Adoption
Subsidy

Missouri State Subsidy Profile

Updated May 2006

State Subsidy Contact Person

Amy Martin
DSS/Children's Division
615 Howerton Court
P.O. Box 88
Jefferson City, MO 65103-0088
Phone: 573-751-8930
Fax: 573-526-3971
E-mail: Amy.L.Martin@dss.mo.gov

NACAC Subsidy Representative (parent/volunteer)

Lori Ross
Executive Director
Midwest Foster Care & Adoption Assn.
3210 S Lee's Summit Road
Kansas City, MO 64052
Work: 816-350-0215 / 866-794-KIDS
Fax: 816-461-7108
Email: rross600@aol.com
Web: www.mfcaa.org

Denise Kelley
Foster and Adoptive Care Coalition
111 North 7th Street, 6th Floor
St. Louis, MO 63101
Work: 314-340-3493
Fax: 314-340-7754
Email: denisekelley@foster-adopt.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://www.dss.mo.gov/cd/adopt.htm

Missouri’s state-specific medical assistance links:

http://www.dss.mo.gov/dms and

http://www.dss.mo.gov/dms/global/pages/about.htm

Missouri’s adoption assistance link:

http://www.dss.mo.gov/cd/adopt/masp.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:

a.   Five years of age or older, without any other characteristics listed below

b.   Minority racial or ethnic parentage

c.   Member of a sibling group of two or more children placed in the same adoptive home at the same time

d.   A handicapping mental, physical or emotional condition

e.   A “guarded prognosis” indicating possible future problems related to the child's condition or status at the time of adoptive placement

Note: Children must be legally free for adoption and have been either in the custody of the Missouri Children’s Division, The Missouri Division of Youth Services, The Missouri Department of Mental Health, or a Licensed Private Child Placing Agency 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 have been either in the custody of the Missouri Children’s Division, The Missouri Division of Youth Services, The Missouri Department of Mental Health, or a Licensed Private Child Placing Agency.

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

Basic rates:

All children who qualify for subsidy receive a basic subsidy package of maintenance, child care, and Medicaid.

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

Medical Foster Care                        $651

Behavioral Foster Care                   $651

Children must meet specific criteria and be staffed and/or approved for these special rates.  Missouri children may be eligible for these specialized maintenance rates on a case-by-case basis.    Missouri law states that children may not receive a maintenance rate higher than the maintenance rate that they received while in foster care. 

The criteria used to define these specialized rates are as follows:

Medical Foster Care (MFC) criteria:

• Requires above normal care and attention due to a medical or developmental disability.
• A completed Medical Foster Care Assessment Tool (CS-10), plus any or all of the following tools to document the child's eligibility:

  i. Complete training by a healthcare provider specific to the child’s needs.

  ii. Medical documentation of existing problems, including a written statement, by the child's physician or his designee of the child's special needs;

  iii. Written documentation from other professionals (e.g., physical therapist, speech therapist, nurse) that outlines the tasks and responsibilities of the parents and the needs of the child;

  iv. Other information that will support the child's need for MFC.

Behavioral Foster Care (BFC) criteria:

• Requires above normal structure and supervision and is less able to assume responsibility for daily care due to behavioral or emotional issues;

• Have behaviors which, if not modified, could result in the youth being designated a status offender;

• History of irresponsible or inappropriate sexual behavior, which has resulted in the need for extraordinary supervision;

• Threatening, intimidating, or destructive behavior which is demonstrated by multiple incidents over a period of time;

• Problems of defiance when dealing with authority figures;

• Significant problems with peer relations;

• Significant problems at school that affect academic achievement or social adjustment;

• Significant problems with lying, stealing, or manipulating;

• Significant problems with temper control;

• Mild substance abuse-related problems;

• Oppositional behavior which contributes to placement disruptions and inability to function productively with peers, parent figures, birth family, etc.;

• Any of the above behaviors when coupled with medical problems.

The referral/approval process:

• A completed referral packet including a list of the specifically identified and described problem behaviors, current social history, appropriate educational material, medical records, recent psychological testing results, recent counseling reports, and residential facility reports, and any other appropriate information.

