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Missouri State Subsidy Profile

Updated October 2010

State Subsidy Contact Person

Amy Martin
DSS/Children’s Division
615 Howerton Court
P.O. Box 88
Jefferson City, MO 65109
573-526-8040
Fax: 573-526-3971
Amy.L.Martin@dss.mo.gov

NACAC Subsidy Volunteer

Midwest Foster Care & Adoption Assn.
Independence, MO
816-350-0215; 866-794-KIDS
Fax: 816-350-0085
info@mfcaa.org
www.mfcaa.org

Denise Kelley
Foster and Adoptive Care Coalition
111 N. 7th St., 6th Floor
St. Louis, MO 63101
314-340-3493
Fax: 314-340-7754
denisekelley@foster-adopt.org


What Is Adoption Subsidy?

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 Missouri. 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 adoption.assistance@nacac.org. If you have state-specific questions, please call your State Subsidy Contact Person or the NACAC Subsidy Volunteer (listed above) for more information.

For more information on Title IV-E eligibility, view our fact sheet Eligibility and Benefits for Federal Adoption Assistance.

Missouri 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/mhd/index.htm

Missouri’s adoption assistance link:
http://www.dss.mo.gov/cd/adopt/masp.htm

Missouri Revised Statutes–453.073 and 453.074:
http://www.moga.mo.gov/STATUTES/C453.HTM

Code of State Regulations, Title 13 Department of Social Services, Division 35 Children's Services, Chapter 38 Adoption and Guardianship Subsidy–13 CSR 35-38.030 and 13 CSR 35-38.040:
http://www.sos.mo.gov/adrules/csr/current/13csr/13c35-38.pdf

Child Welfare Manual, Section 4 Out-of-Home Care, Chapter 30 Subsidizing An Adoption/Legal Guardianship:
http://www.dss.mo.gov/cd/info/cwmanual/section4/ch30/sec4ch30index.htm


Who is Eligible for Adoption Assistance or Subsidy?

1. How does Missouri define special needs to determine eligibility?

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. a. Five years of age or older, without any other characteristics listed below
  2. Minority racial or ethnic parentage
  3. Member of a sibling group of two or more children placed in the same adoptive home at the same time
  4. A disabling mental, physical, or emotional condition
  5. A “guarded prognosis” indicating possible future problems related to the child's condition or status at the time of adoptive placement

To be eligible, 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.

2. Does the state-only funded adoption assistance program differ in any way from the Title IV-E program?

Eligibility criteria are the same as those listed above.

3. Are children adopted from private agencies in Missouri eligible for subsidies?

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.


What Supports and Services Are Available?

Monthly Payments

4. What is the maximum basic monthly adoption assistance maintenance payment in Missouri?

Age Rate
0-5 $232
6-12 $283
13+ $313

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


5. Does Missouri provide specialized rates (based on the extraordinary needs of the child or the additional parenting skill needed to raise the child)?

Medical Rate $671
Behavioral Rate $671

Missouri children may be eligible for these specialized maintenance rates on a case-by-case basis. Children must meet specific criteria and be staffed by a team utilizing a behavioral or medical assessment tool. Additionally, the adoptive parents of children designated as medical or behavioral are provided with the training necessary to meet the additional needs of their children. 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:
    1. Complete training by a healthcare provider specific to the child’s needs.
    2. Medical documentation of existing problems, including a written statement, by the child's physician or his designee of the child's special needs;
    3. Written documentation from other professionals (e.g., physical therapist, speech therapist, nurse) that outlines parents’ tasks and responsibilities the child’s needs of the child;
    4. 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;
  • Has behaviors that, if not modified, could result in the youth being designated a status offender;
  • Has a history of irresponsible or inappropriate sexual behavior, which has resulted in the need for extraordinary supervision;
  • Has demonstrated threatening, intimidating, or destructive behavior which is demonstrated by multiple incidents over a period of time;
  • Has problems of defiance when dealing with authority figures;
  • Demonstrates significant problems with peer relations;
  • Has significant problems at school that affect academic achievement or social adjustment;
  • Has significant problems with lying, stealing, or manipulating;
  • Has significant problems with temper control;
  • Has mild substance abuse-related problems;
  • Exhibits oppositional behavior that 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.

To receive the Behavioral rate, parents and workers must go through the following process;

  • The parent reports the behaviors because of which they believe their child will be eligible for Behavioral rate and requests a staffing. In turn the subsidy worker completes the referral packet requiring supporting documentation from the parent, therapist and other professionals involved with the child. 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.

6. 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 pre-adoptive parent.

7. When a child turns 18, which benefits, if any, continue?

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.

8. Does Missouri offer deferred adoption assistance agreements (agreements with initial monthly maintenance amount is $0 for children at risk of developing special needs later)?

Yes.


