4. 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.)
Alabama offers deferred adoption assistance. Evidence of disability is not required 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 parents.
Alaska offers deferred adoption assistance agreements.
Arizona does not offer deferred adoption assistance. However, an adoption assistance agreement can be negotiated with a $0 maintenance rate.
Arkansas offers deferred adoption assistance.
California offers deferred adoption assistance agreements. If the child is eligible for the Adoption Assistance Program (AAP) and the adoptive family chooses not to apply for the AAP benefits, California requires the responsible public agency to encourage the family to sign a deferred adoption assistance agreement.
Colorado offers deferred adoption assistance. It is known as a 'dormant subsidy' or Medicaid only agreement in which no monetary assistance is immediately given but Medicaid can be received if the parents choose. Documentation of the child’s special needs must be in the service record on file with the county department in order to activate the adoption assistance in the future.
Connecticut does not offer deferred adoption assistance. Connecticut, does, however, have a Subsidy After Finalization. The Subsidy After Finalization option is for children who develop a handicapping condition after adoption finalization that is directly related to conditions existing prior to adoption or genetically related conditions that were undiagnosed at the time of adoption.
Additionally, an adoptive family, whose child is eligible for adoption assistance due to a high risk of developing a diagnosis of a physical, mental or emotional handicapping condition, may opt to for 'medical coverage only.' This means that they choose not to receive monthly Adoption Assistance payments. If their child later develops a diagnosable handicapping condition related to a pre-adoptive risk factor they may be eligible to receive financial assistance in addition to the medical assistance once documentation is submitted to the Connecticut Subsidy Unit.
Delaware offers deferred adoption assistance agreements.
The District of Columbia offers deferred adoption assistance. Deferred agreements are available for children who are at high risk of developing a special need but do not otherwise qualify as special needs. 'High risk' means that a child does not currently evidence a special need but, due to factors in their biological, social, or familial background, are at risk of developing a special need in the future.
Florida offers deferred adoption assistance. If at the time the child is placed for adoption, the adoptive parents choose not to receive adoption assistance for the child, they are encouraged to sign the initial assistance agreement with a payment amount of zero ($0) listed in the agreement. Establishing a deferred adoption assistance agreement preserves future active adoption assistance eligibility for the child in the event that the family needs assistance in meeting the needs of the child.
Georgia offers deferred adoption assistance for children who have been in the permanent custody of the Department of Human Services (DHS). If a child does not meet the definition of a child with special needs prior to adoption finalization and has background factors that may lead to significant medical, physical, or emotional problems in the future, a deferred adoption assistance application is completed by the adopting parent(s). If a significant medical, mental, emotional or physical condition later develops in the child that is related to the background factors, adoption assistance and Medicaid may be instated at the time the condition is known and an agency determination of special needs is made based on documentation from a licensed treatment provider. The benefit would be equal to the amount the child received as a family foster care board rate at the time of the adoptive placement or the foster care maintenance payment amount that would have been paid if the child had been in a family foster home at the time of adoptive placement.
A deferred adoption assistance agreement can also be completed with an adoptive parent(s) who elected to receive supplemental security income (SSI) in lieu of adoption assistance benefits. In these cases, the child was deemed “special needs” prior to adoption finalization, so a subsequent determination of special needs is not required when the parent(s) decides to begin receiving adoption assistance.
Hawaii offers deferred adoption assistance agreements.
Idaho offers deferred assistance. Payments and benefits are established under what is known as 'Agreement Only' assistance where no benefits are paid at the adoptive family’s request. This type of agreement allows families to return to the state at a later date to open the adoption assistance case to obtain benefits and services needed at that time. For children who are eligible for state funded adoption assistance based on the 'at risk' criteria, adoption assistance benefits are not available until such time as the specific disability for which the child is known to be at risk becomes evident. Once an 'at risk' factor becomes evident, the adoptive family must contact the local adoption assistance office to renegotiate/activate the child’s adoption assistance agreement. DHW local offices, link: http://healthandwelfare.idaho.gov/ContactUs/tabid/127/Default.aspx.
