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Maryland State Subsidy Profile

Updated Septemeber 2011

State Subsidy Contact Person

Jill Taylor
Department of Human Resources (DHR)
Social Services Administration
311 W. Saratoga Street
Baltimore, MD 21201
410-767-7695 • fax: 410-333-0922

NACAC Subsidy Representative (parent/volunteer)

Jennifer Klotz
Baltimore, MD 21228

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 Maryland. 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 other states’ subsidy programs are available. If you have additional questions, please contact NACAC at 651-644-3036, 800-470-6665, or 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:

Maryland’s state-specific medical assistance information:

Maryland Statute, Article – Family Law , Title 5, Parts I and II, §5-401 to §5-412
Part I – Adoption Subsidy Act; Part II – Adoption Subsidy Program

(then click on the following links: (1) Family Law; (2) Title 5. Children; Subtitle 4. Adoption Subsidy Act; Part I; and (2) Part II )

Code of Maryland Regulations (COMAR)

Who is Eligible for Adoption Assistance or Subsidy?

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

To qualify as special needs, the child must be one for whom the local department or agency that holds guardianship has made reasonable efforts to find an adoptive family without subsidy, but has not been successful because of one or more of the following factors:

  1. The child is six years of age and over, but not yet 18 years of age
  2. The child’s record clearly documents that the child’s race or ethnic background, in addition to other special needs, prevented an adoptive placement without subsidy (The child’s membership in a minority race or ethnic group alone does not qualify his or her for subsidy.)
  3. The child has a physical or mental disability or is at risk of developing such a disability;
  4. The child has an emotional disturbance or is at risk of developing such a disability
  5. The child is a member of a sibling group being placed togther

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


3. Are children adopted from private agencies in Maryland eligible for adoption assistance?

Yes, provided the agency is licensed in Maryland and the family resides in Maryland. The agency must apply on behalf of the family and provide all needed documentation.

What Supports and Services Are Available?

Monthly Payments

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

In Maryland the maximum monthly adoption assistance payment shall not exceed the applicable foster care board rates, which are as follows:

Age at Adoption Maximum Basic Foster Care Board Rate Maximum Intermediate Foster Care Board Rate

The exception to the above is treatment foster care families who adopt medically fragile children, as defined by statute. These families may be eligible for adoption assistance of up to $2,000 per month.

All adoption assistance amounts must be negotiated. All rate increases must be negotiated based on documented changes in the child’s needs (see question 21).

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

A higher adoption assistance rate may be available for medically fragile children. A medically fragile child means a child who meets at least one of the following criteria:

  1. Depends at least part of the day on mechanical ventilation
  2. Requires prolonged intravenous administration of nutritional substances or drugs
  3. Depends on other device-based respiratory or nutritional support, including tracheotomy tube care, suctioning, oxygen support, or tube feeding on a daily basis
  4. Depends on other medical devices that compensate for vital body functions and who requires daily or near daily nursing care including:
    1. A child who requires renal dialysis as a consequence of chronic kidney failure, and
    2. A child who requires other mechanical devices such as catheters or colostomy bags, as well as substantial nursing care in connection with the disabilities.

In addition, a child may be eligible for a higher adoption assistance rate if he or she in treatment foster care, is adopted by their treatment foster care parents, and has one of the following conditions and is need of a high level of treatment in a family setting:

  1. A serious medical condition including, but not limited to:
    • HIV and symptomatic or has AIDS
    • Multiple disabilities
    • Symptomatic drug-exposed newborn
  2. A serious emotional, behavioral, or psychological condition including:
    • Psychiatric diagnosis by appropriate qualified professionals
    • History of an ongoing substance abuse problem
    • Developmental disability

The treatment foster care rates serve as a basis for negotiating adoption assistance rates for applicable cases.

