High-Risk Definitions
of Special Needs

The North American Council on Adoptable Children (NACAC) maintains and regularly updates its national database on every state’s Title IV-E Adoption Assistance Program. Some states refer to this program as adoption subsidy, and others use the term AAP. As per the federal law, each state has the flexibility to determine its legal definition of special needs. NACAC is urging all states to include the element of "high-risk" within its legal definition of special needs.

Typically, states include within their definitions such categories as physical and emotional conditions of the child, the existence of a sibling group, and the age or ethnic background of the child. If a child meets at least one criteria of the state’s definition, the child is considered a special needs child, and then must meet additional requirements to be IV-E eligible—federally funded.

With the increase in drug and alcohol abuse in this country, as well as the existence of mental illness in biological families and sexual abuse of children, the ability to determine whether a child will have future problems is difficult for adoption social workers. In many cases, young children enter the child welfare system and are placed for adoption, but these children are too young to accurately test for emotional or psychological problems. As a result, more and more children are adopted without subsidies because they are labeled "healthy children" at placement. When the adoptive family returns to the agency for assistance due to the child’s significant problems, the family is either denied services or must endure an arduous administrative hearing process to obtain benefits. We believe there is a better solution for our children and their families.

As of January 2001, 27 states included a high-risk category in their definition of special needs. For example, some states have used similar language to "a child who has a serious physical, mental, or emotional condition or is at high-risk for such."

The Benefits to Agencies

There are many benefits associated with a state including a category of high-risk to its legal definition of special needs. For instance, if an 18-month-old child came into care with a history of schizophrenia in her biological family, it would be quite difficult to guess whether she would develop future problems. If the state had the option of labeling her at high-risk for future problems, the worker could complete the adoption assistance agreement upon finalization of the adoption and negotiate a deferred subsidy agreement with the family. A deferred agreement is one that includes a zero-dollar subsidy and attaches a Medicaid card. The administrative costs of completing the paper work prior to finalization is nominal, and the state does not have any future financial obligations to the family. If the family never returns for assistance, nothing is lost. However, if the family returns to the agency years in the future, the agency can avoid a time-consuming, legal-intensive, and costly administrative fair hearing process. With a deferred agreement on file, the agency need only locate the adoption assistance agreement, and modify it to include a monthly payment for the child, and other appropriate social or medical services.

Other benefits to the state of including a high-risk category is it encourages the adoption of children with high-risks, results in more placement, and contributes to a lower disruption or adoption failure rate.

The Benefits to Families

If a deferred subsidy agreement is negotiated, the family does not receive payment upon finalization of the adoption. However, they do receive something more important—the psychological peace of mind of knowing that if future problems do arise with their child, they have the ability to come back to the agency for assistance. A deferred agreement is a safety net for families. In addition, a deferred agreement also serves as a bond of trust between the agency and the family. If a family trusts their agency, they may consider a second adoption in the future. Experienced adoptive families are an important resource for future placements.

States With a High-Risk Definition of Special Needs

Currently, 27 states have some type of high-risk definition of special needs:

In addition, three states have some level of flexibility in their definitions. Louisiana’s definition allows for case-by-case decision making. Tennessee’s definition includes "any child whose life experiences include neglect, physical abuse, or sexual abuse," while West Virginia’s definition includes "children who appear normal but whose prognosis is guarded due to incest, mental illness, drug use of parents…"

NACAC congratulates these states and their progressive views toward the changing population of children entering out-of-home care. It is our hope that all states will modify their definitions of special needs to include high-risk characteristics and allow families to negotiate deferred agreements. Overall, it is a WIN-WIN situation for everyone.

For state-specific information, please contact the NACAC's Adoption Subsidy Resource Center at 800-470-6665, 651-644-3036, or e-mail at adoption.assistance@nacac.org.