Illinois does not offer deferred adoption assistance. Illinois does offer Conditional Adoption Assistance. Conditional Adoption Assistance is available to children adopted before February 1, 2004. To be eligible for conditional adoption assistance, the child must meet all of the eligibility requirements for adoption assistance and have a documented disability or risk factor not evident at the time of the adoption but that may require intervention, treatment or services in the future.
Indiana offers medical-only adoption assistance agreements or agreements where the monetary amount is zero ($0). The amount of the adoption assistance payment is a negotiable matter and payments can range from zero to the maximum payment. Even with a zero payment, Medicaid is provided to the eligible child and adoption assistance agreements are made with the understanding that dollar amounts can be negotiated upon request by the adoptive parents.
The adoptive family may negotiate an Agreement to Future Adoption Subsidy (Form: 470-0762) with DHS prior to finalization in the following situations:
- The child is eligible for subsidy, but the child or family does not currently need assistance
- The child is “at risk” of being determined a child with special needs by a physician, a qualified mental retardation specialist, or a qualified mental health specialist, or a qualified mental health professional
This includes a written qualifying statement from a specified professional to support the at-risk determination.
If the child meets the special needs criteria in the future, the adoptive family may contact the local DHS office and negotiate an Adoption Subsidy Agreement.
In the Agreement to Future Adoption Subsidy, the adoptive family may request reimbursement up to $500.00 for attorney fees and courts costs for the adoption finalization.
Adoption Subsidy Agreement or Presubsidy Agreement (Form 470-0749). This form verifies that family’s rights and responsibilities in an adoptive placement. The Adoption Presubsidy Agreement is used after a child placed in an adoptive placement and prior to the finalization of the adoption. The Adoption Subsidy Agreement is used after the finalization of the adoption. The Adoption Subsidy Agreement outlines the services the child will receive after the finalization of the adoption.
Kansas offers deferred adoption assistance. A child who has been determined to have a 'Guarded Prognosis' and is not currently being treated for a specific disability or condition, may be eligible for assistance if there are factors his/her genetic, health, and/or social background, which indicate that him/her may develop physical, emotional or developmental problems later.
Kentucky does not offer deferred adoption assistance.
Louisiana does not offer deferred adoption assistance. However, there are situations where a family adopts a “special needs” child without a subsidy and later decides that they should have received a subsidy based on a known or unknown pre-existing condition. After it has been determined that the condition would have made the child difficult to place in an adoptive home without the aid of a subsidy, the child would be eligible for a subsidy after the adoption had been finalized. The State Office Adoption Subsidy Program Manager will review request and make the eligibility determination.
Retroactive Adoption Assistance which refers to adoption assistance approved by the Department for special needs children who are adopted without adoption assistance and are later determined to be eligible.
One Payment Assistance which is a one-time, not recurring payment to meet a special need of the child. Examples of not recurring items are payment for an operation necessitated by a medical condition of the child, payment of legal fees for adoption, and payment for special orthopedic devices for a child.
Maryland offers deferred adoption assistance. Deferred adoption assistance is for 'at risk' special needs designations and requires documentation that a potential special needs condition existed at the time of adoption finalization. The request must be related to the condition that would have made the child eligible for adoption assistance but was unknown at the time of adoption.
Massachusetts offers deferred adoption assistance.
The department may defer the financial assistance of a Tile IV-E or state adoption subsidy when a child meets the other adoption criteria, but she/he is at an age that makes it difficult to diagnose a special need impairment, disorder or condition or she/he is at risk of such an impairment, disorder or condition due to her/his birth history or family history prior to placement. The child is initially provided with the medical assistance benefit, but not the financial assistance benefit. The adoptive family may in the future receive a financial assistance benefit if they request a re-determination of the adoption subsidy decision and submit to the Department’s Subsidy Unit documentation from a qualified professional diagnosing the child’s special needs that the child meets the special needs criteria. The deferred subsidy agreement terminates on the child’s 18th birthday unless otherwise amended.
Michigan does not offer deferred adoption assistance.
Minnesota offers deferred adoption assistance payments for children at risk of developing physical, mental, emotional, or behavioral disabilities. When a child’s eligibility for adoption assistance is based on this criterion, a child is categorically eligible for Medicaid, but cash payments are not made under the adoption assistance agreement unless and until the potential disability manifests itself, as documented by an appropriate health care professional.
