Ala. Admin. Code r. 660-5-22-.06

Current through Register Vol. 43, No. 1, October 31, 2024

Section 660-5-22-.06 - Subsidized Adoption

(1) Adoption subsidy is provided to facilitate the adoption of children with special needs by assisting with the removal of financial barriers to adoption. Adoption subsidy may be provided to children who meet special needs criteria, as well as other eligibility requirements described herein. Adoption subsidy encompasses the principles of the Department's practice model including permanency, stability, well-being, individualized services that are family centered and culturally responsive, community collaboration and professional competence. Adoption subsidy promotes the timely achievement of permanency for children and, through appropriate planning, promotes the opportunity for children to experience love, feelings of belonging and nurturing in a family environment. Adoption subsidy supports the practice of providing family centered and culturally responsive adoptive placements for children.

(2) Requirements and procedures of adoption subsidy are

(a) In order to qualify for adoption subsidy children must meet all four of the following criteria:

1. The child must be legally free for adoption and the Agency/Department have determined and documented that a child cannot or should not be returned to the home of his parents. For Department cases, this is accomplished through the Individual Service Plan and before the permanency goal of adoption is agreed upon. In most cases, termination of parental rights is the last step in meeting this requirement.

2. Children must be determined as having special needs. Adoption subsidy is predicated on the belief and assumption that children with special needs require more than ordinary parental duties from the adoptive parents; that children with special needs usually incur extra expenses; and that parenting children with special needs is more challenging that parenting children without special needs. It is the responsibility of the child's DHR social worker to determine whether the child being placed for adoption has special needs and there are special circumstances that make adoption unlikely without a subsidy. It is reasonable to conclude that the child cannot be placed for adoption, due to a specific factor or condition, without providing adoption subsidy and/or medical assistance through Medicaid. One or more of the following conditions must exist for a child to be determined as having special needs.

(i) Physical or mental disability must have been documented in the record as evidenced by a licensed medical doctor or qualified mental health professional. Normal childhood illnesses do not meet this criterion. Physical disability is defined as a chronically debilitating, progressive, or fatal disease which requires assistance for the child in activities of daily living or requirement of assistance of another person or mechanical device for movement from place to place. Mental disability is defined as a condition which is characterized by impaired intellectual development and impedes the ability to function independently as diagnosed by a licensed medical doctor or qualified mental health professional.

(ii) The child has a known emotional disturbance/ behavioral issue that requires on-going treatment and that has been documented by a mental health professional. Emotional disturbance is defined as an emotional condition which impedes the child's ordinary developmental progress as diagnosed by a medical doctor or qualified mental health professional.

(iii) The child has known and documented factors that place the child at recognized high risk of developing a physical or mental disability at a future time. At the time of placement, the child may not have a documented diagnosis or show any signs of a physical or mental disability. Nonetheless, there are known and documented factors, which are captured in the non-identifying background summary, that place the child at high risk for developing such conditions. Money payment is deferred until the onset of symptoms, but the adoption subsidy agreement must be signed and in effect at the time of placement or prior to the final decree of adoption. High risk of a physical or mental disease means a potentially debilitating condition as diagnosed by a licensed medical doctor or qualified mental health professional.

(iv) Children who are five (5) years of age or older.

(v) The child is a member of a sibling group of two (2) or more being placed for adoption in the same home at the same time.

(vi) A child has racial or ethnic factors that make it unlikely that the child will be adopted without a subsidy. Documentation of how the child's racial or ethnic factors prohibit him/her from being adopted without subsidy must be submitted to the Office of Permanency, Family Services Division. Concurrence must be received from the Office of Permanency prior to the Department entering into any adoption subsidy agreement based on this criterion. Race and ethnicity includes, but is not limited to, African American, Hispanic, Native American, Asian, or other heritage which may prevent a child from being adopted.

3. In most cases, at the time of initiation of adoption proceedings, a child should be in the care or custody of the Department or a public or private child placement agency through on of the following:

(i) a voluntary placement agreement; or

(ii) a voluntary relinquishment; or

(iii) an involuntary removal of the child from the home in accordance with a judicial determination that remaining in the home would be contrary to the welfare of the child. The term "care" refers to the responsibility vested in the Department or public or private agency with such responsibility encompassing the planning provided by the Department or agency when the child has a permanency goal of adoption

4. Reasonable efforts must be made to locate an adoptive resource for a child without benefit of an adoption subsidy or medical assistance under Medicaid, except where it would be contrary to the child's best interests because of the existence of significant emotional ties with the prospective adoptive parents while in the care of these parents as a foster care child. In cases involving foster parents, where there is evidence to support the existence of potential detriment to the child by severing emotional ties with the foster parents who are prospective adoptive parents, no evidence is necessary that reasonable efforts have been made to place the child without subsidy. In such situations, the ISP team should determine that it is in the child's best interest to remain in a home which could not be an adoption resource without an adoption subsidy and medical assistance. Reasonable efforts to locate adoptive parents who can accept the child without a subsidy are not required for foster parent adoptions when there are significant emotional ties that make it in the child's best interest to remain in the foster/adoptive home.

