Adoption
Subsidy

Kentucky State Subsidy Profile

Updated September 2008

State Subsidy Contact Person

Diane Underwood
Adoption Branch Manager
Dept. for Community Based Services
275 East Main Street, 3C-E
Frankfort, KY 40621
Phone: 502-564-2147
Fax: 502-564-5995
E-mail: diane.underwood@ky.gov

NACAC Subsidy Representative (parent/volunteer)

Currently, there is no Kentucky Volunteer. If you or someone you know would like to volunteer to help families learn more about adoption assistance, please call Josh Kroll at NACAC, 800-470-6665 x15 or e-mail joshk@nacac.org.

Adoption subsidies are available for children with special needs. Federal subsidies were created by Congress (through Public Law 96-272—the Adoption Assistance and Child Welfare Act of 1980) to encourage the adoption of special needs children and remove the financial disincentives to adoption for the families. Children may receive a federally funded subsidy under Title IV-E or a state-funded subsidy as per state guidelines. Below we have outlined information related to definitions of special needs, benefits available, and procedures in your state. 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 each state’s subsidy program are available on our web site at www.nacac.org. If you have additional questions, please call the North American Council on Adoptable Children (NACAC) at 651-644-3036 or our subsidy help line at 800-470-6665, or e-mail us at adoption.assistance@nacac.org. If you have state-specific questions, please call your State Subsidy Contact Person or the NACAC Subsidy Representative (listed above) for more information.

Adoption Resources on the Web:
http://chfs.ky.gov/dcbs/dpp/adoptionservices.htm
including Frequently Asked Questions on Adoption and How Do I Get Started

Kentucky’s state-specific medical assistance:
http://chfs.ky.gov/dms/

and Medicaid information: http://chfs.ky.gov/NR/rdonlyres/892533D0-F904-425F-B3FC-CF86B3E5B397/0/MedicaidInfo.pdf

Kentucky’s adoption assistance:
http://chfs.ky.gov/dcbs/dpp/snapsupportingservices.htm
See also Special Needs Adoption Program, SNAP, in the Related Content section.

Kentucky Revised Statutes 199.555, Payment of subsidy to adoptive parents–Conditions.
http://www.lrc.ky.gov/KRS/199-00/555.PDF

Kentucky Revised Statutes 199.557, Federal Title IV-E Adoption Assistance
http://www.lrc.ky.gov/KRS/199-00/557.PDF

Kentucky Administrative Regulations, 922 KAR 1:050
http://www.lrc.ky.gov/kar/922/001/050.htm

1. What specific factors or conditions does your State consider to determine that a child cannot be placed with adoptive parents without providing financial assistance? ("What is your State definition of special needs?")

A child with special needs is defined as a child that has at least one of the following needs or circumstances that may be a barrier to placement or adoption without financial assistance:

1. Two years of age or older and African American
2. Seven years of age or older with a significant emotional attachment or psychological tie to her foster family and the Department has determined that it would be in the child’s best interest to remain with the family
3. A member of a sibling group of two or more children placed at the same time in the same family
4. A physical or mental disability
5. An emotional or behavioral disorder
6. A documented risk of physical, mental or emotional disorder
7. A previous adoption disruption or multiple placements

Note: Children must be legally free for adoption and in the custody of the state of Kentucky to be eligible for adoption assistance.

2. What are the eligibility criteria for the State-funded adoption assistance program?

In order to be eligible for state-funded adoption assistance a child must be a special needs child as defined above, legally free for adoption, and in the custody of the state. DCBS staff must also determine that a reasonable, but unsuccessful effort was made to place the child without providing adoption assistance.

3. The maximum basic monthly adoption assistance maintenance payment in Kentucky is:

These rates are effective July 1, 2007 and mirror the foster care rates:

Basic rate is the regular foster care per diem. In order to receive the Advanced rate the adoptive parent(s) must be an approved regular advanced home, have had the initial 24-hour advanced training, and attend 12 hours of required training per year. To receive the Basic Medically Fragile or Care Plus Home rates, the adoptive parent(s) must have completed the initial training for Medically Fragile or Care Plus Home and is required to attend 24 hours of training per year; the child must meet the definition of a Medically Fragile or Care Plus Home.

