Universal Free School Meal Policies and Participation in the US National School Meal Programs.

Importance School meals can support children's health and educational outcomes; however, in the US, only students from households with incomes at or below 185% of the federal poverty level qualify for free or reduced-price meals. Although the Community Eligibility Provision (CEP) enables schools in higher poverty areas to offer free meals to all students, many schools do not participate; the temporary implementation of federal Universal Free School Meal (UFSM) policies during the COVID-19 pandemic and subsequent state-level policies highlight the need for assessing their impact on participation rates in school meal programs. Objective To examine the impact of federal- and state-level UFSM and related policies on National School Lunch Program (NSLP) and School Breakfast Program (SBP) participation rates during and after the COVID-19 pandemic. Design, Setting, and Participants This comparative effectiveness research study used a natural experiment created by the COVID-19 pandemic to analyze school-level data from the 2019 to 2020 school-year period to the 2023 to 2024 school-year period. A difference-in-difference analysis with linear mixed-effects models was conducted to assess the impact of federal-level UFSM implementation and deimplementation and state-level policies on SBP and NSLP participation rates. School-level meal claims data were analyzed across 14 states with UFSM or related policies and 11 comparison states, and schools participating in the NSLP and the SBP were included in this analysis. Exposures Federal UFSM policy, state-level UFSM policies, CEP participation, and limited expansions of free meal access. Main Outcomes and Measures Participation rates in SBP and NSLP, measured as percentage-point changes over time. Results Federal UFSM during the COVID-19 pandemic increased NSLP and SBP participation by 10 percentage points (range, -8 to 18 percentage points) and 8 percentage points (range, 2-20 percentage points), respectively, where percentage points refers to absolute changes in participation rates. Deimplementation in school year 2022 to 2023 reduced participation by 12 percentage points (range, -15 to -4 percentage points) for NSLP and 10 percentage points (range, -18 to -4 percentage points) for SBP. States that maintained UFSM policies showed consistently higher participation rates compared with states that discontinued UFSM, with increases between 9 and 19 percentage points (NSLP) and between 5 and 26 percentage points (SBP) in the first year of policy implementation, relative to the prior year. CEP participation resulted in substantial participation gains (23 percentage points for NSLP, 13 percentage points for SBP). State policies with limited free meal expansions showed no significant effect. Conclusions and Relevance Results of this comparative research analysis suggest that UFSM policies may effectively increase school meal participation, indicating the need for sustained state and federal support to increase participation rates and potentially mitigate diet-related disparities and food insecurity among children.