CACFP Administrative Manual Section 3.3

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• Terms, Definitions, and Acronyms

Section 3: Centers Reimbursement Determination

Section 3.3: Adult Day Care Centers Reimbursement Determination

An Adult Day Care Center (ADCC) can have enrolled adults that are either eligible or not eligible to participate in the CACFP, depending on the age and residency of the adult. The ADCC must determine which enrolled adults are eligible for the CACFP and distribute Meal Benefit Forms (MBF) to them.

The MBF allows ADCC to determine the meal reimbursement category of adult participants. The number of adult participants by reimbursement category (free, reduced-price, and base), in conjunction with the claimed meals, serve as the basis for the monthly reimbursement claims.

ADCC must maintain a current, complete, and certified MBF for each adult participant claimed in the free or reduced-price eligibility category. When distributing MBFs to families, center staff must also distribute the Letter to Households to inform the adult or adult household member of the procedures regarding eligibility for free and reduced-price meals. A copy of the adult MBF and Letter to Households can be found in the Download Forms section of the Child Nutrition Information and Payment System (CNIPS).

An ADCC may determine a participant to be eligible for free or reduced-price meals according to one of two methods: categorical eligibility or income eligibility.

Categorical Eligibility

An adult participant is categorically eligible for free meal benefits if they receive any one of the following:

• CalFresh benefits
• Food Distribution Program on Indian Reservations (FDPIR) benefits
• Medicaid/Medi-Cal
• Supplemental Security Income (SSI)

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

• Name of the participant
• Case number for CalFresh, FDPIR, SSI, or Medicaid/Medi-Cal
• Signature of the participant/adult household member

Household income and the last four digits of the participant’s social security number (SSN) are not required.  It is a best practice for the certifying official to sign and date the MBF. If any of the required information is missing from the MBF, or if the MBF is not returned, the center must claim the participant at the base rate.

The California Department of Social Services no longer accepts alternative documentation for categorical determinations. All participants claimed at the free or reduced-price rate must have a valid MBF on file. For further information, please see MB CACFP-02-2016: Participant Eligibility Record for Adult Day Care.

Income Eligibility

A participant is income-eligible for meals reimbursed at the free or reduced-price rate if the individual’s family or household size and income, as stated on the MBF, are within the USDA Income Eligibility Guidelines.

A complete adult participant MBF must contain the following household information:

• The names of all adults enrolled in care, for whom the application is made;
 
• The names of all other household members;
 
• Income received by each household member, identified by source of income (this includes gross earnings, wages, welfare, pensions, support payments, unemployment compensation, social security, cash income received or withdrawn from savings, investments, trusts and other resources; individual retirement account and Keogh withdrawals);
 
• The signature of an adult household member that immediately follows a statement verifying that the information provided on the application is true and correct; and
 
• The last four digits of the social security number of the adult household member who signs the application, or an indication that he/she does not possess a social security number.

The MBF also must contain the center’s certification, which consists of the following:

• Certification that the participant is 60 years of age or older, or that the participant meets the functionally impaired eligibility requirements
 
• The participant’s type of residence
 
• Total household income
 
• Certification of eligibility status: free, reduced-price, or base
 
• Certification date for eligibility

It is also a best practice for the certifying official to sign and date the MBF.

If any of the required information is missing from the MBF, or if the household does not submit an MBF, the participant must be claimed at the base rate.

Participant Eligibility Determinations and Duration

Effective Date

For ADC centers, the eligibility effective date may either be:

• the date the participant or adult household member signs the MBF; or
• the date the MBF was certified by an agency official.

If an ADCC uses the participant or adult household member signature date, this date must be within the month of certification or the immediately preceding month, otherwise the effective date must be the date of certification. For example, if a participant signs an MBF on February 1, and the agency completes certification on April 1, the effective date must be April 1.

Duration

MBFs are valid until the last day of the calendar month in which they were originally dated one year earlier. For example, an MBF that was certified by an agency official on October 10, 2016, is valid from October 1, 2016, to October 31, 2017. A household is not required to report an increase in income or a decrease in household size, or ineligibility for benefits, during the calendar year.

Participants that Decline the Child and Adult Care Food Program

If eligible enrolled adults do not wish to participate in the CACFP, it is a best practice for the ADCC to obtain a Decline Participation in the CACFP form which is located in the Download Forms section of the CNIPS. These enrolled adults who may be eligible, must still be included on the eligibility roster and, if using the fixed percentage claiming method, in the fixed percentage calculation. In the calculation, the declining participants would be in the base reimbursement category unless they have a valid MBF that qualifies them for free or reduced price meals.

Adult Day Care Center Eligibility Roster

After an ADCC has determined the enrolled adults that can participate in the CACFP, and the reimbursement eligibility for each, the center’s staff must create a roster. The roster must list all the enrolled adults in their care, both CACFP eligible and noneligible.

For the eligible adults, or adult participants, the ADCC must identify each participant’s reimbursement meal category.

The eligibility roster must include:

• the month and year the roster was created;
 
• each enrolled adult’s name, eligible and not eligible;
  • If the enrolled adult is eligible to participate, the certified reimbursement category (free, reduced-price, or base) and categorical determination, if applicable.
   
• the total number of adult participants in each category; and
 
• the total number of enrolled adults at the site.

A sample adult eligibility roster can be found in the Download Forms section of the CNIPS.

Centers using the fixed percentage claiming method must develop a roster each October and for any other months in which the enrollment, eligibility, or both must be updated on the claim for reimbursement. Centers using the actual count claiming method must develop a roster each month. All for-profit agencies, regardless of claiming method, must develop a roster for each site for every month they submit a claim. More information regarding claim for reimbursement submission can be found in Section 5.1 of this manual.

Helpful Definitions

Eligible Enrolled Adult: An adult enrolled in an ADCC that is 60 years of age or older. If under the age of 60, the participant must be functionally impaired with a plan of care. This definition includes adults who are eligible, but do not wish to participate in the CACFP.

Non-eligible Enrolled Adult: An adult enrolled in an ADCC that is under the age of 60 without a functional impairment and plan of care.

Household: The applicant’s household is defined as “family” in the Program regulations for the adult component of CACFP. This definition is slightly different than the definition used for child care institutions, centers, or day care homes. In the case of adult participants, it is the adult participant and the spouse and any dependents that reside with the adult participant. There may be instances in which a spouse or dependent does not live continuously with the participant. In that case, the spouse or dependent continues to be considered a part of the participant’s family as long as his or her usual residence is with the participant. However, functionally impaired adults living with their parents are considered a “family” separate from their parents for the purpose of determining family-size and income.

References: 7 CFR, Sections 226.2, 226.15(e)(2), 226.19a(b)(8), 226.23(e), and 226.23(f); MB CACFP-01-2015 Guidance on Income Eligibility Determinations and Duration, CACFP Memorandum #1-05: Use of Enrollment Data for Establishing Claiming Percentages and Determining the Eligibility of proprietary Centers, CACFP 21-2012 Adult Day Care Center Eligibility and Licensing/Approval, and USDA Adult Day Care Handbook.

Questions: A list of program specialists that can assist is found on the CACFP Contact List.

This institution is an equal opportunity provider.
Esta institución es un proveedor que ofrece igualdad de oportunidades.