Tennessee State Subsidy Profile
Updated draft • October 2014
(state review pending)
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
NACAC Subsidy Representative (parent/volunteer)
40 Foust Lane
Hollow Rock, TN 38342
2293 Clara Mathis Road
Spring Hill, TN 37174
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 Utah. 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 firstname.lastname@example.org. If you have state-specific questions, please call your State Subsidy Contact Person or the NACAC Subsidy Representative (listed above) for more information.
For more information on Title IV-E eligibility, view our fact sheet Eligibility and Benefits for Federal Adoption Assistance.
Adoption resources on the web:
Adoption Best Practices Manual http://www.state.tn.us/youth/dcsguide/policies/
Administrative policies and procedures (15.11 Adoption Assistance):
Tennessee state-specific medical assistance information:
Tennessee adoption assistance information:
Tennessee Statute §37-5-106 (a) (13):
Click on the Tennessee Code / Click on Title 37, Juveniles /
Click on Chapter 5, Department of Children’s Services / Click on Part 1, General Provisions / Click on Section 106, and scroll down to (a) (13).
Tennesse Administrative Policies and Procedures 15.11:
WHO IS ELIGIBLE FOR ADOPTION ASSISTANCE?
1. How does Tennessee define special needs to determine eligibility?
A child is determined to have special needs if the child has at least one of the following needs or circumstances that may be a barrier to placement or adoption without financial assistance:
- Nine years of age or older and Caucasian
- Of minority heritage, age 2 years or over
- Member of a sibling group of two or more children placed together for the purpose of adoption at the same time
- 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
- Life experiences that include neglect, physical abuse, or sexual abuse that rises to the level of severe child abuse
Children must be in the custody or guardianship of the Tennessee Department of Children’s Services (DCS) or a Tennessee licensed child-placing agency immediately before initiation of the adoption proceedings.
2. Does the state-only funded adoption assistance program differ in any way from the Title IV-E program?
The child must have be or have been in the guardianship of DCS prior to finalization of adoption.
3. Are children adopted from private agencies in Tennessee eligible for adoption assistance?
Only children who meet both the Title IV-E criteria and the special needs definition.
WHAT SUPPORTS AND SERVICES ARE AVAILABLE?
4. What is the maximum basic daily adoption assistance maintenance payment in Tennessee?
5. Does Tennessee provide specialized rates (based on the extraordinary needs of the child or the additional parenting skill needed to raise the child)?
Yes, there are two specialized rates—one called special cirumstances and the other extraordinary. Special Circumstance Rates are designed for children:
- With unique needs due to a diagnosed medical or mental health condition that substantially limits one or more of the following major life activities: (walking, speaking, breathing, working, learning, performance of manual tasks, vision, self care);
- Who require a level of supervision exceeding that of their peers; and
- Who requires extra care due to physical, emotional, or mental disability.
The special circumstances rates are:
Extraordinary adoption assistance rates are determined on a case-by-case basis, but cannot exceed $60 per day. To qualify for an extraordinary rate, the child must have documentation of a significant disabling 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 child who has special needs.
6. When do adoption assistance 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 before the effective date on the adoption assistance agreement.
7. When a child turns 18, which benefits, if any, continue?
For youth adopted at age 16 or older, on or after October 1st, 2010 who are eligible for Title IV-E under Fostering Connections—can continue until 21st birthday if at least one of the follow applies:
- Enrolled in secondary education program
- Enrolled in post seconardy or vocational program
- Incapable of attending school or working due to a disability as determined by a medical professional
Title IV-E adoption assistance that doesn’t meet the Fostering Connections criteria above can continue until 21st birthdy if the youth has a disability that warrants continuation.
For youth receiving Title IV-E adoption assistance who don’t meed the Fostering Connections nor meet the disability that warrant continuation, there adoption assistance can be converted to state funded adoption assistance and follow the rules for continued assistance for that program.
State funded adoption assistance
- Adopted before October 1, 1997—can continue until 21st birthday if youth is in high school, college or post secondary school.
