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In years past, many children were deemed to be "un-adoptable" and languished in foster care, in part due to a lack of financial resources available to support them in an adoptive home. Beginning as early as 1968, some states started a program in which cash benefits were provided to families who adopted special needs children. North Carolina was among these pioneering states that provided state funded adoption assistance. However, there was a financial disincentive for these states (and others who were considering the programs) since the states issuing adoption subsidies were solely responsible for meeting costs. Federal programs only offered financial assistance to children in foster care. This changed dramatically in 1980 with the passage of P.L. 96-272, the Adoption Assistance and Child Welfare Act of 1980. The Act required all states to establish an adoption subsidy program, removing the financial disincentive to states by providing federal dollars to be used as a portion of the cost.
The federal program participates in adoption subsidy payments for children previously eligible for the Title IV-E foster care program. North Carolina continues to participate in the cost of adoption subsidy for non-IV-E children. The subsidy program has proven to be a very important tool in the placement of many special needs children. Subsidies enable a whole new population of families to consider special needs adoption, and there are many, many lives that have changed dramatically because of it.
Adoption Assistance is available for all special needs children when certain criteria are met.
The federal adoption assistance program is limited to those adoptive children who meet the eligibility criteria for the AFDC program or the Supplemental Security Income (SSI) program. In addition, North Carolina counties use state and local funds (without federal reimbursement) to provide assistance to adoptive children with special needs who do not meet the federal eligibility criteria and to provide benefits that are not covered by the federal program.
All of the worker's time spent in adoption activities, including time spent in evaluating a child's need for Adoption Assistance, in establishing his eligibility, in negotiating an agreement with the adoptive parents, in determining when it is appropriate to initiate both monthly cash and vendor payments, and in accomplishing annual review of the Adoption Assistance Agreement is viewed as service time. Use SIS codes on daysheets to claim reimbursement for worker’s time.
Eligibility for subsidy is determined by the status of the child involved and by that child's special needs. A child for whom adoption is the plan, or who has already been adopted, may be determined eligible for Adoption Assistance if certain conditions are present:
1. The child has been removed from his parents by a Voluntary Placement Agreement subject to judicial review or by a court order that includes language that indicates that it was contrary to the child’s welfare to remain in the home.
2. The child is in the placement responsibility of a local department of social services or North Carolina licensed child placing agency authorized to place children for adoption, or was, at the time of the filing of the adoption petition, in the custody of a local department of social services or North Carolina licensed child placing agency or had been in the placement responsibility of an a local department of social services or a North Carolina licensed child placing agency that subsequently placed the child in the custody of a person now pursuing adoption of that child. (This criterion does not apply to foreign born children brought into this country for purposes of adoption by private agencies since the intent of the adoption assistance statute [G.S. 108A-50] and [10A NCAC 70M .0402] is to reduce the number of hard-to-place children growing up in the foster care system. If a foreign born child enters the foster care system due to abuse, neglect, dependency, adoption disruption or adoption dissolution, that child's eligibility is determined in the same way as any other child); and
3. It has been determined that the child cannot or should not be returned to his parents. This means that the state must have reached that decision based on evidence by a court order legally clearing the child through TPR, or the existence of a petition for TPR, or a relinquishment by the parent to a child-placing agency, or, in the case of an orphan child, verification of the death of the parents and
4. The child has special needs. A child is considered a child with special needs when the state has determined:
• That there exists, with respect to the child, a specific factor or condition (such as his/her ethnic background, age, membership in a minority or sibling group, or the presence of factors such as medical conditions or physical, mental, or emotional handicaps)
• because of which it is reasonable to conclude that such child cannot be placed with adoptive parents without providing adoption assistance or medical assistance.
These specific factors or conditions include:
1. Handicap - Known and diagnosed medical, mental, or emotional condition that will require periodic treatment or therapy of a medical or remedial nature. (Separation trauma due to child's age at removal from birth parent's care, number of substitute placements, and children who are known or suspected to be victims of sexual abuse would be considered to be in this category.)
2. Child's Situation:
• member of a family group to be placed together;
• ethnicity or membership in certain minority groups;
• age of child
3. Need for Placement with Known and Approved Family
Such family would find the child's care an undue financial burden without Adoption Assistance. This includes relatives, other than biological parents, with whom a child has a close attachment, foster parents with whom a child has established a positive psychological bond and emotional tie, or other approved adoptive applicants deemed well suited to meet all but the financial component of the child's needs.
4. Potential Handicap-This is a special circumstance that allows eligibility to be established prior to placement without triggering the subsidy at the time the Decree of Adoption is issued. A potential handicap is a hereditary condition, congenital problem or other documented high risk factor leading to substantial risk of future disability.
When this is the only basis for the child's eligibility for subsidy, benefits may begin only at the point of the manifestation of the handicapping condition. When there are other special needs issues, the child would qualify in another category (see above). Documentation of the manifestation of the handicap shall be requested from the adoptive parent(s) and shall become a part of the child's adoption subsidy record.
Note: In an effort to avoid the disruption of existing placements of children who were previously in DSS custody, children receiving assistance under this category will continue to receive the benefits if they are still the responsibility of their adoptive parents(s), even if manifestation of the handicapping condition has not occurred.
5. Finally, there must be a demonstration that a reasonable, but unsuccessful effort has been made to place the child with appropriate adoptive parents without providing adoption or medical assistance. (This requirement is waived when it would be against the best interests of the child because of such factors as the existence of significant emotional ties with prospective adoptive parents while in the care of such parents as a foster child or when the child is being adopted by relatives.)
NOTE: Federal guidance has clarified the requirement for reasonable but unsuccessful efforts to make placements without the subsidy. It was the intent of Congress, with the establishment of the adoption assistance program, to increase significantly the number of children placed in permanent homes. Thus, it is reasonable to conclude that it was not the intent of Congress to force agencies to "shop" for a family which might be less suitable, but is willing to adopt the child without a subsidy, if it has already found a suitable placement for the child.
