Kentucky State Subsidy Profile
Updated October 2013
State Subsidy Contact Person
Adoption Branch Manager
Dept. for Community Based Services
275 East Main Street, 3C-E
Frankfort, KY 40621
NACAC Subsidy Representative (parent/volunteer)
What is Adoption Assistance?
Parents who are thinking about or are in the process of adopting a child with special needs from foster care should know about adoption assistance (also known as adoption subsidy). Federal (Title IV-E) and state (often called non-IV-E) adoption assistance programs are designed to help parents meet their adopted children’s varied, and often costly, needs. Children can qualify for federal adoption assistance or state assistance, depending on the child’s history. Adoption subsidy policies and practices are, for the most part, dependent on the state in which the child was in foster care before the adoption.
Below is information related to definitions of special needs, benefits available, and procedures in Iowa. Answers to select questions were made available by the Association of Administrators of the Interstate Compact on Adoption and Medical Assistance (AAICAMA) through the Child Welfare Information Gateway (www.childwelfare.gov). Profiles for other states’ subsidy programs are available. If you have additional questions, please contact NACAC at 651-644-3036, 800-470-6665, or firstname.lastname@example.org. If you have state-specific questions, please call your State Subsidy Contact Person or the NACAC Subsidy Representative (listed above) for more information.
For more information on Title IV-E eligibility, view our fact sheet Eligibility and Benefits for Federal Adoption Assistance.
Adoption Resources on the Web:http://chfs.ky.gov/dcbs/dpp/adoptionservices.htm
see links for Frequently Asked Questions on Adoption and How Do I Get Started on the right)
Kentucky’s state-specific medical assistance links: http://chfs.ky.gov/dms/
Kentucky’s adoption assistance links:
(See also Special Needs Adoption Program, SNAP, in the Related Content section.)
Kentucky Revised Statutes 199.555, State-funded adoption assistance payments–Conditions.
Kentucky Revised Statutes 199.557, Federal Title IV-E Adoption Assistance
Kentucky Administrative Regulations, 922 KAR 1:050 and 922 KAR 1:060
Standards of Practice Online Manual, Chapter 13—Adoption Services, Adoption Assistance 13.36-13.46.1
Who is Elligible for Adoption Assistance?
1. How does Kentucky define special needs to determine eligibility?
For a child to be considered special needs, the state must determine that the child meets all three of the following criteria:
- The child cannot or should not be returned to the home of his or her parents, because a court of competent jurisdiction has granted a voluntary termination of parental rights (TPR) or involuntary TPR or the parents are deceased.
- The child who has at least one of the following needs or circumstances that may be a barrier to placement or adoption:
- Two years of age or older and member of a racial or ethnic minority group
- Seven years of age or older with a significant emotional attachment or psychological tie to the foster family and the Department has determined that it would be in the child’s best interest to remain with the family
- A member of a sibling group of two or more children placed at the same time in the same family
- A physical or mental disability
- An emotional or behavioral disorder
- A documented risk of physical, mental, or emotional disorder
- A previous adoption disruption or multiple placements
- A reasonable effort has been made to place the child without adoption assistance.
2. Does the state-only funded adoption assistance program differ in any way from the Title IV-E program?
To be eligible for state-funded assistance, children must meet the special needs requirements in question 1 and must be in the custody of the state to be eligible for adoption assistance.
There are two primary differences between state-funded and IV-E-funded adoption assistance:
- State-funded adoption assistance may end earlier than federally funded adoption assistance (see question 7).
- The state will suspend state-funded adoption assistance if the child re-enters foster care, or enters and stays in a residential treatment center, psychiatric residential treatment facility, or psychiatric hospital for longer than 30 consecutive days.
3. Are children adopted from private agencies in Kentucky eligible for adoption assistance?
Children who are not in DCBS custody are only eligible if they meet Title IV-E requirements, and DCBS has determines that they meet the special needs definition before finalization.
What Supports and Services are Available?
4. What are the maximum monthly adoption assistance maintenance payment in Kentucky?
These rates are effective July 1, 2007 and mirror the foster care rates:
Birth 11 yrs.
12 18 yrs.
|Specialized Medically Fragile
Basic rate is the regular foster care per diem.
5. Does Kentucky provide specialized rates (based on the extraordinary needs of the child or the additional parenting skill needed to raise the child)?
