Meal Modifications in the CACFP

Modifications for Participants without a Disability

Parents or household members may request that Child and Adult Care Food Program (CACFP) Operators make meal modifications for participants due to special dietary needs, personal preference, religious reasons, or in other instances that are not related to a disability.  For example, parents may request that their child receives a fluid milk substitute for personal reasons, or that pork products are not served for religious reasons.

Modifications are allowed to the planned meal if the substituted foods/beverages are creditable components in the CACFP.  It is at the CACFP Operator’s discretion to provide meal modifications if the request for the modification is not related to a disability; however, CACFP Operators are strongly encouraged to accommodate the dietary needs of participants without a disability.

Parent/Guardian-Provided Components

For the CACFP Operator to claim reimbursement of a meal for a participant without a disability, the parent or household member may only provide one creditable component per meal; the CACFP Operator must provide all other components.

Requests for Nondairy Beverages

Nondairy beverages served in place of fluid milk must meet the minimum nutrient requirements for fluid milk substitutes (see table below) for the CACFP Operator to claim reimbursement without a signed medical statement.  In addition:
 

• Parents or household members must provide a written request for a nondairy beverage substitute, identifying the medical or other special dietary need that restricts the participant’s diet.  The written request may be incorporated into an existing form (e.g., enrollment record), or on a specific form (e.g., CACFP 49, Request for a Fluid Milk Substitution, accessible in the Download Forms section of the Child Nutrition Information and Payment System [CNIPS] website).  A signed medical statement is not required to serve nondairy beverages that meet the federal minimum nutrient requirements for fluid milk substitutes.

• All beverages served to children of any age in licensed child care centers and homes must be unflavored to comply with the California Healthy Beverages in Child Care Act, as outlined in Section 1596.808 of the California Health and Safety Code. 

Table:  Minimum Nutrient Requirements for Fluid Milk Substitutes per 1 cup (8 oz) 

Nutrient	Amount
Calcium	276 mg
Protein	8 g
Vitamin A	500 IU (150 mcg)
Vitamin D	100 IU (2.5mcg)
Magnesium	24 mg
Phosphorus	222 mg
Potassium	349 mg
Riboflavin	0.44 mg
Vitamin B-12	1.1 mcg

 

Requests for Modifications Other than Nondairy Beverages

For meal modifications (that meet the meal pattern requirements) other than nondairy beverages, CACFP Operators must document the modification on either an existing form (e.g., enrollment record), or on a specific form (e.g., CACFP 12, Parent/Guardian’s Form for Declining a Provider’s Infant Formula or Food or CACFP 84, Parent/Guardian’s Form for Declining a Provider’s Food for Older Children [and adults]; both forms are accessible in the Download Forms section of the CNIPS website).

Modifications for Participants with Disabilities

CACFP Operators must make reasonable food and beverage substitutions, at no extra charge, on a case-by-case basis, for participants with a disability that restricts their diet; however, modifications are not required if they would fundamentally alter the nature of the program.  For example, a small CACFP agency with limited staff and resources is not required to accommodate a request for an expensive medical infant formula if the accommodation would cause undue financial burden on the program.  CACFP Operators should send questions by email to the California Department of Social Services (CDSS) CACFP Nutrition Team at  CACFPMealPatterns@dss.ca.gov to determine how to proceed with requests for meal modifications that may fundamentally alter the nature of the program.
 

Parent/Guardian-Provided Components 

For the CACFP Operator to claim reimbursement of a meal for a participant with a disability, the parent or household member may, but are not required to, provide all but one creditable component per meal; the CACFP Operator must provide a minimum of one component.

In many cases, dietary modifications to accommodate a disability are managed within the meal pattern requirements.  For example, there are many gluten-free foods (e.g., brown rice, quinoa, and corn tortillas) that meet the requirements for a creditable grain in the CACFP.

If the disability involves a request for foods or beverages that meet the meal pattern requirements (e.g., requests for gluten-free foods, pureed foods, or that another fruit be substituted when strawberries are on the menu due to an allergy), a medical statement signed by a state licensed healthcare professional is not required; however, CACFP Operators must document the date they communicated with the parent/guardian to determine a safe and appropriate menu modification.  This can be done on a specific form developed by the CACFP Operator to document the menu modifications made within the meal pattern or on an existing form (e.g., enrollment record).

