IV

i. introduction

Federal and state adoption assistance, commonly referred to as adoption subsidy, are provided to help facilitate the adoption of special needs children by assisting with the removal of financial barriers to adoption. To qualify for adoption subsidy, Alabama children must meet special needs criteria and be in the permanent custody of the State Department of Human Resources (SDHR) or an Alabama non-profit licensed child-placing agency (LCPA). Children placed independently qualify for adoption subsidy only if they are receiving SSI at the time the adoption petition is filed. In addition to financial assistance, many special needs children may be eligible for Medicaid.

The Alabama Subsidized Adoption Act (Code of Alabama, 1975 § 26-10-20 through § 26-10-30) effective December 6, 1979; § 473 and § 475 (3) of the Adoption Assistance and Child Welfare act of 1980 (Public Law 96-272); and the Tax Reform Act of 1986 authorize adoption assistance which makes it possible for children in special circumstances to be adopted.

II. REQUIREMENTS AND PROCEDURES

The child must be certified by the Office of Adoption as eligible for subsidy before payments can begin.

A. Subsidy Criteria

Children in the permanent custody of SDHR or an Alabama LCPA must meet all three (3) of the following criteria to qualify for adoption subsidy.

1. They must be determined as special needs.

The worker must determine that the child being placed for adoption is special needs and has special circumstances that make adoption unlikely due to one (1) or more of the following conditions.

a. The child has a physical or mental disability that has been documented by a medical professional. Normal childhood illnesses (e.g., recurring ear infections in a toddler or allergies) do not meet this criterion.

b. The child has an emotional disturbance that has been documented by a mental health professional. Examples include, but are not limited to, children with a diagnosis of oppositional-defiant disorder or post-traumatic stress disorder.

c. The child is recognized as having a high risk for developing a physical or mental disability. At the time of placement, the child does not have a documented diagnosis for a mental or physical disability or an emotional disturbance, but there are known, documented factors that put the child at high risk for developing such condition. For example, there may have been prenatal exposure to drugs or exposure at birth, but all medical records, at the time of adoptive placement, indicate the child is medically and developmentally on target. The risk is that there may be a later manifestation of some form of learning disability or emotional disturbance based on what is known about the effects of a particular drug found at delivery. Money payment is deferred.

d. The child is age eight (8) years or older.

e. The child is a member of a sibling groups of three or more children who are being placed together at the same time.

f. A child, age two (2) years or older, is African American or of African American heritage.

2. The State must have determined that the children cannot or should not be returned to their parents’ home.

There must be a judicial determination that remaining in the home would be contrary to the child’s welfare. For DHR placements, this requirement is met when the juvenile or family court issues an order terminating parental rights and granting permanent custody of the child to the SDHR.

3. Efforts must have been made to locate an adoptive resource for the child without benefit of a subsidy, unless it has been determined that the child’s best interest is served by remaining in a home which could not be an adoptive resource without a subsidy.

Efforts to locate adoptive parents who can accept the child without a subsidy are not required for foster parent adoptions due to the existence of significant emotional ties.

When the Office of Adoption has placement responsibility (i.e., child has a permanency goal of ‘adoption with an unidentified resource) it is necessary to register children with local, regional and national adoption exchanges; publicize the need for adoptive homes in general and for specific children; and make referrals to specialized public or private agencies. Refer to Termination Of Parental Rights, V. Office Of Adoption Activities For Children Awaiting State Office Placement, for additional information.

B. Types Of Subsidy

The State Department of Human Resources administers both the federal and state adoption subsidy programs which are described in the following sections.

1. Federal Adoption Subsidy (Title IV-E, FCMP)

This subsidy provides a monthly payment, eligibility for Medicaid benefits and Title XX services, and payment for non-recurring adoption expenses. All children who receive SSI benefits at the time of adoptive placement are eligible for federal adoption subsidy. Long-term federal subsidy benefits discontinue once a child reaches age eighteen (18) years unless a determination is made that the child has a mental or physical disability that warrants continuation of the subsidy through age twenty-one (21) years. In most instances, an application for SSI can be made using the 18-year-olds personal income. The SSI award is usually more than the monthly

subsidy payment.