6. When do adoption assistance payments begin?

Adoption assistance payments begin after the adoption is finalized. Generally, the adoption assistance agreement must be signed by the local department of social services director and the adoptive family prior to finalization. Assistance payments are paid on a per diem basis and are mailed to families the 11th day of each month.

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

Adoption assistance payments may be made until the month in which a child attains his 21st birthday, provided (a) the child is still enrolled in an educational or vocational training program, or (b) has a disabling condition that prevents self-sufficiency. In either case, the adoptive parents must remain legally and financially responsible for the child.

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

Yes. Deferred adoption assistance is for “at risk” special needs designations related to physical , emotional or mental health where the child is at risk but has no symptoms. This designation, which is typically for infants, requires documentation that an “at risk” condition exists at the time of adoption finalization. A medical assistance grant is established to provide a financial means to track the child’s health. If symptoms develop, the family can request a monthly amount based on the child’s needs (see question 21).

Medical Care

9. What Medicaid services are available in Maryland?

Adoption assistance recipients receive the same full range of Medicaid benefits that are available to non-adoption assistance recipients. All medically necessary and appropriate services are covered. For more information, visit:
(see what benefits are covered)

Families should use their private insurance as the primary coverage, and the medical assistance coverage as secondary coverage. Parents should contact their adoption assistance caseworker for details regarding eligibility, applying for services, and any required annual re-determination for services.

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.)

Children eligible for state-funded subsidy are eligible for medical benefits, but there are limits to the coverage. For example, IV-E eligible children receive unlimited hospitalization, while children in the state-funded program are only covered for a specified number of days.

11. What mental health services are available?

Public mental health services for children in Maryland are administered by the Department of Health and Mental Hygiene (DHMH). DHMH mental health services may include outpatient therapy, in-patient hospitalization, residential rehabilitation, residential treatment, rehabilitation, supported living, day treatment, and 24-hour crisis intervention.

For general information, visit

or call 410-402-8487.

Parents should contact their adoption assistance worker or medical assistance specialist for information regarding process, eligibility, availability, and duration of services.

Other Benefits

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

May eligibile for reimbursement, up to $2,000 per child, for reasonable and necessary nonrecurring costs including adoption fees, court costs and reasonable attorney fees, health examinations, transportation costs, and food and lodging costs incurred during preplacement visits. Adoptive parents must apply for the reimbursement and sign the nonrecurring costs agreement before the adoption is finalized. The agreement cannot be signed before the receipt of all required documentation. When a family cannot provide documentation before adoption finalization the application will be denied.

Adoptive parents involved in independent adoptions are potentially eligible for these reimbursements provided the children adopted have special needs and proof the birth parents unsuccessfully sought families willing to adopt the child without adoption assistance.

Families adopting a child internationally are ineligible for non-recurring reimbursement if the child has a date of birth on or before September 30, 2012.

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

Child care assistance is not available as part of the adoption assistance program.

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

Respite care is available for children receiving services through Maryland Health Partners (MHP) for mental health services. MHP provides the mental health component of medical care for children with Medicaid eligibility in Maryland, including adopted children with special needs. The child must have a DSM IV diagnosis.

Respite care is also available for children receiving adoption assistance who are also eligible for services from the Developmental Disabilities Administration (DDA). Funding for these services is limited, however. For information about respite for children with mental health diagnoses, and for information about a variety of services including respite for children with developmental disabilities or severe, chronic disabilities caused by physical or mental conditions other than a sole diagnosis of mental illness, visit

In addition, many private organizations offer a variety of respite programs. Search for Maryland resources using the ARCH National Respite Network Respite Locator Service at

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

There is no specific state fund that pays for residential treatment care (RTC) that is not covered by Medicaid for children receiving adoption assistance. However, any Maryland child who is involved with a state agency (Departments of Human Resources, Juvenile Justice, Education, or Health and Mental Hygiene) has access to money available for this level of care through the local management boards (LMB) in each jurisdiction of the state. Therefore, if it is determined that a child needs placement in a RTC facility beyond what Medicaid will allow, that care can be funded.