When the Department has placement responsibility for a child with a permanency goal of "adoption with an unidentified resource", it is necessary to register children with local, regional and national adoption exchanges; publicize the need for adoptive homes in general and for specific children; and make referrals to specialized public or private agencies.

(3) Types and Categories of Adoption Subsidies The Department of Human Resources is designated to administer both the federal and state adoption subsidy programs. Federal title IV-E adoption subsidy is the preferred category. Financial eligibility for both federal IV-E and state adoption subsidy is determined by the State Department Office of Child Welfare Eligibility, Family Services after the initiation of a request by the child's worker. In determining a child's eligibility for either federal or state adoption subsidy, there is no means test for the prospective adoptive parents.

(a) Title IV-E Federal Adoption Subsidy - Title IV-E adoption subsidy provides a monthly subsidy payment, eligibility for Medicaid benefits, Title XX services, and payment for non-recurring adoption expenses. In addition to those children who have been eligible for IV-E foster care maintenance payments and thus IV-E adoption subsidy payments, there are two other groups of children who may considered for federal adoption subsidy benefits. These two groups would not have been eligible for IV-E foster care maintenance payments, but may be IV-E eligible for the purpose of adoption subsidy only. These two groups are the "applicable child" and "non-applicable child."

1. The term "applicable child," as used in adoption subsidy, describes a child who was determined ineligible for IV-E foster care maintenance payments because the child did not meet the former AFDC eligibility points at entry into care, but the same child may now be eligible for federal IV-E adoption subsidy payments. The term "applicable child" is based on the age of the child in the year the adoption subsidy agreement is entered into. The concept of "applicable" children for adoption subsidy is being phased in over a nine year period from 2010 to 2018.

(i) The applicable child must meet the following requirements at the time of initiation of adoption proceedings.

(I) The applicable child is in the care of the Department, a licensed public or private child placement agency, or an Indian tribal organization when adoption proceedings are initiated; and

(II) The applicable child is in care pursuant to an involuntary removal of the child from the home in accordance with a judicial determination to the effect that continuation in the home would be contrary to the welfare of the child; or

(III) The applicable child entered care pursuant to a voluntary placement agreement or a voluntary relinquishment. If a child entered care through the method of a voluntary placement agreement that child must actually have received at least one title IV-E foster care maintenance payment to be eligible for federal IV-E adoption subsidy.

(ii) Applicable children may also be eligible for federal title IV-E adoption subsidy in certain other conditions.

(I) The applicable child meets all medical and disability requirements of title XVI with respect to eligibility for Supplemental Security Income(SSI) benefits; or

(II) The applicable child was residing in the same placement with the child's minor parent who is IV-E eligible and a foster care child in placement through an (a) involuntary removal of the minor parent child from the home in accordance with a judicial determination that continuation in the home would be contrary to the welfare of the child, or (b) a voluntary placement agreement or voluntary relinquishment; or

(III) A child of any age who has been in foster care under the Department's responsibility for at least 60 consecutive months (5 years) at the time an adoption subsidy agreement is entered into is considered an "applicable child." These children must meet the requirements of being in the Department's care at the initiation of adoption proceedings; have best interest language in the first court order; or entered into care through voluntary agreement or voluntary relinquishment.

(IV) Any age sibling(s) of an applicable child who meets special needs criteria in their own right and who is placed in the same adoption placement of the applicable child may be considered eligible for federal IV-E adoption subsidy. Sibling(s) must meet the requirements of being in the Department's care at the initiation of adoption proceedings; have best interest language in the first court order, or have entered into care through a voluntary agreement or voluntary relinquishment and meet the definition of "special needs" in his own right.

2. The child who does not yet meet the age for being phased in as an applicable child is referred to as "non-applicable child." This group of foster care children have been determined ineligible for IV-E foster care maintenance and have not yet reached the age requirements nor does the child meet the other avenues for IV-E eligibility. This child continues to have the eligibility requirements in place prior to the implementation of the "applicable" and "non- applicable" concept of eligibility. The "non-applicable child" must meet the following requirements to be eligible for federal IV-E adoption subsidy.

(i) Be removed from the home of a specified relative or had been living with a specified relative within the past six months and placed in foster care in accordance with a judicial determination to the effect that continuation in the home would be contrary to the welfare of the child, or

(ii) Be removed from the home of a specified relative or had been living with a specified relative within the past six months and placed in foster care in accordance with a voluntary placement agreement and received at least one title IV-E foster care maintenance payment while under the voluntary placement agreement.