Note: It is possible that a child who was denied IV-E eligibility for foster care board payments, due to the absence of “reasonable efforts” being addressed in the initial court order, could be determined IV-E eligible for adoption subsidy. “Reasonable efforts” language is not required for IV-E adoption subsidy eligibility. If IV-E foster care eligibility was denied for this reason only, resubmit an Eligibility for FCMP & ACFC Initial Referral form (PSD-BPA-755) to the Office of IV-E Eligibility for a determination of whether the child currently meets IV-E criteria (except for reasonable efforts language).

2. State Adoption Subsidy (ACFC)

This subsidy provides for a monthly payment. Medicaid may also be available for certain children who meet criteria establishing the need for medical or rehabilitative care. The federal subsidy for non-recurring expenses is available to all children eligible for State Adoption Subsidy. Long-term state subsidy benefits discontinue at age nineteen (19) years unless the child remains in high school. State Adoption Subsidy cannot continue beyond age twenty one (21) years.

Children who will receive state adoption subsidy may be determined eligible for Medicaid. Children are eligible for state subsidy Medicaid when both of the following criteria are met.

1. Prior to execution of the subsidy agreement, the child must have been eligible for Medicaid under the State’s approved Medicaid plan or it must be determined that the child would have been eligible for Medicaid if the standards and methodologies of the Title IV-E foster care program were applied rather than the AFDC standards and methodologies.

and

2. The worker has determined that an adoptive placement without medical assistance cannot be made because the child has special needs for medical or rehabilitative care.

When establishing the child’s need for medical or rehabilitative care, the Office of Adoption considers the child’s conditions, potential or actual, which will not be covered by the adoptive family’s private insurance and which would deter the possibility of adoptive placement without Medicaid coverage. These conditions include, but are not limited to, the following:

· the child’s need for regular prescription medication;

· pre-existing conditions at the time of placement, (e.g., chronic health problems; dental, visual, or hearing problems);

· emotional or behavioral disorders requiring counseling or other treatment;

· the need for speech, physical or other rehabilitative therapy;

· the need for day treatment or special education services;

· the need for nursing care or other specialized medical or rehabilitative services;

· the child’s high risk background (e.g., patterns of mental illness or retardation; history of numerous separations or moves; history of serious abuse or neglect) which could increase the likelihood of serious medical, emotional or adaptive problems in the child’s future.

Medicaid eligibility for a child who receives a state adoption subsidy will continue as long as that adoption subsidy is in effect. If the subsidy is extended beyond age nineteen (19) years, the Office of Adoption will notify Alabama Medicaid about the extension. Medicaid eligibility will not extend beyond the child’s twenty-first (21^st) birthday.

3. Non-Recurring Adoption Subsidy

This subsidy is provided to all children eligible for federal or state adoption assistance. The one-time adoption expenses, paid by adoptive parents, are the only expenses considered as non-recurring. Reimbursement cannot exceed $1,000.00 per child and must be made within two years of the issuance of the final decree.

One-time adoption expenses include reasonable and necessary expenses directly related to the legal adoption of a child with special needs, which are not incurred in violation of state or federal law, and which have not been reimbursed from other sources or other funds. This includes attorney fees; court costs; and supervision of the adopted child’s placement prior to the adoption’s finalization; transportation costs for pre-placement visits and placement; and reasonable lodging and food expenses for the child and/or adoptive parents which are necessary to complete the adoption process.

4. State Medical Subsidy

This subsidy is a special needs subsidy that is limited to the time period of the needed service, and may involve a one-time payment or several payments. The adoptive family’s medical insurance and other public and voluntary community resources must be explored to determine if the treatment and related costs can be covered. Prior approval must be secured from the Office of Adoption prior to

adoptive placement and completion of the subsidy agreement.

a. Counseling

Subsidy can be awarded at the Medicaid rate for outpatient counseling only if a child is in therapy with a non-Medicaid provider at the time of a foster parent adoptive placement or there is no Medicaid provider located in close proximity to the child who has been placed by the Office of Adoption. Payment is made at the Medicaid rate secondary to private insurance.

In seeking approval for counseling subsidy, professional documentation of the child’s need for therapeutic is intervention required. Psychological evaluations submitting as professional documentation must not be older than six months.

Counseling subsidies can be awarded for a maximum of one (1) year and can only be extended under unusual circumstances with verification that no Medicaid provider is within close proximity to the child and adoptive family.

Counseling notes must substantiate that pre-adoptive issues remain the focus of the therapeutic intervention and must accompany the monthly itemized bill submitted to the Office of Adoption. Payment will not be made for sessions which focus on age-appropriate behaviors displayed at home, school or within the community.

b. Orthodontia

Subsidy can be awarded if orthodontia is determined as medically necessary at the time of the adoptive placement and is in progress or set to begin within ninety (90) days of adoptive placement. An orthodontist must provide a written statement of the estimated costs and that the orthodontia is medically necessary.

