Adoption and Guardianship Assistance - North Carolina

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?")

A child with special needs is defined as a child for whom one of the following factors or conditions must exist and be documented in order for the child to be eligible for adoption assistance:

  • Six years of age or older
  • Two years of age or older and a member of a minority race or ethnic group
  • Member of a sibling group of three or more children to be placed in the same adoptive home
  • Member of a sibling group of two children to be placed in the same adoptive home, in which one or more of the siblings meet at least one of the other criteria for special needs
  • Has a medically diagnosed disability that substantially limits one or more major life activity, requires professional treatment, assistance in self-care, or the purchase of special equipment
  • Diagnosed by a qualified professional to have a psychiatric condition that impairs the child’s mental, intellectual, or social functioning, and for which the child requires professional services
  • Diagnosed by a qualified professional to have a behavioral or emotional disorder characterized by inappropriate behavior that deviates substantially from behavior appropriate to the child’s age or significantly interferes with the child’s intellectual, social and personal functioning
  • Diagnosed to be mentally retarded by a qualified professional
  • At risk for a diagnosis described above, due to prenatal exposure to toxins, a history of abuse or serious neglect, or genetic history.
    Note: if the child qualifies only under this criterion, the child must be placed in the potential category where he or she shall receive Medicaid but will receive a zero amount monthly payment until a diagnosis is made. When the diagnosis is made and documented appropriately, a change will be made to the DSS-5095 to reflect payment beginning the month following diagnosis.
  • Meets all of the medical and disability requirements for Supplemental Security Income


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.)

$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.)

North Carolina offers deferred adoption assistance.


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

Adoption assistance payments and benefits may begin in North Carolina the month after adoption finalization.


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 parents are directed to contact their local Department of Heath and Human Services to request a change in an adoption assistance agreement.


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

Post adoption services in North Carolina are administered through the Department of Health and Human Services, Division of Social Services and private and family organizations.

Contact the department of social services in the county of residency or the State Adoption Assistance Specialist for questions about availability of and access to services.

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

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.


What mental health services are provided by your State?

Mental health services for children in North Carolina are administered by the DHHS Division of Medical Assistance (DMA) and include the following examples: inpatient and outpatient hospitalization, including treatment in psychiatric hospitals and mental health centers, inpatient and outpatient substance abuse programs, diagnostic services, therapies, physician’s services and prescription drugs. Mental health services may require prior approval before services can be received.

Access the North Carolina’s general Medicaid website.
Eligibility criteria for Medicaid or Health Choice are provided on the DMA website.

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.


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?

Special needs children with chronic mental or physical conditions or illness may receive services in addition to those covered under North Carolina’s Medicaid plan if services are medically necessary and receive pre-certification under Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Contact your Medicaid caseworker for more details on EPSDT.

North Carolina also has adoption assistance vendor payment for medical and therapeutic services, HIV Supplemental Payments, and Supplemental Special Children Adoption Incentive Fund for child with severe medical and rehabilitative needs. Supplemental Special Children Adoption Incentive Fund is limited to county participation and is therefore not available to all children.

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.


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 have the right to appeal a decision any time adoption assistance benefits have been denied, reduced, or terminated. Requests for a fair hearing or appeal of a decision must be made in writing to the local department of social services. Within five days of receiving notification of the request, the county department of social services must notify the parents that a hearing will be held and hold the hearing. A local hearing officer will review the case and render a decision. If the decision is unfavorable to the parents, the agency will advise parents that they can appeal to the state. Parents have fifteen days of the mailing of the agency’s letter to request a State appeal. If parents wish to appeal the agency’s decision, the agency will submit required materials to the State Hearings and Appeals Section. The Hearing Officer will make arrangements with the parents and agency for the date and time of the hearing. Following the hearing, the Hearing Officer will notify the parents of the parents of the decision. If parents are dissatisfied with the decision, their appeal for review can be submitted to the Chief of the Hearings and Appeals Section. If the final decision of the Hearing and Appeals Section is unfavorable to the parents, they can then appeal to North Carolina’s Superior Court, provided such appeal is filed within thirty days of the receipt of the final decision. Contact the local county office for further information.


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

Yes, for children who are IV-E eligible.

  • Does the guardianship assistance program differ from the adoption assistance program? Yes
  • If so, how does it differ? Eligibility is the same, payments differ.


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

A child is eligible for Guardianship Assistance (GAP) when

  • Child has been removed from his/her home pursuant to a voluntary placement agreement or as a result of a judicial determination to the effect that continuation in the home would be contrary to the welfare of the child
  • The Court determines that reunification and adoption are not appropriate permanency options for the child
  • Child is eligible for foster care maintenance payments and has been placed in the licensed home of the prospective legal guardian for a minimum of 6 consecutive months
  • Child is in the placement responsibility of a North Carolina county child welfare agency at the time of entry into the GAP
  • Child is at least 14 years of age, but not older than 18 years of age, demonstrates a strong attachment to the prospective guardian and has been consulted regarding the guardianship arrangement or, the child is not yet 14 years of age but is being placed in a legal guardianship arrangement with a sibling who meets the age requirement, or placed with a sibling who meets eligibility criteria

For additional information, see the North Carolina Department of Social Services, Appendix 3-7. of the Funding Manual.


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

Yes. Traditional kin or someone who has a significant relationship with the child.


If a specific question is not displayed, the State or Territory did not provide a response to that question.