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Tennessee State Subsidy Profile

Updated July 2008

State Subsidy Contact Person

Vicki L. Davis
Department of Children's Services-Adoption Services
Cordell Hull Building, 8th Floor
436 Sixth Avenue North
Nashville, TN 37243-1290
Phone: 615-532-5634
Fax: 615-532-6495

NACAC Subsidy Representative (parent/volunteer)

Betty Hastings
40 Foust Lane
Hollow Rock, TN 38342
Phone: 731-986-5316
Fax: 731-986-5316

Marsha Boren
2293 Clara Mathis Road
Spring Hill, TN 37174
Phone 615-804-5209

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 ( Profiles for each state’s subsidy program are available on our web site at 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 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: (click on Chapter 15)

Adoption Best Practices Manual

Administrative Policies and Procedures, 15.11 Adoption Assistance

Tennessee’s state-specific medical assistance:

Tennessee’s adoption assistance:

Tennessee Statute §37-5-106 (a) (13)

  1. Click on the folder Tennessee Code
  2. Click on Title 37, Juveniles
  3. Click on Chapter 5, Department of Children’s Services
  4. Click on Part 1, General Provisions
  5. Finally click on Section 106, and scroll down to (a) (13).

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. Nine years of age or older and Caucasian
  2. Child of minority heritage, age 2 years or over
  3. Member of a sibling group of two or more children placed together for the purpose of adoption at the same time
  4. The child has a moderate to severe medical, physical or psychological condition, diagnosed by a licensed physician, psychologist or licensed mental health professional and the identified condition requires treatment.
  5. Life experiences that include neglect physical abuse or sexual abuse which rises to the level of severe child abuse

Note: Children must be in the custody and/or guardianship of the Tennessee Department of Children’s Services or a Tennessee licensed child-placing agency, immediately prior to the initiation of the adoption proceedings.

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 meet the special needs criteria as defined above and in the custody and/or guardianship of the state of Tennessee Department of Children’s Services or a Tennessee-licensed child-placing agency immediately prior to the initiation of the adoption proceedings.

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

Basic Rates:


Daily Rate





Special Circumstances:


Daily Rate





Extraordinary Adoption Assistance Rates are determined on a case by case basis, but do not exceed $60.00 per day.

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

To qualify for an extraordinary rate, the child must have documentation of a significant handicapping medical or psychological disability.  The day-to-day level of care needs and supervision must go above and beyond the level of care generally expected in parenting a special needs child.

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 expenses may include legal fees, adoption fees (including an application and home study done by a private child-placing agency); travel expenses (travel, food, and lodging) related to the placement; health and psychological examinations related to completing the home study; and fees for supervision of the placement by a private child-placing agency before the adoption is final.  The reimbursement limit is $1,500 per child.

6. What Medicaid services are available in Tennessee?

Covered Services:   

  • Visits to the doctor
  • Regular check-ups
  • Shots for children
  • Preventive services
  • Prescription drugs
  • Pregnancy services
  • Alcohol and drug abuse treatment
  • Hospital
  • Mental health
  • Laboratory and x-ray
  • Home health
  • Transportation (under special circumstances)
  • Medical equipment
  • Dental and vision care for children/young adults up to age 21
  • Ambulance transportation
  • Hospice care
  • Residential treatment
  • Any medically necessary treatment

For more information, call 800-669-1851.

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

When DCS places a child with state-funded adoption assistance monthly payments, the child is eligible for TennCare prior to finalization. After finalization, TennCare benefits may continue for a child receiving state-funded adoption assistance for his/her medical or rehabilitative needs.

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

Public mental health services in Tennessee are administered by Department of Human Services (DHS), Department of Mental Health and Developmental Disabilities (DMHDD) and include the following examples: outpatient/counseling treatment, residential treatment, prescription drugs, inpatient hospitalization, mental health centers, crisis phone lines/assessment teams and state psychiatric hospitals.

Tennessee’s Medicaid program is known as TennCare. Children with serious mental illness are eligible for what is known as “mental health case management” services through TennCare.  Information regarding available services and locations is available on the DMHDD web site.  The TennCare web site can be accessed through the DMHDD site.