In an effort to find an adoptive home for a child, the agency should first look at a number of families in order to locate the most suitable family for the child [unless the child is already residing with family who will be adopting]. Once the agency has determined that placement with a certain family would be the most suitable for the child, full disclosure should be made of the child's background, as well as known and potential problems.
If the child meets the State's definition of special needs with regard to specific factors or conditions, then the agency can pose the question of whether the prospective adoptive parents are willing to adopt without a subsidy. If they say that they cannot adopt the child without a subsidy, the agency would meet the requirement that there be a reasonable, but unsuccessful, effort to place the child without providing adoption assistance
The financial criteria for federal adoption assistance eligibility addresses the circumstances of the child rather than the adoptive parents. An income requirement or a means test cannot be imposed to restrict eligibility for adoption assistance. In regard to children with an income, such as, but not limited to, Social Security benefits, Veteran's benefits, Supplemental Security benefits, the receipt of such income shall not arbitrarily, or automatically generate a denial, termination, or reduction in the receipt or amount of Adoption Assistance monthly cash payments.
If a child receives SSI prior to the adoption, the SSI may or may not continue when the child is adopted because the child’s eligibility will be based on the income of the adoptive parent(s). The adoptive parent(s) must apply for SSI for the child. In cases where the income and resources of the adoptive parent(s) do not affect the child’s eligibility for SSI, the Social Security Administration will count dollar-for-dollar the amount of Title IV-E adoption assistance paid to the parent(s), thus decreasing the SSI benefit by the amount of the adoption assistance payment.
It is important for potential adoptive parent(s) to understand that the child’s receipt of SSI benefits following the adoption will depend on the adoptive parent(s)’ income.
Eligibility for Adoption Assistance benefits should be established prior to a child's placement for adoption but must be established prior to the finalization of the adoption.
AFDC eligibility must be documented at the time of removal only. . This requirement applies to any child whose adoption was finalized on or after October 1, 2005.
Determination of eligibility and administration of the benefits are the responsibility of the child's resident county Department of Social Services regardless of whether the child is in the custody of the county Department of Social Services or is in the placement responsibility of a private child-placing agency.
If North Carolina residence cannot be established for a child who is the placement responsibility of a North Carolina private child-placing agency, (for example, if neither of his birth parents is a resident of the state), the Department of Social Services in the county of the private agency's main office shall be the agency to determine the child's eligibility and to administer the program.
Eligibility for assistance is based upon the child's special needs status. Approval for assistance must include the criteria which documents that reasonable, but unsuccessful efforts, have been made to place the child with adoptive parents without providing adoption assistance (See previous discussion of Federal guidance regarding adoption assistance).
All children for whom adoption is the plan must be considered for eligibility for adoption assistance. Failure to find a child eligible when he meets the categorical criteria may be the basis for an appeal that could result in a finding that would require an agency to make retroactive adoption assistance payments and other related benefits.
Establishing the eligibility for adoption assistance is a task of the services staff of a child's resident agency. The agency is required to use the Adoption Assistance Eligibility Checklist (DSS-5012). Documentation sufficient to establish eligibility can be in the form of statements of diagnosis and/or prognosis from physicians, psychiatrists, speech and other therapists, etc. Documentation in reference to high risk potential should be supported by information about the child's and birth parents' background. This documentation shall be attached to the DSS-5012.
The final step in the eligibility process is to have a completed, signed adoption assistance agreement with the adoptive parents. This can be entered into anytime after placement, but must be signed before the Decree of Adoption. Once eligibility has been determined, there is no need for further redetermination. Agencies must send a yearly notice to adoptive parents to determine the status of the child. (See sample letter.)
Note: If an agency has not established eligibility or has determined incorrectly that a child is ineligible, a request for a hearing on this matter from the adoptive parents shall provide the opportunity for the county to reverse an earlier decision in reference to making adoption assistance benefits available. In effect, this allows agencies to begin adoption assistance any time after the adoption is final following a request from the adoptive parents regardless of whether or not the above eligibility process had been followed prior to the adoption.
North Carolina offers benefits in the categories listed below. In order to offer these benefits, an adoption assistance agreement with the adopting parents must be in place. Any individual child may qualify for all types. Also, if a subsidy is in place for one type of benefit, additional types may be added in the future if the circumstances warrant it. Specific types of subsidy include:
G.S. 108-49 was rewritten in 1999 and states that a county Department of Social Services shall pay, at a minimum, the monthly graduated adoption assistance payment for eligible children as set by the General Assembly. A county Department of Social Services may make adoption assistance payments in excess of the monthly graduated rates, but cannot make adoption assistance payments in excess of the amount that the child received as a foster child.
For example, children who are HIV positive may receive additional payments while in foster care and may receive these additional benefits as part of the adoption assistance payment. Other children may receive additional money for their therapeutic needs while in foster care, and the county may choose to continue this supplement when the child is adopted. If a county has agreed to participate in the Special Children Adoption Incentive Fund, the state will share in the supplemental payment when the child is adopted.
The Special Children Adoption Incentive Fund was established by the General Assembly in the 2000 legislative session. The Fund is capped at $500,000 and is available on a “first come, first served” basis to a child who qualifies and is in the custody of a county Department of Social Services that has agreed to participate in the Fund. The purpose of the Fund is to make adoption a possibility for children with very special needs who would otherwise remain in the foster care system because of the financial loss to foster parents. Counties who participate in the Special Children Adoption Fund must commit to provide 50% of the cost of the incentive; the state provides the other 50%. The entire amount of the supplement is paid to the adoptive parents by the state and the state charges the county for its share of the cost.
Procedure for Monthly Payments to Adoptive Parents
(1). Standard Monthly Cash Payments
The General Assembly changes the amounts of foster care maintenance payments from time to time. Adoption Assistance payments are tied to the foster care board rates and go up or down with changes in legislation.
|
$390 |
0-5 years |
|
$440 |
6-12 years |
|
$490 |
13-18 years |
(Current as of 04-01-06)
Standard monthly cash payments are issued from the Division of Social Services' Controller's Office from information entered on the DSS-5095. The deadline for entry is the 3rd to the last working day of the month. Failure to meet the deadline is a county's responsibility and that agency is responsible for the payment to the adoptive parent(s).