C. Subsidy Amount

The amount of the adoption subsidy payments are determined through an agreement with the adoptive parents and the Department of Human Resources, and takes into consideration the adopting parents’ circumstances and the needs of the child being adopted. In no case may the amount of a subsidy payment exceed the foster care board payment (including difficulty-of-care payments) that would have been paid during the period for which the child would have been eligible. A child’s private income must be considered with the adoption subsidy reduced by that amount. The levels of adoption subsidy payments are described in the following sections.

1. Regular Rate

Payment may be negotiated up to the regular foster care board payment rate without approval from the Office of Adoption.

2. Level One Difficulty of Care

A $50 fee may be awarded in addition to the regular rate if the child was receiving a “Level One Difficulty of Care” payment (per foster care policy) prior to the adoptive placement.

3. Therapeutic Rate

A therapeutic subsidy rate requires prior approval from the Office of Adoption and is based on supporting professional documentation of behaviors and issues the child’s is presenting at the time of adoptive placement. The required documentation is a psychiatric or psychological evaluation (performed within the last six months) and the most recent therapist’s (and/or therapeutic support) reports defining the extraordinary care or structure the foster/adoptive parents must provide in order for the child to function. The child must have a DSMD-IV diagnosis and meet the criteria for placement in a therapeutic foster home. Approval is given for one year and is subject to annual renewal. Note: Counseling subsidy cannot be awarded with the therapeutic rate.

4. Medically Fragile Rate

This rate requires prior approval from the Office of Adoption and is awarded for children who have special health care needs related to chronic physical, developmental, behavioral or emotional conditions (as defined in Medically Fragile Policy And Procedures). The rate is based on the amount of care required rather than the child’s diagnosis. There must be documentation from a the child’s attending physician that the child requires specialized care beyond ordinary parental duties, and the documentation must define the extraordinary care and/or special medical treatment needed. Approval is given for one year and is subject to annual renewal. Note: Counseling subsidy cannot be awarded along with the medically fragile rate.

D. Private Income

A child’s private income may be from various sources and must be considered when a subsidy is awarded. The following sections describe procedures for handling a child’s private income.

1. Supplemental Security Income (SSI)

In all cases where the child receives SSI, a federal adoption assistance agreement must be signed. Payment from the subsidy program is deferred if the amount the child receives is equal to or more than the regular payment rate unless the Office of Adoption has approved the child for the medically fragile or therapeutic rate.

The County Department will continue to receive benefits until the final decree of adoption is issued. After the subsidy agreements are signed in foster parent adoptions, the County Department will continue to disburse payments to the foster/adoptive parents. For children placed by the Office of Adoption, the Placement Consultant will provide instructions on submitting the monthly SSI check to the Office of Adoption.

After the adoption is final, the child’s worker must provide written notification to the Social Security Administration (SSA) that the Department is no longer legally responsible for the child. Any benefits on hand are to be returned to SSA. The adoptive parents will need to apply for SSI benefits for the child using the family’s income and provide the child’s worker with a copy of the SSI Determination Notice.

If SSI benefits are reduced or terminated, federal adoption assistance payments must be authorized by completing Section III of the Termination of Parental Rights/Foster Parent Adoption Placement form (DHR-FCS-2136). Submit the 2136 and a copy of the SSI Determination Notice to the Office of Adoption. Subsidy payments will be reduced by the amount of the SSI.

If a child’s SSI is terminated, the worker must notify the Alabama Medicaid Agency to award Medicaid benefits under the federal adoption subsidy program.

2. Social Security (SS) and Veteran’s Administration (VA) Benefits

If the child meets the criteria for special needs and receives Social Security or VA Benefits, a state adoption subsidy agreement may be signed subsidy payments will be reduced by the amount of the benefits. If the benefits exceed the subsidy rate, notation must be made at the bottom of the State Subsidy Agreement to the effect that “Should SS of VA benefits be reduced or terminated, the regular rate for adoption subsidy will be awarded.” The child is eligible for a Non-Recurring Expenses subsidy since “special needs” has been established.

Depending on the amount of the monthly benefit, the child may have never received a foster care board payment or foster care Medicaid. Medicaid cannot be awarded since the child did not meet criteria for foster care Medicaid.