MHDD Services for Children and Youth links (System of Care) (Serious Emotional Disturbance) (Wraparound Process)

MHDD general:

Crisis Information Line: and

TennCare Children’s Page:

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?

Tennessee does not provide additional finances or services for medical or therapeutic needs not covered under their state medical plan to children receiving adoption assistance.  No additional financial assistance or services are available outside of the adoption assistance agreement. Adoption assistance agreements initiated on or after October 1, 1997 require that medically necessary services be funded by either private insurance (family coverage) or TennCare.  If it becomes necessary for an adoptive family to travel 150 miles or more one way from home to receive medical treatment, DCS will reimburse travel costs (not including food) to the adoptive family for one parent and the child.

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 Tennessee are administered by the Department of Children’s Services (DCS) through DCS, private agencies, and parent groups. Post adoption services include the following examples:

  1. Information and referral (through the adoption assistance worker)
  2. Awareness events
  3. Support groups
  4. Therapeutic intervention/targeted case management
  5. Respite
  6. Search services (information)

The Department of Children’s Services currently provides targeted case management services through the Family Support Services program to any family with a child at risk of entering state custody. A new post adoption program is being developed and will soon be available to adoptive families. Contact the Adoption Services Team Coordinator in the local Department of Children’s Services office regarding information and contact persons. The Program Specialist in Adoption Services is also available to provide information at 615-532-5637.

Various parent and private organizations provide support to adoptive families. The Carroll County Foster Parents Association looks to recruit new parents and enlighten and inform the public about the foster care and adoption system. Address: 40 Foust Lane; Hollow Rock, TN 38242—731-986-5316

The Johnson County Foster Adoptive Care Association is a rural organization that sponsors foster/adoptive parent recruiting events.  Address: 399 Mill Creek Road, Mountain City, TN—423-727-4925

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

For mediation and/or search services, Tennessee law mandates the provision of non-identifying and medical information to adoptees and access to sealed adoption records for persons over twenty-one years of age.  There are other criteria which have to be met for access to records to occur.  Phone inquires regarding access to sealed adoption records can be made to the Adoption Unit at 615-532-5637.  For other inquires, see the DCS Regional Office Phone Directory:

Though not a post adoption service, children who are eligible for Adoption Assistance are also eligible for TennCare, which can used to provide for some therapeutic/preservation services.  TennCare provides for medically necessary services such as outpatient treatment, residential treatment and hospitalizations. Adoptive parents with access to family insurance coverage must first utilize their private insurance with TennCare as the secondary coverage.  TennCare is the primary provider for children whose adoptive families do not have access to family coverage.

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?


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

TennCare provides residential treatment when documented to be medically necessary. For children who are ineligible for private insurance and TennCare, Adoption Assistance will pay for residential treatment when it is a part of the Adoption Assistance Agreement.  All placements must be approved in writing by the State Office Program Director.

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

Tennessee offers deferred adoption assistance. Children who do not meet the definition of special needs but are at high risk of developing severe medical or psychological/psychiatric problems in the future are eligible for deferred adoption assistance. The following risks may be considered: (a) any child whose genetic background or birth family (birth mother/birth father) medical history indicates significant potential for developing physical/psychological problems, (b) a drug/alcohol exposed infant, (c) a child who has a history of multiple foster/adoptive disrupted placements of 3 or more.  Non-recurring expenses and other benefits/services are not included in Deferred Adoption Assistance. At the point the child exhibits problems related to those identified high risks, the parents may request a revision/activation of the Adoption Assistance Agreement to receive benefits and services to meet the changed needs of the child.

14. Does Tennessee operate a subsidized guardianship program?


Programmatic Procedures

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

For new approvals, the Team Coordinator, in the region, must approve the case. For renewals/ revisions, the county supervisor approves the case.             

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

There are no income scales or resource guidelines. Staff negotiate with the adoptive family the type and amount of assistance based on the child's needs and the family's circumstances. The department also works with the family to utilize other resources that are available (e.g., insurance, Shriner's Hospital, etc.).