Medical Care

9. What Medicaid services are available in Missouri?

Services provided include:

  • 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 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 from birth through age 20:

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

10. What medical benefits are available for state-funded children? (Children who have federally funded/Title IV-E subsidy are automatically eligible for Medicaid benefits.)

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.


Other Benefits

11. In Missouri, what nonrecurring adoption expenses directly related to the finalization of an adoption may be reimbursed?

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

12. Is child care available? If yes, who is eligible and how do families access child care?

Missouri offers child care on each adoption subsidy agreement for children to age 13 when both parents are working.

13. Is respite care available? If yes, who is eligible and how do families access respite care?

Respite care is available as a service, accessed through the family’s subsidy agreement. A subsidy agreement can be rewritten/renegotiated at any time to include respite, if approval is granted. To receive approval, families should contact the worker who arranged their subsidy, or contact the adoption specialist in their county. Parents must document the need for respite and the benefit of respite to the child’s placement stability.

The respite program allows for a limited amount of respite care per each 30-day period. Respite rates are set by policy. Currently, a total of 12 respite units (at $20 per unit or $240 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 $380 per year. Children previously approved to receive the Career maintenance amount may be approved for up to 24 units per year at $40 per unit, or $960 per year. A respite unit is a 24 hour day.

14. Is residential treatment available? If yes, who is eligible and how families access residential treatment services?

Residential treatment costs may be met through the Subsidy agreements as an added service. The agreement 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.
Assistance with approval of or location of an appropriate residential placement is obtained through the residential care coordinators across the state.

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.

15. What other post-adoption services are available in Missouri and how do families 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, 314-340-7722 or 1-800-FOSTER3.

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

Parents are encouraged to 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 and Medicaid.

Not all services may be available in all cases. Parents should contact their adoption assistance worker or post-adoption services contact for information regarding process, eligibility, availability, and duration of services.

16. If the assistance listed above in questions 11 to 14 is for specific services, must these services be explicitly identified in the adoption assistance agreement?

Yes.


What Should Families Know About Applying for Subsidy?

17. Who initiates the adoption assistance agreement?

The family initiates the agreement through an application process after being made aware of the program by their children’s service worker or private case manager.

18. Who makes the final determination on an adoption subsidy agreement?

Adoption subsidy agreements are approved by the Division Director.

19. How do families request a subsidy after finalization of an adoption?

Families may apply for a subsidy at county offices after finalization of the adoption, however, if the family declined a subsidy at the time of the adoption or asserts that were not advised of subsidy at the time of the adoption they will be denied and will be required to go through an administrative hearing. To start the process, families should contact their local Children’s Division office.


How Can a Family Adjust an Adoption Assistance Agreement?

20. Can adoptive parents ask to change an adoption assistance agreement?

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 family’s circumstances or the child’s needs and are submitted to the child’s Children’s Division Adoption Subsidy Worker.

Requests for assistance above the basic subsidy package must be accompanied by supporting documentation from appropriate sources.
Time-specific services do not automatically renew and must be must be reviewed and reauthorized.

21. What steps does a family go through to appeal an adoption assistance decision in Missouri?

If a family disagrees with a decision made by the Division regarding subsidy, they have a right to request a fair hearing within 30 days after receiving written notification from the Division.

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 to the family’s Adoption Subsidy Worker within 30 days from the date of the contested Children’s Division action notification and sent to the local Children’s Division office. Parents may request a fair hearing form (CD-53) through the Adoption Subsidy Worker or the adoption supervisor. This form is to be completed either by the family’s Adoption Subsidy worker or the family.

Requests are referred to fair hearing staff after a supervisory review process. Examples of situations where family may request a fair hearing may include 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 the end date on the adoption assistance agreement.


What Else do Families Need to Know?

22. 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 review agreements and recommend their approval to the Division Director. Technical assistance is provided by Central Office program staff.

The federal contribution for Title IV-E-eligible children is 62.03%. This is known as the Federal Financial Participation (FFP) rate. The remaining cost of the program is funded entirely with state funds.

23. 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. Contact Amy Martin (573-526-8040) for more information.

24. Does Missouri offer a tuition waiver program?

No.

25. Does Missouri offer a state adoption tax credit?

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.

26. Does Missouri have any program to support an adoptee whose adoptive parents die until the child is adopted again?

Missouri will continue Medicaid coverage until the new agreement is negotiated with the new adoptive parent.

27. What else differentiates Missouri’s adoption assistance program from others around the country?

As required by statute, the Children’s Division must file an annual report on the subsidy program to the legislature, including 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.



North American Council on Adoptable Children (NACAC)
970 Raymond Avenue, Suite 106
St. Paul, MN 55114
phone: 651-644-3036
fax: 651-644-9848
e-mail: info@nacac.org
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