New York Adoption Subsidies
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The purpose of this information is to help caseworkers expedite the adoption subsidy eligibility and approval process, with special emphasis on handicapped subsidies. Approvals of adoption subsidy requests are often delayed when the quality or content of documentation that is presented with the application does not support the rate requested. This information will clarify what is needed from doctors and mental health professionals to document child need. It may be useful to share portions of this information with these professionals.
The glossary, and explanation of the process are intended to help the subsidy application process work better for all concerned; however, no attempt has been made to address all potential issues that may arise concerning the adoption subsidy program. Caseworkers are encouraged to consult with their supervisors and legal staff about specific case issues.
What are Adoption Subsidies?
Adoption subsidies are monthly maintenance payments (see Glossary: Maintenance Subsidy) that may be available based on the special needs of a child. Adopted children (see Glossary: Adoptive Placement) may also be eligible for the federal Medical Assistance program or for state-funded Medical Subsidy. Review of all adoption subsidies is based on presentation and approval of documentation that meets statutory and regulatory requirements. Except for unknown preexisting conditions, adoption subsidy agreements must be approved before completion of the adoption (see Glossary: Approved Subsidy). An adoption subsidy agreement is a contract between the prospective adoptive parent(s) and the local department of social services.
Maintenance subsidies continue until the child is 21, unless the adoptive parent is no longer legally responsible for the support of the child or the child is no longer receiving any support from the adoptive parent. Medical Assistance and Medical Subsidies continue for handicapped children within these same parameters. Medical Assistance for hard-to-place children is not continued past the 18th birthday unless there is a determination of need.
Why are Adoption Subsidies available?
Subsidies are provided to help meet the special needs of caring for handicapped and hard-to-place children and to encourage and facilitate their adoption. Subsidies help children who are no longer able to remain with their birth family gain a warm and supportive family.
Adoption subsidies are available for handicapped and hard-to-place children who are in the custody and guardianship of the local commissioner of social services, or an authorized voluntary agency in New York State, or a certified or approved foster parent. Not every child in the guardianship and custody of a commissioner or a voluntary agency in New York State is eligible for a subsidy.
Eligibility for adoption subsidies is based on federal and state statutes and regulations. Eligibility determination requires verification that the child meets regulatory standards as supported by provision and approval of required documentation. Rates for maintenance payments are generally based on severity of child need. For an adoption subsidy to be approved, the child need must fall within the rate category established by each social service district. Documentation that requirements for rate eligibility are satisfied must be provided.
How are applications submitted?
An adoption subsidy application in the form of the adoption subsidy agreement is submitted for eligibility determination and approval. Prospective adoptive parents fill out this agreement at an adoption agency or the local social services district office with the assistance of their caseworker. The application is submitted for review to the county and the New York State Office of Children and Family Services, unless the Office has delegated its approval authority to the local district. This one-time subsidy eligibility and rate determination must be audit worthy and must support the rate established. All applications must be approved prior to adoption finalization unless the case falls within the small window of post-finalization or upgrade requests.
What level of Adoption Subsidy payment will be approved?
A hard-to-place child who qualifies for an adoption subsidy generally will receive a basic rate. A child determined to be handicapped may receive subsidy at the basic, special, or exceptional rate. The level of handicapped subsidy is an administrative decision based on the medical and/or psychological documentation presented. The documentation review is related to definitions of adoption subsidy rates in regulations and categories established by each social service district. Appropriate documentation must be submitted to support the level of subsidy requested. The prospective adoptive parent(s) and the caseworker will decide who is responsible for obtaining this information and will ensure that proper documentation is submitted with the subsidy application.
Local districts may establish levels of payment within the basic, special, or exceptional rates for handicapped children.
Some districts use parental income and family size to determine the percentage of the subsidy to be paid. Districts may not approve less than 75 percent of the appropriate rate.
What is required documentation?
The regulations require that documentation must be provided by a medical doctor, a psychologist, or a psychiatrist. Subsidies are based on actual problems, not risk of future problems. The purpose of the documentation is not to qualify the child for the basic, special, or exceptional rate - it is to describe child need. Doctors and mental health professionals are not required to know the regulations, and they are not expected to make recommendations on rates. Rates are recommended by caseworkers, and final approval is an administrative function.
Initial application (prior to finalization):
Almost all adoption subsidy applications are submitted prior to finalization. The adoption subsidy application agreement may be submitted as soon as the child is in the home of the prospective adoptive parent(s). Applications based on handicapped status must have the documentation described above. This should be current (less than one year old). Doctors need to be specific about child need, describing behaviors, frequency and severity of the problem, intervention requirements, testing, results, diagnosis/ diagnoses, treatment recommendations, and prognosis. All initial adoption subsidy applications must receive final approval prior to finalization of the adoption in order to satisfy federal requirements and to ensure Maintenance payment and Medical Subsidy or Medical Assistance as warranted. If an initial application results in a fair hearing, a new application generally must be submitted and approved prior to finalization after the fair hearing.
