Adoption
Subsidy

Maryland State Subsidy Profile

Updated March 2007

State Subsidy Contact Person

Stephanie Johnson Pettaway
Department of Human Resources (DHR)
Social Services Administration
311 W. Saratoga Street
Baltimore, MD 21201
Phone: 410-767-7506
Fax: 410-333-0922
E-mail: spettawa@dhr.state.md.us

NACAC Subsidy Representative (parent/volunteer)

Jennifer Klotz
Center for Adoptive Families
5750 Executive Drive, Suite 107
Baltimore, MD 21228
Office: 410-402-1121
Fax: 410-402-1122
E-mail: jklotz@adoptionstogether.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://63.236.98.116/adopt/index.htm

Maryland’s state-specific medical assistance links:

http://www.dhmh.state.md.us/mma/mmahome.html

Maryland’s adoption assistance links:

http://63.236.98.116/adopt/finhelp.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?")

To qualify on the basis of the child’s special needs, the child shall be one for whom the local department or agency which holds guardianship has made reasonable efforts to find an adoptive family without subsidy, but has not been successful because of one or more of the following factors:

1. Six years of age and over, but not yet 18 years of age;
2. Race or ethnic background, as follows:
   1. The child’s membership in a minority race or ethnic group alone does not qualify for subsidy,
   2. Documentation in the child’s record shall clearly indicate how the child’s minority background, in addition to other special needs, prevented an adoptive placement without subsidy;
3. Physical or mental disability or risk of it;
4. Emotional disturbance;
5. Membership in a sibling group; or
6. Recognized high risk of a physical or mental disease

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 or the adoptive family’s income may make them eligible even if the child does not meet the definition of special needs. An assessment is conducted to determine if the adoptive family’s resources are limited and are within state eligibility requirements.

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

The maximum monthly adoption assistance payment shall not exceed the applicable foster care board rates, which is as follows:

The maximum basic foster care board rate: $635

The maximum intermediate foster care board rate: $750

The exception to the foregoing is treatment foster care families who adopt medically fragile children, as defined by statute.  These families may be eligible for subsidy of up to $2,000 per month.

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

A higher subsidy rate may be available for “medically fragile” children.  A medically fragile child means a child who:

1. Depends at least part of the day on mechanical ventilation;
2. Requires prolonged intravenous administration of nutritional substances or drugs;
3. Depends on other device-based respiratory or nutritional support, including tracheotomy tube care, suctioning, oxygen support, or tube feeding on a daily basis;
4. Depends on other medical devices that compensate for vital body functions and who requires daily or near daily nursing care including:
   1. A child who requires renal dialysis as a consequence of chronic kidney failure, and
   2. A child who requires other mechanical devices such as catheters or colostomy bags, as well as substantial nursing care in connection with the disabilities.

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.

Reasonable and necessary nonrecurring costs include: adoption fees, court costs and reasonable attorney fees, health examinations, transportation costs, and food and lodging costs incurred during preplacement visits.       

Adoptive parents involved in independent or intercountry adoptions are potentially eligible for these reimbursements.  Adoptive parents must apply for the reimbursement and sign the nonrecurring costs agreement before the adoption is finalized. The agreement will not and cannot be signed prior to the receipt of all the required documentation.  When a family cannot provide documentation prior to the adoption finalization the application will be denied.

The reimbursement limit is $2,000 per child.

6. What Medicaid services are available in Maryland?

Adoption assistance recipients receive the same full range of Medicaid benefits that are available to non-adoption assistance recipients. All medically necessary and appropriate services are covered.

Contact Rose Ann Meinecke (410-767-1488), Chief, Division of Children’s Services, Medical Care Policy Administration, Department of Health and Mental Hygiene

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 inMaryland.  Below is information on the Medicaid benefits available for state-funded children.

Yes, children eligible for state-funded subsidy are eligible for medical benefits. However, there are caps on the coverage (i.e., IV-E eligible children receive unlimited hospitalization, while children in the state-funded program are only covered for a specified number of days). In general, the benefits are also more restricted in the state-funded program.

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

Public mental health services for children in Maryland are administered by the Department of Health and Mental Hygiene (DHMH). DHMH mental health services include the following examples: outpatient therapy, in-patient hospitalization, residential rehabilitation, residential treatment, rehabilitation, supported living, day treatment, and 24-hour crisis intervention.

Maryland’s Public Mental Health System: http://www.dhmh.state.md.us/mha/geninfo.htm and http://www.dhmh.state.md.us/mha/geninfo.htm#services%20covered.

Or phone the toll-free help line: 800-888-1965

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?