The system will automatically increase the adoption assistance payment as a child ages into a higher payment category.
Since it is the county’s responsibility to enter data for receipt of the standard cash payments, questions by adoptive parents regarding these payments should be answered by the county. It is inappropriate to advise adoptive parents to call the Division if cash payments, including the HIV supplemental payments and the Special Children Adoption Incentive Fund payment, have not been received or have been misplaced. Contacts on matters regarding adoption assistance benefits should be between adoptive parents and the county, then the county and the state office. This is most important because a check cannot be tracked without the SIS identification number. It is the responsibility of the agency to provide this number to the Division. In no instance, should adoptive parents be advised to call the Division of Social Services' budget office regarding cash payments.
(2). HIV Payments
HIV supplemental payments are made in separate payments to the adoptive parent(s). For initial eligibility, DSS-5159 form and a copy of the physician’s statement must be submitted. No supplemental payments will begin until a copy of the physician’s letter confirming the child’s current diagnosis is received. The county must make monthly requests for the continuation of HIV payments.
Requests should be received by the 15th of the month. Positive or negative changes in medical status which result in a change in the HIV supplemental adoption assistance amount shall be reported on the DSS-5159 form within 30 days of the date of agency notification by the physician. Counties will be responsible for making adjustments for overpayment in the event of seroreversion or death of the child. Maintenance of letters and records verifying eligibility status will be subject to county audit.
The HIV Diagnostic Classifications from the National Center for Disease Control have been used to determine the amount of supplemental HIV payment for a child. The chart below provides the amounts and diagnoses:
Code |
Value |
AMOUNT |
E |
Perinatally exposed infant 0-24 mos. who cannot be classified as definitely infected, but who has antibody to HIV, indicating exposure to an infected mother. |
$800.00 |
N |
Infant, child or youth who meets one of the CDC definitions for infection but who has no previous signs or symptoms of HIV. |
$1000.00 |
A |
Infant, child or youth who shows mild signs or symptoms of HIV. |
$1200.00 |
B |
Infant, child or youth who shows moderate signs or symptoms of HIV. |
$1200.00 |
C |
Infant, child or youth who shows severe signs or symptoms of HIV. |
$1200.00 |
T |
Child aged 0-21 with laboratory evidence of HIV infection who has a resulting terminal diagnosis with a life expectancy of less than six mos. |
$1600.00 |
(3). Special Children Adoption Incentive Fund (only applies to counties that participate in this Fund).
Special Children Adoption Incentive payments are determined on an individual basis. These supplemental payments are also made in separate payments to the adoptive parent(s). Monthly requests from counties are not required for the continuation of these payments to the adoptive parents. After approval is given by the Division for a child to receive payments from the Special Children Incentive Fund and the Decree of Adoption has been entered, the Division will submit the payment requests to the Controller’s office. Monthly payments will continue until the county advises the Division to terminate the payments. The following procedure must be followed before a child is approved and payments begin.
Submit the following forms to establish the child’s potential eligibility of the child for monthly payments from the fund Fund to:
Adoption Program Coordinator
North Carolina Division of Social Services
325 North Salisbury Street, Suite 715
2409 Mail Service Center
Raleigh, NC 27699-2409
1. DSS-5213 Verification of Child’s Need for Daily Supervision
2. DSS-5214 Agency’s Verification of Legal Custody and Child's Living Arrangement for Past Six Months
3. DSS-5215 Verification of Child’s Health Condition
It is always very helpful to include a letter from the adoptive parent(s) regarding the daily needs of the child.
Once these forms are received, the Division will determine the child’s eligibility and will provide written notification immediately to the requesting agency. If approved, the agency will have 60 days, unless a written request is approved for an extension, to submit the following documents:
1. DSS-1814 Decree of Adoption
2. DSS-5013 Adoption Assistance Agreement
3. DSS-5211 Special Children Adoption Incentive Fund-Request for Payment
4. DSS-5212 Special Children Adoption Incentive Fund- Supplemental Adoption Assistance Agreement
5. DSS-5095 Child Placement and Payment System showing that child's payment has begun.
When the final documents are received, and the agency has entered a DSS-5095 for the child to receive the standard adoption assistance rate, the Division will submit information to the controller’s office for the supplemental checks to be sent to the adoptive parent(s). These checks are usually sent out after the 10th of the month.
Vendor payments provide assistance for services or treatment for handicapping conditions which existed prior to the time of the child's placement for adoption. It is not necessary for these conditions to have been identified prior to the placement, but rather to have existed.
An example—
If a child is adopted, and breaks his spine as a result of an accident, he is handicapped but the condition did not exist prior to placement and he may not use vendor benefits to pay for his care related to that condition.
If, however, after placement, the child is diagnosed as having had a degenerative bone disease which becomes known only after placement, he may use vendor benefits for this condition, as it existed, but was not known to anyone, prior to the adoptive placement.
Vendor payments may be provided up to a maximum of $2400 per year for any combination of medical and/or non-medical services or treatment not covered by any medical insurance program, such as Medicaid or private insurance. This means the total amount of $2400 may be used for medical services; the total amount of $2400 may be used for non-medical services; or the total amount of $2400 may be used for a combination of medical and non-medical services.
Non-medical services include any service that helps to alleviate a condition that existed prior to the adoptive placement. Based on the individual needs of a child, non-medical may include psychological, therapeutic, or any service that remedies a condition that is a result of a condition that existed prior to the adoptive placement.
Examples include, but are not limited to,
• tutorial service,
• tuition,
• specialized day care,
• orthopedic appliances (braces, special shoes, etc.), orthodontic appliances (braces, retainers, etc.),
• repair of broken glasses, eyeglasses, wheelchairs, hearing aids, computers and other learning aids,
• respite care, and
• specialized clothing or equipment.
