Participation in the community eligibility provision - a universal free school meals policy in the United States in 2014-2020.

Abstract

We assessed the association of participation in the Community Eligibility Provision, a universal free school meals policy in the United States, with school and area-level characteristics, and how these associations changed between 2014 and 2020. Using logistic regression models with district-clustered standard errors, in 53,391 eligible schools nationwide, adjusted prevalence of participation was 3.8 percentage points (pp) lower among high schools relative to elementary schools (95% CI: 1.6, 6.0), 8.9 pp lower in small relative to large school districts (95% CI: 4.8, 13.0), 10.9 pp lower in suburban relative to urban schools (95% CI: 6.9, 14.8), and 13.3 pp lower in schools in non-Medicaid expansion relative to expansion states (95% CI: 17.1, 20.7). Over time prevalence of participation in majority Hispanic schools increased to a lesser extent than participation in majority Black schools. Addressing barriers to policy adoption in schools with persistently lower participation will be critical to increase equitable access to universal free school meals.