Meal Modifications in the CACFP

Modifications for Participants without a Disability (Other than Fluid Milk Substitutes)

A parent, guardian, adult participant, or a person on behalf of an adult participant may request that CACFP operators make meal modifications (other than fluid milk substitutes) for participants with dietary preferences that are not related to a disability. for example, a parent/guardian or adult participant may request that another meat/meat alternate food (e.g., chicken) is substituted for pork for religious reasons or that a meat alternate product (e.g., beans) is substituted for meat because they follow a vegetarian diet.

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.

Expenses incurred when making meal modifications that exceed the reimbursement rate are paid by the CACFP operator. the cost of meal modifications may be paid from the nonprofit food service account.

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.

Documenting Requests for Modifications

For meal modifications (that meet the meal pattern requirements) other than nondairy beverages (addressed in the Requests for Fluid Milk Substitutes section), CACFP operators must document the modification on either an existing form (e.g., enrollment record), or on a specific form (e.g., CACFP 12: Request for Creditable Meal Modifications for Infant Participants or CACFP 84: Request for Creditable Meal Modifications for Child and Adult Participants), per the CDSS CACFP Administrative Manual, Section 9.2: Meal Pattern Documentation Requirements. Both forms CACFP 12 and 84 are accessible in the Download Forms section of the CNIPS website.

Modifications for Participants with a Disability That Restricts Their Diet

CACFP operators must make meal modifications, at no extra charge, for participants with a disability that restricts their diet. According to the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, and the applicable USDA regulations at 7 CFR Part 15b, a person with a disability is any person who has a physical or mental impairment which substantially limits one or more ‘major life activities,’ which includes, but is not limited to eating.

Most physical and mental impairments will constitute a disability and the focus for CACFP operators should be on ensuring equal opportunity to participate in the Program.

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.

CACFP operators must review each participant’s situation and meal modification requests on a case-by-case basis and should communicate with parents/guardians or the adult participant to determine how best to accommodate the participant’s needs.

Note: CACFP operators are not required to make modifications that would result in a fundamental alteration in the nature of the Program. For example, providing an expensive medical infant formula to accommodate an infant’s disability may be so financially burdensome for a small CACFP agency with one staff member that it would make operating the Program unfeasible and would fundamentally alter the nature of the Program. In this example, the CACFP operator would not be required to provide the requested medical infant formula.

CACFP operators facing a very expensive request should first engage in dialogue with the participant and/or the participant’s parents or guardian. CACFP operators should send questions by email to the CDSS CACFP Nutrition Team at CACFPMealPatterns@dss.ca.gov if concerned that a request for meal modifications may fundamentally alter the nature of the program.

Procedures for Requesting Meal Modifications

CACFP operators must provide households and participants with:

• Notice of the procedure for requesting meal modifications for disabilities, which should include providing a written final decision on each request.

• The process for procedural safeguards related to meal modifications for disabilities, which should ensure CACFP operator staff understand the procedures for handling requests for meal modification.

Additional information on procedural safeguards is available on page 9 of the USDA Policy Memo, CACFP 14-2017, Modifications to Accommodate Disabilities in the CACFP and SFSP.

Parent/Guardian-Provided Components

For the CACFP operator to claim reimbursement of a meal for a participant with a disability, the parent/guardian or adult participant may provide all but one creditable component per meal; the CACFP operator must provide a minimum of one component. Program operators may not require a parent, guardian, adult participant or person on behalf of an adult participant to provide any of the required components of a meal.

An exception to the requirement for the CACFP operator to provide a minimum of one component to claim reimbursement of a meal for a participant with a disability is if the participant only consumes one component. In this situation, the CACFP operator can claim meals without providing a minimum of one component. For example, if a participant can only consume gastric tube (G tube) feedings and the household provides and administers the G tube formula, the CACFP operator can claim meals for reimbursement because there are costs incurred by the CACFP operator to support the administration of the G tube feedings.

Modifications That Meet Meal Pattern Requirements

In many cases (including Requests for Fluid Milk Substitutes), dietary modifications to accommodate a disability can be 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 that may be served to participants with a gluten intolerance or allergy.

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 or a registered dietitian (RD) is not required; however, CACFP operators must maintain written documentation for creditable food item substitutions made to the planned menu for both participants with a disability (unless a medical statement is on file) and those with a dietary preference to demonstrate the meal pattern requirements are met per the CDSS CACFP Administrative Manual, Section 9.2: Meal Pattern Documentation Requirements. This can be done on a specific form developed by the CACFP operator to document the meal modifications made within the meal pattern or on an existing form (e.g., enrollment record). Such meals are reimbursable.

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. Expenses incurred when making meal modifications that exceed the reimbursement rate are paid by the CACFP operator. The cost of meal modifications may be paid from the nonprofit food service account.

Medical Statements

CACFP operators may use Form ID CACFP 97, Medical Statement to Request Special Meals or Accommodations in the CACFP for Participants with a Disability, available in the Download Forms section of the CNIPS website, to obtain the level of documentation required to implement a sound nutrition plan for participants with dietary restrictions due to a disability. Medical statements are only required for CACFP operators to claim reimbursement for meals if the required meal modifications do not meet the meal pattern requirements. (Note: Although not required, program operators may choose to require a written medical statement for all disability meal modifications, including those that can be accommodated within the meal pattern requirements. Operators should consider the burden of requiring medical statements and must inform parents, guardians, and their children, if age appropriate, of the process for requesting meal modifications.)

Written medical statements must:

• • Briefly describe how the disability restricts the participant’s diet;
  • An explanation of how to accommodate the participant’s disability;
  • Identify foods to omit from a participant’s diet;
  • Recommend foods to substitute; and

When operators believe the medical statement is unclear or lacks sufficient detail, they must obtain appropriate clarification.

The CDSS encourages operators to take a team approach to providing modifications for participants with disabilities. The team should work with the child’s parent or guardian, participating adult, or a person acting on behalf of the adult participant to review the request and develop a solution as quickly as possible. The team should be advised that medical information obtained must be kept confidential.

Notes:

• Medical statements may be signed electronically, by hand, or with a stamp.

• Signed medical statements may not be altered by CACFP operators or parents/guardians to document additional or clarifying information about a participant’s disability or meal modification(s). Additional or clarifying information must be documented separately (e.g., written clarification stapled to the medical statement).

Requests for Specific Modifications

CACFP operators are generally not required to provide a specific modification requested in the medical statement (e.g., brand name), as long as they offer a modification that accommodates the participant’s disability safely and effectively. CACFP operators should communicate with parents/guardians to identify whether the specific modification (e.g., brand name) is the only effective accommodation, or whether it would be safe and appropriate to provide an alternate modification.

Accommodating Disabilities Without a Medical Statement

CACFP operators are encouraged to work with families and adult participants to obtain medical statements and any needed clarification regarding requests for meal modifications. 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, licensed healthcare professional, or RD 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 or an RD;

• 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 and USDA Policy Memo, CACFP 07-2025, Requirement to Accept Medical Statements from Registered Dietitians for Schools and Child and Adult Care Institutions and Facilities.