Agencies must obtain documents to support the needs of an individual child.
Counties make payments directly to the provider or the adoptive parents and request reimbursement through the use of the DSS-5095. The DSS-5115, Adoption Assistance Program Payment Instructions, should be used to document these transactions.
Parents adopting special needs children are eligible for reimbursement of non-recurring costs of the adoption. The non-recurring expenses for the adoption of a special needs child must be reimbursed by the state agency responsible for the administration of the adoption subsidy program. This is true whether the adoption is an independent placement or one facilitated by a public or private agency. It should be noted that the child is eligible under the criteria established for children receiving adoption assistance, with the exception of the requirement that the child be in the custody or placement responsibility of a child-placing agency.
Reimbursable costs include adoption fees, court costs, attorney fees, and other expenses that are 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 are not reimbursed from other sources or other funds.
These expenses can include such costs as the pre-placement assessment, including physical and psychological examinations, transportation and reasonable costs of lodging and food for the child and/or the adopting parents when necessary to complete the placement or adoption process, and supervision of the placement. In cases where siblings are placed and adopted either separately or together, each child is treated as an individual with separate reimbursement for non-recurring adoption expenses up to the maximum amount allowable for each child. If parents have reimbursable expenses that are allowable, the reimbursement of these expenses must not depend on the income and resources of the parents.
There can be no limit placed on either the amount in any type of nonrecurring expenses or the number of types of nonrecurring expenses for which a child may be eligible. The only allowable limit is for the total amount of incurred expenses of $2,000 per child.
Payments are available to parents participating in intercountry adoptions as long as it can be determined that :
• the child cannot or should not return to the home of his or her parents;
• there exists a specific factor or condition because of which it is reasonable to conclude that the child cannot be placed with adoptive parents without providing assistance; and
• a reasonable, but unsuccessful effort was made to place the child with appropriate parents without providing adoption assistance.
If these conditions are met and the parents request payments prior to the finalization of the adoption, nonrecurring payments must be made. (ACYF-CB-PA-01-01).
Non-Recurring costs must be requested by the adoptive parents and approved prior to the entry of the Decree of Adoption. Counties make direct payments and request reimbursement from the State on the DSS-5095.
In North Carolina, children who receive adoption assistance must be evaluated for eligibility for Medicaid benefits. IV-E eligible children are categorically eligible and the Medicaid should automatically be triggered by an application filed by the social worker on the child’s behalf. The county with custodial responsibility is responsible for the Medicaid application. Non IV-E children are eligible for Medicaid coverage if they have been made eligible for adoption assistance and the child's income is below allowable limits.
Financial eligibility is determined based upon the child's income and resources only. Income and resources of the adoptive parents are not counted. As federal requirements specify that these children meet Categorically Needy income and resource requirements, they must be eligible under M-AF criteria. (Refer to Family and Children’s Medicaid Manual, effective 10-1-99 03-01-2002?).
North Carolina joined the Interstate Compact on Adoption and Medical Assistance (ICAMA) in October 1999, thereby becoming one of several states that provide Medicaid for non IV-E children who receive adoption assistance benefits. Refer to policies and procedures established by the Division of Medical Assistance (Family and Children’s Medicaid Manual Section 3230 Chapter IV).
Children who are recipients of adoption subsidy are eligible for services without regard to income. This provides an opportunity for the social worker and family to identify a set of post-adoption services that may be helpful in keeping the new family system intact.
There are four ways that a child can be eligible for title IV-E adoption assistance.
• Child is AFDC eligible and meets the definition of a child with special needs. Adoption assistance eligibility that is based on a child’s AFDC eligibility is predicated on a child meeting the criteria for such at the time of removal.
• Child is eligible for Supplemental Security Income (SSI) benefits and meets the definition of a child with special needs. The child’s SSI eligibility must be established by the time the adoption petition is filed. A child does not have to be in agency custody to qualify for assistance if he is SSI eligible and meets the definition of a child with special needs.
• Child is eligible as a child of a minor and meets the definition of a child with special needs. A child is eligible in this circumstance if the child’s parent is in foster care and receives IV-E foster care payments that cover both the minor parent and the child at the time the adoption petition is initiated, and prior to the finalization of the adoption.
• Child is eligible due to prior IV-E adoption assistance eligibility and meets the definition of a child with special needs. In situations where a previous adoption has dissolved or the adoptive parents die, the child is treated as though his or her circumstances are the same as those prior to the previous adoption. Since IV-E adoption assistance eligibility need not be re-established in subsequent adoptions, the manner of a child’s removal from the adoptive home, including whether the child is voluntarily relinquished to an individual, a public or private agency is irrelevant.
Funding for IV-E adoption assistance cash payments is a combination of federal, state, and county funds.
Child’s Immigrant Status
Alien children must be AFDC eligible under the State's July 16, 1996 plan and must also meet the PRWORA definition of "qualified alien" to be eligible for Federal adoption assistance. Benefits for alien children not eligible for Federal adoption assistance come from IV-B funds.
Children found eligible for monthly cash benefits who are not IV-E eligible are eligible to receive monthly cash payments from IV-B funds. Funding is derived from federal IV-B funds, (North Carolina has retained the discretion to use and has opted to make available for non IV-E children), state and county funds.
The State Adoptive Fund is available for children in the legal custody of a North Carolina licensed private agency and who are not SSI eligible. If the child receives SSI, the funding source is IV-E.
Funding for this category of children is provided from IV-B funds and state funds. No county funds are required as match, with the exception of the Medicaid.
Adoptive parents will be expected to explore and use available resources other than these benefits for payment of services related to alleviating the child's special needs. However, for children also approved for assistance after adoption from the Children’s Special Health Services, Division of Maternal and Child Health, Department of Environment, Health and Natural Resources, benefits from the vendor categories of Adoption Assistance are to be exhausted before the family turns to children's Special Health Services for assistance. Vendor payments are not included in the requirements of PL 96-272 for a subsidy program. Therefore, whether the children are IV-E or IV-B eligible, the funding source is IV-B and county funds and the county share is the same. SAF-eligible children receive vendor payments reimbursed through IV-B funds.