After the adoption is final, the County Department must contact the Social Security Administration or the Veteran’s Administration to request termination of the Department be terminated as payee. Any fund balances are disbursed to the adoptive parents. The adoptive parents can be given the Social Security claim Number or the Veteran’s Administration claim number ONLY in order to make application for continued benefits.

3. Other Income

In some instances, a child has private income (e.g., trust fund) which is inaccessible to the child and the adoptive parents until the age of majority is reached. Whether the child would be eligible for state or federal adoption subsidy depends on the exact circumstances. The County Department should contact the Office of Adoption for consultation.

E. Adoption Subsidy Agreements

It is the Department’s responsibility to notify the child’s prospective adoptive parents about the availability of adoption subsidy, to negotiate the amount, and to enter into a subsidy agreement. The subsidy agreement is usually completed and entered into at the time of the adoptive placement; however, the written subsidy agreement must be completed prior to the Final Decree of Adoption being issued. The Adoptive Home Placement Agreement (DHR-FCS-2130) and the subsidy agreement must be signed by the Department and the adoptive parents before payments can begin.

The Termination of Parental Rights/Foster Parent Adoption Protocol and Checklist (DHR-FCS-2132) provides the guidelines for completing the adoption subsidy process, fee forms and instructions.

When foster parents are adopting the child, the County Department negotiates the subsidy amount, discusses the terms of the agreement, and completes the subsidy agreement forms with the foster/adoptive parents. When the Office of Adoption makes a child’s adoptive placement, the Placement Consultant discusses the subsidy, negotiates the payment amount, and completes the agreement forms.

1. Prior To Subsidy Negotiations

County Departments must take the following steps prior to negotiating the types and amount of adoption subsidy with the prospective adoptive parents. The child’s worker must:

(a) establish that the child meets the subsidy criteria;

(b) verify the category of eligibility – State subsidy (ACFC) or Federal subsidy (FCMP and SSI);

(c) If the state category of eligibility is ACFC (state subsidy), determine if the child meets the criteria for state subsidy Medicaid. Worker must complete Medicaid eligibility for State Adoption Subsidy Medicaid DHR-FCS-2134. (See forms and instructions)

(d) If the child appears eligible, request and receive approval from the Office of Adoption for subsidy at the medically fragile or therapeutic rate, counseling subsidy or orthodontia subsidy.

2. Subsidy Agreement Forms

The appropriate forms must be completed and signed by the adoptive parents and the Department representative. The following list identifies these forms (located

in Forms And Instructions) and to whom they apply.

· Federal (IV-E) Adoption Assistance Agreement (DHR-FCS-2123) – for children who are IV-E eligible (FCMP)

· Federal (IV-E) Adoption Assistance Agreement/SSI (DHR-FCS-2125) – for children whose SSI exceeds the regular board payment and are not approved for the medically fragile or therapeutic rate

· Alabama Adoption Subsidy Agreement (DHR-FCS-2122) – for children who receive ACFC foster care board payment

· Federal (IV-E) Adoption Assistance Agreement (Non-Recurring Expenses) (DHR-FCS-2124) – for children who are to receive State Adoption Assistance

· Adoption Subsidy Agreement Counseling (DHR-FCS-2127) – for children who receive outpatient counseling (payment at the Medicaid rate only) and prior approval has been given by the Office of Adoption

· Alabama Subsidy Agreement Orthodontics (DHR-FCS-2128) - for children who have medically necessary orthodontia needs and prior approval has been given by the Office of Adoption

3. Termination Of Subsidy Agreements

An adoption subsidy agreement can be terminated only when:

· the child reaches the age limit per the terms of the agreement; or

· the child is no longer the adoptive parents’ legal dependent; or

· the child is subsequently determined not to be eligible; or

· the adoptive parents are no longer providing any support to the child.

The Office of Adoption will send written notice to the adoptive parents when

payments are terminated.

F. Financial Procedure

The Office of Adoption prepares the subsidy payrolls for submission to the Finance Division on a monthly basis. The payrolls are due to the Finance Division on the last day of the month. Subsidy payments are mailed between the 6^th and 15^th of each month from the State Treasury Department, Comptroller’s Office. Checks are not late until after the 15^th, and no follow-up action will be taken prior to this date.

The following procedures apply when steps in sections E. 1. and 2. have been completed and a child is to be placed on the adoption payroll.

