Updated July 2020

Below you will find information about the adoption assistance benefits that may be available to families who adopt children from foster care in Tennessee. Adoption subsidy policies and practices are, for the most part, dependent on the state where the child was in foster care before the adoption.

State Contact

Erika Conwell
Department of Children’s Services/
Division of Foster Care & Adoptions
UBS Tower, 9th Floor
315 Deaderick Street
Nashville, TN  37243-1290

NACAC Volunteer

Betty Hastings
Hollow Rock, TN 
Phone: 731-986-5316
Fax: 731-986-5316
E-mail: tenn.bettyboop@yahoo.com

Marsha Boren
Spring Hill, TN 
Phone 615-804-5209
E-mail: marshaboren@charter.net

What Is Adoption Assistance?

Parents who are thinking about or are in the process of adopting a child from foster care should know about adoption assistance (also known as adoption subsidy). Adoption assistance programs are designed to help parents meet the needs of children they adopt from foster care. Children can qualify for federal adoption assistance or state assistance, depending on the child’s history. (For more information on federal adoption assistance (Title IV-E) eligibility, view our fact sheet Eligibility and Benefits for Federal Adoption Assistance.)

Answers to select questions were made available by the Association of Administrators of the Interstate Compact on Adoption and Medical Assistance through the Child Welfare Information Gateway (www.childwelfare.gov).

If you have state-specific questions, call your State Agency Adoption Assistance Contact or the NACAC Volunteer (listed above). If you have questions about a specific adoption assistance payment (such as the payment being late or you are changing addresses or bank account), call your State Agency Adoption Assistance contact or the general number for that agency.

For other questions, contact NACAC at 651-644-3036, 800-470-6665, or adoption.assistance@nacac.org.

Adoption resources on the web:

Tennessee state-specific medical assistance information: 



  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
  • 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  as indicated by DCS or adjudicated by a court and defined in TCA 37-1-102 (b) (A-D), “Severe child abuse.”
  • The child has a medically diagnosed disability which substantially limits one or more major life activities, requires professional treatment, and assistance in self-care.
  • 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 the child’s intellectual, social and personal functioning.
  • The child is diagnosed to be intellectually disabled by a qualified professional.
  • The child’s life experiences include three (3) or more consecutive years in Tennessee custody.
  • The child meets the criteria for a deferred subsidy due to one or more of the following:
    • The child is at risk for a condition described above due to prenatal exposure to toxins; a history or severe neglect and/or abuse or serious neglect; genetic history;
    • The child has a history of multiple (three or more) disrupted foster or adoptive placements that are documented.
    • The child is diagnosed with Neonatal Abstinence Syndrome.

Children must be in the custody or full guardianship of Tennessee Department of Children’s Services or a Licensed Child Placing Agency prior to the initiation of adoption proceedings.  Children in partial guardianship are not eligible for the Adoption Assistance Program.

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

If a child does not meet the Title IV-E Adoption Assistance elgibility requirements, the child might be eligible for State Funded, non-IV-E, Adoption Assistance.  The child has to meet the special needs criteria and must be in DCS custody/guardianship prior to finalization of the adoption.

Children who are in the custody/guardianship of a Licensed Child Placing Agency are not eligible for state funded Adoption Assistance but are only eligible for Title IV-E adoption assistance as long as they meet the Title IV-E criteria.

  1. Are children adopted from private agencies in Tennessee eligible for adoption assistance?

Yes.  Children who are in the guardianship of a Licensed Child Placing Agency, are only eligible for Adoption Assistance in Tennessee if they meet the Federal Title IV-E requirements, and the requirements in question 1 related to special needs.



  1. What is the maximum basic daily adoption assistance maintenance payment in Tennessee?


Daily Rate





  1. 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:

  1. 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);
  2. Who require a level of supervision exceeding that of their peers; and
  3. Who requires extra care due to physical, emotional, or mental disability.

The special circumstances rates are:


Daily Rate





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. Extraordinary adoption assistance rates are reserved for children who have already met all three of the criteria that qualifies them for a special cirucumstance adoption assistance rate, but have additional needs that are so unique and extensive that they cannot be met at the regular or special circumstance rate.

  1. 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.

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

Adoption assistance can continue to receive state-funded adoption assistance up to the age of 21 as long as the youth is 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 disabling condition. 