(iii) The non-applicable child must meet the requirements with respect to the former AFDC program of July 16, 1996, or

(iv) The non-applicable child must meet all of the requirements of title XVI with respect to Supplemental Security Income benefits, or

(v) Be a child of a IV-E eligible foster care child, living in the same placement and whose payments in foster care are IV-E foster care maintenance payments, or

(vi) Be child who was eligible for title IV-E adoption subsidy in a previous adoption which is dissolved or the adoptive parents have died. Verification of the child's special needs determination and previous IV-E eligibility is required.

(vii) The Department must have determined the child to be a child with special needs.

3. It is possible that a child, who was ineligible for title IV-E foster care maintenance payments due to the absence of "reasonable efforts" language being included in the initial court order or a court order issued within 60 days of entering care, could be eligible for IV-E adoption subsidy. "Reasonable efforts to prevent removal" language in the initial court order or a court order issued within 60 days of entering care is not a requirement for IV-E adoption subsidy payments." The Department makes this determination.

(b) State Adoption Subsidy - State adoption subsidy provides a monthly subsidy payment. To be eligible for State adoption subsidy, the child must meet the criteria for special needs and have private income less than the age appropriate foster care maintenance payment. Medicaid is also available for certain children who meet criteria established to determine the need for medical or rehabilitative care. The federal subsidy for non-recurring expenses is also available to all children eligible for State Adoption Subsidy. State adoption subsidy continues up to age nineteen (19) years (age of majority). If the child is still in high school with a goal of graduation, the state adoption subsidy may continue until the child graduates from high school, is no longer enrolled in high school, or attains the age of 21, whichever comes first.

1. The Department assures that health insurance for special needs children for whom there is an adoption subsidy agreement between the state and the children's adoptive parent(s) is available. The Department recognizes that special needs children are likely to need continued medical, mental health or rehabilitative care. Health insurance can be title XIX Medicaid or a comparable medical plan. If the child does not qualify for Medicaid, there must be documentation that the adoptive parents can and will provide private health insurance for the adoptive child. Private health insurance meets the requirement for the child to have health insurance coverage.

2. A child is eligible for state adoption subsidy Medicaid when both of the following criteria are met.

(i) At the time the adoption subsidy agreement is negotiated, the child who was eligible for Medicaid under the State's approved Medicaid plan for foster care children will be eligible for Medicaid through the adoption subsidy Medicaid. If the child was not eligible for Medicaid while in foster care and at the time the adoption subsidy agreement was negotiated, a determination must be made of whether the child would be eligible for Medicaid if the standards and methodologies of the title IV-E foster care program were applied, rather than the former AFDC standards and methodologies that are applied to state foster care Medicaid. If the child is not eligible for one of the foster care Medicaid categories and the adoptive parents cannot or will not provide health insurance, eligibility for SOBRA Medicaid and ALLKids is explored.

(ii) It has been determined that an adoptive placement without medical assistance cannot be made because the child has known, pre-existing and on-going needs which are professionally documented for medical, mental health, or rehabilitative care.

3. When establishing a child's need for continued medical, mental health or rehabilitative care, a child's conditions, potential or actual, that would cause or deter the child's adoption without Medicaid/health insurance coverage are considered. These conditions include, but are not limited to the following ;

(i) the child's need for regular prescription medication;

(ii) pre-existing non-routine medical conditions at the time of placement;

(iii) emotional or behavioral disorders requiring on-going treatment;

(iv) need for on-going speech, physical or other rehabilitative therapies;

(v) need for day treatment or special education services that cannot be provided through the educational system;

(vi) need for nursing care or other specialized medical or rehabilitative services;

(vii) the child's known and professionally documented high risk background which could increase the likelihood of serious medical, emotional or adaptive problems in the child's future but onslaught of symptoms can be expected while the child is still a minor.

4. A child's Medicaid eligibility continues as long as the adoption subsidy is in effect. If the state adoption subsidy is continued beyond age nineteen, Medicaid is also extended. However, if Medicaid eligibility is based on receiving state adoption subsidy, the Medicaid cannot extend beyond the child's twenty-first birthday.

5. If a child who receives a state adoption subsidy and Medicaid moves to another state, the Medicaid may be reciprocated by the new resident state provided the Interstate Compact on Adoption and Medical Assistance procedures are followed.

(4) Non-Recurring Adoption Subsidy Expenses - One time adoption expenses include reasonable and necessary expenses 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 have not been reimbursed from other sources or other funds. All children eligible for an adoption subsidy, either federal or state, are eligible for a federal non-recurring subsidy.