Mississippi offers deferred adoption assistance. Deferred means, no adoption assistance payment is provided at the time of the adoption; however, due to the documented risk factors in the child’s medical history or background, or the medical history or background of the child’s biological family; the child is at risk to acquire a medical condition, a physical, mental, developmental or emotional disorder. Families will need to submitted current documentation to the agency.
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 the following basic subsidy services:
- Maintenance (daily living expenses including room and board, clothing and incidentals) at base rate to age 18;
- MO HealthNet coverage to age 18 or maximum of age 21 on a yearly negotiated 18+ Agreement; and
- Child Care to age 13 – if both parent(s) /guardian(s) and the single parent/guardian is working
- Respite for the same length of time that maintenance has been approved and consistent with policy units which correspond to the maintenance level approved.
Adoptive parent(s) may decline any or all of these services; guardian(s) may decline services as well, however are required to receive maintenance of at least one dollar.
In the event that services are declined, the parent(s) or guardian(s) must sign a dated statement indicating specifically which 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.
Montana offers deferred adoption assistance.
Nebraska does not offer deferred adoption assistance.
Nevada offers deferred adoption assistance agreements. Adoptive parents may elect to defer financial or medical assistance for an otherwise eligible special needs child until assistance is needed. Eligible children must meet the special needs criteria and Medicaid eligibility criteria at the time of adoption.
New Hampshire offers deferred adoption assistance.
An adoptive family may re-apply for adoption subsidy on behalf of a child placed by CP&P and initially found ineligible for the subsidy benefit. The adoptive family may apply for adoption subsidy at any time after finalization if the child develops problems traceable to his or her genetic heritage or pre-adoptive experiences.
If the child is determined to have special needs, the subsidy is effective retroactive to the date of the date of the re-application, unless the family caused an undue delay (three months or longer) by not providing sufficient documentation in a timely manner.
New Mexico offers deferred adoption assistance.
New York does not offer deferred adoption assistance.
North Carolina offers deferred adoption assistance.
North Dakota offers deferred adoption assistance. A monthly payment may be deferred if agreed upon by the adoptive family and the county. Payment for nonrecurring expenses may be made and Medicaid offered for a family who defers the monthly subsidy. A monthly amount may be negotiated at any point the child’s needs warrant reconsideration.
Ohio offers deferred adoption assistance.
Oklahoma offers deferred adoption assistance. It is referred to as “Agreement only” adoption assistance. “Agreement only” children must meet the special needs criteria or be at risk of developing a special need, and the adoptive family must apply prior to adoption finalization. The application process is the same for deferred adoption assistance as it is for adoption assistance, except that the family indicates on the application that they are requesting “Agreement only” adoption assistance. This means that the family will not receive benefits at the present time but is eligible to receive benefits in the future if needed.
Oregon offers deferred adoption assistance. Deferred adoption assistance agreements provide assurance that the family can request a change in benefits if the need or circumstance arises in the future. The adoptive parents, through the caseworker, must submit an adoption assistance application for what is known as “agreement only” which must be signed by the adoptive parents and the agency prior to adoption finalization.
Pennsylvania does not have deferred adoption assistance agreements. However, if an adoption assistance payment is not required at the time the agreement is signed or negotiated, a $0 payment may be specified in the Adoption Assistance Agreement. This practice allows for renegotiation if the circumstances of the child or adoptive family should change.
Rhode Island offers deferred adoption assistance. A child at high risk of developing a medical condition or a physical, emotional or mental disability, based upon family background or history, may be eligible for deferred adoption assistance, which would include medical assistance without financial assistance. In the event a disability, based upon family background or history, is diagnosed in the future, the child may then be eligible to receive financial assistance. For a child to be eligible to receive deferred adoption assistance, an adoption assistance agreement must be created, signed, and approved prior to the finalization of the adoption. The specific background factor(s) or family history that might place the child at risk for future problems must be included in the adoption assistance agreement.
South Carolina offers deferred adoption assistance. Adoptive parents and the state must sign the adoption assistance agreement prior to adoption finalization with a payment level of zero and eligibility for Medicaid indicated in the agreement. The payment rate can be raised in the future to meet the changing needs of the adopted child.
