CACFP Policy Memo Number 46

DOH-CACFP: Number 46 (12/99), Revised (02/09), Supersedes Number 7 (5/95)

TO: All CACFP Sponsoring Organizations

FROM: Lynne Oudekerk, Acting State Director, Child and Adult Care Food Program

SUBJECT: CACFP Requirements for Meal Substitutions and Meal Pattern Modifications

I. Purpose and Scope

  1. USDA has issued instructions to CACFP clarifying Program regulations concerning the service of meals to participants with special dietary needs. This memorandum establishes CACFP policy for: (1) providing food substitutions and meal pattern modifications to standard meal patterns for disabled and non-disabled Program participants with special dietary needs, and (2) ensuring Program accessibility to participants with disabilities.
  2. This memorandum also includes a list of agencies which can help Sponsoring Organizations meet the needs of disabled participants.

II. Definitions

  1. "Disabled" and "disability" have the same meaning as "handicapped" when used by USDA. See attached excerpt from 7 CFR 15b.3.
  2. "Food substitutions" are allowable when one creditable food item from the planned menu is replaced by another creditable food of the same food component category (e.g., when cottage cheese replaces hamburger, or peaches replace citrus sections). These substitutions are permitted to accommodate a participant's food preferences, food allergies, or other health concern, or when a menu item is not available. (Food substitutions must be documented on food production records or daily delivery invoices.)
  3. "Meal pattern modifications" represent changes to the menu which result in less than the minimum meal pattern requirements being met for food components (e.g., no bread or bread alternate component is served or a liquid nutrition supplement is served instead of solid foods) or serving size. Meal pattern modifications are only permitted if medically necessary for conditions such as diabetes or for potentially life-threatening food allergies.

III. Requirements for participants with Disabilities

  1. Food substitutions and/or meal pattern modifications are mandatory to accommodate participants whose disability restricts their diet as specified by a licensed physician.
  2. Meal pattern modifications (but not food substitutions) require a medical order.
  3. The medical order required for mandatory meal pattern modifications must describe:
    1. The participant's disability and how the disability restricts their diet; and
    2. the major life activity affected by the disability; and,
    3. the food(s) to be omitted and the food(s) that must be substituted.

IV. Requirements for Non-Disabled Participants

  1. No accommodation of dietary needs of non-disabled participants is required by CACFP.
  2. Food substitutions are permitted for non-disabled participants. No medical documentation is required, however, it is recommended.
  3. Meal pattern modifications are permitted, but not mandated, if a medical order is provided.
  4. The medical order required for meal pattern modifications must describe:
    • The participant's medical or other special dietary need which restricts their diet; and
    • The food(s) to be omitted and the food(s) that may be substituted.
  5. If a parent or guardian of a non-disabled participant or an adult participant elects to supply a food item(s), the meal can be claimed for reimbursement if the Sponsor supplies at least one other meal component. However, if the food item is a meal pattern modification, the appropriate medical order must be available.

V. General Considerations

  1. Sponsors are responsible for ensuring that day care centers and family day care home providers under their jurisdiction comply with the requirements outlined in this memorandum.
  2. Meals that follow medically ordered meal pattern modifications will be reimbursed at the same reimbursement rate as other eligible meals.
  3. Sponsors cannot charge extra for any substituted or special food items, whether provided to disabled or non-disabled participants.
  4. USDA recommends that Sponsors use the services of a Registered Dietitian in implementing special diet orders.

VI. Program Accessibility

  1. Where existing food service facilities are not completely accessible and usable, Sponsors must provide assistance to serve food to handicapped persons. Sponsors are responsible for the accessibility of food service sites and for ensuring assistance with feeding, where needed. Sponsors are encouraged to ensure that persons with disabilities participate with non-disabled persons in a natural environment or setting to the maximum extent appropriate to the needs of the disabled participant. The cost of adaptive feeding equipment or for additional staff to assist at mealtime are allowable costs for expenditure of CACFP funds. However, meals will be reimbursed at the standard rate, (no additional reimbursement is available).

VII. References

  1. References used to compile this memorandum include:
    1. 7 CFR 226.20;
    2. FNS Instruction 783-2; and,
    3. 7 CFR 15b.
  2. If you have any questions regarding this memorandum, please contact a CACFP Nutritionist at:
    1. Albany - (518) 402-7400 or 1-800-942-3858 ext. 27103
    2. Buffalo - (716) 847-4531
    3. New York City - (212) 268-7604.
    4. Rochester - (585) 423-8106
    5. Syracuse - (315) 477-8127
  3. For assistance with disabled individuals you may contact the following agencies:
    1. New York State Education Department, Office of Vocational & Educational Services for Individuals with Disabilities, Early Childhood Direction Center at (518) 473-4381. There are fifteen regional Centers, check for one in your area.
    2. New York State Department of Health, Early Intervention Program for assistance with children with developmental disabilities up to age three at (518) 473-7016.
    3. New York State Department of Health, Physically Handicapped Children's Program for assistance with children with physical disabilities up to age twenty-one at (518) 474-2001.
    4. New York State Office of the Advocate for Persons with Disabilities at (800) 522-4369.


Definition of Handicapped Participants - From 7 CFR Part 15b.3 Definitions

  • (I) "Handicapped person" means any person who has a physical or mental impairment which substantially limits one or more major life activities, has a record of such an impairment, or is regarded as having such an impairment.
  • (J) "Physical or mental impairment" means (1) any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: Neurological; musculoskeletal; special sense organs; respiratory, including speech organs; cardiovascular; reproductive; digestive; genitourinary; hemic and lymphatic; skin; and endocrine; or (2) any mental or psychological disorder, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities. The term "physical or mental impairment" includes, but is not limited to, such diseases and conditions as orthopedic, visual, speech, and hearing impairments; cerebral palsy; epilepsy; muscular dystrophy; multiple sclerosis; cancer; heart disease; diabetes; mental retardation; emotional illness; and drug addiction and alcoholism.
  • (K) "Major life activities" means functions such as caring for one's self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working.