NACAC | Adoption Subsidy

Mary Dyer
Department of Health and Human Services (HHS)
301 Centennial Mall South
Box 95044
Lincoln, NE 68509-5044
Phone: 402-471-9331
Fax: 402-471-9034
E-mail: mary.dyer@hhss.ne.gov

Pamela Allen
Nebraska Foster and Adoptive Parent Association
315 S 9th, Ste 10
Lincoln, NE 68508
Work: 402-476-2273
Home: 402-694-6700
Fax: 402-476-2273
E-mail: nfapa@alltel.net
Web: www.nfapa.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.

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:

Note: Children must be legally free for adoption 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 a ward of the state of Nebraska in the custody of the Department of Health and Human Services at the time the adoption petition is filed.

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

Age	A	B	C
0-5	$222	$326	$431
6-11	$291	$394	$494
12-18	$351	$461	$576

Special consideration and Central Office approval are needed for rates above these figures.

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

There is a 53-question checklist (Foster Care Pay Checklist) that workers—usually foster care workers—review and complete along with the prospective adoptive parents. A printout of this checklist should be available to the adoption worker. Prior to the adoption finalization, the child's checklist is updated every six months or when a child changes placements. Providers and foster and adoptive parents have input in completing the checklist.

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.

Nonrecurring adoption expenses include reasonable and necessary adoption fees, court costs, attorney fees, and other expenses directly related to the legal adoption of the child which have not been reimbursed from any other source of funds.

Note: The child need not have been adopted through an adoption agency to qualify for nonrecurring cost reimbursement. As such, intercountry adoptions may be included in the program if the child is special needs.

The reimbursement limit is $1,500 per child.

Applications are made to the assigned worker for state wards, or to Mary Dyer for all others.

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

Non-IV-E children must meet the criteria for special needs (see question #1) and be a ward of Health and Human Services at the time of adoption.

Public mental health services for children in Nebraska are administered by the DHHS System and includes the following examples: outpatient mental health and substance abuse treatment services, including evaluation (by a supervising practitioner/psychiatrist/psychologist individual), group/ family psychotherapy; individual/group/family substance abuse counseling, family assessment, mental/home health and personal care services, intensive family preservation services, medication checks, crisis intervention services.

These services are part of a continuum of care designed to prevent hospitalization or to facilitate the return of the client to functioning within the community with less frequent contact with the mental health or substance abuse professionals. Services include: treatment foster care services, treatment group home services, residential treatment services for children/adolescents, inpatient mental health services, and inpatient mental health services for clients age nineteen (19) years or younger in institutions for mental disease (IMDs). Medicaid is administered by Megellan, Nebraska’s managed care contractor. Length of care is determined by Megellen and based on a child’s need. Nebraska’s Medicaid services: http://www.hhs.state.ne.us/med/medserv.htm. All adoption assistance services end in Nebraska once a child reaches nineteen years of age.

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?

Nebraska offers what is known as Payment for Pre-Existing Medical Conditions. Funding is available to adoptive parents for medical or mental health services not available through any other program or benefit. Examples of such services include mental health care, inpatient hospitalization, and medications. Eligible adoptive parents must exhaust all other resources before this funding is available, including their own private insurance. Payment for services is made directly to providers. The need for services must be listed in the adoption assistance agreement and conditions cannot be added after adoption finalization. However, conditions can be changed if the child’s original diagnosis was incorrect. Inpatient psychiatric and residential treatment care is covered in some cases. These services require prior authorization before treatment and coverage is for up to eighteen months of care. Length of care is determined by Megellan and based on a child’s need.

Nebraska also offers what is known as a Special Service Subsidy. Funds are allocated on a one-time basis for a specific service or item for a specified period of time. Services or items must relate to the child’s special needs as indicated in the original adoption assistance agreement and are only available if no other program or resource exists to meet the child’s need. These services must be connected to the special need indicated on the original subsidy agreement. Examples of such services and items include: specially designed furniture, house modifications designed to accommodate a child’s particular special need, and transportation expenses necessary for a child to receive medical services for a condition in existence prior to adoption finalization. Modifications to the home must be recommended by The Assistive Technology Partnership, an agency contracting by HHS. The specific modification and the estimated cost must be included in the original adoption assistance agreement and approved by the Central Office adoption specialist prior to the adoption finalization.