  • An eligibility determination must be completed Tennessee SACWIS system, for all youth turning 18, 19, or 20 years old to determine if the youth will remain eligible for the adoption assistance subsidy past the age of 18.  Continued eligibility for youth 18, 19, or 20, regardless of the funding source, is determined through a Review of Eligibility process within our system based on the Adoption Assistance program requirements.
  • Title IV-E Adoption Assistance:  A child/youth determined eligible for Title IV-E Adoption Assistance can continue their adoption subsidy funding through Title IV-E until the age of 21 if the youth has a moderate to severe disability/handicapping condition, documented by a licensed provider, which requires treatment or substantially limits the child or youth in one or more major life functions.
  • Title IV-E Fostering Connections Adoption Assistance who was UNDER the age of 16 at the time of adoption finalization:  A child/youth determined Title IV-E Fostering Connections Eligible and was under the age of 16 at the time of adoption finalization can continue  to receive an adoption assistance subsidy payment through Title IV-E Fostering Connections until the age of 18.  The subsidy can be evaluated prior to the youth’s 18 birthday to determine if the youth can continue to receive a subsidy through non-applicable Title IV-E or State Funded Adoption Assistance.
  • Title IV-E Fostering Connections Adoption Assistance youth who was 16 or OLDER at the time of adoption finalization can continue receiving adoption assistance subsidy payments until they reach the age of 21 years if one of the following are true:
    • The youth is under the age of 21 and is a full time student in high school; or
    • The youth is under the age of 21 and is a full time student in an institution which provides post-secondary or vocational education;
    • The youth is determined incapable for employment or attending school due to a medical condition documented by a licensed provider;
  • State Funded Adoption Assistance is available to youth beyond the age of 18 years provided the youth is under the age of 19 years and is a full time student in high school.
  • Youth determined ineligible to continue funding through Title IV-E (non-applicable) or Title IV-E Fostering Connections (applicable) can have their adoption assistance agreement funded through another funding source provided the youth meets the requirements.
  1. 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.  Deferred Adoption Assistance is a type of Adoption Assistance reserved for children who only meet the deferred crieteria prior to finalization of an adoption, making them ineligible for Adoption Assistance payments.

These children are recognized as high risk and have the potential to develop significant medical, psychological, emotional, or behavioral issues due to their past history, High risk considerations include;

  • Any child whose genetic background or birth parents’ medical history indicates potential for developing physical/psychological problems;
  • An infant who was exposed to alcohol/drugs where such exposure is documented in the child’s birth record; or
  • A child who has a history of multiple (three or more) disrupted foster or adoptive placments documented in our system;
  • A child diagnosed with Neonatal Abstinence Syndrom (NAS).

Non-recurring expenses can be included in the agreement for children determined eligibile for deferred adoption assistance.  Their agreements will have a daily rate amount of ‘0’ until the agreement is made active. 

Children eligible for Title IV-E deferred adoption assistance can receive Medicaid.  A child determined eligible for state deferred Adoption Assistance is not eligibile for Medicaid.  Children who are in the custody/guardianship of a Licensed Child Placing Agency have to be determined Title IV-E eligible for Deferred Adoption Assistance.

The adoptive parents may request active Adoption Assistance at the time they believe their child meets the special needs definition, based on the high risk factors identified in their application and agreement for Deferred Adoption Assistance.  Once the request has been approved for active adoption assistance, maintenance payments are made.  No retroactive payments or services can be made.



  1. 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
  • 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

Visit these websites to learn more:

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.

  1. 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 an adopted child is eligible for State Funded Adoption Assistance, the child is eligible for TennCare if the child has a medical/psychological rehabilitative need.

  1. 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 and Subsstance Abuse Services, 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.

Behaviorial Health: http://tn.gov/behavioral-health

Intellectual & Developmental Disabilities:  http://tn.gov/didd/

TennCare Children’s Page: https://www.tn.gov/tenncare.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.  Parents should use contact information on the back of the TennCare cards if they have questions about available services, or 800-878-3192, TennCare Solutions.


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

Any child who meets the special needs criteria for Title IV-E or State Funded Adoption Assistance is eligible for non-recurring adoption expenses.  DCS payment of expenditures for non-recurring expenses is a one time expense which parents are ultimately responsible and may not exceed $1500 per child.  The non-recurring expenses may include attorney fees, court cost (typically an attorney billed expense), birth certificate cost (typically an attorney billed expense), the application fee, home study by a private child placing agency and supervision of placement, travel expenses and health and psychological examination, if required, related to the completion of the home study.

