Chapter 5 : Section 22

Case Management for In-State and Out-of-State Children

Procedures

Prior to Adoption Finalization

The child's local office DCS Specialist or private agency adoption case manager:

• Assists families with the process of adopting children in the care and custody of the Department or of a licensed private child placing agency in Arizona including informing the adoptive parent(s) about the adoption subsidy program. See Supervising Adoptive Placements.

• Assists the adoptive parent(s) to complete the Adoptive Family Subsidy Application, including obtaining the necessary documentation. See Adoption Subsidy: Eligibility, Application, Review, and Appeals.

• Ensures the Adoption Subsidy Agreement (if approved) is signed by the adoptive family and the adoption subsidy supervisor prior to the finalization of the adoption.

• Closes the adoption case immediately preceding the finalization of adoption, sends the order of adoption to, and notifies the assigned Subsidy Specialist or Supervisor that the adoption finalized. Notification of the finalized adoption is required to initiate the enrollment of medical coverage for the child(ren). See Petitioning and Finalization.

After the adoption is final

The Adoption Subsidy Specialist:

• is responsible for the case management after finalization of the adoption and the local office DCS Specialist closes the adoption case;

• ensures that the Adoption Subsidy Program is sent an email containing information that the adoption has been granted within three days of finalization;

• assists adoptive parent(s) to locate and utilize supportive and preventive services in their communities;

• ensures adoptive parent(s) are aware of Title XIX benefits and assists in accessing services for which they are eligible;

• may attend behavioral health staffings, Child and Family Team meetings, or Individualized Education Plan (IEP) meetings as part of the treatment team when possible and requested by the adoptive parent(s);

• when placement in an in-patient behavioral health facility or other out-of-home placement is requested, refers the adoptive parent(s) to public, private and/or community resources, explores and advocates for alternative services that will maintain the child in the home, and informs the adoptive parent(s) that if out-of-home placement is authorized, the maintenance payment may be renegotiated or suspended;

• when applicable, encourages the adoptive parent(s) to make a written request to the child's school for an evaluation to determine if the child is eligible for special education and/or related services, and encourages parent(s) of children receiving special education or related services, who believe the child’s needs are not being met, to request a review of the child's IEP;

• refers requests for special services to the Adoption Subsidy Supervisor or Subsidy Behavioral Health Specialist and Subsidy Program Manager, as appropriate, for prior authorization; and

• conducts a review of all children in cooperation with the adoptive parent(s) after the first year of receiving adoption subsidy, and periodically thereafter as follows:

  • for children who are not residing with the adoptive parent(s), every six months or as determined by a management review; or

  • for youth over the age of 18 who are enrolled in and regularly attending high school and has not graduated or received a GED, every six months as determined by the management review.

• conducts a review every six months for youth adopted at the age of sixteen or seventeen years of age who is receiving extended subsidy beyond age 18 to verify continued eligibility.

Extending Subsidy beyond age 18

Prior to the child's 18th birthday, determine if the adoptive parent(s) will be requesting that subsidy be extended.

If yes, request documentation that the child:

• is enrolled in and attending a high school recognized by the Department of Education,

• is making progress toward completion of a degree, and has not graduated or received a GED; or

• has a physical or mental condition that prevents the child from being a full-time student or continuing their schooling. Documentation should be from a qualified professional familiar with the child.

If a child was adopted at sixteen or seventeen years of age, the adoption subsidy may continue through age 20 if one or more of the following apply:

• The child is completing secondary education or an educational program that leads to an equivalent credential or is enrolled in an institution that provides post-secondary or vocational education;

• The child is employed at least eighty hours a month;

• The child is participating in a program or activity that promotes employment or removes barriers to employment; or

• The child is unable to be a full-time student or employed because of a documented medical condition.

Review the request with the Adoption Subsidy Supervisor, if needed. The Adoption Subsidy Supervisor will determine if an extension requires review by the Subsidy Program Manager or Assistant Director for approval as needed.

Adoption subsidy for children placed out of the adoptive home

When the Adoption Subsidy Program is notified that an adopted child is no longer residing in the adoptive home. The Adoption Subsidy Specialist shall:

• notify the Adoption Subsidy Supervisor;

• verify that contact with the adoptive parent(s) or child will not interfere with the DCS investigation before talking to any member of the adoptive family;

• if contact with the adoptive parent is approved, send an out of home letter to the adoptive parent(s) notifying that payments may be suspending if the following information is not received:

  • the circumstances for the child no longer being in the home,

  • an anticipated return date; and

  • documentation of expenses the adoptive parent(s) is paying for the child, such as educational, medical, and placement costs; Expenses should be consistent with the subsidies received by the family and directly related to care and costs associated with the child’s needs as identified on the agreement.