In certain circumstances, RTC may be funded without committing the child to the state agency’s custody. The families of children with mental health or developmental disabilities may enter into a voluntary placement agreement with the local department in order to access the care.

Parents should contact their adoption assistance caseworker or post-adoption services contact for information regarding eligibility and how to access residential treatment services.

16. What other post-adoption services are available in Maryland and how do families find out more about them?

Post-adoption services in Maryland are administered by the Department of Human Resources, Social Services Administration and may include:

  1. Information and referral
  2. Counseling
  3. Search, contact and reunion services
  4. Waiver of higher education tuition and fees
  5. Provision of medical and family history
  6. Childcare reimbursement
  7. Financial assistance (in addition to adoption assistance)

Adoptive parents should contact the adoption agency that placed the child or the local department of social services ( for referral to local services. DHR may make services available on request to eligible families of children adopted through the local department of social services. Adoptive families may be placed on a waiting list for post-adoption services in accordance with available DHR staff resources.

Post-adoption services are detailed in the Code of Maryland Regulations at

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?


What Should Families Know About Applying for Subsidy?

18. Who initiates the adoption assistance agreement?

The family must request assistance. The child’s caseworker, the supervisor, and other appropriate staff shall determine eligibility for every child who is to be placed for adoption.

19. Who makes the final determination on an adoption assistance agreement?

The final agreement has to be signed by the director of the local department in the county where the family resides. If the family's application for adoption assistance is denied, the worker must notify the family in writing of that decision and of the reasons within five working days of the decision. This notice must also contain information about the parents’ right to appeal the decision.

20. How do families request adoption assistance after finalization of an adoption?

Families who wish to apply for adoption assistance after finalization may apply through the agency that handled the adoption. The family must provide documentation (such as medical, psychological, and/or educational records) that establish that the child’s special needs existed, but were not known, before the adoption and would have made the child eligible for adoption assistance. If eligibility is established, the family and the director of the local department sign an agreement.

How Can a Family Adjust an Adoption Assistance Agreement?

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

Adoptive parents may request a change in the adoption assistance agreement if there is a change in the child’s needs or the family’s circumstances. The department and the family review agreements annually, but parents can request a change whenever there is a need by contacting (in person, by phone, or in writing) the agency that placed the child.

The agency will advise and assist the family in collecting documentation necessary to support the request and determine eligibility for the requested change. If the adoption agency is private, they will forward the request and the documentation to the public agency for consideration. The local Department of Social Services reviews the request and approves or denies it.

If parents do not receive the requested change, they can request a fair hearing and appeal the decision through the local office ( that denied the request.

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

Adoptive parents can request a fair hearing whenever there is disagreement with a decision that affects their child’s adoption assistance benefits. Parents should make requests for fair hearing to their adoption assistance worker or the director of the local department that made the contested decision. Requests can be made in person, over the phone, or in writing and must be made within 30 days of the notice of contested decision. Once a request is received, the department will send the family a fair hearing request form to complete and return to the department. The local department will then forward the form to the Office of Administrative Hearings. An Administrative Law Judge (ALJ) will hear the case, render a decision, and notify the family of the decision.

Parents should call their adoption assistance case manager for assistance.

For more information on the fair hearing, visit

What Else do Families Need to Know?

23. How is the adoption assistance program operated and funded in Maryland?

The program is state supervised/state administered. Policy and regulations relating to adoption assistance and other programs are made at the state level. The counties make decisions related to children’s eligibility.

In Maryland, the federal contribution to Title IV-E-eligible children is 50 percent (the Federal Financial Participation/FFP rate). The remaining cost of the program is funded with state funds.

24. Does Maryland operate a subsidized guardianship program?

Yes. The Guradianship Assistance Program provides legal stability for children who are unable to return home to their birth parents and where adoption has been ruled out as an option. The program allows relative caregivers to take full legal responsibility for children without terminating parental rights while also receiving financial support.