For IV-E eligible children, Medicaid should automatically be triggered by an application filed by the social worker on the child’s behalf. For IV-B children Medicaid, the determination of whether the child has special medical needs is made by the child's Adoption Assistance worker in the county. Once the child is initially determined as Medicaid eligible under special needs criteria, the eligibility determination is binding as long as adoption assistance remains in effect (unless the child begins receiving income other than adoption assistance.
Redetermination of eligibility is required to ascertain if the child remains eligible based on income.) A redetermination of financial eligibility is not required. Coverage terminates at age 18 or whenever the adoption assistance is terminated.
Medicaid will be provided for IV-E eligible children if the adoptive parents reside in another state at the time of the finalization of the adoption or move to another state after the Decree of Adoption has been entered. The receipt of Medicaid for non IV-E eligible children who reside in another state is dependent on whether or not the other state is a member of the Interstate Compact on Adoption and Medical Assistance (ICAMA) and has agreed to provide reciprocity to other states for Non IV-E eligible children.
Non-recurring adoption expenses are considered an administrative expenditure of the Title IV-E adoption assistance program. Federal reimbursement is available at a 50% matching rate for state expenditures up to $2,000 for any adoption. The child is eligible for this benefit and reimbursement is available under this program regardless of whether or not the child is IV-E eligible. The county's share of these expenses is 25 %.
The Adoption and Safe Families Act of 1997 extends eligibility of Title IV-E Adoption Assistance benefits to a child who was determined eligible for Adoption Assistance benefits and is available for adoption due to dissolution of the prior adoption. Dissolution may have occurred because the parental rights of the adoptive parents have been terminated, the adoptive parents have relinquished rights to an agency, the adoptive parents have given consent for an independent adoption, or the adoptive parents have died.
In order to maximize the benefits of Title IV-E for all children, it is important to assess each child’s eligibility for IV-E at the time of the re-adoption.
For children who return to the custody of a Department of Social Services, these guidelines should be followed:
If the child was not IV-E eligible in the prior adoption, but due to the circumstances of the adoptive parents at the time of the dissolution would meet the eligibility criteria for the AFDC program, or is a recipient of Supplemental Security Income (SSI), the child would be IV-E eligible for the re-adoption.
If the child was IV-E eligible in the prior adoptive placement, but would not be IV-E eligible due to the circumstances of the adoptive parents at the time of the dissolution, then the child’s eligibility category for adoption assistance would revert to the IV-E eligibility status of the prior adoption.
If the child were SAF eligible in the prior adoptive placement, but would not be IV-E eligible due to the circumstances of the adoptive parents at the time of the dissolution, the child’s eligibility category for adoption assistance would be IV-B.
For children who are returned to the custody of a private agency, or placed in the custody of a private agency, these guidelines should be followed:
If the child’s previous eligibility category was SAF, and the child is not a recipient of SSI, the eligibility category is SAF.
If the child receives SSI, the eligibility category is IV-E.
If the child was IV-E eligible in the prior adoption, the eligibility category would be IV-E.
If the child was IV-B eligible in the prior adoption, the eligibility category would be IV-B unless the child is a recipient of SSI. If the child receives SSI, the eligibility category would be IV-E.
If the child was placed independently by the prior adoptive parents, the eligibility category for the re-adoption would be the same as in the prior adoption.
Responsible Agency
If the child is placed in the custody of a Department of Social Services where the adoptive parents resided when the dissolution occurred, it is the responsibility of that agency to determine eligibility, to provide adoption assistance benefits, and to manage the adoption assistance case when the child is readopted.
If the child is placed in the custody of a private agency, it is the responsibility of the county where the adoptive parents resided when the dissolution occurred to determine eligibility, to provide adoption assistance, and to manage the adoption assistance case when the child is readopted.
If a child is placed independently, it is the responsibility of the original county to provide adoption assistance and to manage the adoption assistance case when the child is readopted.
Note: This extension of eligibility is only for adoption assistance when a child is readopted. When a child returns to agency custody and is placed in foster care, the process of determining eligibility for foster care has not changed. It is most important to keep applications and documentation for the different funding sources in the record.
The Adoption Assistance Agreement (DSS-5013) must be completed before adoption assistance benefits can be provided. This agreement must be a written instrument that is binding on all the parties. It is entered into by the prospective adoptive parent(s) and the child's agency (the agency responsible for determining eligibility).
The agreement must spell out all of the responsibilities of the parties and detailed financial reporting requirements. The agreement must specify the types and amounts of assistance, the types of services available, and the conditions under which benefits or services may be increased or decreased. The agreement must specify the date for beginning and ending benefits and services. (The agreement must state the beginning month and year rather than indicating “a month after the Decree of Adoption”. If the exact month and year are not known, it is permissible to give a date when assistance is reasonably expected to begin.) The agreement must include specific discussion of what will happen if the adoptive family moves out of state or if the adoptive parents die. The agreement must describe the procedure for requesting a fair hearing. Provisions of the agreement can be changed only after negotiation with the adoptive parents.
Once a child has been determined eligible for adoption assistance, no redetermination of his eligibility is necessary; however, the child's agency must review the adoption assistance agreement on periodic basis to ensure that the child remains in the financial responsibility of the adoptive parent(s). As long as the parents remain financially and legally responsible, even if the child is out of the home, adoption assistance can continue. (Examples: child runs away, child is in treatment or incarcerated and parents are expected to provide support.)
According to ACFY-CB-PA-01-01 dated 1-23-01, “A parent is considered no longer legally responsible for the support of a child when parental rights have been terminated or when the child becomes an emancipated minor, marries, or enlists in the military”. “Support” is defined as various forms of financial support. This includes, but is not limited to, payments for family therapy, child support, tuition, clothing, maintenance of special equipment in the home, or services for the child’s special needs.