Maryland offers a program knows as One-Time Subsidy.  This program covers specific expenses or special services related to the adoption of a particular child or children, such as necessary physical alterations to the home to accommodate a handicapped child and special equipment not otherwise provided for. The need or potential need for these services must be requested and adoption assistance application for this One Time Only payment must be made and approved.  The amount of the one-time subsidy is equal to the expense or the service to the family, up to a maximum of six (6) months financial subsidy payment at the 100 percent of the appropriate foster  care board rate.  It cannot exceed the intermediate board rate paid at the time of the request.  The state and federal government fund the One-Time Subsidy program as determined by the need for the money and whether it meets certain federal definitions.  If the grant exceeds $2,000 allowed by the federal government, then the balance up to 100 percent of a year’s board rate is 100 percent state-funded.  Please ask your adoption assistance worker for an explanation of program specifics.

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

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 Maryland are administered by the Department of Human Resources, Social Services Administration and include the following examples:

1. Information and referral
2. Counseling
3. Search, contact and reunion services
4. Waiver of higher education tuition and fees
5. Provision of medical and family history
6. Childcare reimbursement

Adoptive parents are directed to contact the adoption agency that placed the child or the local Departments for referral to agencies in the area where the family resides. DHR may make services available on request to eligible families of children adopted through the local department of social services. Adoptive families are placed on a waiting for post adoption services in accordance with available DHR staff resources.

Respite care is available for children receiving services through Maryland Health Partners (MHP) for mental health services.  MHP provides the mental health component of medical care for children with Medicaid eligibility in Maryland.  The child must have a DSM IV diagnosis.  This group includes adopted special needs children.

Respite care is also available for subsidized children eligible for services from Developmental Disabilities Administration (DDA).  When DDA cannot provide the services, they often provide the funding to the family.

In addition, many private organizations offer a variety of respite programs. See the ARCH National Respite Network Respite Locator Service, search by state to locate Maryland’s respite programs, link: http://www.respitelocator.org/index.htm.

Post adoption services are detailed in the Code of Maryland Regulations available on-line at: http://www.dsd.state.md.us/comar/07/07.02.12.21.htm.

Contact local DHR county offices: http://63.236.98.116/county.htm.

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?

There is no specific state fund that pays for residential treatment care (RTC) (not covered by Medicaid) for children in subsidized adoption.  However, any Maryland child who is involved with a state agency (Departments of Human Resources, Juvenile Justice, Education, or Health and Mental Hygiene) has access to money available for this level of care through the local management boards (LMB) set up in each jurisdiction of the state.  Therefore, if it is determined that a child needs placement in a RTC facility over and above what Medicaid will allow, that care can be funded.

Additionally, in certain circumstances the care may be funded without committing the child to the custody of a state agency.  The families of children with mental health or developmental disabilities may enter into a voluntary placement agreement with the local department in order to access this level of care.

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

Yes. Maryland offers deferred adoption assistance.  Deferred adoption assistance is for “at risk” special needs designations and requires documentation that a condition existed at the time of adoption finalization or that the child is/ was at risk for special need.  The request must be related to the condition that would have made the child eligible for adoption assistance but was unknown at the time of adoption.

14. Does Maryland operate a subsidized guardianship program?

In 1997, the Subsidized Guardianship program began as a five-year demonstration waiver project.  The demonstration project ended after the five-year waiver.  During the 2006 Maryland General Assembly, the legislators authorized state money to fund the current guardianship subsidy without any contributions from the federal government.  Funding is available to offer the subsidy to 500 children including approximately 200 children from the demonstration project and 300 new children.  The project is offered to families whose children are randomly selected and who agree to participate in the program.  Children are eligible for the subsidy until the age of 18 or 21 if they are enrolled in a formal education program or have a documented disability.  A guardian receives the subsidy in the amount of $585/child to cover the daily needs of the child.  The rate is higher than TANF, but lower than the adoption subsidy rate.  In addition, the child is also eligible for state funded Medical Assistance.

To participate in the program, the following criteria must be met:

1. Child is randomly selected through an automated computer system;
2. Child must have lived with the potential relative for a minimum of six months and the relative must complete a comprehensive home study;
3. Child must be in the custody of the state and in a stable, nurturing, and safe out-of-home placement;
4. Reunification with birth parent and adoption are not permanency planning options;
5. Potential guardian must have some means of financial support independent of the subsidy.

For more information:

Sharon Hargrove
Department of Human Resources
311 W. Saratoga St., 5th Floor
Baltimore, MD 21201-3521
Phone: 410-767-7587
Fax: 410-333-6556

Programmatic Procedures

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

The child’s caseworker, the supervisor, and other appropriate staff shall determine eligibility for every child who is to be placed for adoption. The final agreement has to be signed by the director of the local department in the county where the family resides.