• if a response to the letter is received, the Adoption Subsidy Specialist shall;

  • work with the adoptive parent(s) to compile applicable documentation and negotiate the rate of maintenance payments since the child is no longer residing in the adoptive home;

  • inform the adoptive parents that maintenance payments may be renegotiated or suspended to cover the cost of the child being in the care and custody of a state agency if the child was removed from the adoptive parent(s) home by the Department or another state agency;

  • consult with the Adoption Subsidy Supervisor to discuss the negotiated maintenance rate and receive supervisor approval;

  • determine, with the Adoption Subsidy Supervisor, whether referral to the Subsidy Behavioral Health Specialist is appropriate and if so, provide case information, the name of the child, and contact information for the adoptive parent(s), and

  • have the adoptive parent(s) sign a new Adoption Subsidy Agreement if they agree to a negotiated subsidy rate;

• if the adoptive parent(s) fail to respond to the letter within 30 days, the Adoption Subsidy Specialist will send a second out of home letter, to be signed by the Adoption Subsidy Specialist and the Adoption Subsidy Supervisor, to advise the adoptive parent(s):

  • that as a condition of continuation of subsidy payments, the adoptive parent(s) must produce evidence of the support they are providing on behalf of the adopted child who is currently not residing in the home;

  • payments are now suspended until the Adoption Subsidy program receives this information within 14 days of the second out of home letter’s being sent;

  • they have the right to appeal a decision to suspend subsidy payments;

  • what steps must be taken to initiate an appeal action; and

  • the timeframe in which an appeal must be initiated.

Adoption subsidy payments shall only be suspended upon approval of the Adoption Subsidy Supervisor and Subsidy Program Manager, after the initial out of home letters have been sent to the adoptive parent(s) and the timeframe for response has expired.

After information has been received from the adoptive parent(s), a letter denying continued subsidy payments due to the adopted child being out of the home must be approved by the Adoption Subsidy Supervisor, the Subsidy Program Manager, and the Assistant Director of Foster Care & Post-Permanency Supports.

A request by the adoptive parent(s) for payments to continue while the adopted child to remains out of their home for more than one year must be approved by the Adoption Subsidy Supervisor, Subsidy Program Manager, Program Administrator, and the Assistant Director of Foster Care & Post-Permanency Supports.

If an adopted child has been placed in an Inpatient Behavioral Health Facility and the adoptive parent(s) are requesting assistance to cover all or some of the cost from the Adoption Subsidy program, seek approval from the Adoption Subsidy Supervisor, the Subsidy Program Manager, Program Administrator, and the Assistant Director of Foster Care & Post-Permanency Supports.

When the adopted child in DCS custody returns to the adoptive home, send an Adoption Subsidy Rate Evaluation, CSO-1079B and Adoption Subsidy Review, CSO-1062A, and renegotiate the adoption subsidy. Adoption Subsidy Specialist will enter the information in the Adoption Subsidy Review record in Guardian.

Complying With Interstate Compact on Adoption and Medical Assistance (ICAMA)

To maintain medical coverage for adoption subsidy children who move to another state, adoptive parent(s) shall notify their Arizona Adoption Subsidy Specialist of their anticipated date of relocation, their new address, and any other information required by the ICAMA. If the resident state's Title XIX Medicaid program does not cover any service that is typically covered by Arizona Health Care Cost Containment System (AHCCCS), Arizona's Adoption Subsidy Program may cover the service if it is related to pre-existing conditions on the Adoption Assistance Agreement. Routine medical and dental services shall not be covered.

Any request for special services shall be prior authorized by the Arizona Adoption Subsidy program and determined to be medically necessary.

Adoption subsidy children from other states residing in Arizona

The ICAMA Administrator is responsible for initiating and maintaining AHCCCS coverage for adoption subsidy children who move to Arizona from another state.

Arizona adoption subsidy children residing in another state

If the child has an Adoption Subsidy Agreement, and the child resides in a state that offers Medicaid reciprocity, the Department shall submit eligibility information and initiate enrollment in the Title XIX Medicaid program in the child’s state of residence.

If the child has an Adoption Subsidy Agreement, and resides in a state that does not offer Medicaid reciprocity (Hawaii, Illinois, Nevada, and New Mexico), the Department will continue to be responsible for special services related to the pre-existing conditions on the Adoption Subsidy agreement. The requested service(s) shall be prior authorized by the Arizona Adoption Subsidy program. Routine medical and dental services shall not be covered.

When notified that an adoption subsidy child is moving out of Arizona, or moving from one state to another, the Adoption Subsidy Specialist shall:

• change the child’s address in Guardian;

• notify the ICAMA Administrator and the Adoption Subsidy Title IV-E Eligibility Supervisor of the anticipated move;

• complete the necessary ICAMA forms (these can also be completed through the ICAMA portal;) and

• send the ICAMA forms to the ICAMA contact in the receiving state (state of child's residence);

The ICAMA contact is found on the ICAMA website.

Documentation

When an adopted child with an active adoption subsidy is taken into the custody of DCS, the Adoption Subsidy Specialist will update Guardian to reflect any changes in maintenance and special service authorizations. Do not end-date the agreement on the Adoption Subsidy Agreement record.

The Adoption Subsidy Specialist will document the following in the Provider Notes screen:

• any referrals to community services and supports provided to the family and attach as artifacts results of IEP’s and CFT’s or other staffings when in attendance;

• any significant communication by phone or email with adoptive parents;

• the results of periodic reviews; and

• add applicable family members as Note Persons to each Provider note.

The Adoption Subsidy Supervisor documents in Notes the discussion with the Adoption Subsidy Specialist and decision about maintenance payments when a child is no longer living in the home.

Upload and attach the following items as artifacts to the child’s Adoption Assistance Agreement in Guardian:

• Order of Adoption;

• Signed Adoption Subsidy Agreements;

• Welcome letters;

• Out of home letters;

• Age of Majority Letters;

• Closure letters (with notice of appeal to rights); and

• Supporting documentation related to out of home approval for continuation of adoption subsidy.

Effective Date: October 27, 2022

Revision History: November 30, 2012, August 03, 2018, June 13, 2019, August 14, 2019, February 1, 2021