To receive the Advanced Care Plus Home rate the adoptive family is an approved Care Plus home for one year or more and meets the requirements mentioned above, and the child must meet the definition of a Care Plus Home. To receive the Advanced Medically Fragile rate, the adoptive parent(s) is a nurse with a current active license and meets the requirements mentioned above, and the child must meet the definition of Medically Fragile. To receive the Degree Medically Fragile rate, the adoptive parent is a current active registered nurse or physician, and the child must meet the definition of Medically Fragile.

The Specialized Medically Fragile rate may be paid to a resource home that completes all requirements for an Advanced and Degreed Medically Fragile Resource Home and receives individual documented training from a health professional in how to care for specific specialized medically fragile child who is placed in the Resource Home. The child must also require supervision by a physician or registered nurse. Initial Medically Fragile Training requirements must also be met.

4. Specialized rates are based on the extraordinary needs of the child, and/or the additional parenting skill needed to raise the child. If Kentucky offers these rates, the criteria used to define them are as follows:

There are two specialized maintenance rates:

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 may include, but are not limited to:

1. Uncontrollable diabetes, the child’s diabetes cannot be effectively controlled by either medication or diet and as a result, other body functions are affected so that the child may, at any time, go into a coma;
2. A child who requires the use of a monitor: apnea, oxygen, or cardiac;
3. Neurological or physical impairments to a degree that the child is non-ambulatory and requires 24 hour care;
4. Feeding problems that require nasal gastric or gastronomy tubes because of a condition associated with low weight, often a genetic condition; or
5. Tracheotomy requiring frequent suctioning and changing.

Care Plus Home—Is a remedial care program for acting out, troubled children and youth. A Care Plus Home allows a child to live in the least restrictive environment where the parent, role-model, is trained to implement planned, remedial supervision and care leading to positive changes in the child’s behavior. A Care Plus Home serves children and youth whom:

1. Have serious emotional problems
2. Are due to be released from treatment facilities
3. Display aggressive or destructive behaviors or other disruptive behaviors
4. Are at risk of being placed in more restrictive settings
5. Are at risk of institutionalization, or
6. Have experienced numerous placement failures

5. Parents can receive payment or reimbursement for certain nonrecurring adoption expenses directly related to the finalization of an adoption. Below are the allowed expenses and the limit per child.

Allowable expenses are: court costs, adoption fees, attorney fees (not to exceed $40.00 per hour for individual attorneys and $75.00 per hour for attorneys affiliated with a firm), home study costs (including health and psychological examinations), placement supervision costs (prior to adoption), and reasonable transportation, food, and lodging for the child and/or adoptive parents when necessary to complete the placement.

Requests for nonrecurring adoption expenses shall be approved prior to finalization of the adoption to be eligible for reimbursement. Adoptive parents have a two-year period after such approval to submit expenses for payment.

The reimbursement limit is $1,000 per child.

6. What Medicaid services are available in Kentucky?

• Renal Dialysis
• Pharmacy
• Podiatry
• Primary Care Center
• Rural Health Clinic
• Independent Laboratory
• Vision & 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
• Hospice
• 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—Medicaid covers durable medical equipment (wheelchairs, hospital beds, etc.). Orthotic appliances (braces) and prosthetic devices (artificial limbs, eyes, etc.) are also included as a benefit element under this program.

For more information on Medicaid services, call 502-564-6636.

7. Children who have federally funded (Title IV-E) subsidy are automatically eligible for Medicaid benefits. However, it is the state's decision whether state-funded (non-Title IV-E) children are eligible for Medicaid benefits in Kentucky. Below is information on the Medicaid benefits available for state-funded children.

Children placed with subsidy agreements are usually eligible for a Medicaid card. In some cases, if the child has income then the State limits their “kick in” and the child will not qualify for Medicaid benefits (e.g., Social Security Survivors benefits; VA benefits; “Black-Lung” benefits). There are very few of these exceptions. To determine Medicaid eligibility for non-IV-E children, Medicaid officials look only at the income of the child. Medicaid benefits available for non-IV-E children do not differ from those available to IV-E children.

