Adoption and Guardianship Assistance - Missouri

Date: September 2023

What specific factors or conditions does your State consider to determine that a child cannot be placed with an adoptive family without providing financial assistance? ("What is your State definition of special needs?")

Children in the care and custody of the Missouri Department of Social Services (DSS) Children’s Division are considered special needs.

A child not in the care and custody of DSS is defined as having special needs if he/she has at least one of the following needs or circumstances that may be a barrier to placement or adoption without financial assistance:

  • Under the age of 18
  • In the care and custody of a licensed child-placing agency
  • A child who cannot or should not be returned to the home of his/her parents
  • A child with 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 condition or physical, mental, or emotional handicaps) that may be a barrier to placement for adoption without financial assistance.
  • A child who has a condition (i.e., a state of health or behavior) that results in a guarded prognosis (although the child may appear normal) due to mental illness or retardation, drug usage by, or venereal disease of the parents
  • A child who has a history that includes circumstances such as long-term out-of-home care, incest, or social or genetic complication in the family background


What is the maximum amount a family may receive in non-recurring adoption expenses from your State? (Adoptive parents can receive reimbursement of certain approved, "one-time" adoption expenses incurred in the process of finalizing a special needs adoption.)

Up to $2,000 per child.


Does your State enter into deferred adoption assistance agreements? (In some States, adoptive parents can enter into an agreement in which they choose to defer the receipt of a Medicaid card, the monthly monetary payment, or both and can elect to receive the Medicaid card and/or monetary payment at another time.)

All children who are adopted or children who are placed for legal guardianship with an eligible relative or qualified close nonrelated person through the Children’s Division are eligible for basic subsidy services, including maintenance, health care coverage, child care to age 13, and respite.

Adoptive parent(s) may decline any or all of these services; guardian(s) may decline services as well, however, they are required to receive maintenance of at least one dollar.

If services are declined, the parent(s) or guardian(s) must sign a dated statement indicating what services they are declining. This statement is to be filed in the subsidy record and documented in the explanation section of the agreement.

Basic services declined cannot be approved at a future date. All basic subsidy services must be addressed in the explanation section in some manner.


When can adoption assistance payments and benefits begin in your State?

Adoption assistance payments and benefits begin upon the signing of the adoption subsidy agreement by both the adoptive parents and the division director which occurs prior to the finalization of adoption.


How are changes made to the adoption assistance agreement in your State?

  • When can a parent request a change in the adoption assistance agreement?
  • How does a parent request a change in the adoption assistance agreement?
  • What if a parent does not receive the change they request in the adoption assistance agreement?

Adoptive families can request a change in the adoption assistance agreement at any time, either in person or in writing. Requests for modification to the agreement are based on changes in the circumstances of the family or the needs of the child and are submitted to the Children’s Division adoption specialist. Requests for assistance above the basic subsidy package must be accompanied by supporting documentation from appropriate sources. Services within the agreement that are time specific must be must be reviewed and reauthorized.

If the agency and the adoptive parent(s) are unable to agree upon the terms of this agreement or any service proposed and the division issues a written decision denying the services that the adoptive parent(s) feel adversely affect the child, they are entitled to a review. The review procedure shall be initiated upon a written request from the adoptive parent(s) to the local Children’s Division within 10 days of receipt of the written notice of the denial from the division.

If a family disagrees with a decision made by the Division regarding subsidy, they have a right to request a fair hearing within 30 days after receiving written notification from the division. If the adoptive parents wish to request a fair hearing, they must contact their social service worker to request the necessary paperwork.


What types of postadoption services are available in your State, and how do you find out more about them?

Postadoption services can be accessed by contacting the local Adoption Resource Center or adoption subsidy worker with the Children’s Division. Other resources include:

Many private organizations offer a variety of respite options. See the ARCH National Respite Network Respite Locator Service, search by state to locate: Missouri's respite programs.


What mental health services are provided by your State?

The Division of Behavioral Health (DBH) is responsible for making sure that prevention, evaluation, treatment, and rehabilitation services are available for individuals and families that need public mental health services throughout the State of Missouri.

If you would like more information, please call (573) 751-8017 or e-mail

For more information regarding the Department of Behavioral Health or Department of Mental Health and the services offered, please visit the Missouri Department of Mental Health website.

Through the MO HealthNet for Kids program, children receive full, comprehensive coverage including primary, acute and preventative care, hospital care, dental and vision care as well as prescription coverage

The Missouri DSS Children’s Treatment Services (CTS) section of the State Child Welfare Manual offers details about the services across the Division’s continuum of care. Medicaid coverage is secondary to any private insurance of the adoptive family.


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?

