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4. Specialized rates are based on the extraordinary needs of the child, and/or the additional parenting skill needed to raise the child. If Alabama offers these rates, the criteria used to define them are as follows:

Difficulty of care considerations:

1. Children who have exceptional physical, mental, emotional, or behavioral needs

2. Children with extreme illness or disabilities requiring nursing care (excluding children in residential treatment facilities)

3. Emotionally disturbed children requiring therapeutic care

4. Medically fragile children.

5. Parents can receive payment or reimbursement for certain nonrecurring adoption expenses directly related to the finalization of an adoption. Below are the allowed expenses and the limit per child.

Eligible expenses include attorney fees, court costs, criminal records clearance, medical and psychological evaluations, supervision of the placement prior to finalization, transportation costs for placement and pre-placement, and the reasonable costs of lodging and food for the child and/or adoptive parents necessary to complete the adoption process.

All families adopting special needs children (including private agency adoptions, independent adoptions, and intercountry adoptions) are potentially eligible for reimbursement of nonrecurring expenses. For determining eligibility, adoptive parents are required to pay for expenses incurred and provide the Office of Adoption with original receipts in order to claim reimbursement. In extreme hardship cases, adoptive parents may submit unpaid attorney fees for direct payment to the Office of Adoption. Payment is made upon verification of finalization. All claims must be made within two years of the final adoption decree.

The reimbursement limit is $1,000 per child.

6. What Medicaid services are available in Alabama?

Services Available:

• Ambulatory Surgical Centers

• Prenatal Services

• Family Planning

• Transportation

• Home & Community-Based Services

• Nursing Home Care

• Hospice

• Ambulance

• Adult Eye Care

• Laboratory & X-ray

• Renal Dialysis Program

• Doctor—Medicaid will pay for 14 doctor's visits per year that are provided in a doctor's office, in an outpatient setting, or in a nursing home.

• Hospital—Inpatient care: 16 days per year of inpatient care; coverage is for a semi-private hospital room (2, 3, or 4 bed accommodations). Outpatient care: 3 non-emergency outpatient hospital visits each year. Examples of non-emergencies include upset stomach, sore throat, or fever. Medicaid will also pay for emergency outpatient services when an emergency actually exists. Examples of emergencies are broken bones, severe bleeding, and severe shortness of breath. Visits to the hospital on an outpatient basis are unlimited if you go in for surgery, lab work, X-ray services, radiation, or chemotherapy only.

• Health Care Clinics and Centers—Medicaid pays for medical services available at rural health clinics, and community health centers.

• Community Services for Substance Abusers and the Mentally Ill

• Home Health Care—Services for the mentally retarded and developmentally disabled; this program provides services for persons of all ages who are SSI eligible and who have been diagnosed by a doctor to be mentally retarded or developmentally disabled.

• Case Management—Case management services help Medicaid eligible mentally ill or mentally retarded persons, handicapped and foster children up to age 21, pregnant women, and AIDS/HIV positive individuals of any age receive needed services in their community.

• Prescription Drugs—Most Medicaid recipients are required to pay a co-payment for each prescription and refill.

• EPSDT (MediKids)—MediKids examinations (called screenings) may be done up to nine times before the child reaches two years old and once a year after the child's second birthday. MediKids screenings do not count against the child's limit for doctor visits. Hospital care: although it is not part of the MediKids program, in certain hospitals, children under 6 years of age receive unlimited inpatient days. Dental Care: Medicaid will pay for routine dental care for children under 21 years of age through the EPSDT program. A dental check-up every six months is included. Eye care: Children under 21 years of age may be examined every year for eye problems. Hearing: children under 21 years of age may be examined every year for hearing problems. Psychiatric Care: unlimited medically necessary inpatient psychiatric services are provided to children under 21 years of age in certain psychiatric hospitals.

7. Children who have federally funded (Title IV-E) subsidy are automatically eligible for Medicaid benefits. However, it is the state's decision whether state-funded (non-Title IV-E) children are eligible for Medicaid benefits in Alabama. Below is information on the Medicaid benefits available for state-funded children.