• A staffing is held with the parent, the social service worker, and when available, the behavioral consultant.

• A recommendation is made, and the referral and recommendation are sent to the supervising Regional Office for approval.

• The adoptive parent must complete BFC training or an equivalent of the training prior to receiving payment.  Payment is not retroactive to date of placement.

The Career Parenting Program:    (Rate:  $47 per day) 

This program may also be used as a treatment of choice to assist adoptive parents caring for seriously challenged children. In these instances, the subsidy-eligible child is placed in this type of care, but the adoptive parents themselves may not receive the higher rate.  A voluntary case is opened with the family in order to work towards the reintegration of the child back into the adoptive home.

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.

Such expenses are limited to: legal costs associated with adoption proceedings, agency fees and supervisory costs prior to finalization, and transportation, food, and lodging expenses necessary to affect the adoptive placement.  Families must apply during adoption subsidy application, negotiation, and approval processes.

Families are notified of this program through courts, private agencies, and local Children’s Division offices.  Children ineligible for the Missouri Adoption Subsidy Program (e.g., children adopted in independent and inner-country proceedings)may still be eligible for nonrecurring cost reimbursement if they meet special needs definition and IV-E requirements, and if the adoption is being handled in Missouri.

The reimbursement limit is $2,000 per child.  Nonrecurring adoption expenses are not provided for children adopted internationally.

6. What Medicaid services are available in Missouri?

Services Provided:

• Inpatient hospital care
• Outpatient hospital
• Laboratory and x-ray when prescribed by a physician
• Nursing home
• Emergency ambulance
• Audiology/hearing aids
• Podiatry
• Ambulatory surgical services
• Respite
• Durable medical equipment and certain prosthetic and orthotic devices
• Home health care
• Optometry/eyeglasses
• Family planning
• Dental—including dentures
• Nurse midwife
• Hospice
• Transplant
• Certified nurse practitioner
• AIDS waiver
• Mentally retarded/developmentally disabled
• Case management for pregnant women
• Physician—whether furnished in the office, home, hospital, nursing home, or elsewhere. The only physicians who can receive payment are those who are licensed as MDs or DOs
• Drugs and medicines—that have been prescribed by a physician, dentist, or podiatrist and that are obtained from a licensed pharmacy.
• Personal care and adult day health care—provided in the home as an alternative to nursing home care.
• Rehabilitative therapies—for adaptive training in the use of prosthetic and orthotic devices, braces, and artificial larynxes
• Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) services
• Community psychiatric rehabilitation
• Comprehensive substance treatment and rehabilitation (C-Star)
• Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) of eligible persons under 21 years of age.
  

The following services are available for children age 0-20 years:

• Speech therapy
• Physical development
• Occupational therapy
• Guidance
• Physical therapy
• Vision
• Psychological counseling
• Dental
• Private duty nursing
• Hearing
• Case management
• Lead poisoning
• Orthodontics – medically necessary
• Social work services
• Immunizations
• Other medically necessary services
• Screening

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

Both IV-E eligible and state-only children are automatically eligible for Medicaid through the adoption subsidy agreement.  State-only children receive the same coverage as IV-E children including equal application of policy and payment rates.

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

Public mental health services for children in Missouri are administered through the DSS Division of Medical Services (DMS) and includes the following examples: inpatient and outpatient hospital care, respite, prescription drugs, community psychiatric rehabilitation, comprehensive substance treatment and rehabilitation (C-Star), physician services, psychological counseling, and case management. For children in DSS Children’s Division custody in out of home placement, Children’s Treatment Services include the following examples: day treatment, evaluation and diagnosis, family residential treatment, family therapy, group counseling, individual counseling, respite care, and resource coordination.

See the Missouri DSS Children’s Treatment Services link: http://www.dss.mo.gov/cd/cts.htm, phone DMS at 573-751-3425. The DSS Children’s Division operates a Parental Stress Helpline 24 hours a day, seven days a week at 1-800-367-2543. Medicaid coverage is secondary to any private insurance of the adoptive family.

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?