Children must meet the following eligibility requirements:

  • The child has been removed from his/her home pursuant to a voluntary placement agreement or as a result of a judicial determination that continuation in the home would be contrary to the welfare of the child.
  • The child is eligible for foster care maintenance payments and has been residing with the relative caregiver for six consecutive months.
  • It has been established that return home or adoption are not appropriate permanency options for the child.
  • The child demonstrates a strong attachment to the relative caregiver and the relative caregiver has a strong commitment to caring permanently for the child.
  • The child is a full-time elementary or secondary school student, or is incapable of attending school due to a documented medical condition;
  • With respect to a child age 14 or older, the child has been consulted regarding the guardianship arrangement.
  • The relative caregiver shall have some means of financial support independent of the Guardianship Assistance Program for the child (employment, Temporary Cash Assistance, social security, survivor’s benefits, TDAP etc.) If the relative caregiver is receiving a TCA Child-only grant, it may not be used in computing income as this grant will end with the establishment of a subsidy.
  • Sibling groups may be eligible in the same guardianship arrangement if the State agency and the relative caregiver agree on the appropriateness of the arrangement for the siblings and at least one of the children meets the eligibility criteria.
  • Guardianship assistance may be paid on behalf of each sibling placed in the guardianship of the provider.
  • The monthly assistance payment amount shall be negotiated based upon the child’s specific needs, but may not exceed 100% of the foster care board rate which would have been paid on behalf of the child if the child had remained in a foster family home.
  • The Guardianship Assistance Program may not extend beyond the child’s 21st birthday.

Payments will be negotiated based on the child’s specific needs, but cannot exceed the foster care board rate the child would have received. Payments may be adjusted periodically based on the caregiver’s and child’s circumstances. Guardians may be eligible for nonrecurring expense reimbursements and medical assistance.

25. Does Maryland offer a tuition waiver program?

Maryland offers the Maryland Waiver, which allows foster youth and former foster youth who meet certain criteria to attend college in Maryland tuition-free. To be eligible, adopted youth must meet all of the following criteria:

  • Be a Maryland resident
  • Be adopted after their 13th birthday, or adopted with a sibling who was adopted after their 13th birthday.
  • Attend a State college in Maryland
  • Have completed the Free Application for Federal Student Aid (FAFSA)

The waiver is good for five years after the youth first enrolls in college. The waiver does not pay for a training program, nor does it cover the cost of books and or transportation.

In addition, the Maryland Education and Training Voucher (ETV) Program offers funds to foster youth and former foster youth to enable them to attend colleges, universities, and vocational training institutions. Students may receive up to $5,000 a year for four years as they pursue higher education. The funds may be used for tuition, books, or qualified living expenses. These funds are available on a first-come, first-served basis

26. Does Maryland offer a state adoption tax credit?


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

In certain circumstances, Maryland offers assistance through the state adoption assistance program to an adoptee whose adoptive parent dies. The adoption assistance is available until the child’s 18th birthday provided an adult assessed as a responsible caregiver agrees to assume legal custody for the child, and signs an adoption assistance agreement. The caregiver is encouraged to adopt but does not have to do so.

28. What is the payment schedule for adoption assistance? Who do I contact if I haven't received my payment? Can I receive my adoption assistance through direct deposit?

Adoption subsidy checks are usually received by the 12th of month. If adoptive parents have questions or concerns regarding their payment they should contact the call center at 1-877-347-2729. Families can receive their payment through check or direct deposit.

29. What else differentiates Maryland’s adoption assistance program from others around the country?

Adoptive families of non-special needs children may qualify for a state-funded adoption assistance based on their family income. If a family's adjusted gross income is less than 80 percent of the latest published state median income for a family of their size (including the adopted child), they may qualify for adoption assistance. This program is being eliminated, likely by the end of 2011.


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