The Department may reimburse adoptive parents an amount up to $1000 per child for reasonable and necessary non-recurring expenses associated with the finalization of adoption of children eligible to receive subsidy. Specified procedures for reimbursement of adoptive parents for non-recurring expenses require adoptive parent to submit to the County Department the following:

(a) A written request for reimbursement of payment filed no later than twelve months from the date of the final adoption decree;

(b) Original paid receipts;

(c) An itemized bill listing the full name of the child, date of service, and items or services received; and

(d) A copy of the Final Adoption Decree.

The County Department is responsible for reviewing all documents for accuracy and submitting them to the State Department within fifteen months of the final adoption decree for processing and reimbursement. Reimbursement is made directly to the adoptive parent.

Direct payment for non-recurring expenses may be made directly to an attorney for the provision of non-recurring legal expenses associated with the finalization of an adoption as all or part of the maximum amount of $1000 for non-recurring expenses. For direct payment, a representing attorney must submit to the State Department within 12 months of the date of the final adoption decree the following documentation:

1. A written request for payment submitted no later than twelve months from the date of the Final Decree;

2. An original itemized bill which contains the full name of the child for whom services were rendered. The adoptive parent must sign the original bill confirming the provision of services and indicate agreement for payment to be made directly to the attorney.

3. A current Request for Taxpayer identification Number and Certification (W-9); and

4. A copy of the Final Adoption Decree.

(5) State Medical Time-Limited Subsidies - A state funded medical subsidy payment is a special needs subsidy that is limited to the time period of the needed service, and may involve a one-time payment or several payments. The adoptive family's medical insurance and other public and voluntary community resources must be explored to determine whether treatment and related costs can be covered without a subsidy. Prior approval by the State Department is to be secured for a state funded medical subsidy before the adoptive placement and before completion of the adoption subsidy agreement. The two types of state funded time limited medical subsidy are counseling services and orthodontia services subsidy.

(a) A state funded medical subsidy may be awarded at the Medicaid rate for outpatient counseling only in the following situations.

1. A child is in therapy with a non-Medicaid provider at the time of a foster parent adoptive placement; or

2. There is no Medicaid provider located in close proximity to the child at the time of placement in a non-foster parent adoption; or

3. Payment is made at the Medicaid rate and is secondary to private insurance.

Prior to any payment for counseling services being made the following process must occur. Known and documented pre-adoptive issues are the focus of state funded therapeutic counseling services. Professional documentation of the child's need for therapeutic counseling services is submitted to the State Department for approval. Psychological evaluations used to substantiate need must be current to within six months of the request for therapeutic counseling services. Written approval from the State Department is to be received before negotiation and completion of the adoption subsidy agreement.

Counseling services may be awarded for a maximum of one year. Should a child receive such services for a year but continue to need the service, professional documentation regarding current circumstances is submitted to the State Department. The professional documentation must be based on pre-adoptive issues which warrant continuation of counseling subsidy beyond one year. Verification that there is no Medicaid provider within reasonable proximity to the child and family is necessary.

(b) A state funded medical subsidy may be made for orthodontia services if the work is determined to be medically necessary and is in progress or is set to begin within ninety days of adoptive placement. Prior to adoptive placement, the State Department must provide to the county department written approval for the orthodontia services that is based on the orthodontist's professional documentation of medical necessity and a written estimate of the costs of the services. Orthodontia services should be completed prior to legal finalization of the adoption.

(6) Adoption Subsidy Amounts - The amount of the adoption subsidy is determined case by case, through negotiation and agreement with the adoptive parents and the Department, and considers the adopting parent's circumstances and the needs of the child being adopted. The amount of adoption subsidy cannot exceed the foster care maintenance payment that would have been paid during the same period if the child had been in a foster family home. A child's private income is considered in negotiation of the adoption subsidy amount. The amount of the actual adoption subsidy payment may be less that the Department's standard foster care maintenance payment because the child's income is considered in the negotiation of the adoption subsidy amount, as it was also considered in the actual foster care maintenance payment. The amount the prospective adoptive parents will receive should consist of the adoption subsidy payment plus the child's private income. It is the responsibility of the Department to notify the source agency of the child's private income that the child will be receiving an adoption subsidy and whether the adoption is a federal IV-E subsidy or a state subsidy.

(a) The rate structure of adoption subsidy payments is based on the type of care the child received while in foster care prior to adoptive placement. The rate structure for adoption subsidy is consistent with the premise that any child receiving adoption subsidy is a special needs child who may have greater than ordinary or usual care needs. The Department's various foster care rates are considered as supplements to the basic foster care maintenance payment and therefore the rate structure for adoption subsidy payments is consistent with the rates that would have been paid, including the supplements had the child remained in foster care.

1. Regular subsidy rate is paid for children who meet the special needs criteria and for whom a determination has been made that the child would be unable to be adopted without the adoption subsidy payment. This is a negotiated rate and can never exceed the amount the child would have received for basic foster care maintenance.

