Updated March 2021
Below you can find information about the adoption assistance benefits that may be available to families who adopt children from foster care in North Carolina. Adoption subsidy policies and practices are, for the most part, dependent on the state where the child was in foster care before the adoption.
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 North Carolina. 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:
North Carolina’s state-specific medical assistance links:
North Carolina’s adoption assistance links:
North Carolina General Statutes: 108A-49 to 108A-50.1:
North Carolina Administrative Code: 10A NCAC 70M.0101 to 70M.0604:
North Carolina’s Child Welfare Funding Manual—Adoption Assistance:
Who is Eligible for Adoption Assistance or Subsidy?
1. How does North Carolina 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:
- The child is six years of age or older;
- The child is two years of age or older and a member of a minority race or ethnic group;
- The child is a member of a sibling group of three or more children to be placed in the same adoptive home;
- The child is a member of a sibling group of two children to be placed in the same adoptive home, in which one or more of the siblings meet at least one of the other criteria for special needs;
- The child has a medically diagnosed disability which substantially limits one or more major life activity, requires professional treatment, assistance in self-care, or the purchase of special equipment;
- The child is diagnosed by a qualified professional to have a psychiatric condition which impairs the child’s mental, intellectual, or social functioning, and for which the child requires professional services;
- The child is diagnosed by a qualified professional to have a behavioral or emotional disorder characterized by inappropriate behavior which deviates substantially from behavior appropriate to the child’s age or significantly interferes with child’s intellectual, social and personal functioning;
- The child is diagnosed to be mentally retarded by a qualified professional;
- The child is at risk for a diagnosis described above in items e through h, due to prenatal exposure to toxins, a history of abuse or serious neglect, or genetic history.
Note: if the child qualifies only under this criteria, the child must be placed in the potential category where they shall receive Medicaid but will receive a zero amount monthly payment until a diagnosis is made. When the diagnosis is made and documented appropriately, a change shall be made to the DSS-5095 to reflect payment beginning the month following diagnosis.
Children must be legally free for adoption and must be in the placement responsibility of a North Carolina agency authorized to place children to be eligible for adoption assistance. Placement responsibility must either:
- currently be with a North Carolina agency authorized to place children for adoption,
- have been in such an agency’s responsibility at the time of the filing of the adoption petition,
- have been in such an agency’s responsibility when the agency placed the child in the custody of a person now pursuing adoption of that child.
2. Does the state-only funded adoption assistance program differ in any way from the Title IV-E program?
To be eligible for state-funded adoption assistance a child must meet all of the criteria in question 1 above (be a child with special needs, be legally free, and be under the placement responsibility of an authorized North Carolina agency).
3. Are children adopted from private agencies in North Carolina eligible for adoption assistance?
Yes, if they meet the criteria in question 1 above. Private agency workers are responsible for sending documentation of the child’s eligibility to county adoption staff. Private agency staff work with the county where the child resides. For more information, call Beth Riley, DSS, at 910-986-8078.
What Supports and Services Are Available?
4. What is the maximum basic monthly adoption assistance maintenance payment in North Carolina?
5. Does North Carolina provide specialized rates (based on the extraordinary needs of the child or the additional parenting skill needed to raise the child)?
Special provisions can be made for
- HIV children, including:
- $800 (indeterminate HIV status)
- $1,000 (confirmed HIV-infected, asymptomatic)
- $1,200 (confirmed HIV-infected, symptomatic)
- $1,600 (terminally ill with complex care needs); and
- Children with Therapeutic Needs being adopted by their foster parents. Families receive higher board rates based on child’s special needs. Supplemental adoption assistance rates vary to maintain the same payment the child received while in foster care.
6. When do adoption assistance payments begin?
Adoption assistance payments and benefits may begin in North Carolina after adoption finalization.
7. When a child turns 18, which benefits, if any, continue?
Benefits of this program cease at the time of the child’s 18th birthday for children adopted
prior to their 16th birthday, or at the time the adoptive parents no longer have financial
and/or legal responsibility for the child. Benefits may continue to the young adult’s 21st
birthday if the youth is adopted after his or her 16th birthday as long as one of the following
requirements is met:
- Completing high school or a program leading to an equivalent credential; or
- Enrolled in an institution that provides postsecondary or vocational education; or
- Participation in a program or activity designed to promote or remove barriers to
- Employed for at least 80 hours per month; or
- Incapable of completing the educational or employment requirements due to a
medical condition or disability.