Medicaid coverage is granted to all Federal (IV-E) subsidy recipients. Non IV-E eligible children placed for adoption for whom there is in effect a signed approved state adoption subsidy agreement may be determined eligible for Medicaid.

It must be determined that the child cannot be placed for adoption without medical assistance because of the child’s special needs for medical or rehabilitative care. Prior to the 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 AFDC methodologies.

8. What mental health services are provided by your State?

Public mental health services for children in Alabama are administered through the Alabama Medicaid Agency and include the following examples: mental health services, psychiatric hospital services, physician services, and prescription drugs. Medicaid pays for medically necessary services in a psychiatric hospital for children under twenty-one years of age with prior approval by Medicaid. The services received from a mental health center do not count against regular doctor's office visits or other Medicaid covered services. Alabama's Medicaid link: http://www.medicaid.state.al.us/ and District Offices link: http://www.dhr.state.al.us/Counties.asp. See also the Alabama Medicaid Agency’s Programs link: http://www.medicaid.alabama.gov/programs/index_programs.aspx?tab=4 under Mental Health Services.

Note: Not all services may be available in all cases. Contact your adoption assistance worker or medical assistance specialist for information regarding process, eligibility, availability, and duration of services.

9. Does your State provide additional finances or services for medical or therapeutic needs not covered under your State medical plan to children receiving adoption assistance?

A counseling subsidy may be awarded for those children who are receiving services at the time of adoptive placement from a provider who does not accept Medicaid. Payment is made at the Medicaid rate and is for outpatient counseling services only. All financial assistance is subject to the availability of state funds.

For children who are in need of orthodontia for medical reasons, it is possible for a medical subsidy to be offered if this determination has been made prior to the adoptive placement.

Note: Not all services may be available in all cases. Contact your adoption assistance worker for information regarding process, eligibility, availability, and duration of services.

10. What types of post adoption services are available in your State and how do you find out more about them?

Post adoption services in Alabama are administered by the Department of Human Resources through contract with outside agencies. Known as the Alabama Post Adoption Connections (APAC) program, services are provided through five offices located throughout the state. Post-adoption services include the following examples:

1. Information and referral

2. Educational programs

3. Educational materials

4. Support groups

5. Buddy families

6. Resource libraries

7. Scholarships/Camperships

For more information, contact the Alabama Post Adoption Connection link: http://www.casapac.org or phone: 1.866.803.2722. See also the Alabama Foster and Adoptive Parent Association (APAC) link: http://www.afapa.org or phone 1.888.545.2372. Additional adoption resources link: http://www.dhr.state.al.us.

Note: Not all services may be available in all cases. Contact your adoption assistance worker or post adoption services contact for information regarding process, eligibility, availability, and duration of services. 

11. If the additional assistance (listed above in questions #8 -10) is to cover specific services (e.g., counseling/mental health services, respite care, etc.), must these services be explicitly identified in the adoption assistance agreement?

Yes.

12. How are residential treatment costs covered (if at all) for adoptive families? What procedures must a family follow to receive these services?

Subsidies may cover outpatient counseling, but not residential treatment.

13. A deferred adoption assistance agreement is one in which the initial monthly maintenance amount is $0. Does Alabama offer such agreements?

Alabama offers deferred adoption assistance. Evidence of disability is not necessary at the time of placement, but professional documentation of a high risk of developing a physical, emotional or psychological disability is necessary. The high-risk background is based on the documented emotional or psychological history of the child's biological family.

14. Does Alabama operate a subsidized guardianship program?

No.

Programmatic Procedures

15. Who makes the final determination of a child's subsidy eligibility in Alabama? What roles, if any, do workers and administrators at the county, district, or regional level play in eligibility determination and/or assistance negotiation?

The State Office of Adoption.