17. When do subsidy payments begin?

Adoption assistance payments become effective the date of the adoption finalization. Neither the state-funded nor the Title IV-E assistance programs may make a payment prior to the effective date on the adoption assistance agreement.  

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

Yes.  The guidelines are the same for children who are in the custody/ guardianship of private agencies as for children who are in the custody/ guardianship of DCS.

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

If an adoption assistance agreement was entered into prior to October 1, 1997, a child can continue to receive State Funded adoption assistance up to the age of 21 as long as they are attending any accredited school full time.  Federal Title IV-E adoption assistance may continue until the child is 21 if there continues to be a handicapping condition.

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

The adoptive family must renew the adoption assistance agreement annually.  If a lapse occurs between the date the assistance agreement expires and the effective date of renewal, DCS may not make payment for the period of time not covered (unless the lack of coverage results from DCS error).  If appropriate, medical documentation must also be provided for these reviews.     

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

Adoptive parents can request a change in the adoption assistance agreement any time there is a change in the circumstances of the family or the needs of the child. Parents can contact the Adoption Assistance Designee by phone in the local Department of Children’s Service office to request a revision to the adoption assistance agreement.  Supporting professional documentation must be provided by the parent to the Adoption Assistance Designee.  The adoption assistance contract is revised to reflect any approved change.

If the request is denied, the parent can appeal the decision by requesting and completing the “Appeal for Fair Hearing” form. See the Central Office Phone Directory:
and Regional Office Phone Directory:

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

Adoptive parents can request a fair hearing whenever there is disagreement with a Department of Children’s Services (DCS) decision that affects their child’s adoption assistance benefits.  When DCS revises, terminates, or denies adoption assistance, the adoptive parents may appeal the decision.  “Appeal for Fair Hearing” forms are available through the Permanency Designee/Permanency Specialist in the local DCS office. The completed form is returned to the Permanency Designee/Permanency Specialist who forwards the form to the Appeals Hearing Officer.  The hearing is then scheduled by the Hearing Officer.  If the parents disagree with hearing decision, they can request a reconsideration of the decision.  The adoptive parents may, as a final recourse, file an appeal in Chancery Court.
Regional Office Phone Directory:

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.

An application for adoption assistance may be filed after finalization of the adoption. However, according to federal guidelines, the application is denied and the adoptive parents may appeal the denial. A fair hearing is held and the parent(s) present all evidence to establish eligibility.

Initial contact may be made with the Permanency Specialist in the county where the family resided at the time of placement. A Permanency Specialist Designee is assigned to each region of the state. This designee assures that all forms and information are shared with the adoptive parent(s).

System Operation and Program Funding

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

The program is state supervised/district and county administered.  This means that personnel at the state office are responsible for making policy decisions regarding the adoption assistance program, and provide guidance to county and regional offices.  Decisions related to children’s eligibility are made at the county/local office.

The federal contribution to Title IV-E-eligible children is 65.29% in Tennessee. This is known as the Federal Financial Participation (FFP) rate.  The remaining cost of the program is funded with all state funds.

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

Tennessee ETV Program You may be eligible for funding of up to $5,000 per year while you are in college or a vocational or technical training program!

You may qualify if:

  1. You are enrolled in a post-secondary or approved job-training program.
  2. You are in foster care or you were in foster care as a teenager, after the age of 16 and you are a U.S. citizen or qualified non-citizen
  3. You aged out of the foster care system at age 18 or were adopted from foster care with adoption finalization after your 15th birthday, or left foster care after your 16th birthday.
  4. You have been accepted into or are enrolled in a degree, certificate or other program at a college, university, technical or vocational school and you show satisfactory progress towards that degree or certificate.

To find out more about the specific eligibility requirements for your state, contact your caseworker or:
Michael Leach
Director of Independent Living
Tennessee Department of Children's Services
Cordell Hull Bldg 8th Fl
Nashville, TN 37243
Phone: 615-253-3503

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