Chapter 5 : Section 23

Types of Subsidy

Policy

The Department may provide the following types of adoption subsidy, as determined by the needs of the child:

medical coverage through Title XIX eligibility;
maintenance payments;
special services subsidy; and
reimbursement of nonrecurring adoption expenses.

The Department shall enroll eligible children who are U.S. citizens or lawfully present in the United States in the Title XIX AHCCCS or Medicaid program in their resident state upon finalization of the adoption. Eligibility for Title XIX Medicaid coverage is determined based on the criteria established by the child’s state of residency.

Maintenance payments may be provided to assist the family with expenses incurred on behalf of the child, but they are not intended to cover all expenses involved in the care of the child.

The Department shall deduct public or private monetary benefits paid to the child from the monthly maintenance subsidy, as allowed under state or federal law. Such benefits include but are not limited to Social Security (SSA) and Veteran’s (VA) benefits.

Special services subsidy is provided for extraordinary, infrequent, or uncommon needs related to the pre-existing special needs conditions of the child on the Adoption Subsidy agreement.

The Adoption Subsidy Program is the payer of last resort for special services subsidy.

All special services shall be authorized by the Adoption Subsidy program prior to receipt of the service.

A one-time payment, up to $2,000, is available to reimburse parents for reasonable and necessary nonrecurring adoption expenses incurred in the legal process of adopting a child with special needs, including filing the adoption petition and related court costs and attorney fees.

The amount of nonrecurring adoption expenses paid by the department shall not exceed $2000, for each adoption petition except if good cause exists as determined by the Department. The Department shall not pay non-recurring adoption expenses for a child and siblings or half-siblings who are adopted by the same adoptive parents and whose parental rights were terminated within sixty days of each other, unless the child and all the siblings or half-siblings are on the same adoption petition.

To be eligible for reimbursement for nonrecurring adoption expenses, the child must meet the federal definition of special needs but the Department does not need to have responsibility for placement and care.

Nonrecurring adoption expenses reimbursement is limited to the actual costs incurred for reasonable and necessary expenses. Any single expense is subject to review by the Department.

Claims for non-recurring adoption expenses must be submitted no later than nine months after the adoption is final.

The adoption subsidy agreement, including nonrecurring expenses, shall be signed by the adoptive parents and the Adoption Subsidy Supervisor prior to the final decree of adoption.

Procedures

Providing Medical Coverage

The Adoption Subsidy Title IV-E Eligibility Unit will enroll the child in AHCCCS/Medicaid once the final adoption is verified.

No less than three days following the finalization of the adoption, the child's local office DCS Specialist, contract, or private agency adoption case manager will send an email to the Adoption Subsidy Specialist notifying them of the date of the finalization. When received, forward the final order of adoption l to the Adoption Subsidy Specialist. The Adoption Subsidy Specialist will notify the Adoption Subsidy Title IV-E eligibility unit by entering date of adoption finalization in the computer based program. The Adoption Subsidy Title IV-E eligibility unit will enroll the child in AHCCCS utilizing the AHCCCS system as soon as the notification is received.

Providing maintenance payments

The amount of maintenance subsidy is determined by the Management Review and based on a child’s current special needs and the family’s circumstances. The amount of the maintenance subsidy shall not exceed the rate the child is eligible to receive in foster care. If a Title 8 permanent guardian seeks to adopt the child, they shall be eligible for adoption subsidy at the permanent guardianship subsidy rate established by the Department. See procedures in Adoption Subsidy Eligibility, Application, Review and Appeals for additional information.

If a child is or may be eligible for direct benefits, such as SSI, SSA, or VA benefits before the adoption is final:

The Department continues to be the representative payee.
When the adoptive parent is not the foster parent, the Department may pay the adoptive parents the amount of the maintenance payment for which the child has been determined eligible.
When a private agency or an adopting parent is payee, the amount of the benefit must be deducted from the adoption subsidy maintenance payment. In no case shall a combination of adoption subsidy and state and federal benefits to which the child is entitled exceed the amount of the maintenance payment for which the child was approved.