Note: CACFP Operators cannot deny requests for meal modifications due to a disability (unless the modification may fundamentally alter the nature of the program); however, they have the authority to require a medical statement signed by a healthcare professional even if the modification can be met within the meal pattern.

Additionally, if the participant has a disability that can be accommodated by providing a nondairy beverage that meets the federal minimum nutrient standards for fluid milk substitutes, CACFP Operators must obtain a request in writing from the parent/guardian or participant (see the Requests for Nondairy Beverages section above).

Modifications That Do Not Meet Meal Pattern Requirements

If the disability involves a request for foods or beverages that do not meet the meal pattern requirements, the CACFP Operator must request and retain a signed written medical statement to claim those meals for reimbursement.  For the safety of the participant, CACFP Operators should make modifications immediately upon notification of the disability. See the Accommodating Disabilities Without a Medical Statement section below for information on claiming meals while waiting for a signed medical statement.

Medical Statements

CACFP Operators may use Form ID CACFP 97, Medical Statement to Request Special Meals or Accommodations in the CACFP, available in the Download Forms section of the CNIPS website in English and Spanish, to obtain the level of documentation required to implement a sound nutrition plan for participants with dietary restrictions due to a disability.

Medical statements due to food allergies must: 

1. Briefly describe how the disability restricts the participant’s diet;
2. Identify foods to omit from a participant’s diet;
3. Recommend foods to substitute; and,
4. Be signed by a state-licensed healthcare professional*

 Medical statements that do not include food allergies must:

1. Briefly describe the existence of a mental or physical disability;
2. Describe how the disability impacts the participant;
3. Identify the modification needed; and,
4. Be signed by a state-licensed healthcare professional*

* For this purpose and per California Health and Safety Code, Section 11150, the CDSS considers a state licensed healthcare professional in California to be a licensed physician, dentist, or the following healthcare professionals when acting within the scope of their ability to write prescriptions:  physician assistant, nurse practitioner, naturopathic doctor, registered nurse, and out-of-state provider.  CACFP institutions that operate another federal child nutrition program (CNP) in addition to the CACFP, should contact the appropriate oversight agency to determine which state licensed healthcare professionals can sign medical statements to accommodate disabilities for that CNP.

Notes:  

Requests for Brand Name Foods and Beverages

CACFP Operators should not delay meal modifications while waiting for the family to submit a medical statement or if the CACFP Operator needs additional clarification from the parent, guardian, or physician about the meal modification required.  CACFP Operators can claim meals with dietary modifications that do not meet the meal pattern requirements without a signed medical statement if they: 

• Maintain documentation of the initial conversation with the family where they first learned of the need for an accommodation and requested the family obtain a signed written medical statement from a state-licensed healthcare professional;

• Document all follow up with the family if the CACFP Operator does not receive the requested medical statement as anticipated, including what will be done to accommodate the child until a medical statement is received; and,

• Diligently continue to follow up with the family until a medical statement is obtained or the request is rescinded.

 

Note:  CACFP Operators should maintain a method of recordkeeping (e.g., written, electronic) for follow-up communications with parents/guardians to clarify meal modifications listed in a medical statement to justify meal modifications that do not meet the meal pattern requirements to the CDSS during a CACFP administrative review.

For additional guidance on accommodating meal modifications for participants with disabilities, access the U.S. Department of Agriculture Policy Memo CACFP 14-2017, SFSP 10-2017: Modifications to Accommodate Disabilities in the CACFP and Summer Food Service Program.

Modifications for Participants with Food Sensitivities 

According to the Americans with Disabilities Act, any physical or mental impairment impacting the ‘major life activity’ of eating is considered a disability.  

If the participant has a disability that affects their behavior, preferences, and/or sensitivity to food, beverages, or the meal service environment, CACFP Operators must provide a reasonable modification for the participant. For example, some children with autism have sensory sensitivities and prefer food of a certain texture or color. They may require the same foods every day and need to maintain a regular routine.  

However, some children with autism may not have a special dietary need that requires accommodations; therefore, CACFP Operators must review each child’s situation on a case-by-case basis and should communicate with parents/guardians to determine how best to accommodate the child’s needs.  

Below are resources on feeding children with autism. 

• Parent’s Guide to Feeding Behavior in Children with Autism

• Overcoming Feeding Difficulties in Children with Autism Spectrum Disorder | USU 

• The Feeding Doctor web page