2. Level One Difficulty of Care adoption subsidy is paid for the child who received a Level One Difficulty of Care foster care maintenance payment prior to the adoptive placement. In addition to the regular adoption subsidy rate, the child may receive a $50.00 Level One Difficulty of Care adoption subsidy payment. This rate is negotiated and approved by county departments.

3. Therapeutic adoption subsidy payments may be available to assist families who are adopting a child with emotional and behavioral needs which require additional therapeutic services to meet the child's needs and to prevent the likelihood of requiring a more restrictive setting. The State Department approves a therapeutic adoption subsidy payment. The need for therapeutic adoption subsidy must exist at the time of the adoptive placement or be linked to documented information regarding the child's background and circumstances prior to adoptive placement. Criteria for a therapeutic adoption subsidy are:

(i) Eligibility for State or Federal Adoption Subsidy;

(ii) A diagnosis from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) current to within six months of application;

(iii) Behaviors that may pose a risk of serious harm to self or others through the display of aggressive and/or delinquent activities, destructiveness, resistance to authority, sexual disturbance and are present at the time of the request;

(iv) Behaviors exhibited in more than one setting; and

(v) Additional services required to meet the therapeutic needs of the child includes, but is not limited to, substitute care, 24 hour awake supervision, intensive therapy or psychiatric services that focus on therapeutic issues not managed through medication and that routinely requires more than two or more visits per week.

Supporting professional documentation is required for approval of therapeutic adoption subsidy rate and must be current to within six months of the request for therapeutic adoption subsidy rate. Documentation for the approval of therapeutic adoption rate includes, but is not limited to, psychiatric or psychological evaluations; therapist progress notes indicating therapeutic efforts and outcomes; treatment plans; educational records; health records; and Multi-Systemic Assessment Tool (MAT) where available.

Children eligible for and receiving state funded therapeutic adoption subsidies are subject to having their continued need for therapeutic adoption subsidy reviewed. Current information and documentation is required to determine whether a child's need for state funded therapeutic adoption subsidy continues to exist. If supporting documentation no longer substantiates that a child requires therapeutic care, the state funded therapeutic adoption subsidy rate may be changed. The amount of the state funded adoption subsidy rate should be re-negotiated with the adoptive parent(s) and changed to the basic age appropriate adoption subsidy rate based on the child's current needs. The special need that originally established the child as a special needs child for adoption subsidy purposes is not to be reviewed. There is no review of children who receive a federal IV-E therapeutic adoption subsidy.

Therapeutic adoption subsidy rate and a counseling subsidy cannot be awarded at the same time, because counseling is a service provided as part of therapeutic services and is included in the therapeutic adoption subsidy rate.

4. Medically fragile adoption subsidy payments may be approved for children with special health care needs related to chronic physical, developmental, behavioral or emotional conditions. Prior to adoptive placement, there must be a determination that the child continues to require medically fragile care received while in foster care placement and that adoption is not likely to occur without a medically fragile adoption subsidy.

Approval of medically fragile adoption subsidy is made by the State Department. There must be current supporting professional documentation regarding the need for medically fragile adoption subsidy. Current supporting professional documentation includes a letter of professional assessment, completed within three months prior to the request, by the child's attending physician)s) specifying the child's diagnosis and prognosis and defining what extra-ordinary and specialized care and medical treatment the child requires.

Children eligible for and receiving state funded medically fragile adoption subsidies are subject to having their continued need for medically fragile adoption subsidy reviewed. If the child no longer needs medically fragile care, as supported by professional documentation, the amount of adoption subsidy payments is re-negotiated and changed to the appropriate adoption subsidy amount based on the current needs of the child, but not to exceed the age appropriate standard foster care maintenance payment. There is no review of children who receive a federal IV-E medically fragile adoption subsidy.

Medically fragile subsidy rate and a counseling subsidy cannot be awarded at the same time because counseling is a service provided under the medically fragile services and included in the medically fragile adoption subsidy rate.

(7) Child's Private Income and Amount of Adoption Subsidy payment - A child's private income may be from various sources and must be considered when an adoption subsidy agreement is negotiated with the prospective adoption parents. The source of the income determines how the child's private income is managed.

(a) A child eligible for and receiving Supplemental Security Income (SSI) benefits meets the definition of a child with special needs relative to adoption subsidy. There are no additional criteria that a child must meet to be eligible for a federal IV-E adoption subsidy when eligibility is based on meeting SSI requirements. In negotiating an adoption subsidy agreement for a child who receives SSI benefits, it is necessary to consider the monthly SSI payments in establishing the child's specific adoption subsidy amount. If the amount of the child's monthly SSI is equal to or greater than the regular adoption subsidy payment rate, a regular adoption subsidy payment is deferred and this is noted on the Adoption Subsidy Agreement.