If the family's application for subsidy is denied on the basis of the child's ineligibility, or for any other reason, the worker must notify the family in writing of that decision and of the reasons for it within five (5) working days of the decision. This notice must also contain a notice of the right to appeal the decision.

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

No—Program eligibility rests with the child and is without regard to adoptive family income. 

When the child is not eligible based upon the special needs of the child and the family has limited income, the family might be eligible for a subsidy based on the family’s income (see Question 25).

17. When do subsidy payments begin?

In the case of foster parent adoptions, subsidy payments may begin upon receipt of signed subsidy agreements.  In other adoptions, placement planning continues upon receipt of a signed agreement, with payments beginning on the day of placement.

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

Yes, provided the agency is licensed in Maryland and the family resides in Maryland.  The agency must apply on behalf of the family and provide all needed documentation.

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

Adoption assistance payments may be made until the month in which a child attains his 21st birthday, provided the child is still enrolled in an educational or vocational training program on a full-time basis, or a handicapping condition prevents self-sufficiency.  Additionally, the adoptive parents must remain legally and financially responsible for the child.  These payments are totally funded by federal and/or state funds.

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

The local department shall review continued eligibility for subsidized adoption on an annual basis for as long as the subsidy continues. This is accomplished by having the family file a reapplication form annually. Reapplication forms shall be issued by the agency at least one month prior to the due date for reapplication.

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

Adoptive parents may request a change in the adoption assistance agreement if there is a change in the needs of the child or the circumstances of the family. The Department and the family review agreements annually, but parents can call and request a change whenever there is a need.   Requests can be made in person, over the phone, or in writing.  Parents are asked to contact the agency that placed the child when requesting a change.  The agency will advise and assist the family in collecting the documentation necessary to support their request and determine eligibility for the requested change.  If the adoption agency is private, they will forward the request and the documentation to the public agency for consideration.  The package is reviewed and a decision to approve or deny the request is made by the local Department of Social Services.

Both the Department and the adoptive parent(s) must agree to all changes.  Adoption assistance payment amounts automatically increase when a child reaches the age of twelve.  If parents do not receive the requested change, they can request a fair hearing and appeal the decision through the local Department that denied the request. Contact local county offices, link: http://63.236.98.116/county.htm.

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

Adoptive parents can request a fair hearing whenever there is disagreement with a Department decision that affects their child’s adoption assistance benefits. Parents are directed to make requests for fair hearing to their adoption assistance worker or the Director of the local Department that made the contested decision. Requests can be made in person, over the phone, or in writing and must be made within thirty days of the notice of contested decision. Once a request is received, the Department will send the family a fair hearing request form to complete and return to the Department. The local Department will then forward the form to the Office of Administrative Hearings. An Administrative Law Judge (ALJ) will hear the case, render a decision, and notify the family of the decision.

Call your adoption assistance case manager or 800-332-6347 for assistance, or send completed request forms directly to the following address:

Office of Administrative Hearings
Administrative Law Building
11101 Gilroy Road
Hunt Valley, Maryland 21031-1301

For complete information and/or to obtain a fair hearing request form, see Maryland’s Family Investment Administration’s page, How to have a hearing if you think we are wrong: http://63.236.98.116/fia/hearing.htm.

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.

Families who wish to apply for a subsidy after finalization of an adoption may apply through the agency that handled the adoption.  The family must provide documentation (i.e., medical/psychological/educational records) that establish the child’s special needs existed before the adoption and would have made the child eligible for subsidy, but were not known at the time of adoption.  If eligibility is established, the family and the director of the local department sign an agreement.

System Operation and Program Funding

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

The program is state supervised/state administered.  Policy and regulations relating to subsidy and other programs are done at the state level. The counties make decisions related to children’s eligibility.

The federal contribution to Title IV-E-eligible children is 50.00% in Maryland. This is known as the Federal Financial Participation (FFP) rate. The remaining cost of the program is funded entirely with state funds.

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

Adoptive families of non-special needs children may qualify for a state-funded adoption subsidy based on their family income.  If a family's adjusted gross income is less than 80 percent of the latest published state median income for a family of their size (including the adopted child), they may qualify for adoption assistance.

Maryland offers the Maryland Waiver, which allows children who meet certain criteria to attend college in Maryland.  To be eligible for the waiver you must meet the following criteria:

1. Be a Maryland resident
2. Be in a foster care placement at the time you are graduating high school, or successfully completed your GED or adopted after your 14th birthday.
3. Attend a college in Maryland
4. The waiver does not pay for a training program, nor does it cover the cost of books and or transportation.
5. Applicant must complete the Free Application for Federal Student Aid, FAFSA.
6. Waiver is good for 5 years after first year enrolling.