8. What mental health services are provided by your State?

Public mental health services in Kentucky are administered by the Cabinet for Health and Family Services (CHFS), Department for Medicaid Services and include the following examples: 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 fourteen Regional MH/MR Boards. IMPACT Plus is a multi-disciplinary mental health program for children. The program is a collaborative effort of the Departments for Medicaid Services, Community Based Services and Mental Health and Mental Retardation Services designed to help provide community-based services for Medicaid (and KCHIP) eligible children with complex treatment needs. The goal of IMPACT Plus is for parents or caregivers to be able to understand both their child's needs and the systems involved, so that they will have the knowledge in the future to weave in and out of service systems as their child's needs indicate.

CHS mental health services: http://mhmr.ky.gov/. Medicaid services: http://chfs.ky.gov/dms/. Or phone 502-564-2147

Note: Not all services may be available in all cases. Contact your adoption assistance worker or medical assistance specialist for information regarding process, eligibility, availability, and duration of services.

9. Does your State provide additional finances or services for medical or therapeutic needs not covered under your State medical plan to children receiving adoption assistance?

Kentucky offers therapeutic services in addition to the Medicaid services offered under their state plan. Funding is available for Extraordinary Medical Expenses. Reimbursements for medical expenses not covered under medical assistance or the family’s private insurance are 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 (cover 50%); tutoring (in certain situations); physical, occupational, speech and behavioral therapy (one session per week per child); special equipment (in certain circumstances), customized equipment, and daycare.

10. What types of post adoption services are available in your State and how do you find out more about them?

Post adoption services in Kentucky are administered by the Cabinet for Families and Children, Department for Community Based Services (DCBS), and largely contracted through outside agencies. Post-adoption services include the following examples:

1. Information, resource/referral
2. Education/training programs
3. Education material
4. Support groups
5. Support groups (Adoption Support Network)
6. Mentoring (Resource Parent Mentor Program)
7. Therapeutic intervention
8. Respite Care
9. Post adoption placement stabilization services

Kentucky has several organizations dedicated to adoption. Contact your adoption assistance worker or local DCBS office about the Foster/Adoptive Support and Training (FAST) Center, Adoption Support for Kentucky, and the Kentucky Foster/Adoptive Care Association. Contact the Kentucky CFHS offices: http://chfs.ky.gov/contact/

The Special Needs Adoption Program (SNAP) Supporting Services: http://chfs.ky.gov/dcbs/dpp/Special+Needs+Adoption+Program+(SNAP).htm
Or phone SNAP at 800-432-9346.

Respite Care—The 7-1-00 foster care rate includes one (1) day per month of respite care. Families receiving these rates are not eligible for additional respite reimbursement unless the child qualifies for medically fragile or care plus home. Families may request two (2) additional respite days per month for these children. Respite Care may also be considered for families who do not receive a monthly subsidy or whose monthly subsidy is less than the 7-1-00 rates. At no time can the respite reimbursement exceed the applicable foster care per diem.

Many private organizations offer a variety of respite options. See the ARCH National Respite Network Respite Locator Service, search by state to locate Kentucky’s respite programs: http://www.respitelocator.org/

Note: Not all services may be available in all cases. Contact your adoption assistance worker or post adoption services contact for information regarding process, eligibility, availability, and duration of services.

11. If the additional assistance (listed above in questions #8 -10) is to cover specific services (e.g., counseling/mental health services, respite care, etc.), must these services be explicitly identified in the adoption assistance agreement?

Yes.

12. How are residential treatment costs covered (if at all) for adoptive families? What procedures must a family follow to receive these services?

Children with active adoption assistance agreements may qualify for residential treatment through post adoption placement stabilization funds. There is a 90-day limit on the length of stay in residential facilities that are funded through this mechanism. Families should contact their R & C worker for information.

13. A deferred adoption assistance agreement is one in which the initial monthly maintenance amount is $0. Does Kentucky offer such agreements?

No, Kentucky does not offer deferred adoption assistance.