Adoption subsidy payments are not deferred for children receiving SSI and approved for either therapeutic or medically fragile adoption subsidy payments. The SSI is used to make the regular adoption subsidy payment while the medically fragile or therapeutic adoption subsidy payment is made separately.

After the adoption becomes final, the adoptive parents may apply for the child's SSI to continue, taking into account the adoptive parents' income. It is the responsibility of the adoptive parents to inform the Department of the decision from Social Security Administration to continue SSI benefits for the child. Although the adoptive child's SSI may terminate at the adoption finalization, Medicaid continues for twelve months after the SSI terminates. After twelve months of continued Medicaid, the Department certifies to Alabama Medicaid federal adoption Medicaid eligibility.

(b) Social Security and Veteran's Administration (VA) Benefits - If a child receives Social Security or VA benefits and meets the criteria for special needs, either a federal or state adoption subsidy agreement may be entered into, depending upon the child's eligibility for IV-E. Social Security and veterans benefits can continue after finalization of the adoption and should be considered in negotiations on the amount of the adoption subsidy.

(c) A child may have private income which is inaccessible to the child until attaining the age of majority. The exact circumstances determines whether the child is eligible for a federal IV-E adoption subsidy or a state adoption subsidy.

(8) Adoption Subsidy Agreements - The Department has the responsibility for informing prospective adoptive parents about the availability of adoption subsidy for the adoptive child. The Department is responsible for negotiating the amount of the adoption subsidy and to complete the adoption subsidy agreement. Such agreement should be completed and signed by the adoptive parents and the County Department Director or Agency Designee at the time of adoptive placement but must be signed prior to the final decree of adoption. Payments will not begin until the adoption subsidy agreement is signed by the child's worker and the adoptive parents.

(a) An adoption subsidy agreement is a written agreement, binding on all parties, between the Department and the prospective adoptive parents. Adoption Subsidy Agreements must meet the following requirements:

1. Signed by the adoptive parents and the child's worker at the time of adoptive placement, but no later than the final decree of adoption;

2. Be in effect before any adoption subsidy payments are made;

3. Specify the duration of the agreement;

4. Specify the nature and amount of any payment, services, and assistance to be provided under the agreement;

5. Specify the child's eligibility for Medicaid and title XX services;

6. Specify that the agreement remains in effect regardless of the State of residence of the adoptive parents; and

7. Specify that if the adoptive parents move to another state and needed services specified in the agreement are not available in the other state, the Department is financially responsible for providing the specified service(s).

(b) Prior to negotiating the adoption subsidy agreement with the prospective adoptive parents, the following steps must occur:

1. The child is established as meeting the special needs adoption subsidy criteria;

2. The category of eligibility is verified as either federal or state adoption subsidy;

3. Determination of whether child meets the criteria for state adoption subsidy Medicaid, if child did not receive Medicaid in foster care;

4. Determination of whether a child who was receiving therapeutic or medically fragile foster care payments can be adopted without the continuation of such payments. If the determination is that the child cannot be adopted without the continuation of such payments, prior approval from the State Department must be requested and received for the therapeutic or medically fragile rate of adoption subsidy.

5. If the child needs counseling or orthodontia subsidy, prior approval must be requested and approved by the State Department before negotiation the adoption subsidy agreement.

(c) Appropriate adoption subsidy forms must be completed and signed by the adoptive parents and the Department representative. A copy of the signed agreement must be provided to all parties to the agreement.

(9) Special Subsidy Situations - Federal IV-E adoption subsidy regulations provide circumstances under which a child may continue to be eligible for federal IV-E adoption subsidy.

(a) A child who was eligible for a IV-E adoption subsidy at the time of a prior adoption shall be treated as meeting the requirements for a federal IV-E adoption subsidy in the following situations;

1. After the final adoption decree is issued, the adoptive parent's rights are terminated and the adoption is dissolved; or

2. The adoptive parent(s) dies; and

3. The child would not meet the IV-E requirements for a non-applicable child at the time of the adoption dissolution, but would meet such requirements if the prior adoption were treated as never having occurred; and

4. The child meets the criteria for special needs.

(b) In the case of an applicable child whose adoption has dissolved, the child meets the requirements for a federal IV-E adoption subsidy in the following circumstances.

1. The child is available for adoption because the parental rights of the adoptive parents have been terminated; or

2. The child's adoptive parents have died; and

3. The child meets the criteria for special needs.

(c) Any eligible child for whom there is a federal adoption subsidy agreement in effect is eligible for Medicaid in the State in which the child remains. Should a child receiving a federal IV-E adoption subsidy move with the adoptive family to another state, Medicaid is awarded in the new state of residence. Medicaid in these situations is issued in the child's new state through the Interstate Compact on Adoption and Medical Assistance (ICAMA).