Yes, as outlined in the chart above. There are three tiers of payments—basic, advanced, and degree. There are also two specialized maintenance levels—Medically Fragile and Care Plus:
Medically Fragile—Children who have a condition, as documented by a physician, that can become unstable and change abruptly, resulting in a life-threatening situation, may be considered medically fragile. Medical conditions and procedures required may include, but are not limited to:
- Uncontrollable diabetes where other body functions are affected so that the child may, at any time, go into a coma
- A child who requires the use of an apnea, oxygen, or cardiac monitor
- Neurological or physical impairments to a degree that the child cannot walk and requires 24 hour care
- Feeding problems that require nasal gastric or gastronomy tubes because of a condition associated with low weight (often due to a genetic condition)
- Tracheotomy requiring frequent suctioning and changing
- To receive the Basic Medically Fragile rates, the child must meet the critieria above and the adoptive parent(s) must have successfully completed the Medically Fragile training, which is either:
- 24 hours of training in the areas of growth and development, nutrition, medical disabilities, current certification in CPR, and current certification in first aid or,
- The one-day (six-hour) curriculum, which includes medically fragile orientation and the medically fragile curriculum “Join Hands Together.”
- To receive the Advanced Medically Fragile rate, the child must meet the criteria above, the parent(s) must have completed the training listed for Basic Medically Fragile rates, and at least one of the adoptive parent(s) must be a licensed practice nurse (LPN) with a current active license.
- To receive the Degree Medically Fragile rate, the child must meet the criteria above, the parent(s) must have completed the Medically Fragile training, and at least one adoptive parent must be a currently active registered nurse (RN) or physician.
The Specialized Medically Fragile rate may be paid to a family that completes all requirements for Advanced and Degreed Medically Fragile care and that receives individual documented training from a health professional in how to care for a specific specialized medically fragile child who is placed with the family. The child must also require supervision by a physician or registered nurse. The key factor in determining the rate for each Specialized Medically Fragile child is the level of extra professional care required by that child daily and the level of the adoptive parents’ professional medical licensure.
Care Plus Home—Care Plus Homes are remedial care programs for children or youth who act out or are troubled. A Care Plus Home allows a child to live in the least restrictive environment where the parent is trained to provide planned, remedial supervision and care leading to positive changes in the child’s behavior. A Care Plus Home serves children and youth who:
- Have serious emotional problems
- Are due to be released from treatment facilities
- Display aggressive or destructive behaviors or other disruptive behaviors
- Are at risk of being placed in more restrictive settings
- Are at risk of institutionalization, or
- Have experienced numerous placement failures
- To receive the Care Plus Home rates, the adoptive parent(s) must have completed the initial 30 hours of training for Care Plus Home and attend 24 hours of training per year. In addition, the child’s needs must meet Care Plus Home criteria, which are outlined above.
- To receive the Advanced Care Plus Home rate, the adoptive family must meet the Care Plus Home criteria described above and have been an approved Care Plus Home for at least one year.
- To receive the Regular Advanced rate the adoptive parent(s) must be approved as a Regular Advanced resource home, have had an initial 30-hour initial training, and attend 24 hours of required training per year (including on child sexual abuse).
6. When do adoption assistance payments begin?
Adoption assistance payments and benefits may begin at adoption placement or adoption finalization, but only after an Adoption Assistance Agreement (DPP-1258) has been signed. When payments begin at placement, the payments are called pre-adoptive payments and also require a signed Adoption Placement Agreement (DPP-195).
7. When a child turns 18, which benefits, if any, continue?
If the child was receiving state-funded adoption assistance before his 18th birthday, he can continue to receive assistance payments until the month of graduation from high school or age 19 (whichever comes first).
Adoption assistance is available to age 21 if the child is determined to be totally and permanently disabled by the Medical Review Team (MRT) with the Division for Disability Determination Services. If MRT determines the child is not totally and permanently disabled, then the assistance can be extended if the child is 18 and still in high school. In such cases, assistance can continue until high school graduation or age 19, whichever comes first.
8. Does Kentucky offer deferred adoption assistance agreements (agreements where initial monthly maintenance amount is $0 for children at risk of developing special needs later)?