Missouri offers CTS which are services that should be helpful in reducing risk and improving family functioning. CTS provide services across the Division’s continuum of care. All children and families served through CTS must have active involvement with the Division, such as an open child abuse/neglect investigation, family assessment, family centered service case, family-centered out-of-home case or adoption. CTS are purchased by the Division on behalf of the family and CTS should be used, as a payer of last resort, with children and families to prevent child maltreatment and to treat its negative consequences. These services are administered by third party providers, which may include the provision of counseling and therapy; parent aide and education services; and/or, intensive in-home services (family preservation). Services are provided in order to keep children from entering Family Centered Out-of-Home Care (FCOOHC) as well as to return children safely to their homes or other permanency plan.

Children and families may present a multitude of problems, which may require a variety of services. Contracted services to an individual or family should be provided based on the goals developed by the Children’s Service Worker, family or individual, and the provider.

CTS are established through contracts with vendors statewide to provide the following:

  • Therapeutic services
    • Therapeutic services are primarily intended to provide mental health assessments, psychological testing and treatment to children and family’s not otherwise eligible, covered, or receiving the specific mental health services by another entity.
  • Non-Therapeutic services
    • Non-therapeutic Services are intended to provide a way for the Division to offer a variety of services as needed based on the identified needs of children and families. The client or group of clients served through non-therapeutic services must have active/open CA/N, case management or adoption involvement with the Division. Services intended to prevent further incidents of child abuse and neglect, to meet the case specific needs of children, and families with open/active involvement with the Division.
  • Intensive In-Home Services
  • Intensive Family Reunification
  • Crisis Funds Dispersement
  • Language Translation and Interpretive Services for People with Hearing Loss
  • Interpretive and Counseling Services for the Deaf
  • Transportation
  • Drug Testing
  • Paternity Testing
  • Medical Examinations (SAFE Network and Other Medical Examinations) Needed during a CA/N Investigation
  • Legal Feeds
  • Paying for Medical Records
  • Emergency medical examination services (related to CA/N investigations

More information regarding CTS may be found in the Child Welfare Manual.


What is your State's process for applying for a fair hearing? (A fair hearing is a legal, administrative procedure that provides a forum to address disagreements with agency decisions.)

Adoptive parents can request a review whenever they disagree with any Children’s Division decision related to an adoption assistance agreement. Requests must be made in writing within ten days from the date of the contested Children’s Division action notification and sent to the local Children’s Division office. Requests are referred to fair hearing staff after a supervisory review process. A fair hearing request may be made when a child is determined to be ineligible for adoption assistance, when a request for assistance made by the family is denied and family is notified through receipt of a CD-87, or when services have been removed, prior to then end date on the adoption assistance agreement. A written request for a fair hearing must be received by the Children’s Service Worker, within 30 calendar days of the date the provider/applicant received or refused the written Notification of Resource Home Adverse Action. Upon receiving a request for a hearing, the worker will attempt to resolve the issues informally with the applicant/resource provider while concurrently preparing for the Fair Hearing. The informal meeting should take place within 10 working days of the worker receiving the fair hearing request.

A fair hearing form (CD-53) may be requested through the Adoption Specialist, or the Specialist’s supervisor, and is to be completed either by the family’s Adoption Specialist or by the family. The Child Welfare Manual provides specific information about the fair hearing process.


Does your state, territory, or tribe offer a guardianship subsidy or assistance (monthly payments and medical coverage) program?

Yes. Assistance is available regardless of the child’s title IV-E eligibility. There is no difference in benefits or eligibility between IV-E and State/territorial/tribal guardianship programs. Children are eligible for the same services and service amounts regardless of the funding stream.

  • Does the guardianship assistance program differ from the adoption assistance program? No, there is no difference between programs.


What are the eligibility criteria for a child to receive guardianship assistance?

The child must be under the age of 18 at the time of adoptive or legal guardianship placement. At the time of planning for adoption or legal guardianship, the child must meet one of the following circumstances: Be in the custody of the Children’s Division. Children in the care and custody of the Children’s Division are considered special needs, and are in turn automatically eligible for Missouri Adoption Subsidy; OR Be in the custody of a child-placing agency licensed in accordance with Section 4, Chapter 9 (Adoption and Guardianship Process), Subsection 6 – Subsidizing an Adoption/Legal Guardianship of the Child Welfare Manual.


Do families have to meet a kinship definition to receive guardianship assistance? If yes, how is kinship defined?

Any subsidies available to adoptive parents shall also be available to a qualified relative of a child or a qualified close nonrelated person who is granted legal guardianship of the child in the same manner as such subsidies are available for adoptive parents. "Close nonrelated person" means any nonrelated person whose life is so intermingled with the child that the relationship is similar to a family relationship; "relative" means any grandparent, aunt, uncle, adult sibling of the child or adult first cousin of the child, or any other person related to the child by blood or affinity.


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