Adoptions of New York State children that occur without subsidy may be eligible for a post-finalization request for subsidy under very limited circumstances. Children who have a preexisting condition unknown to the parent at the time of finalization and diagnosed after the adoption is finalized may qualify for non-IVE Maintenance and/or Medical Subsidies. The application process requires the same quality of documentation as the initial application and must also contain certification that the request covers a preexisting condition. Additionally, the medical or mental health professional must verify the date of diagnosis.
Children adopted with a subsidy may undergo a worsening of the initial conditions for which the subsidy was approved. If these conditions change to the extent that the qualifications for a higher rate are met, an application for an upgrade may be requested. This application must be supported with current examination(s), must document the changes in child need, and must fulfill all other documentation requirements. Upgrade requests for unchanged or stable conditions that existed at the time of adoption but were not fully documented will not be approved. The decision whether to grant an upgrade is at the discretion of the local social services district and the Office of Children and Family Services.
What doesn't support subsidies?
A large number of applications contain information from prospective adoptive parent(s), teachers, IEPs, OP-5 forms or their equivalent, physical therapists, speech therapists, and occupational therapists. These sources can support, but cannot replace necessary documentation. The heavy workload of medical professionals is recognized; however, progress notes, rate authorizations, a prescription form stating a problem, and a diagnosis without supporting psychosocial history will not be sufficient documentation for a rate determination. The purpose of the exam is not to qualify the child for a particular rate; it is to assess child need and to show frequency and severity of specific behaviors and conditions for which the parent must provide services. Accepted documentation must be audit worthy.
What about risk of future problems?
Many children have a risk of developing problems in the future that are not evident at the time of the initial adoption subsidy application. The risk may be noted with the initial subsidy request documentation, and if related problems cause an increased child need, an application for an upgrade may be appropriate in the future. Children developing other types of problems not related to preexisting conditions or directly attributable to preadoptive circumstances will not qualify for postadoptive assistance.
What if the case doesn't meet requirements for a subsidy?
There are times when the adoption subsidy application does not meet any of the hard-to-place qualifications and when documentation cannot be produced to support the handicapped definition or the rate for which the application was submitted. Every effort should be made to ensure that necessary documentation is available and reviewed. However, when the case cannot be approved as requested, and the parent(s) refuse a lower rate for which they qualify, or are not eligible for any other rate, the case is denied. The denial can be done at the local level when the child is deemed ineligible for the adoption subsidy, or it can be done at final approval. Local or state officials must send a denial letter that informs parent(s) of their right to request a fair hearing within sixty days of the denial of an adoption subsidy application. The fair hearing process offers a vehicle for the parent(s) to question decisions. Hearing officers review the application in terms of statutes and regulations, and provide a decision in response to the fair hearing request.
How can subsidies be expedited?
Subsidies are provided as part of the adoption process in over 80 percent of cases; therefore, it is important that the application process should be familiar to caseworkers. The information needed is not different from the information that should be used for a foster care rate determination (see Glossary: Foster Care Board Rate). Collection of good data that meets the requirements of the regulations can start long before the process terminating parental rights occurs. Information may need to be updated, but a solid baseline can be established when a child is placed.
To make the application process work faster and more smoothly,
- Collect concise, complete, and current records of examinations from the required professionals for all children in care. When this is done consistently from the time the child enters foster care, families will receive correct rates authorized each year to meet child needs, and parents will have realistic expectations of the rate they are likely to receive.
- Work with medical and mental health professionals to share the purpose of the examinations and required content.
- Plan to have current examinations completed so that updated reports are available when the subsidy agreement is submitted.
- Assess child need based on CURRENT (not past or projected) conditions.
- Help prospective adoptive parent(s) with needed training and resource identification to ensure that treatment recommendations are followed.
- Review all materials submitted. They must be thorough and current.
- Read 18 NYCRR 421.24 and 427.6 in your policy library. Use this for decision making.
- E-mail NYSAS with questions on regulation interpretation and policy.
- Promise a rate to prospective adoptive parent(s) prior to final approval.
- Request a rate that is not supported by documentation.
- Submit incomplete information or material more than one year old.
- Finalize an adoption before the subsidy agreement is approved. This will jeopardize payment and may result in no medical or maintenance payment.
For more information, contact the New York State Adoption Service at
1-800-345-KIDS (5437) Or email us at:
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