ADOPTION SUBSIDY
table of contents
i. introduction
ii. requirements AND PROCEDURES
A. Subsidy Criteria
B. Types Of Subsidy
1. Federal Adoption
2. State Adoption
3. Non-Recurring Expenses
4. State Medical
a. Counseling
b. Orthodontia
C. Subsidy Amount
1. Regular
2. Level One Difficulty Of Care
3. Therapeutic
4. Medically Fragile
D. Private Income
1. Supplemental Security Income (SSI)
2. Social Security (SS) And Veteran’s
Administration (VA)
3. Other Income
E. Adoption Subsidy Agreements
1. Prior To Subsidy Negotiations
2. Subsidy Agreement Forms
3. Termination Of Subsidy Agreements
F. Financial Procedures
1. Initial Award
2. Changes And Adoption Disruptions
3. Billing For Counseling And Orthodontia
4. Reimbursement Of Non-Recurring Expenses
table of contents
ii. general requirements (Cont’d)
5. Authorizing Subsidy Medicaid
6. Children With Private Income
G. Annual Recertification And Modifications
H. Review And Fair Hearing
iii. special subisidy situations
A. Dissolved Adoptions And Continued
Eligibility For Subsidy
B. Medicaid Coverage For Children Moving
Between States
C. Children Placed By Licensed
Child-Placing Agencies
D. Independent Adoptions
E. International Adoptions
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,
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 (21st) 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);
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).
(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 6th
and 15th of each month from the State Treasury Department,
Comptroller’s Office. Checks are not
late until after the 15th, 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.