- Adopted between October 1, 1997 and February 29, 2008—can continue until 21st birthday if youth is still in high school.
- Adopted on or after March 1, 2008—can continue until 19th birthday if youth is still in high school.
8. Does Tennessee offer deferred adoption assistance agreements (agreements where initial monthly maintenance amount is $0 for children at risk of developing special needs later)?
Yes. Children who do not meet the definition of special needs but are at high risk of developing severe medical, psychological, or psychiatric problems in the future are eligible for deferred adoption assistance. The following risks may be considered:
- any child whose genetic background or birth parents’ medical history indicates potential for developing physical or psychological problems
- an infant who was exposed to drugs or alcohol which is documented in the child’s birth records
- a child who has three or more disrupted foster or adoptive placements that are documented in TFACTS
- a child that meets the definition of Safe Haven
- a child diagnosed with Neonatal Abstinence Sydrome (NAS)
Nonrecurring expenses and other benefits and services are not included in deferred adoption assistance, however Medicaid can be provided. At the point the child exhibits problems related to those identified high risks, the parents may request a revision or activation of the adoption assistance agreement to receive monthly adoption assistance and services to meet the child’s changed needs.
9. What Medicaid services are available in Tennessee?
Covered services include:
• Visits to the doctor
• Regular check-ups
• Shots for children
• Preventive services
• Prescription drugs
• Pregnancy services
• Alcohol and drug abuse treatment
• 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
More information is available by calling 800-669-1851.
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) for one parent and the child.
10. What medical benefits are available for state-funded children? (Children who have federally funded/Title IV-E adoption assistance are automatically eligible for Medicaid benefits.)
When DCS places a child with state-funded adoption assistance monthly payments, the child is eligible for TennCare before finalization. After finalization, TennCare benefits may continue for a child receiving state-funded adoption assistance for his or her medical or rehabilitative needs.
11. What mental health services are available?
Public mental health services in Tennessee are administered by the Department of Human Services (DHS), Department of Mental Health Services (DMHS), and Department of Intellectual and Developmental Disabilities (DIDD) and include: outpatient counseling treatment, residential treatment, prescription drugs, inpatient hospitalization, mental health centers, crisis phone lines/assessment teams, and state psychiatric hospitals.
Under TennCare, children with serious mental illness are eligible for “mental health case management” services. Information about available services and locations is available on the sites listed below.
www.state.tn.us/mental/mhs/soc2.html (System of Care)
www.state.tn.us/mental/mhs/soc5.html (Serious Emotional Disturbance)
www.state.tn.us/mental/mhs/soc4.html (Wraparound Process)
DMHS Office of Children and Youth: http://www.tn.gov/mental/children/child_main.shtml
Crisis Information Line: http://tn.gov/mental/recovery/crisis_serv.shtml and
TennCare Children’s Page: http://state.tn.us/tenncare/tenndercare/special.html
Please note that not all services may be available in all cases. Parents should contact their adoption assistance worker or medical assistance specialist for information about process, eligibility, availability, and duration of services.
12. In Tennessee, what nonrecurring adoption expenses directly related to the finalization of an adoption may be reimbursed?
Parents can be reimbursed for up to $1,500 per child for nonrecurring expenses such as 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.
13. Is child care available? If yes, who is eligible and how do families access child care?
14. Is respite care available? If yes, who is eligible and how do families access respite care?
Tennessee does not provide any respite services through the adoption assistance program. Many private organizations provide respite options, which can be found on the ARCH National Respite Network Respite Locator Service at http://www.respitelocator.org/.
15. Is residential treatment available? If yes, who is eligible and how do families access residential treatment services?
TennCare provides residential treatment when documented to be medically necessary. For children who are ineligible for private insurance and TennCare, DCS 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.