14. Does Kentucky operate a subsidized guardianship program?

Kentucky runs a Kinship Care program that provides monthly payments to relatives.

Programmatic Procedures

15. Who makes the final determination of a child's subsidy eligibility in Kentucky? What roles, if any, do workers and administrators at the county, district, or regional level play in eligibility determination and/or assistance negotiation?

The local worker prepares a subsidy request for any child who appears to meet necessary criteria. These requests are then forwarded through appropriate supervisory channels for final approval by the Service Region Administrator or designee of each Region. Central Office staff gives technical and programmatic support to the regions.

16. Will Kentucky consider my family income to determine my child's eligibility for an adoption subsidy?

Family income and resources are used only in determining state-funded, extraordinary medical co-payment percentages.

17. When do subsidy payments begin?

Adoption assistance payments and benefits may begin at adoption placement (i.e. when the Adoption Placement Agreement is signed) or adoption finalization. When payments begin at placement, known as pre-adoptive placement, the payments are called pre-adoptive payments. When begun at finalization, they are called post-adoptive payments and are approved prior to finalization and begin at the time of finalization.

18. Do children adopted from private agencies in Kentucky receive the same subsidies as those children adopted from public agencies?

Children adopted from private agencies are not eligible for subsidies except in rare cases where a child is IV-E eligible and has special needs.

19. When my child turns 18, which benefits, if any, are available to our family?

If the child was receiving state-funded adoption assistance prior to his 18th birthday, he can continue to receive subsidy payments until the month of graduation from high school or age 19 (whichever comes first).

A subsidy is available to age twenty-one (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 a child does not qualify for the extension of the Title IV-E funded subsidy (i.e. MRT determines child is not totally and permanently disabled), then the subsidy can be switched to state funded if the child is 18 and still in high school. It can then continue until high school graduation or age 19, whichever comes first.

20. A child's adoption assistance agreement may be periodically reviewed by the state. What is the typical process used in Kentucky?

Yearly contact is required with a biennial renewal process, and may be done by mail or through a home visit.

To receive the Advanced Rate, the adoptive parent(s) must be an approved regular advanced home and is required to attend 12 hours of training per year.

To receive the Medically Fragile or Care Plus Home rates, the adoptive parent(s) must be an approved Medically Fragile or Care Plus Home and is required to attend 24 hours of training per year.

21. Can adoption assistance agreements be modified if requested by adoptive parents?

A request or renegotiation can be made at any time when there is a change in the child's special needs or the circumstances of the family. In rare instances, where a significant change in the family’s situation may negatively affect the stability of the placement, renegotiation may be warranted. Requests are made to the family’s Social Services Worker (SSW) and forwarded through supervisory and administrative channels for approval by the Service Region Administrator or designee. Requests can be verbal or written. Parents are directed to phone, e-mail, or send requests to their local Social Service Worker (SSW). A new adoption assistance agreement form (DSS-1258) must be completed to incorporate the requested change, if approved. The SSW will obtain documentation from the parents concerning the change in the child’s special needs or conditions or the circumstances of the family. Parents can request a change in the adoption assistance agreement before or after adoption finalization when they can show a significant change in the family’s situation that may negatively affect the stability of the adoptive placement. Increases and decreases in the adoption assistance payment and benefits are possible and requested changes take effect no earlier than the date of the request. When a family requests an increase the Social Services Worker will:

1. Evaluate the situation
2. Obtain documentation concerning special needs or conditions
3. Negotiate the adoption assistance agreement with the family
4. Prepare an Adoption Assistance Renegotiation Form
5. Forward the Form through supervisory and administrative channels for approval by the Service Region Administrator or designee
6. After approval of the Form, obtain the adoptive family’s signature and distribute to the adoptive family, Children’s Benefit’s 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.

Kentucky no longer automatically suspends the Title IV-E funded subsidy when a child enters foster care.

22. What are the exact steps a family must go through to access the fair hearing/appeal process in Kentucky?

Adoptive parents have the right to request a fair hearing any time the Cabinet for Health and Family Services 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 thirty days from the date of the disputed agency decision or action. The SSW sends along with the notice the DPP-154, Service Appeal Request informing the family of their right to file a service appeal as outlined in SOP 1.5 Service Appeals. A request for hearing shall be made by an adoptive parent within 30 days of notice of action.