9. What Medicaid services are available in Kentucky?
- Renal dialysis
- Primary care center
- Rural health clinic
- Independent laboratory
- Vision and hearing screening
- Family planning
- Nurse midwife
- Birthing center
- Nurse anesthetist
- Mental health
- Skilled nursing facility
- Intermediate care facility
- Ambulatory surgical center
- Home health
- Medical transportation
- Physician—Routine office visits, house calls and follow-up visits.
- Hospital—Most inpatient hospital services are covered for a limited number of days.
- Dental—Coverage is limited but includes X-rays, fillings, braces for severe malocclusions, simple extractions, and emergency treatment for pain, infection and hemorrhage. Coverage is available for certain other dental services for recipients under age 21.
- Intermediate Care Facility for the Mentally Retarded and Developmentally Disabled (ICF/MR/DD)
- Durable medical equipment such as wheelchairs, hospital beds, orthotic appliances (braces), and prosthetic devices (artificial limbs, eyes, etc.)
For more information on Medicaid services, call 502-564-6636.
10. What medical benefits are available for state-funded children? (Children who have federally funded/Title IV-E adoption assistance are automatically eligible for Medicaid benefits.)
Children placed with adoption assistance agreements are usually eligible for a Medicaid card. In a very few cases, if the child has income (such as Social Security Survivors benefits, VA benefit, Black-Lung benefits), the child will not qualify for Medicaid benefits. To determine Medicaid eligibility for children who are not-IV-E eligible, Medicaid officials look only at the child's income. Medicaid benefits available for non-IV-E children do not differ from those available to IV-E children.
11. What mental health services are available?
Public mental health services in Kentucky are administerred by the Cabinet for Health and Family Services (CHFS), Department for Medicaid Services and include the following: inpatient psychiatric hospitals, psychiatric residential treatment facilities, targeted case management for children, community mental health center care, and prescription drugs.
Community Mental Health Centers provide publicly funded community mental health, mental retardation, and substance abuse services through 14 regional Mental Health and Mental Retardation (MH/MR) boards. In addition, services may be available through IMPACT Plus, which is a multi-disciplinary mental health program for children. A collaborative effort of the Departments for Medicaid Services, Community Based Services and MH/MR Services, the program is designed to provide community-based services for Medicaid- and KCHIP-eligible children with complex treatment needs.
For more information, visit http://dbhdid.ky.gov/kdbhdid/default.aspx or http://chfs.ky.gov/dms/ .
Not all services may be available in all cases. Parents should contact their adoption assistance worker or medical assistance specialist for information regarding process, eligibility, availability, and duration of services.
12. In Kentucky, what nonrecurring adoption expenses directly related to the finalization of an adoption may be reimbursed?
Parents may be reimbursed for expenses of up to $1,000 per child for court costs, adoption fees, attorney fees, home study costs (including health and psychological examinations), placement supervison costs (before adoption), and reasonable transportation, food, and lodging for the child and adoptive parents when necessary to complete the placement.
Requests for nonrecurring adoption expenses must be approved before adoption finalization. Adoptive parents have a two-year period after receiving approval to submit expenses for payment.
13. Is child care available? If yes, who is eligible and how do families access child care?
Yes, if the adoptive parent(s) are working or if the child has a specific therapeutic need. In either case, the family must talk with their Recruitment and Certification (R&C) worker to access this service.
14. Is respite care available? If yes, who is eligible and how do families access respite care?
For children who qualify for Basic, Advance, and Degree Medically Fragile and Care Plus Home rates, families may be reimbursed for two additional respite days per month (the first day is covered by the monthly payment). For children approved for Specialized Medically Fragile rates, families may be reimbursed for three additional respite days per month.
Families who do not receive monthly payments or who receive less than the maximum for their placement level (as listed in question 4) may request reimbursement for some respite care. They must submit receipts for the respite for the extra days to the billing specialist under the Extraordinary Medical program.
In addition, many private organizations offer a variety of respite options. Parents can search for Kentucky options in the ARCH National Respite Network Respite Locator Service: http://www.respitelocator.org.
Parents should contact their adoption assistance worker or post-adoption services contact for information regarding respite services.
15. Is residential treatment available? If yes, who is eligible and how do families access residential treatment services?
Children with active adoption assistance agreements may qualify for payment for up to 90 days of residential treatment per year through post-adoption placement stabilization services (PAPSS) funds. Families should contact their R &C worker for information. Adoptive parents do not have to relinquish custody of their child to receive this service. If the placement exceeds 90 days, then a voluntary commitment is pursued.