When a child is or may be eligible for direct benefits, such as SSI, SSA, or VA benefits after the adoption is final:

The adoptive parent(s) must apply as representative payee for the benefits for which the child is eligible.
If the adoptive parent(s) become representative payee, the amount of the benefits received, other than SSI, shall be deducted from the maintenance payment. Benefits are deducted from the maintenance payment using the Co-Pay window in CHILDS.
The adoptive parent is responsible for notifying the Social Security Administration of the dollar amount of the adoption subsidy maintenance payment when the child is eligible for SSI benefits.

If a child is placed in a hospital, Behavioral Health In-Patient facility or other out-of-home placement, the Adoption Subsidy Specialist will contact the adoptive parents and request that they submit documentation that they continue to be legally responsible for the child and are providing financial and emotional support to the child. The Adoption Subsidy Specialist will submit the documentation to the Management Review to determine if the monthly maintenance payment should be renegotiated.

If an adopted child is in DCS custody and placed in an out-of-home placement, the Adoption Subsidy Specialist will contact the parents and request that they submit documentation about how they continue to provide financial and emotional support to the child. The Adoption Subsidy Specialist will submit the documentation to the Management Review to determine if the monthly maintenance payment should be renegotiated. See Adoption Subsidy Case Management for In-State and Out-of-State Children. The DCS Specialist may request the Court assess the adoptive family the amount of the adoption subsidy maintenance payment.

If the adoptive parents report that they have not received a maintenance payment, the Adoption Subsidy Specialist will:

Determine whether the check was issued by checking if the Service Approval is active in Guardian.
Determine whether the address is correct in the Provider record in Guardian.
Determine if the provider has been set up for direct deposit.
Determine when the warrant was issued and if it was issued via paper check or EFT by searching the Active Remittances in the Finance area of Guardian. If the warrant that is missing was issued via a paper check, and it is in issued status, open that record and check the explain box. If the check was returned to the Payment Processing Unit (PPU), it will be documented there along with the current status.
If unable to determine if the check was returned or it was issued via EFT, contact the Payment Processing Unit (PPU).
Inform the parents that there is a ten business day (two week) waiting period to allow time for the check to be delivered or returned.
If the parent inquires after the waiting period has passed, follow the steps above to determine the status of the check. If the check has not been returned, contact PPU to request that a bond of indemnity and instructions for completion, be issued to the parents. Once the bond of indemnity has been received by PPU, a stop payment will be placed on the original check and a new check will be issued.
If the check is received by the parent after they have submitted the bond of indemnity, they must check with the PPU to determine if the stop-payment was completed before they attempt to cash the check. After the stop-payment is completed, it is too late to cash the check.
Advise the parents that the time frame for replacing a check is about two weeks from the time they submit the bond of indemnity.

Providing special service subsidy

The adoptive parent will request special services from the Adoption Subsidy Specialist and receive approval from the Adoption Subsidy Program prior to the adoptive parent incurring the specified expense. The request shall include:

documentation that the service is related to a condition listed on the Adoption Subsidy Agreement;
documentation from a qualified professional that the service is necessary; and
- If the requested services is for placement in a behavioral health placement, such as an in-patient behavioral health facility, the documentation must include the efforts made to maintain the child in a less restrictive setting and that the placement was not effective.

documentation that the adoptive parent has requested the service and the service has been denied or documentation that the service is not available from other potential funding sources, such as AHCCCS/MEDICAID, private insurance, school district, or other community resources.

Adoption Subsidy Respite is a temporary relief from parenting a special needs child as defined by the conditions listed on the child’s subsidy agreement. All resources must be exhausted first prior to requesting respite through the subsidy program. All respite requests shall be prior approved by submitting the Respite Request Form, CSO-2058 to the Adoption Subsidy Program. The need for respite shall be related to the child’s special needs conditions on the adoption subsidy agreement.