South Dakota offers deferred adoption assistance. South Dakota will write an adoption assistance agreement prior to finalization which will be held inactive until the adoptive parent requests a review to activate it.
Tennessee offers deferred adoption assistance. Children who do not meet the definition of special needs but are at high risk of developing severe medical or psychological/psychiatric problems in the future are eligible for deferred adoption assistance. The following risks may be considered: (a) any child whose genetic background or birth family (birth mother/birth father) medical history indicates significant potential for developing physical/psychological problems, (b) a drug/alcohol exposed infant, (c) a child who has a history of multiple foster/adoptive disrupted placements of 3 or more due to a documented medical or psychological diagnosis which directly resulted in the disruption. Non-recurring expenses and other benefits/services are not included in Deferred Adoption Assistance. At the point the child exhibits problems related to those identified high risks, the parents may request an activation of the Adoption Assistance Agreement to receive benefits and services to meet the changed needs of the child.
Texas offers deferred adoption assistance only in exceptional circumstances.
Utah offers deferred adoption assistance.
Vermont offers deferred adoption assistance. Children must meet the special needs criteria or be in the high risk category and the adoptive family must apply prior to adoption finalization. Termination of parental rights on both parents must be complete and documentation of efforts to place the child without assistance must be made by the placing agency. Eligibility determinations for deferred assistance are made on a case-by-case basis and children must meet Title IV-E/SSI eligibility criteria.
Virginia offers deferred adoption assistance. Virginia refers to these agreements as “conditional agreements”. Conditional adoption assistance is available when payments and services are not needed at the time of placement but may be needed later. A conditional adoption assistance agreement is granted at the request of the adoptive parents when a child:
- Has a physical, mental, or emotional disability present at the time of placement;
- Has a hereditary tendency, congenital problem or birth injury;
- Could develop emotional or other problems resulting from separation from birth parents, placement in foster care;
- May need help later with daily living expenses; or
- When the child has perinatal drug exposure and when the birth parents medical history is unknown.
A conditional adoption assistance agreement does not provide money payments or services. It is an agreement that allows the adoptive parents to apply for state adoption assistance after the final order of adoption and commits the agency to providing state adoption assistance when the adoptive parents apply, if it is determined that the need is related to one of the conditions described above. Children for whom services are requested after final order of adoption are not eligible for Medicaid through adoption assistance unless a conditional adoption assistance agreement was signed before the entry of the final order of adoption and the signed agreement documents the children’s medical and rehabilitative needs. The documentation must be from a qualified professional such as a physician, psychiatrist, psychologist, or licensed therapist.
Washington offers deferred adoption assistance. Adoptive parents can enter into an adoption assistance agreement with a zero amount (no payment) in the same way they enter into an Adoption Assistance agreement.
West Virginia offers deferred adoption assistance. The child must be in the custody of the Department or a licensed West Virginia Child Placing Agency and at risk of developing a special need in the future. At risk is defined as having a significant statistical or medical probability of occurrence that is not merely speculative. Several factors may be considered for the deferred determination of potential special needs when the child is healthy, developmentally on track at time of placement, appears emotionally stable, and does not seem to meet the criteria for special needs prior to adoption finalization. Factors for consideration include
- A child with a birth family history of mental illness, mental retardation or incest
- A child who is developmentally on track but has a significant risk factor which may present itself at a later date
- A child who is displaying normal behaviors at time of placement but who has a reported history of physical or sexual abuse, and neglect, or has had multiple failed placements
- The child is a state ward
In Wisconsin, a child in the guardianship of an adoption agency who does not have a known special need, but who is at high risk of developing special needs may have an adoption assistance agreement in the amount of $0.00. The amount specified in the agreement is effective the month of adoption finalization.
If special needs can be documented twelve months or more from the date of adoption a new, time-limited, rate may be established via an amendment to the adoption assistance agreement. Questions regarding adoption assistance amendments may be directed to the Department of Children and Families, Adoption Services Section, toll-free at 866-666-5532.
Wyoming does not offer deferred adoption assistance. However, if the child was adopted from the State of Wyoming foster care system, a minimal adoption assistance agreement is already in place and can be adjusted in the future if necessary. Also, children are able to receive "Medicaid only" adoption assistance agreements. Under such agreements, Medicaid is received without a monthly monetary payment.