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 Nebraska are administered by the DHSS Office of Protection and Safety through contracted agencies and parent organizations. Services include the following examples:

Many services are contracted through the University of Nebraska, Center for Children, Family, and Law (CCFL):

Nebraska has a contract with the NE Foster and Adoptive Parent Association. The Association has an annual adoption conference and three foster parent conferences each year with adoption information presented. Contact the Association, phone: 877.257.0176 or 402.476.2273. Additional information is available from the local DHSS agency, adoption assistance worker, or post adoption services contact. To locate a local HHS office:

Many private organizations offer a variety of respite options. See the ARCH National Respite Network Respite Locator Service, search by state to locate Nebraska's respite programs:

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?

To be covered, a pre-existing medical condition must be specified on the initial assistance agreement. Medicaid providers must be used if available in the community. If not, rates are set using the Medicaid rates and guidelines.

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

Under certain circumstances, inpatient psychiatric care and residential care (up to 18 months) may be covered under the “Payment for Pre-Existing Medical Conditions” program. Residential treatment requires prior approval. (See Question 8 for more details of coverage)

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

Yes. A child is eligible for the subsidized guardianship program if she/he is a ward of the Department at the time the guardianship is ordered by the court and meets the criteria for subsidized guardianship as follows:

A child’s eligibility ends upon the child’s 19th birthday, when the child becomes self-supporting, upon the death of the child or guardian, or when the guardianship order is terminated.

Payments to the guardian may include maintenance costs, medical and surgical expenses, and other costs incidental to the care of the child. The child under guardianship shall be a child for whom the guardianship would not be possible without the financial aid provided.

The subsidized guardianship program was created in the mid-1980s. For more information, contact Mary Dyer at 402-471-9331 or mary.dyer@hhss.ne.gov.

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

Adoption staff in each service area approve the subsidy. (Each service area decides which adoption staff person is in charge of the approval process.) The Adoption Specialist and the Central office approve subsidies for children in the custody of private agencies, those who are SSI eligible in private adoptions, those eligible who were previously adopted with a Title IV-E subsidy, and approve reimbursement for nonrecurring costs.

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

There is no means test or consideration of family income. However, we do ask the family to make a self-determination of need for subsidy.

Adoption assistance payments and benefits may begin after adoption finalization.

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

Yes—but for federal Title IV-E eligible children only (i.e. private agency children may not receive “special service” payments). For wards of private agencies, private agency workers complete all necessary forms and send them to the central office adoption specialist. The specialist shall then notify the private agency of the eligibility determination within 45 days.

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

Title IV-E subsidy is terminated at age 18, unless the child is disabled (as documented by SSI or the state disability team), in which case the subsidy is extended to age 19. State-funded subsidy is terminated at age 19.

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

There is no state requirement to annually review subsidy agreements. It is the responsibility of the adoptive family to notify the agency if there is any change in circumstances that would make them ineligible for subsidy.

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

Adoptive parents can request a change in the adoption assistance agreement at any time. Changes may be made at the request of the adoptive family whenever there are changes in family circumstance or when a change in law or regulation indicates the need for a modification in the agreement. Requests must be made in writing to the adoption assistance worker and parents must send information substantiating the change in family circumstance to the DHSS. To locate a local Nebraska HHS office, see the office locator:

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

Adoptive families have the right to request a fair hearing any time a DHHS action or inaction affects adoption assistance eligibility, the amount of payment, and/or the Department fails to act with reasonable promptness. Requests must be made to the HHS Director in writing within ninety days of the contested action or inaction. The Director will forward this request to the Legal Division. A hearing officer will conduct the fair hearing and listen to both sides, but will not make a decision at the hearing. Parents will receive a written decision in the mail from the hearing authority within ninety days of the hearing request. S end fair hearing requests to the following address:

Director
Department of Health and Human Services
P.O. Box 95044
Lincoln, Nebraska 68509

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.

The Department of Health and Human Services shall pay the treatment costs for the care of an adopted minor child that are the result of an illness or condition if the following conditions apply: (1) within three years after the decree of adoption is entered the child is diagnosed as having a physical or mental illness or condition which predates the adoption; (2) the child was adopted through the department; (3) the department did not inform the adopting parents of such condition prior to the adoption; (4) the condition is of such nature as to require medical, psychological, or psychiatric treatment and is more extensive than ordinary childhood illness; and (5) the child was a ward of the Department of Health and Human Services prior to the adoption.

Parents should contact the adoption staff person who finalized the adoption if they believe the child is eligible and their situation meets these criteria.

The program is state supervised/state administered. This means that policy decisions are made by personnel at the state office, and subsidies are approved at one of the five service area offices.

The federal contribution to Title IV-E-eligible children is 57.93% in Nebraska. 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 Nebraska's adoption assistance program from others around the country.