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

No, child care is not available through adoption assistance.

  1. 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 https://archrespite.org/respitelocator.

  1. 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.

  1. 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)

For more information about post-adoption services, families should contact the Adoption Services Team Coordinator in the local DCS office or ASAP services 888-848-ASAP or www.tnasap.org.

Tennessee Foster and Adoptive Care Association, Inc. is another resource for families, www.tfaca.net or 423-745-2049.  They have advocates and regional contacts on the website.

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 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 https://www.tn.gov/dcs/contact-us/regional-offices.html.

Please note that not all services may be available in all cases. Parents should contact their Subsidy Specialist or post-adoption services contact for information regarding process, eligibility, availability, and duration of services.

  1. 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?



  1. Who initiates the adoption assistance agreement?

The DCS Family Services Worker, Permanency Specialist for DCS, or the adoption worker for a Licensed Child Placing Agency initiates the adoption assistance process prior to finalization.

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

For new approvals, the Team Coordinator or Team Leader must approve the case.  Cental Office approves adoption assistance agreements for Licensed Child Placing Agency children determined eligible for adoption assistance.  Ongoing maintenance of adoption assistance records are managed by the Central Office Subsidy Unit.

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

Adoptive parents who apply for adoption assistance after finalization will have to complete an application in the area office serving of their residence.  Tennessee residents who adopted and moved out-of-state may apply for adoption assistance in the area office serving the county of their residence at the time of finalization.

Out-of-state adoptive parents, who resided out-of-state at the time the child was placed by a Licensed Child Placing Agency, may apply for adoption assistance in the area office serving the county from where the child was placed for adoption.


  1. 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 to change or modify the adoption assistance agreement, the parent must contact their Subsidy Specialist for their region.  Parents will need to provide supporting professional documentation to the Subsidy Specialist. The adoption assistance agreement will be revised to reflect any approved changes.

If the request is denied, the parent will receive, via regular mail, a letter of Denial, Termination, or Change and a Notice of Appeal.  The parent can appeal the decision by requesting and completing the Appeal for Fair Hearing form, and returning it to the Admintrative Procedures office within 10 days.

Regional office contacts: 

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

Whenever DCS revises, terminates, or denies Adoption Assistance, the Adoptive parent may appeal the decision in accordance with the rules and procedures of the State’s fair hearing and appeal process.  If the parents appeal within 10 days of the written notice from DCS, the assistance continues pending the outcome of the appeal.

Parents must return a completed form to the address listed in the letter of Denial, Termination or Change within 10 days.  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.


  1. How is the adoption assistance program operated and funded in Tennessee?

The program is state supervised 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 64.96% in Tennessee. The remaining cost of the program is funded with all state funds.

  1. Does Tennessee operate a subsidized guardianship program?

The Federal Guardianship Assistance Program (GAP) in Tennessee is called the Subsidized Permanent Guardianship (SPG) program.  Subsidized Permanent Guardianship first began in Tennessee as a Title IV-E waiver demonstration project December 6, 2006.  Tennessee’s modified state plan was approved by the Children’s Bureau effective April 1, 2009.

Information about the SPG program is located https://www.tn.gov/dcs/program-areas/qi/policies-reports-manuals/policiesprocedures.html, policy 15.15, and the Subsidy Manual for Adoption Assistance and Subsidized Permanent Guardianship.

For more information regarding the Tennessee Subsidized Guardianship Program, contact:

Odessa Krech, Program Director, Foster Care
UBS Tower, 9th Floor
315 Deaderick Street
Nashville, TN 37243

  1. 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:

Brian Stephens
Independent Living Services Director
Tennessee Department of Children’s Services
UBS Tower, 9th Floor
315 Deaderick Street
Nashville, TN 37243

  1. Does Tennessee offer a state adoption tax credit?

Tennessee does not offer a state adoption tax credit.

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

No, Tennessee does not have a program to support an adoptee when an adoptive parent dies.

  1. 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?

Tennessee encourages adoptive families to receive their adoption assistance through direct deposit, paper checks are also an option. Adoption assistance payments are paid on the 15th of the month. For families that are having problems with their payment they can contact Erika Conwell at 615-741-9951 or

  1. What else differentiates Tennessee’s adoption assistance program from others around the country?



Tennessee Legal Sources:

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). 

Tennessee Adoption Assistance Policy 15.11

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