(d) A child who is in a legal guardianship arrangement and has been receiving kinship guardianship payments, for purposes of determining financial eligibility for adoption subsidy payments, is treated as never having received kinship guardianship payments. The placement of such child with the relative guardian involved and any kinship guardianship payments made on behalf of the child shall be considered never to have been made, relative to the child's financial eligibility for adoption subsidy payments. However, the adoptive child must meet all adoption subsidy requirements including "special needs." A child who has been in a legal kinship guardianship arrangement and that arrangement is dissolved and the plan for the child is adoption, that child must meet the special needs criteria established for the Adoption Subsidy Program.

(e) Children placed for adoption by a licensed public or private child placing agency (LCPA) may be eligible for a federal IV-E adoption subsidy and a non-recurring adoption subsidy payment if the child meets the adoption subsidy criteria. The LCPA is responsible for submitting evidence of eligibility to the State Department of Human Resources for a determination of eligibility. State DHR negotiates the adoption agreement with the prospective adoptive parents and administers the subsidy agreement. The LCPA shall continue supervisory responsibilities until the final adoption decree is issued.

(f) A child who is independently placed for adoption may be eligible for an adoption subsidy if:

1. The child is eligible for Supplemental Security Income (SSI) at the time the adoption petition is filed; or

2. The child received title IV-E adoption subsidy in a previous adoption which is now dissolved and the adoptive parents' rights have been terminated, or the adoptive parents are deceased and the child continues to meet the special needs criteria.

(g) Both federal and state adoption subsidy programs are intended to move special needs children out of the foster care system and into permanent hones. No adoption subsidy payment can be made in the case of an international adoption to

1. A child who is not a citizen or resident of the United States; or

2. A child adopted outside of the United States or was brought into the United States for the purpose of being adopted and could be considered a child with special needs.

3. The only exception to the international adoption exclusion is if the initial international adoption of the child by the adoptive parents fails and the child is subsequently placed into foster care. The child would then be required to meet all of the adoption subsidy requirements.

(10) Periodic Review of Adoption Subsidy Payments

(a) It is the responsibility of the adoptive parents who are receiving adoption subsidy payments to keep the Department informed of the adoptive child's circumstances which may make the child ineligible for payments or eligible for a different amount of payment. In specific circumstances, a periodic review may be necessary. The special needs that qualified a child for adoption subsidy are always considered to exist and are never re-considered in any review of adoption subsidy. The adoption subsidies that may be reviewed are

1. State funded medically fragile or state funded therapeutic adoption subsidy payments may be reviewed. Adoptive parents may receive a request for information that may impact the adoption subsidy payments. Professional documentation from the child's doctors and/or therapists specifying the child's diagnosis, prognosis and the specialized care or services the child continues to require must be provided to the Department.

(i) If the information received by the Department indicates a substantial change in the conditions that caused a need for state funded medically fragile or therapeutic adoption subsidy, from when the adoption subsidy agreement was signed, the department may, after notice to the adoptive parent(s) modify the state funded adoption subsidy agreement, services, subsidy payment or any combination of these.

(ii) If the above information is not received, the state funded medically fragile or therapeutic adoption subsidy payment is subject to being reduced to the regular adoption subsidy rate. The adoptive parent should receive notice of any change in the adoption subsidy payment rate and may request a review if the child's current circumstances. The age appropriate regular adoption subsidy payment is not impacted by a change in the state funded medically fragile or therapeutic subsidy.

2. State funded counseling services can only be extended beyond one year if the adoptive parents submit professional documentation that supports and verifies the need to continue state funded counseling 4.services. There must also be verification that no Medicaid provider is within reasonable proximity to the child and family.

3. A state adoption subsidy for a child past the child's nineteenth birthday must be approved for extension during the month that the child turns nineteen. Thereafter, it must be reviewed annually. The State Department is responsible for sending the adoptive parent(s) review/report forms. Adoptive parents must inform the State Department if the child is still attending high school and submit documentation on the school or school system's letterhead verifying enrollment and anticipated date of graduation.

4. Title IV-E adoption subsidies for children age 18 up to 21 must be approved during the month the child turns 18 and annually thereafter until the child reaches 21. The State Department is responsible for sending review/report forms to adoptive parent(s). It is the responsibility of the adoptive parents to inform the State Department if the child remains in the adoptive parents' care and continues to meet criteria for the extension of IV-E Adoption Subsidy as outlined in the forms sent to the adoptive parents. Supporting professional documentation that verifies how the child meets the criteria for continuing the IV-E Adoption Subsidy must be sent to the State Department.