Benefits must continue for young adults who meet these eligibility requirements, even if
extended benefits were not in effect at the time their Adoption Assistance Agreement was
signed by all parties and the agreement reflects benefits terminating at age 18. The
payments must continue to be made to the adoptive parents in these situations and cannot be transferred to the young adult.
8. Does North Carolina offer deferred adoption assistance agreements (agreements where initial monthly maintenance amount is $0 for children at risk of developing special needs later)?
Yes. Children eligible for adoption assistance in “potential“ category receive Medicaid and vendor payment until manifestation of special needs related to pre-existing conditions.
9. What Medicaid services are available in North Carolina?
Covered services include:
- Hospitalization (pre-admission review is required before hospitalization for non-emergency care)
- Inpatient laboratory and X-ray services
- Hospice care
- Care through home health agencies
- Nurse midwife services
- Treatment in psychiatric hospitals and mental health centers
- Prescription drugs
- Medical examinations and treatment
- Ambulance transportation (when medically necessary)
A total of 24 visits per year will be covered for the following services:
- Hospital outpatient
- Outpatient laboratory and X-ray
- Eye examinations
- Clinic services
- Family planning services
- Hearing aid services
The following services may be covered with prior approval:
- Care in a skilled nursing or intermediate care facility
- Durable medical equipment
- Limited dental services and medically necessary orthodontia
- Hearing aids
- Personal care services in the home
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.)
All children, including non-IV-E children, are eligible for Medicaid.
11. What mental health services are available?
Mental health services for children in North Carolina are administered by the DHHS Division of Medical Assistance (DMA) and may include inpatient and outpatient hospitalization (including treatment in psychiatric hospitals and mental health centers), inpatient and outpatient substance abuse programs, diagnostic services, therapies, physician’s services and prescription drugs. Mental health services may require prior approval before services can be received.
Not all services may be available in all cases. Parents should contact their adoption assistance worker or medical assistance specialist for information regarding process, eligibility, availability, and duration of services.
For more information, visit https://dma.ncdhhs.gov/.
12. In North Carolina, what nonrecurring adoption expenses directly related to the finalization of an adoption may be reimbursed?
Nonrecurring expenses of up to $2,000 per child may include reasonable and necessary adoption fees, court costs, and attorney’s fees incurred by adoptive parents and directly related to the legal adoption of an eligible child. Other nonrecurring costs include those associated with the adoptive home study, physical and psychological examinations, transportation and reasonable costs of food and lodging for the child and/or adoptive parents, and post-placement supervision.
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?
Respite care is not a service offered through the adoption assistance program. Some counties may cover it as a Title XX services or through other funding streams, including the Vendor Payments program. In addition, many private organizations offer respite options. Search for North Carolina programs in the ARCH National Respite Network Respite Locator at https://archrespite.org/respitelocator.
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.
15. Is residential treatment available? If yes, who is eligible and how do families access residential treatment services?
Medicaid may cover a residential facility’s treatment program component. Residential treatment costs (up to $2,400 per year) may be covered under the Vendor Payments program.
16. What other post-adoption services are available in North Carolina and how do families find out more about them?
Children with chronic mental or physical conditions or illness may receive services in addition to those covered under North Carolina’s Medicaid plan if services are medically necessary and receive pre-certification under the Early and Periodic Screening, Diagnosis and Treatment program (EPSDT). Parents should contact their Medicaid caseworker for more details on EPSDT.
North Carolina also has vendor payment for medical and therapeutic services, HIV Supplemental Payments, and Supplemental Special Children Adoption Incentive Fund for child with severe medical and rehabilitative needs. The Supplemental Special Children Adoption Incentive Fund is limited to county participation and is therefore not available to all children.
Post-adoption services in North Carolina are administered through the DHHS Division of Social Services and private and family organizations. Post-adoption services may include:
- Information and referral
- Support groups
- Respite care
Local departments of social services (DSS) and four contract private adoption agencies provide post-adoption services, although all services are not available in all counties. For information on available services, parents should contact DSS in their county of residence, the state post-adoption contact or Beth Riley at email@example.com or 910-986-8078.