Because reimbursement of non-recurring costs is available to children who will not be eligible for other adoption assistance benefits, a separate application (DSS-5145) must be completed for this program. In the event the child was not the placement responsibility of an agency, the adoptive parents must provide the documentation to the county department of social services to justify the child's eligibility as a special needs child.
When eligibility for reimbursement of non-recurring adoption expenses has been established, the responsible county department of social services shall enter into a one-time only Agreement (DSS-5146) with the adoptive parents to indicate the items and amounts approved for reimbursement, provided the total reimbursed expenses shall not exceed $2,000. The agreement shall be signed by the adoptive parents and by the Director of the county department of social services and must be dated. One copy of the Agreement is to be given to the adoptive parents and one copy is retained in the child's file.
Non-recurring costs for international adoptions has been addressed earlier, but it is important to emphasize the federal guidelines (ACYF-CB-PA-01-01) regarding international adoptions. The federal statute does not categorically exclude these children from participation in the Title IV-E adoption assistance program. (See earlier discussion in Section II E, Non-Recurring Expenses)
Benefits become available after the entry of the Decree of Adoption except for those children who are eligible due to a potential handicap. Benefits for those children are available at the time manifestation of the handicap is documented.
In many cases, agencies will make foster care payments and/or provide Medicaid benefits during the supervision period, but prior to the entry of the Decree of Adoption. In cases where Medicaid benefits are the only ones being received, authorization for medical assistance should be done in accordance with procedures contained in the Division of Medical Assistance manual material.
When foster care board payments are also to be received, the adoptive home must be licensed.
Children approved to receive Adoption Assistance benefits become eligible to receive these benefits the first month following the month in which the Decree of Adoption is issued. The child's social worker is responsible for assuring that the proper information is entered into the Child Placement and Payment System. (See Child Placement and Placement System Manual.)
There may already be a DSS-5095 because non-recurring benefits were paid using the child’s name and SIS number for foster care. Close any existing DSS-5095 and DSS-5094. Complete a new DSS-5095 in the child’s adoptive name according to the instructions in the CPPS manual for all children for whom on-going adoption assistance benefits will be made.
Any request for cash payments following the entry of the Decree of Adoption requires a fair hearing (See section on Appeals). Payments are to be made only for benefits or services provided on or after the effective date of the Adoption Assistance Agreement. Therefore, when retroactive payments are approved the date on the Adoption Assistance Agreement must cover the period for the retroactive payment.
Benefits of this program cease at the time of the child's 18th birthday or at the time the adoptive parents no longer have financial and/or legal responsibility for the child. In cases where adoption assistance terminates before a child’s 18th birthday, the adoptive parents must be given the right to appeal any decision to terminate the assistance. Adoptive parents must be informed that they are responsible for notifying the child's agency if the child is no longer eligible for adoption assistance and they will be responsible for reimbursement to the agency in the event they receive a payment after the child's eligibility ceases.
Vendor benefits are available to providers of medical, psychological, therapeutic and/or remedial services either through direct payments or through reimbursement to the adoptive parents. These payments for service are available for conditions the child had when placed in his adoptive family and for which he has or will be found eligible. The social worker will provide the adoptive parents with instructions for payment to providers (Form DSS 5115).
A request for vendor benefits may be made at any time following the entry of the Decree of Adoption if the child's adoptive parents can provide documented proof that the child’s condition existed prior to the adoption.
All benefits, including cash payments, vendor payments, and Medicaid are the responsibility of the county Department of Social Services agency that is responsible for the child’s adoption assistance agreement, regardless of the residency of the child. The county where the child resides after the entry of the Decree of Adoption is responsible for post-adoption services.
Cash payments and vendor payments are the responsibility of the county Department of Social Services agency that is responsible for the child’s adoption assistance agreement. Post adoption services are the responsibility of the state where the child resides.
If the child is IV-E eligible and lives in or moves to another state, Medicaid will be provided by the state in which he lives. This is not an automatic process so the placing county must apply for these benefits on behalf of the child by completing the necessary paperwork. Even though some states will provide Medicaid benefits without the completion of the Interstate Compact on Adoption and Medicaid Assistance (ICAMA), it is important to complete this paperwork in every case when a family moves to another state.
If the child’s adoption assistance benefits are funded by State Option (IV-B or SAF), the continuation of Medicaid in another state will depend on whether or not that state has joined the Interstate Compact on Adoption and Medicaid Assistance (ICAMA) and has chosen the option to provide reciprocity. There are states that may provide Medicaid for these children even though they are not members of ICAMA. Therefore, it is important that applications are made for every child who lives in another state.
Policies and procedures established by the Division of Medical Assistance must be followed in order for a child to receive Medicaid in another state. (See DMA Family & Children Medicaid Manual Section 3230 Chapter IV). The ICAMA forms must be completed for all children living in other states. North Carolina joined ICAMA in 1999, and there may be some children who have been previously denied benefits because our state was not a member of the ICAMA. Applications should be made for these children.
The adoption must be finalized before the Interstate Compact on Adoption and Medicaid Assistance (ICAMA) paperwork can be completed. Once the Decree of Adoption has been issued, all paperwork must be sent to the Interstate Office to be forwarded to the child’s state of residence. Submit all documents in triplicate.
1. Complete all sections of Form 6.01 (DSS-5249)
Interstate Compact Administrator
DHHS, DSS
Family Support and Child Welfare Services
325 N. Salisbury Street
2409 Mail Service Center
Raleigh, NC 27699-2408
2. Form 6.02 (DSS-5248) is notice to the adoptive parent(s). The county should send the family a completed ICAMA Form 6.02 (DSS-5248), a copy of the ICAMA Form 6.01 (DSS-5249) that was sent to the receiving state, and a copy of the child’s Adoption Assistance Agreement.