16. What other post-adoption services are available in Tennessee and how do families find out more about them?
Post-adoption services in Tennessee are provided by DCS, private agencies, and parent groups. Post-adoption services include:
- Information and referral (through the adoption assistance worker)
- Awareness events
- Support groups
- Therapeutic intervention/targeted case management
- Search services (information)
DCS currently provides targeted case management services through the Family Support Services program to any family with a child at risk of entering state custody. For more information about post-adoption services, families should contact the Adoption Services Team Coordinator in the local DCS office or the Program Specialist in Adoption Services at 615-532-5637.
Tennessee Adoption Support and Preservation (TN ASAP) provides post-adoption support programs to assist adoptive families for more information, http://www.tnasap.org/
For mediation or search services, Tennessee law mandates the provision of non-identifying and medical information to adoptees and access to sealed adoption records for persons older than 21. There are other criteria that have to be met for access to records. Individuals can call the Adoption Unit at 615-532-5637 for access to sealed records. For other information, see the DCS Regional Office Phone Directory at http://tennessee.gov/youth/dcsguide/regadmincontactinfo.htm.
Please note that 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.
17. If the assistance listed above in questions 13 to 16 are for specific services, must these services be explicitly identified in the adoption assistance agreement?
Yes for residential treament.
WHAT SHOULD FAMILIES KNOW ABOUT APPLYING FOR ADOPTION ASSISTANCE?
18. Who initiates the adoption assistance agreement?
The permanency specialist.
19. Who makes the final determination on an adoption assistance agreement?
For new approvals, the Team Coordinator must approve the case.
20. How do families request adoption assistance after finalization of an adoption?
An application for adoption assistance may be filed after adoption finalization. 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 evidence to establish eligibility.
Parents should first contact the Permanency Specialist in the county where the family resided at the time of placement. This designee assures that all forms and information are shared with the adoptive parent(s).
HOW CAN A FAMILY ADJUST AN ADOPTION ASSISTANCE AGREEMENT?
21. Can adoptive parents ask to change an adoption assistance agreement?
Adoptive parents can request a change in the adoption assistance agreement any time there is a change in the family’s circumstances or the child’s needs. To make the request, parents call the Adoption Assistance Designee in the local DCS office. Parents will need to provide supporting professional documentation to the Adoption Assistance Designee. The adoption assistance agreement will be 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.
Local DCS officers are listed at
22. What steps does a family go through to appeal an adoption assistance decision in Tennessee?
Adoptive parents can request a fair hearing whenever they disagree with a 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. Parents must return a completed form to the Permanency Designee/Permanency Specialist, who will forward the form to the Appeals Hearing Officer. The Hearing Officer will then schedule the hearing. 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.
See the link to find local DCS offices under Question 21.
WHAT ELSE DO FAMILIES NEED TO KNOW?
23. How is the adoption assistance program operated and funded in Tennessee?
The program is state supervised and district and county administered. This means that personnel at the state office are responsible for making policy decisions about the adoption assistance program, and provide guidance to county and regional offices. Decisions related to children’s eligibility are made at the county or local office.
The federal contribution to Title IV-E-eligible children (known as the Federal Financial Participation or FFP rate) is 64.99% in Tennessee. The remaining cost of the program is funded with all state funds.
24. Does Tennessee operate a subsidized guardianship program?
Yes. For more information, http://www.state.tn.us/youth/fostercare/spg.htm
25. Does Tennessee offer a tuition waiver program?
Tennessee offers an Educational/Training Voucher program, which provides funding of up to $5,000 per year for college or vocational or technical training program. Youth may qualify if:
- They are enrolled in a post-secondary or approved job-training program.
- They are in foster care, were in foster care after their 16th birthday, they aged out of foster care at age 18, or they were adopted after their 15th birthday.
- They are a U.S. citizen or qualified non-citizen.
- They have been accepted into or are enrolled in a degree, certificate, or other program at a college, university, technical or vocational school and show satisfactory progress toward that degree or certificate.
More information is available from the caseworker or from:
Interdependent Living Director
Tennessee Department of Children's Services
1280 Foster Avenue
Nashville, TN 37243
615-253-0024 • fax: 615-253-2272