1. Initial Award

Submit the following items to the Office of Adoption to initiate adoption subsidy payments.

· Termination Of Parental Rights/Foster Parent Adoption Placement form (DHR-FCS-2136) with Section II and III completed. The child must be discharged from foster care on ACWIS with a discharge reason of Adoption, and the foster care board payment terminates on the date the Adoptive Home Placement Agreement is signed.

· An original signed copy of the Adoptive Home Placement Agreement (DHR-FCS-2130).

· An original signed copy of the adoption subsidy agreement(s).

· A subsequent justification memorandum specifying the child’s special needs; category of eligibility and of subsidy.

· A copy of the Summary of Non-Identifying Information.

· A copy of the adoption placement interview narrative where the terms of the adoption subsidy agreements were discussed.

· An original signed copy of a 1099 or W-9 with social security number and signature of the adoptive parent who will be payee.

This form is secured from the CWOA.

· The initial award letter (Original) for children with private income.

2. Changes/Disruptions

Complete and submit the Termination Of Parental Rights/Foster Parent Adoption Placement form (DHR-FCS-2136) to notify the Office of Adoption about the following:

· change of address for adoptive parents;

· a disrupted adoption; and

· increases or decreases in the on-going subsidy amounts due to information reported or known to the County Department.

3. Billing For Counseling And Orthodontia Subsidies

Once the Office of Adoption has given prior approval for these subsidies, the provider submits the original bills directly to the Office of Adoption. The bills must be itemized, providing the date of service and the service rendered. The provider must have a 1099 on file with SDHR’s Finance Division.

4. Reimbursement for Non-Recurring Expenses

Adoptive parents must pay for expenses incurred and provide the Office of Adoption with original paid receipts and an itemized bill in order to claim reimbursement. The itemized bill must list the date of service and the service provided. Reimbursement for non-recurring expenses is limited to $1,000 per child. Claims must be filed after the Final Decree of Adoption is issued and within two (2) years of the Final Decree’s date. Reimbursement is not made when an adoption disrupts prior to finalization.

In the case of extreme financial hardship where the adoption could not otherwise be completed, payment for attorney fees and court costs may be made to the adoptive parents upon receipt of the following three (3) items.

· Final Decree of Adoption

· Itemized copy of the attorney’s bill and/or court costs

· Verification of the court’s approval of all charges for expenses related to the adoption

5. Authorizing Subsidy Medicaid

When a child is eligible for federal adoption subsidy, the Federal Adoption Subsidy Medicaid form (DHR-FCS-2133) is completed using the child’s adoptive name and T #. When a child is eligible for state subsidy Medicaid, the State Adoption Subsidy Medicaid Form (DHR-FCS-2134) is completed. Submit the appropriate and cover letter to:

Certification Support Division

Alabama Medicaid Agency

P.O. Box 5624

Montgomery 36130.

The Alabama Medicaid Agency issues only one (1) white paper Medicaid card to the adoptive parents. After the Final Decree of Adoption, the adoptive parents must secure the amended birth certificate and a social security number in the child’s adoptive name. The child’s worker, in foster parent adoptions, or the Office of Adoption Placement Consultant will provide this information to the Alabama Medicaid Agency in order for a permanent Medicaid card to be issued in the child’s adoptive name.

6. SSI Children

If a child’s private income is reduced or terminated, the child’s worker must complete Section III of the Termination Of Parental Rights/Foster Parent Adoption Placement form (DHR-FCS-2136) and submit it to the Office of Adoption along with the official Reduction/Termination Notice (original). All documents listed in section F. 1. Initial Award must be on file in the Office of Adoption before the child will be placed on the subsidy payroll. If SSI is terminated, the worker will also need to authorize Medicaid per section 5. above.

G. Annual Recertification And Modifications

Adoptive parents are required to complete an annual statement of continued need for subsidy as long as payments are continued. During the anniversary month of the initial adoption subsidy agreement, the Office of Adoption will send recertification forms to the adoptive parents. These forms must be signed and returned to the Office of Adoption certifying that the child remains in the adoptive parents’ care and that the condition(s) that caused the child to be certified continue(s) to exist. If the adoptive parents fail to complete the recertification forms, subsidy payments will terminate.

If the child’s subsidy is at the medically fragile or therapeutic rate, professional documentation, supporting that the child continues to meet the criteria for this level of care, must be submitted with the recertification forms. Otherwise, the subsidy payment will be reduced to the regular adoption subsidy rate.