3. Form 6.03 (DSS-5250) is a Report of Change/Family Status. This form should be completed and should accompany the Form 6.01 (DSS-5249) and is to be used whenever you are aware of a change in status.
If the State agency has responsibility for placement and care of a child, that State is responsible for entering into the adoption assistance agreement and paying the title IV-E adoption subsidy, even if the child is placed in an adoptive home in another State. If the State agency does not have responsibility for placement and care, it is the adoptive parents’ State of residence where the adoption assistance application should be made. In that event, the public child welfare agency in the adoptive parents’ State of residence is responsible for determining whether the child meets the definition of special needs, entering into the adoption assistance agreement and paying the subsidy, consistent with the way public benefits are paid in other programs.
Likewise, if a title IV-E adoption dissolves or the adoptive parents die and the child is placed with a State agency that assumes responsibility for placement and care, it is the placing State’s responsibility to determine whether the child meets the definition of special needs, and pay the subsidy in a subsequent adoption. If, however, a public child welfare agency is not involved in the subsequent adoptive placement of a child, it is the public child welfare in the subsequent adoptive parents’ State of residence that is responsible for determining whether the child meets the definition of special needs, entering into the adoption assistance agreement, and paying the subsidy. The State of the child’s initial adoption or the State that pays the title IV-E adoption assistance in the child’s initial adoption is irrelevant in a subsequent adoption.
In a single parent family, if the parent dies, or in a two-parent family if both parents die, the adoption assistance benefits must be terminated. Adoption assistance cannot be transferred to another person. If the child is readopted by a family member or an unrelated person, the child is eligible for adoption assistance after the re-adoption occurs. The child does not have to return to agency custody in order to receive adoption assistance after the re-adoption occurs. If the child enters the custody of a department of social services or a licensed child placing agency, his category of adoption assistance in a re-adoption is based on the eligibility status of the previous adoption.
If an adoption dissolves by a relinquishment or a termination of parental rights, the child is eligible for adoption assistance only when the child is readopted.
When a child is placed into an adoptive home, a new file must be created which will reflect adoption assistance information and documentation. This file is to be in the child's adoptive name. The file must contain a cross-reference to the child's original file so that should the case be audited, documentation establishing the child's eligibility for benefits can be made readily available to the auditors. The new Adoption Assistance case file is to be given a new county case number in accordance with standard agency procedure.
The agency must retain the original file of all children eligible for adoption assistance at least until the child becomes 18. This is not exclusive to files pertaining to children who are eligible for adoption assistance only. The original file of all children the agency placed for adoption should be retained. This file must contain documentation of eligibility for the original funding program (foster care), either IV-E or SFHF, and thus will provide a complete audit trail.
At a minimum, this file shall contain background information of the child and his biological family, placement history, the child's medical, psychological and/or psychiatric information, educational information (i.e. child's pre-placement summary), documentation to support eligibility for adoption assistance and documentation of the child's legal clearance for adoption. While the primary purpose of this file is to create an audit trail, it is critical to remember that this serves as a repository of information to be shared with the child when he reaches his majority to enable him to understand the reasons and process of his placement.
Assistance Case File must contain the following:
1. Adoption Assistance Eligibility Checklist (DSS-5012). This form must indicate those components of the program for which the child is eligible or may be eligible under the category of potential handicap.
2. Medical records, psychologicals, etc. that are needed in cases in which documentation of a handicapping condition must be provided. At the time the new case file is set up, every effort must be made to delete any identifying information contained on such documents such as the child's original name, names of siblings, other relatives, etc.
3. Copies of the Adoption Assistance Agreement (DSS-5013) and Periodic Review Letters.
4. Copy of Petition for Adoption.
5. Copy of Decree of Adoption.
6. Service Client Information Change Notice (DSS-5027).
7. Child Placement and Payment System Form (DSS-5095).
8. Copies of statements from vendors, if applicable.
9. EIS forms related to Medicaid, as need and eligibility indicate, according to instructions in the EIS User's Manual.
10. All correspondence pertaining to the child's receipt and termination of Adoption Assistance benefits.
Adoptive parents, or prospective adoptive parents, of a child with special needs have the right to appeal the agency's denial, failure to inform them of the availability of assistance, the amount, a decrease, or termination of Adoption Assistance benefits for the child. If applicants or potential recipients of financial benefits or service programs believe they have been wrongly denied financial assistance, not informed of the availability of a program of assistance, or excluded from a service program, they have a right to a hearing. It is the responsibility of a fair hearing officer to determine whether extenuating circumstances exist and whether the applicant or recipient was wrongly denied eligibility.
Policy requires that eligibility for Adoption Assistance monthly cash payments be established prior to the child's placement for adoption and requires, also, that the Adoption Assistance Agreement be signed prior to entry of the Decree for Adoption. Requests for monthly cash assistance made for children not covered under the provisions described above must follow the appeals process for resolution. The Adoption Assistance appeals process is the same as that used for other Public Assistance appeals and would be resolved through the same channels. The county department of social services staff member assigned to hear Public Assistance appeals is the person who should conduct the hearing. (At no time shall someone in a decision-making capacity regarding the child’s eligibility serve as hearing officer.)
The following procedures should be followed when a parent requests adoption assistance cash payments:
1. The adoptive parents should be advised to submit a written request to the child’s agency for adoption assistance monthly cash payments.
Within five days notification, the county department of social services must notify the parents that a hearing will be held and hold the hearing. NOTE: If the adoptive parents request benefits that have previously not been provided, and the agency agrees that the child should have been found eligible, the agency may not administratively change its eligibility determination, but may avoid a trial-type evidentiary hearing. The undisputed documentary evidence could be presented to the hearing officer for his or her review and determination made on the written record (ACYF-CB-PA-01-01).
2. At the hearing, the agency may make a determination as to whether or not sufficient information has been presented to substantiate that, based on eligibility requirements in place prior to adoptive placement, the child could have been found eligible for Adoption Assistance monthly cash payments at that time.