16. What other post-adoption services are available in Kentucky and how do families find out more about them?
In addition to Medicaid services, Kentucky provides funding for extraordinary medical expenses. Reimbursement for medical expenses not covered under medical assistance or the family’s private insurance is available for services related to the special need for which adoption assistance was granted. Family co-payments, based on rates determined through application of an income scale, are required in some instances. Some of the specific services eligible for reimbursement include orthodontia (covers 50 percent); tutoring (in certain situations); physical, occupational, speech, and behavioral therapy (one session per week per child); special equipment (in certain circumstances); customized equipment; and child care. Parents will need to work with their regional billing specialist to obtain reimbursement for these payments. Parents will need to complete an annual financial form to receive reimbursement for extraordinary medical expense reimbursement. This information is needed to determine co-pays.
Intensive in-home services (such as family therapy, intensive respite care, in-home paraprofessional attendance, etc.) are occasionally available to prevent out-of-home placement for children or to smooth the transition home from residential treatment. The maximum amount that can be reimbursed is $10,000. (Families should contact their R & C worker to request this service.)
Other post-adoption services in Kentucky are administered by the Cabinet for Families and Children, Department for Coummunity Based Services (DCBS), and largely contracted through outside agencies. Post-adoption services may include:
- Information, resource/referral
- Education/training programs
- Education material
- Support groups
- Mentoring (Resource Parent Mentor Program)
- Therapeutic intervention
- Post-adoption placement stabilization services
Kentucky has several organizations that provide these services, including Foster/Adoptive Support and Training (FAST) Center, Adoption Support for Kentucky, and the Kentucky Foster/Adoptive Care Association. To learn more about whom to contact and which services may be available, parents should contact their adoption assistance worker or local DCBS office (find the local offices at http://chfs.ky.gov/contact/ ).
Please note that not all services may be available in all cases.
17. If the assistance listed above in questions 13 to 16 are for specific services, must these services be explicitly identified in the adoption assistance agreement?
Some services must be listed in the subsidy agreement, while other services such as support groups, mentoring, and referral services, educational materials, etc., are available to all adoptive parents.
What Should Families Know about Applying for Adoption Assistance?
18. Who initiates the adoption assistance agreement?
The adoption assistance agreement is initated by the R & C worker.
19. Who makes the final determination on an adoption assistance agreement?
The regional R & C worker makes the determination, which is then approved by the supervisor and Service Region Administratior (SRA) or the SRA’s designee. Central Office approves exceptions and reviews disputed cases if needed.
20. How do families request adoption assistance after finalization of an adoption?
It depends on if the assistance is state funded or Title IV-E:
State funded—Whena finalized adoption (for which adoption assistance has not been previously approved) is near dissolution due to the need for extraordinary medical care, adoption assistance may be requested for these expenses only. A monthly payment is not an option available in state-funded post-finalization requests. Approval is contingent upon the availability of resources of the Department and all of the following criteria must be met:
- The child was placed for adoption by the Cabinet for Health and Family Services;
- The child was considered hard-to-place before the adoption;
- The parents have made a reasonable effort under the circumstances to meet the needs of the child without any assistance; and
- The child is under 18 years of age.
IV-E: For children who are IV-E eligible, adoptive parents may request adoption assistance any point after finalization as long as one of the following situations has occurred:
- The state agency failed to notify adoptive parents of the availability of adoption assistance for children with special needs;
- Assistance was denied based upon an erroneous determination by the state that a child did not meet special needs criteria; or
- Relevant facts related to the child, the biological family, or the child's background that may have affected a child's special needs determination, were known but not presented to the adoptive parents prior to finalization.
To start the process, families should contact their local social services office.
How Can a Family Adjust an Adoption Assistanc Agreement?
21. Can adoptive parents ask to change an adoption assistance agreement?
A request or renegotiation can be made at any time when there is a change in the child's special needs or the family’s circumstances. In rare instances, where a significant change in the family’s situation may negatively affect the stability of the placement, renegotiation may be warranted. Parents make a verbal or written request to the family’s Social Services Worker (SSW).