Missouri offers what is known as Special Services.  Funding may be used for the family or child and only when no other resources are available to meet the identified need.  Costs may be on a one-time or on-going basis and include: treatment or rehabilitative services (including day care and respite care), residential treatment services, and medical or dental services not covered under Medicaid.  Prior authorization, professional documentation of need, and a listing of the need for Special Services in the adoption assistance agreement are required for eligibility.

Missouri also offers what is known as Time-Limited Services.  Funding is intended to meet the short- or long-term diagnostic and treatment needs nature as secondary coverage.  Parents must use private insurance as primary coverage whenever possible and Medicaid will serve as secondary coverage in these situations.  The Division will not supplement payment made by private insurance.

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 Missouri are administered through the Department of Social Services, Children’s Division as well as adoptive family organizations and include the following examples:

1. Information and referral
2. Education programs
3. Support groups program
4. Therapeutic intervention
5. Advocacy
6. Respite
7. Residential treatment
8. State adoption registry

For post adoption services information, contact:

Foster and Adoptive Care Coalition: http://www.foster-adopt.org, or phone 314-340-7722 or 1-800-FOSTER3. 

Midwest Foster Care and Adoption Association: http://www.mfcaa.org, or phone 816-350-0215 or 1-866-794-KIDS.

Missouri Foster Care and Adoption Association at 417-538-4362

The Adoption Exchange at 800-554-2222

Respite care is available as a special service.  It is accessible through the family’s subsidy agreement.  A subsidy agreement can be re-written and re-negotiated at any time to include respite, if approval is granted.  This would allow for a limited amount of respite care per each 30-day period.  Families contract with a respite provider; the rate of pay is established and included in the agreement.  Families should contact the worker who arranged their subsidy, or contact the adoption specialist in their county of residence.  The need for respite must be documented.  Respite rates are set by policy.  Currently, a total of 12 respite units (at $20.00 per unit or $240.00 per year) may be approved for children receiving the base maintenance subsidy rate.  Children receiving BFC or medical maintenance may be approved for up to 19 units of respite per year at the BFC/medical daily rate of pay per unit, or $400.00 per year.  Children previously approved to receive the Career maintenance amount may be approved for up toe 24 units per year at the rate of $40.00 per unit, or $960.00 per year.

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?

Residential treatment costs may be met through the “Special Services” program. Subsidy agreements must be renegotiated if residential care services are requested by the adoptive parents.  Custody must not be transferred from the adoptive parents when securing these services.

We also seek the assistance of our area residential treatment technical assistance staff to help locate an appropriate resource.  For highly challenging situations, a referral will also be made to the Children and Adolescents Special Service Project or the Psychiatric Diversion Team for problem-solving and treatment recommendations.

A voluntary case is opened with the family when a child enters residential care in order to work towards the reintegration of the child into the adoptive home.  If the family is unwilling to participate, residential services are not authorized through subsidy.

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

Yes, Missouri offers deferred adoption assistance.

14. Does Missouri operate a subsidized guardianship program?

Yes. Missouri has subsidized guardianship for grandparents, aunts, uncles, adult siblings and first cousins of the child.  Children who qualify for this program will receive the same resources as those offered through the adoption subsidy program.  The contact person is Amy Martin (573-751-8930).

Programmatic Procedures

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

All children in Children’s Division custody or who are in the custody of the Department of Mental Health, Division of Youth Services or a Licensed Private Child Placing agency who meet special needs criteria are eligible for subsidy.  Decisions are subject to second and third level supervisory review and approval.  The agreement is finally approved by the Division Director after recommendation by the Regional Director.           

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

There are no established income guidelines to be applied in determining if adoptive parents are eligible for subsidy.

17. When do subsidy payments begin?

Adoption assistance payments and benefits may begin in Missouri at the time the petition to adopt has been filed if the child is legally free for adoption. Until that time, foster care payments may be made to the placement resource.

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

Yes, however, children in the custody of these agencies must meet special needs criteria. In addition, these benefits are available to children in the custody of the Division of Youth Services and the Department of Mental Health. They follow the same policies and procedures that the Children’s Division staff follow. The local office handles the review and approval process upon referral of the agreement by the agency having the child's custody. Agencies are also responsible for the annual review of the agreement and referral to the Children’s Division if advice and counsel are needed.

