (Senate Bill (SB) 98, Chapter 24, Statutes of 2020) authorized the transfer of child care and development programs administered by the California Department of Education to the California Department of Social Services (CDSS) effective July 1, 2021. The content on this page may not be current and involves the Child and Adult Care Food Program (CACFP) that has moved to CDSS. Visit the CDSS CACFP web page External link opens in new window or tab. or call 1-833-559-2420 for more information.

Table of Contents
Terms, Definitions, and Acronyms

Section 4: Day Care Home Reimbursement Determination

4.3 Meal Benefit Form for Providers

If a home does not qualify for Tier I reimbursement through area eligibility, the sponsor may try qualifying the home by determining if the DCH provider is income or categorically eligible. To make this determination, the sponsor must have the provider complete a Meal Benefit Form (MBF) for Providers.

Categorical Eligibility

A provider’s home is categorically eligible for Tier I benefits if he or she is a member of a household that receives:

  • CalFresh benefits;

  • California Work Opportunity and Responsibility to Kids (CalWORKs) payments; or

  • Food Distribution Program on Indian Reservations (FDPIR) benefits

The MBF for Providers for a categorically eligible provider must contain the following information:

  • Provider’s name

  • Case number for CalFresh, CalWORKs, or FDPIR

  • Signature of the provider

Household income and the last four digits of the social security number (SSN) of the provider are not required.

Income Eligibility

A provider’s home can be categorized as eligible for Tier I reimbursement if the provider’s household size and income falls within the limits of the USDA Income Eligibility Guidelines.

The MBF for an income eligible provider must contain the following information:

  • Provider’s name

  • Names of all household members and, if applicable, their sources of income

  • Provider’s signature

  • The last four digits of the SSN of the provider or checks the box that says Check here if no SSN


The MBF for Provider must also contain the sponsor’s certification at the end of the last page, which consists of the following:

  • Check eligibility status: Tier I or Tier II

  • Total annual household income, if applicable

  • Categorical Eligibility, if applicable

  • Provider eligible for Tier I reimbursement: Yes or No

  • Provider’s own child(ren) eligible for Tier I reimbursement: Yes or No

  • Printed name and signature of the eligibility official

  • Certification date for eligibility
Duration of Provider’s Income or Categorical Eligibility Determination

Determinations of eligibility for Tier I reimbursement, by either categorical or income eligibility, are valid from the first day of the month in which the determination is made. A certified MBF for Provider is valid from the beginning effective date until the last day of the same calendar month in the following calendar year. For example, a MBF for Provider certified for an established provider on September 10, of the current calendar year is valid from September 1, of the current year until September 30, of the following calendar year.

Verification of Provider’s Income or Categorical Eligibility

Sponsors must verify that the information submitted for a categorically or income eligible provider is accurate.

Acceptable written evidence to verify a provider’s categorical eligibility includes copies of:

  • A current notice of eligibility for CalFresh benefits

  • An award letter from CalWORKS or FDPIR

An identification card for the benefit program is not an acceptable form of verification unless the card contains an expiration date.

Acceptable written evidence to verify a provider’s income eligibility includes copies of:

  • Pay or wage stubs from employers or a letter from employers confirming wages

  • Tax forms

A collateral contact should be used only in cases when the provider has not been able to provide adequate written evidence. The provider may designate a collateral contact outside the household who is knowledgeable about the household's circumstances and can give verbal confirmation of the household's income or receipt of eligible benefits.

Collateral contacts include employers, social service agencies, migrant workers agencies, and religious or civic organizations. The collateral contact should not be someone who might be affected by the provider's receipt of Tier I reimbursement instead of the lower Tier II rates—such as a family member or other relative, neighbor, or household of the children in the provider's care.

A sponsor may make the verification with the collateral contact in person or by phone, and must document all collateral contacts by date.

Provider’s Own Children

A Provider’s own children are any children who reside in the household (i.e., economic unit), such as the provider’s own children by birth or adoption, foster care, grandchildren, or housemates’ children who are part of the economic unit.

Meals served to the provider’s own children can be reimbursed only if the provider is determined to be categorically or income eligible for Tier I reimbursement. Tier II reimbursement for meals served to the provider’s own children is not allowed. Additionally, a DCH determined as Tier I by area eligibility does not qualify the DCH to receive reimbursement for meals served to the provider’s own children. 

Eligibility Criteria for Provider’s Own

The provider’s own children may be eligible for reimbursement if the following criteria are met:

  1. The children meet the age requirements

  2. The children are part of the provider’s household

  3. At least one enrolled, eligible, nonresident child is present and eating the same meal(s) claimed for reimbursement

  4. The provider is income or categorically eligible for Tier I reimbursement; this is not applicable to automatically eligible children
Categorical Eligibility of Provider’s Own

If the provider’s own children are categorically eligible for Tier I reimbursement, the entire household qualifies for the Tier I reimbursement; thereby qualifying the provider’s home as Tier I.

Automatic Eligibility of Provider’s Own

The automatic eligibility of a provider’s own child only qualifies that child for Tier I reimbursement. The automatic eligibility of Tier I for the child does not transfer to the home. The provider must still fill out a MBF for Provider and try to qualify for Tier I via categorical or income eligibility. 

Meals served to the provider’s own automatically eligible children are reimbursed at a Tier I rate, in a Tier I home, or Tier II High, in a Tier II home. Meals and snacks are reimbursable at the higher rates if the eligibility criteria for provider’s own is met.

The provider’s own children are automatically eligible for Tier I reimbursement if they:

  • Participate in Head Start (HS) or Early Start (ES)

  • Are eligible for FRPM in the NSLP

  • Are homeless

  • Are migrant

  • Are a foster child

The following documentation can be accepted:

  • For HS or ES, an approved HS or ES application, a statement of HS or ES enrollment, or a list of children enrolled which is signed and dated by an HS or ES official.
  • For free-reduced priced meals in the NSLP, a certification letter of meal benefits signed and dated by a school official.
  • For homeless, a certification signed and dated by the homeless liaison or shelter director showing the child’s name, the effective date of participation, and the residence (i.e., shelter).
  • For migrant, a certification signed and dated by the local operating agency’s or school district’s Migrant Education Program coordinator.
  • Foster children must be legally placed in a home by an approved foster care agency. The provider’s home must be appropriately licensed by the State of California to care for foster children. Providers must maintain the foster care placement documents for record keeping.

If the above documentation is not available, or cannot be verified, the provider must list the child on the MBF for Provider and include the child as part of the household.

Reference: 7 CFR, sections 226.2, 226.15(f), 226.23(e)(1), 226.18(b), 226.18(e); MB USDA-CACFP-02-2012 Transmission of Household Income Information, MB 06-219 Eligibility of Day Care Home Provider’s Residential and/or Own Children; and USDA Eligibility Manual for School Meals, USDA Eligibility Guidance for Family Day Care Homes

Questions:   Kayla Christensen | | 916-324-6153
Last Reviewed: Monday, June 28, 2021
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