3. If the agency finds the child to be eligible negotiations can be made at that time with the adoptive parents to determine the beginning date and amount of payment for the child. If the agency and the parents cannot reach an agreement, the agency shall advise the parents of their right to appeal the agency's decision in regard to the amount and beginning date. The parents should be advised to notify the agency of their decision to appeal within fifteen days of the mailing of the agency's letter.
If the agency determines that the child would not have been found eligible, the adoptive parents must be notified of this by the agency in writing. The agency shall advise the adoptive parents of their right to appeal the denial of assistance within 15 days of the mailing of the agency's letter.
4. If the parents wish to appeal the agency's decision, the agency completes the Request for State Appeal form (DSS-1473). When completed, the form and other required materials are sent to the State Hearings and Appeals Section, Division of Social Services.
The State Hearings Officer will make arrangements with the parents and agency for the date and time of the hearing, which will be held in the agency.
Following the hearing, the State Hearings Officer will notify the parents of the decision in regard to Adoption Assistance. If the parents are dissatisfied with the decision, their appeal for review can be submitted to the Chief of the Hearings and Appeals Section, Division of Social Services.
5. Final decisions of the Hearings and Appeals Section, if not to the satisfaction of the parents, can be appealed to the Superior Court in accordance with G.S. 108A79 (k), provided such appeal is filed within thirty (30) days of the date of receipt of the final decision. The decision by the Chief Hearing Officer is the final decision for the agency.
If the child is found eligible for Adoption Assistance, the county department, in conjunction with the State Division of Social Services, is responsible for negotiating with the parents to establish the effective date of initiating benefits, unless the date is otherwise established by the State Hearings Officer or the Superior Court.
A guide to an appropriate retroactive beginning date would be either:
the month following entry of the Decree of Adoption in the case of a child with a known physical, mental, emotional, or other condition creating on-going expense for proper care/treatment at that time: or
the month in which the adoptive parents first request the monthly cash payment, based on the child's needs. This could be soon after the Decree of Adoption was filed or it could be several years later.
An Assistance Agreement must be prepared and backdated to the beginning date of the retroactive payments. This is important because adoption assistance cannot be given without an agreement to cover the period in which it is given.
The county department shall notify the Division of Social Services of the decision in writing. The letter should include the adoptive parent’s address and social security numbers, the child’s SIS I. D. number, the funding source, a copy of the decision as a result of the appeal, the beginning date for retroactive payments, and the monthly and yearly break-down of payments
Payment will be issued from the Division, with a sight draft sent to the county department for its share of the payment. (The state may claim Federal Financial Participation for IV-E eligible children from the earliest date of eligibility as reflected in the signed agreement).
For continuing payments to the adoptive parents the adoption assistance information must be entered on the DSS-5095.
If for some reason the check is not delivered to the adoptive parent(s), it is returned to the county office. It is important to see if the check has been returned to the county before requesting a replacement check. A request for a replacement check, Form 8129, must be completed by the agency if a check is lost or stolen and mailed to:
DHHS- Controller’s Office
Program/Benefit Payments Section
2019 Mail Service Center
Raleigh, NC 27609-2409
The controller’s office will not issue a replacement check until it has been shown that the original check has cleared. Therefore, adoptive parents must be advised that a request for a replacement check cannot be made before the 10th of the month. Replacement checks are mailed to the agency and not to the adoptive parent. If an adoptive parent is in desperate need for cash assistance, the agency may provide the payment and request reimbursement from the adoptive parent when the replacement check is issued. This agreement must be between the adoptive parent and the agency. The controller’s office will not issue replacement checks payable to the agency.
When it is determined that an overpayment to an Adoption Assistance recipient has occurred, the county should establish a repayment agreement and repayment schedule with the family at that time. When payments are made by the family, the county should complete a DSS-1656, Refund Receipt, and send a copy of the receipt and a county check to the following address:
DHHS Controller's Office
Program/Benefit Payments Section
2019 Mail Service Center
Raleigh, NC 27699-2019
The repayment will be credited to the child's check history screen in the Child Placement and Payment System. You may verify the adjustment through your PQA 403, Cash Adjustment Register.
Effective January 1, 1999 criminal record checks must be included in pre-placement assessments before approval can be given for the adoption of a child who is or was in the custody of a department of social services. Adoption assistance cannot be provided if field #29 is not completed on the DSS-5095. When approval is given for retroactive payments for adoptions that were finalized prior to January 1, 1999, enter the date of the decision of the appeal hearing and note in the record that the adoption was finalized prior to 1999.
Refer to IRS publication 968 for detailed information on tax benefits to adoptive parents. This publication can be found at http://www.irs.ustreas.gov. Adoption assistance payments for children with special needs are not countable income for tax purposes. Adoptive parents should keep records, including adoption assistance agreement, to provide proof that the child receives adoption assistance because of his or her special needs.
Adoption assistance checks cannot be automatically deposited in the adoptive parent’s bank account. When/if this becomes a possibility, agencies and adoptive parents will be notified.
The private agencies must depend on the departments of social services to determine eligibility and provide adoption assistance benefits to children who are relinquished to the custody of private agencies. Therefore, it is incumbent on the departments of social services to provide timely services to these agencies so placements will not be delayed. When a request is made to an agency, the eligibility determination should be completed within 30 days of the referral. Private agencies should not have to make repeated calls to the departments of social services asking for action on the request.
As stated in Section II C 1-Establishing Eligibility, the determination and administration of the benefits are the responsibility of the child’s resident county department of social services. The child’s resident county is the county where the mother resided at the time of the child’s birth. The permanent address of the mother is indicated on the DSS-1804, Relinquishment of Minor for Adoption by Parent or Guardian.
It is the responsibility of the departments of social services to obtain the necessary documents for the determination of eligibility from the referring private agencies. The departments of social services shall not set higher standards for documentation from the private agencies than are required for children in agency.
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For questions or clarification on any of the policy contained in these manuals, please contact your local county office. |
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