(11) Continuation of Adoption Subsidy Payments and Other Changes

(a) Alabama has elected to continue federal IV-E adoption subsidy payments and Medicaid for certain IV-E eligible children after age 18 and up to age 21 who meet certain criteria. The State Department is responsible for working with adoptive parents to determine whether federal IV-E adoption subsidy can continue after age 18 and up to age 21. In order for federal IV-E adoption subsidy payments to continue after age 18 and up to age 21, professional documentation must be submitted to the State Department substantiating that one of the following conditions exist.

1. The adoptive child is determined by a doctor to be physically or mentally disabled; or

2. The adoption subsidy agreement was entered into after the child attained the age of 16 and one of the following criteria applies to the child:

(i) Currently enrolled in high school; or

(ii) Participating in GED preparation classes; or

(iii) Currently enrolled in a college or a university, full or part time; or

(iv) Currently enrolled in a vocational or trade school; or

(v) Participating in Job Corps; or

(vi) Participating in classes on resume writing and intervies skills; or

(vii) Employed at least 80 hours per month (could be employed full time or part time, at one or more employers); or

(viii) Incapable of participating in any of the above activities due to a medical condition; or

(ix) Other category is included to capture exactly what activity the child may be involved that pertains to education and employment.

(b) Alabama has elected to continue state adoption subsidy, and if applicable Medicaid, for certain children after age 19 and up to age 21 if the child is still in high school with a goal of graduation. Documentation of enrollment in a viable high school program on school letterhead is required along with anticipated date of graduation. State adoption subsidy will continue until the child graduates from high school or attains the age of 21, or is no longer in high school, whichever comes first.

(c) Adoption subsidy payments may increase due to a child reaching certain age ranges. The age ranges are 0-2, 3-5, 6-12, and 13-18. Age appropriate payment increases should be made annually. Adoption subsidy payments may increase if the legislature grants an across the board increase in foster care board rates.

(d) Adoptive parents should immediately notify the State Department in writing or through electronic mail when there is a change of address. Adoption subsidy payments are not forwarded.

(12) Termination of Adoption Subsidy Payments

(a) Once a child has been determined eligible for a federal IV-E adoption subsidy, the child remains eligible and the adoption subsidy payment continues, unless one of the following circumstances occurs.

1. The child reaches the age of 18 and does not meet the requirements for "Continuation of Federal IV-E Adoption Subsidy Payments After Age 18;" or

2. The child continued to receive a federal IV-E adoption subsidy past age 18 due to a documented mental or physical disability, but has now attained the age of 21; or

3. The adoptive parent(s) are no longer legally responsible for the support of the child who has not attained the age of 18; or

4. The child is no longer receiving support from the adoptive parent(s); or

5. The child becomes legally emancipated; or

6. The child dies; or

7. The child's adoption is terminated, either through disruption before finalization or dissolution after finalization; or

8. The adoptive parent(s) request termination of the adoption subsidy agreement; or

9. The child is no longer the legal dependent of the adoptive parent(s).

(b) A child receiving state adoption subsidy payments remains eligible and the adoption subsidy payments continue, unless one of the following circumstances occurs.

1. The child attains age nineteen, the age of majority. If the child is still in high school at age 19, the state adoption subsidy may continue until the child graduates from high school, is no longer enrolled in high school or attains the age of 21, whichever comes first.; or

2. The adoptive parent(s) are no longer legally responsible for the support of the child; or

3. The child is no longer receiving support from the adoptive parent(s); or

4. The child dies; or

5. The adoption is terminated, either through disruption before the finalization or dissolution after finalization; or

6. The adoptive parent(s) request termination of the adoption subsidy agreement; or

7. The child is no longer the legal dependent of the adoptive parent(s).

(13) Appeal and Fair Hearing Any subsidy decision where an application is denied or an adoption subsidy is reduced or terminated, and the placement agency or the adoptive parent(s) deem such action adverse to the adopted child, the applicant or parent recipient shall have the right to request in writing a fair hearing. Such request must be received within 30 days of the date of notice regarding the decision of the Department. The hearing will be in accordance with the Alabama Administrative Procedures Act.

Ala. Admin. Code r. 660-5-22-.06

Effective October 11, 1983. Emergency amendment effective March 1, 1989. Permanent amendment effective June 9, 1989. Succedent emergency amendment effective January 23, 1991. Succedent permanent amendment effective May 9, 1991. Succedent emergency amendment effective April 3, 1992. Succedent permanent amendment effective July 9, 1992. Succedent emergency amendment effective September 30, 1993. Amended: Filed December 6, 1993. Succedent permanent amendment effective January 10, 1994.

Amended by Alabama Administrative Monthly Volume XXXIV, Issue No. 03, December 31, 2015, eff. 1/21/2016.

Author: Margaret Livingston

Statutory Authority:Code of Ala. 1975, Title 26, Chapter 10; Adoption Assistance and Child Welfare Act of 1980 ( P.L. 96-272).