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

Subsidy services may be continued to age 21 for children with extraordinary mental, physical, or dental conditions requiring care after age 18. Such conditions must be documented by appropriate treatment professionals. Subsidies may also continue (through their month of graduation) to children over 18 if such children have not completed their high school education by their 18th birthday.              

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

Assistance agreements must be reviewed with adoptive parents at least annually.  The Division shall provide written notice of the need for such reviews at least 60 days prior to the effective date.  If no changes are indicated, agreements may be automatically renewed. However, if the family indicates changes are needed due to changes in circumstance or the needs of the child, plans and agreements are revised within the law and policy limitations of the program.  Time specific services must be reviewed and reauthorized.   They do not automatically renew.

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

Adoptive families can request a change in the adoption assistance agreement at any time, either in person or in writing.  Requests for modification to the agreement are based on changes in the circumstances of the family or the needs of the child and are submitted to the child’s Children’s Division Adoption Specialist, who should be located within their local county office.  Requests for assistance above the basic subsidy package must be accompanied with supporting documentation from appropriate sources.  Adoption assistance agreements are reviewed on a yearly basis. DSS sends written notice of the need for such reviews at least sixty days prior to the effective date.  If parents do not indicate a need for change in the agreement, agreements may be automatically renewed.  Services within the agreement that are time specific do not automatically renew and must be must be reviewed and reauthorized.

If a family disagrees with a decision made by the Division regarding subsidy, they have a right to request a fair hearing regarding that issue within ten days after receiving written notification from the Division.  If they wish to request a fair hearing, they must contact their social service worker to request the necessary paperwork.  A hearing officer through the Division of Legal Services will arrange a hearing. Information regarding the request and documentation will be shared at this hearing.  The family may hire an attorney if they wish, however, the Division will not cover this expense.  The hearing officer will make a determination on the case once both sides have presented evidence.  Once the hearing officer makes his or her determination, the matter is sent to the Division Director for final approval/disapproval and the determination will be sent to the family and the county for follow-through.

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

Adoptive parents can request a fair hearing whenever they disagree with any Children’s Division decision related to an adoption assistance agreement. Requests must be made in writing within ten days from the date of the contested Children’s Division action notification and sent to the local Children’s Division office.  Requests are referred to fair hearing staff after a supervisory review process.  A fair hearing request may be made when a child is determined to be ineligible for adoption assistance, when a request for assistance made by the family is denied, or when services have been removed, prior to then end date on the adoption assistance agreement.  The request for a fair hearing is to be made to the family’s Adoption Specialist in writing.  A fair hearing form (IM-87) may be requested through the Adoption Specialist, or the Specialist’s supervisor, and is to be completed either by the family’s Adoption Specialist or by the family.

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 can obtain such a subsidy through normal application channels (county offices) when conditions manifest themselves which were not apparent before the adoption, or if the family was not made aware of the availability of an adoption subsidy. To start the process, families should contact their worker at the local county office.

System Operation and Program Funding

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

The program is state supervised/state administered.  This means that both policy and eligibility decisions are made by personnel at the state office.  However, regional administrative and supervisory staff approve agreements and recommend their approval to the Division Director.  Technical assistance is provided by Central Office program staff.

The federal contribution to Title IV-E-eligible children is 61.93% in Missouri. This is known as the Federal Financial Participation (FFP) rate. The remaining cost of the program is funded entirely with state funds. Counties do not share in the cost.

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

Missouri families adopting a special needs child on or after January 1, 1988 may be eligible to receive a Missouri Adoption tax credit for nonrecurring adoption expenses. These expenses can be claimed up to $10,000 if the adopting parent(s) have not been reimbursed by federal, state, or local resources.

Missouri children may been seen at: http://www.dss.mo.gov/cd/adopt

As required by statute, the Children’s Division must file an annual report on the subsidy program to the legislature, including, but not limited to, the number and types of subsidies being paid, an accounting of state and federal funds expended, and a projection of future monetary needs to maintain the subsidy program.