16. Will Alabama consider my family income to determine my child's eligibility for an adoption subsidy?

The income of the adopting family is not a factor in determining subsidy. The resources of the family in the form of medical insurance are taken into consideration for a subsidy to cover medical needs as are the resources available in the community (Crippled Children's Services, Mental Health, Vocational Rehabilitation Services, etc.).

17. When do subsidy payments begin?

Adoption assistance payments and benefits may begin at adoption placement.

18. Do children adopted from private agencies in Alabama receive the same subsidies as those children adopted from public agencies?

Yes.

19. When my child turns 18, which benefits, if any, are available to our family?

State-funded subsidy may be continued until a child reaches age 21, provided s/he is in high school or in a specialized training program for the intellectually impaired, the purpose of which is to aid him/her in becoming self-supporting.

20. A child's adoption assistance agreement may be periodically reviewed by the state. What is the typical process used in Alabama?

When subsidies are for more than one year, adoptive parents shall present an annual signed certification that the adopted child remains under care and that the condition(s) that caused the child to be certified continue to exist. If the child receives a subsidy for medical expenses, a current evaluation by the attending physician must be presented. Failure on the part of adoptive parents to complete recertification forms will result in termination of payments.

21. Can adoption assistance agreements be modified if requested by adoptive parents?

Adoptive parents can make a request for a change in the adoption assistance agreement at any time when there is a change in the circumstances of the family or the needs of the child. Professional documentation supporting the requested change is required, when/if appropriate. Requests for change must be in writing to the Program Manager, Office of Adoption. If an adoptive parent disagrees with a decision regarding a request for change in the adoption assistance agreement, a fair hearing can be requested through written notice to the Program Manager, Office of Adoption. Send requests for change to the following address:

Program Manager

Office of Adoption 

50 Ripley Street

 Montgomery, AL 36130-4000

22. What are the exact steps a family must go through to access the fair hearing/appeal process in Alabama?

Adoptive parents have the right to request a fair hearing to review any DHR decision affecting the receipt of their child's adoption assistance benefits. After a request for fair hearing is received, it is forward to the state administrative hearings office. The hearings office will then send a notice giving the date, time, and place of the hearing. This notice will be sent at least ten days before the hearing. The notice also will explain what to do if parents cannot come to the hearing as scheduled. Parents may bring witnesses, friends, relatives, or a lawyer to help present their case. The hearing officer will record the hearing so that the facts are taken down correct. The hearing officer will listen to both sides but will not make a decision at the hearing. Instead, parents will receive a written decision in the mail, issued by the hearing authority, a few weeks later. Parents should receive a hearing decision within ninety days of the hearing request. The written decision will explain to parents how to ask for an administrative appeal if they do not agree with the decision rendered. Send written requests for a fair hearing to the following address:

Marie Youngpeter, Program Manager

Alabama Department of Human Resources

Office of Adoption 

50 North Ripley Street 

Montgomery, AL 36130-4000

23. Families may request a subsidy after the finalization of an adoption under certain circumstances. Below is the process by which families access a subsidy after finalization.

A written request is necessary along with any supporting documentation. A letter should be addressed to:

Marie Youngpeter, Program Manager

Office of Adoption

Alabama State Department of Human Resources

50 North Ripley Street

Montgomery, AL 36130-4000

System Operation and Program Funding

24. How is the subsidy program operated and funded in Alabama?

The program is state supervised/state administered. This means that both policy and eligibility decisions are made by personnel at the state office.

The federal contribution to Title IV-E-eligible children is 69.51% in Alabama. This is known as the Federal Financial Participation (FFP) rate. The remaining cost of the program is funded entirely by state funds. Local/county governmental units are not responsible for any portion of the state share of IV-E adoption assistance payments.

25. Below are other programs that may delineate Alabama's adoption assistance program from others around the country.

N/A

Additional Information you may want to include in Question 25

(a) Does your state have a state tax credit for adoption? If so, what is the amount? Where can parents go for more information (phone number or web address)?

(b) Does your state offer a College Tuition Waiver or College Scholarship for foster and/or adopted children? What are the eligibility criteria? Where can parents go for more information (phone number or web address)?