For a list of county agencies, visit https://www.ncdhhs.gov/divisions/dss/local-county-social-services-offices.
For a list of the post-adoption agencies, visit: https://www.ncdhhs.gov/post-adoption-support-and-resources and scroll down to the bottom of the page.
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?
No. Previously existing conditions must be detailed in the agreement, but it is not necessary to identify specific services in the agreement. However, services must be related to treatment needs, and treatment needs should be related to the special needs and pre-existing conditions identified in the adoption assistance agreement.
What Should Families Know About Applying for Subsidy?
18. Who initiates the adoption assistance agreement?
The local DSS has responsibility for determining assistance eligibility. Adoption assistance payments are issued from the state DHHS.
19. Who makes the final determination on an adoption assistance agreement?
20. How do families request adoption assistance after finalization of an adoption?
If the child qualifies for adoption assistance under the “potential” category, upon manifestation of child’s special needs the adoptive parent will contact the agency for activation of adoption assistance benefits.
After finalization, parents can contact the local DSS and request adoption assistance benefits based on the child’s special needs. The local DSS will hold a fair hearing regarding the request. If a family is successful in a fair hearing, their local social worker will process all of the necessary paperwork.
How Can a Family Adjust an Adoption Assistance Agreement?
21. Can adoptive parents ask to change an adoption assistance agreement?
Adoption assistance agreements include the state mandated cash payment rate based on the age of the child and no adjustment can be made to those standardized rates.
22. What steps does a family go through to appeal an adoption assistance decision in North Carolina?
Adoptive parents have the right to appeal a decision any time adoption assistance benefits have been denied, reduced, or terminated. Parents must make a written requests for a fair hearing or appeal of a decision to the local DSS (https://www.ncdhhs.gov/divisions/dss/local-county-social-services-offices). Within five days of receiving notification of the request, the county DSS must notify the parents that a hearing will be held and then hold the hearing within five days. A local hearing officer will review the case and render a decision. If the decision is unfavorable to the parents, the agency will advise parents that they can appeal to the state. Parents have 15 days from the mailing of the agency’s letter to request a state appeal.
If the decision is appealed to the state, the local DSS will submit required materials to the State Hearings and Appeals Section. A hearing officer will make arrangements with the parents and agency to schedule the hearing. Following the hearing, the hearing officer will notify the parents of the decision. If parents are dissatisfied with the decision, they can appeal to the Chief of the Hearings and Appeals Section.
If the final decision of the Hearing and Appeals Section is unfavorable to the parents, they can then appeal to North Carolina’s Superior Court, provided such appeal is filed within 30 days of the receipt of the final decision.
What Else do Families Need to Know?
23. How is the adoption assistance program operated and funded in North Carolina?
The program is state supervised/county administered, which means that state staff are responsible for making policy decisions about the adoption assistance program, and providing guidance to county offices. Counties make decisions related to children’s eligibility. North Carolina has 100 county departments of social services, all of which are mandated to provide adoption services.
In North Carolina, the federal contribution to Title IV-E-eligible children is 65.78 percent (known as the Federal Financial Participation or FFP rate). The remaining cost of the program is funded with 16.435 percent state funds and 16.435 percent county funds.
24. Does North Carolina operate a subsidized guardianship program?
25. Does North Carolina offer a tuition waiver program?
The state has no specific tuition waiver program, but children who were adopted after the age of 16 or children who remain in foster care after their 16th birthday are eligible for the Education Voucher. Visit https://studentportal.fc2sprograms.org/login.
Or for additional information, contact:
NCReach provides state-funded grants to pay for tuition, fees, books and room and board for former foster care and youth adopted after age 12 to attend community colleges and public universities in North Carolina .
26. Does North Carolina offer a state adoption tax credit?
No. The adoption tax credit was not extended after 2013. So for tax year 2014 and going forward there is no longer a state adoption tax credit.
27. Does North Carolina have any program to support an adoptee whose adoptive parents die until the child is adopted again?
28. What else differentiates North Carolina’s adoption assistance program from others around the country?