If a client files a timely appeal of a substantiation of abuse or neglect (CAPTA Appeal), and the appeal meets acceptance criteria, the matter is referred for an administrative hearing. If substantiation is overturned by agreement or by judgment, the SSW or other Cabinet staff notifies the alleged victims' parents that the substantiation has been overturned. A client’s complaint regarding actions of DPP may also be submitted for an administrative hearing. Such complaints are known as service appeals. A hearing officer conducts the hearing and any pre-hearing conferences (an opportunity for mediation and possible settlement). The following is are example reasons for request for fair hearing:

1. Failure by the Cabinet to approve a prospective adoptive parent who meets the requirements of 922 KAR 1:100, Agency Adoptions, and 922 KAR 1:350, Family Preparation, for the placement of an adoptive child.
2. Failure by the Cabinet to place an adoptive child in an approved adoptive parent’s home with reasonable promptness.
3. Except as otherwise provided by law, failure by the Cabinet to provide an adoptive parent with known relevant facts regarding the child, child’s background prior to finalization of the adoption, or biological family.
4. Failure by the Cabinet to advise an adoptive parent of the availability of adoption assistance as described by 42 U.S.C. 673 and 922 KAR 1:050, Approval of Adoption Assistance.
5. Determination by the Cabinet that an adoptive parent is ineligible for adoption assistance upon execution of an adoptive placement agreement as described by 922 KAR 1:050, Approval of Adoption Assistance.
6. 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 as described by 922 KAR 1:050, Approval of Adoption Assistance.

For V/TDD services, please call the Office of the Ombudsman at 800-372-2973. 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

23. Families may request a subsidy after the finalization of an adoption under certain circumstances. Below is the process by which families access a subsidy after finalization.

In the policy, there are two parts: state funded and IV-E.

State funded: When a 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 the following criteria shall exist:

• The child was placed for adoption by the Cabinet for Health and Family Services;
• The child was considered “hard-to-place” prior to 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.

Adoptive parents may request adoption assistance at any point after finalization for Title IV-E funded Adoption Assistance.

One of the following situations shall have occurred:

1. State agency failed to notify or advise adoptive parents of the availability of adoption assistance for children with special needs;
2. Assistance was denied based upon an erroneous determination by the state that a child did not meet Special Needs Criteria; or
3. Relevant facts, which may have affected a child's special needs determination, regarding the child, the biological family, or the child's background were known but not presented to the adoptive parents prior to finalization.

To start the process, families should contact their local social services office.

System Operation and Program Funding

24. How is the subsidy program operated and funded in Kentucky?

The program is state administered. This means that all policy and eligibility decisions are handled by the state office.

The federal contribution to Title IV-E-eligible children is 70.13% in Kentucky. This is known as the Federal Financial Participation (FFP) rate. The remaining cost of the program is funded entirely with state general funds.

25. Below are other programs that may delineate Kentucky's adoption assistance program from others around the country.

Kentucky offers a College Tuition Waiver. The eligibility criteria pursuant to Kentucky Revised Statute (KRS) 164.2847 (http://www.lrc.state.ky.us/KRS/164-00/2847.PDF) are as follows:

1. Over age 18 and the family receives state-funded adoption assistance under KRS 199.555; or
2. Is currently placed in foster care by the Cabinet for Health and Family Services (CHFS) or the Department for Juvenile Justice (DJJ); or
3. Is in an Independent Living Program; or
4. Was in the custody of CHFS or DJJ prior to being adopted by a family that resides in Kentucky; or
5. Was in the custody of CHFS or DJJ on his or her 18th birthday

The student must also meet all entrance requirements for the post secondary institution and must maintain academic eligibility (i.e. 2.0 Grade Point Average).

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. Allowable expenses include but are not limited to the following:

• Books
• Rent Assistance
• Daycare
• Transportation
• Utilities
• Food

For more information on the College Tuition Waiver and the Educational Training Voucher, call 1-800-232-5437.