The SSW will obtain documentation from the parents about the change in the child’s condition or the family’s circumstances. The SSW will:
- Evaluate the situation
- Obtain documentation concerning special needs or conditions
- Negotiate the adoption assistance agreement with the family
- Prepare an Adoption Assistance Renegotiation Form
- Forward the Form through supervisory and administrative channels for approval by the Service Region Administrator or designee
- After approval of the Form, obtain the adoptive family’s signature and distribute to the adoptive family, children’s benefits worker, and regional billing clerk
If adoptive parents disagree with the agency’s answer to the requested change, they can file a service appeal request form (DPP-154), which initiates a fair hearing.
22. What steps does a family go through to appeal an adoption assistance decision in Kentucky?
Adoptive parents have the right to request a fair hearing any time the Department of Community Based Services (DCBS) makes a decision affecting their child’s adoption assistance benefits. Requests for fair hearing must be made in writing within 30 days from the date of the disputed agency decision or action. With any agency decision on adoption assistance, the SSW will send the family the DPP-154, Service Appeal Request, which informs the family of their right to file a service appeal as outlined in SOP 1.5 Service Appeals.
The following are example reasons for a request for fair hearing related to adoption assistance:
- Failure by the Cabinet to advise an adoptive parent of the availability of adoption assistance
- Determination by the Cabinet that an adoptive parent is ineligible for adoption assistance upon execution of an adoptive placement agreement
- Denial of a request for a change in payment level due to a change in an adoptive parent’s circumstances at the time of renewal of an adoption assistance agreement
Parent can send requests for fair hearing to the following address:
Office of Performance Enhancement
Quality Initiatives Branch
275 East Main Street, 3E-K
Frankfort, Kentucky 40621
Those who need V/TDD services, should call the Office of the Ombudsman at 800-372-2973.
Once the hearing request has been received, a hearing officer conducts the hearing and any pre-hearing conferences (an opportunity for mediation and possible settlement).
What Else do Families Need to Know?
23. How is the adoption assistance program operated and funded in Kentucky?
The program is state administered, which means all policy and eligibility decisions are handled by the state office.
The federal contribution to Title IV-E-eligible children’s adoption assistance (known as the Federal Financial Participation or FFP rate) is 69.83 percent in Kentucky. Remaining program costs are funded with state general funds.
24. Does Kentucky operate a subsidized guardianship program?
The Kinship Care program, which provides monthly payments to relatives, is no longer accepting new applications. Families currently receiving benefits under the Kinship Care program will continue to do so.
25. Does Kentucky offer a tuition waiver program?
Yes. Youth are eligible for tuition waivers at public Kentucky college and universities if they are:
- Over age 18 and the family receives state-funded adoption assistance under KRS 199.555; or
- Is currently placed in foster care by the Cabinet for Health and Family Services (CHFS) or the Department for Juvenile Justice (DJJ); or
- Is in an Independent Living Program; or
- Was in the custody of CHFS or DJJ before being adopted;
- Was in the custody of CHFS or DJJ on his or her 18th birthday
Children who were adopted from Kentucky but who no longer reside in Kentucky are eligible for the tuition waiver, but must pay the difference between the in-state tuition rates and out-of-state rates.
The student must also meet all entrance requirements for the post secondary institution and must maintain academic eligibility (meaning he or she maintains at least a 2.0 grade point average). For more information, read http://www.lrc.ky.gov/Statutes/statute.aspx?id=42283.
Kentucky also offers an Educational Training Voucher (ETV). The ETV is available for children who were adopted from CHFS when they were 16 years of age or older. The maximum amount available is $5,000 per student per year. Students eligible for the tuition waiver may also be eligible for the ETV. These funds can be used for expenses related to helping a student stay enrolled in school. Allowable expenses include but are not limited to:
- Rent assistance
For more information on the College Tuition Waiver and the Educational Training Voucher, call 800-232-5437.
26. Does Kentucky offer a state adoption tax credit?
27. Does Kentucky have any program to support an adoptee whose adoptive parents die until the child is adopted again?
Some of the services in place at the time of the adoptive parents’ death remain in place, including tuition waviers, Educational Training Voucher (ETV), Medicaid, Independent Livining Programs, and PAPSS Services. If the child comes back into the custody of the Cabinet, the child would receive all the services that are offered to children in foster care.
28. What else differentiates Kentucky’s adoption assistance program from others around the country?
Kentucky has more support services and pays a higher adoption assistance rate than most other states. Kentucky has not had any cuts in the adoption assistance rates or the services provided to adoptive parents and children who are adopted.
Each year, adoptive families are required to complete an annual contact form and return it to their local DCBS office.