Respite that is available from other sources such as the Integrated Health Plans providing behavioral health services or the Division of Developmental Disabilities (DDD) must be exhausted prior to approval of respite from adoption subsidy.
Respite may not substitute for child care, baby sitting, transportation or other services.
Respite must be reauthorized every year and unused hours do not carry over to the next year.
Additional respite requires authorization by the Management Review. If additional respite is necessary, the request must include documentation of the special circumstances or conditions that make it necessary. Assessment of need should be provided by a professional who has a relationship with the family or by the Adoption Subsidy Specialist if no other professional is involved.
Respite will be paid according to the Adoption Subsidy fee schedule. Over ten (10) hours will be considered a full day and the maximum rate for a day is the hourly rate times 10. (No more than 10 hours will be reimbursed per day.)

If more than one child is cared for at the same time by the same provider, the first child will be paid at the full rate and the second and subsequent children will be paid at half the rate of the first child (not to exceed the child’s normal rate). Siblings are encouraged to attend respite together to provide the adoptive parent a temporary relief from parenting children.
Respite may not be provided by members of the child's household.

Modifications or repairs to structures, vehicles or equipment are limited to modifications or repairs related to the special needs conditions of the child as listed on the Adoption Subsidy agreement. Requests must include documentation of necessity by a professional, indication of attempts to finance the modification or repairs using other resources, and three estimates from qualified vendors of the cost of the proposed modification or repair. Adoption Subsidy does not cover additions to structures.

If the request for special service subsidy is approved the Adoption Subsidy Specialist will:

advise the family of the specifics of the approval and the rate; and
advise the family to submit a claim for reimbursement after the service has been provided, but no later than nine months from the date of service.

The Adoption Subsidy Claims Specialist will:

verify with the Adoption Subsidy Specialist that the service was approved;
check payment requests for completeness and necessary prior authorizations;
coordinate with third party payers to ensure that primary payments have occurred;
review previous claim forms to avoid duplicate payments; and
make payment(s) according to AHCCCS, DCS or Adoption Subsidy fee schedule and procedures.

Reimbursement for the prior authorized service will be made directly to the parent who will pay the provider. If requested by the adoptive parent due to the adoptive parent’s inability to pay, the Department may pay the service provider directly.

If the request is denied, follow procedures in Adoption Subsidy Eligibility, Application, Review & Appeals to notify the family of their right to appeal the denial and the procedures to initiate an appeal.

Reimbursement of nonrecurring adoption expenses

When the final Order of Adoption and documentation of expenses is received from the adoptive parent, the Adoption Subsidy Specialist will determine which expenses are to be paid and for what amount and authorize the payment in Guardian.

If there are questions about whether an expense is appropriate for reimbursement or if it is reasonable and necessary, the Adoption Subsidy Specialist will submit the request for non-recurring expenses to the Adoption Subsidy Supervisor for a decision.

If requested, the Adoption Subsidy Supervisor will review the requested expenses and determine if they are reasonable and necessary.

Reimbursement for nonrecurring expenses will be made directly by the Department to the adoptive parent who will pay the providers. If requested by the adoptive parent and documented on Reimbursement of Nonrecurring Adoption Expenses, Parent’s Authorization for DCS to Reimburse Attorney Directly, CSO-1354A, the Department may pay an attorney directly.

Documentation

Place the final Order of Adoption in the hard copy case record.

Initiate monthly maintenance payments by ensuring the completion and signature of the Adoption Subsidy Agreement in Guardian by the adoptive parents and the Adoption Supervisor.

Complete the Co-Pay field when completing the Service Approval in Guardian to update federal or state benefits that are deducted from the maintenance payment.

Enter as an artifact in the case record information received from the adoptive parents that documents they continue to be legally responsible for the child and are providing financial and emotional support to the child.

Enter a Note in the case record containing information received from the adoptive parents to support a request for special services subsidy.

When a special service subsidy has been approved, enter the Service Approval in Guardian to initiate nonrecurring payments.