Children retain eligibility for adoption assistance across state lines. The adoption assistance agreement parents have with a child’s adoption assistance state is valid in all states and the child’s maintenance payment will continue even if the family moves. However, an interstate move or placement can affect the other adoption assistance benefits a child receives and will affect Medicaid.  Below we explore the issues that might arise in adoptions across state lines or when adoptive families move to a new state after adoption.

Understanding Terms
  • Adoption assistance state—For children in public foster care, this is the state that has legal custody of a child and is responsible for determining a child’s eligibility for adoption assistance. The adoption assistance state never changes, regardless of where the child or family lives.
  • State of residence—Residence is important for Medicaid purposes because Medicaid is generally received through one’s state of residence.
  • “Sending” and “receiving” states—The terms, used in interstate placements, typically refer to the state that “sends” or places a child for adoption and that the state where the adoptive family lives or “receives” the child.  
  • Adoption assistance agreement— This is the legally binding contract between the adoption assistance state agency that placed the child for adoption and the adoptive family that outlines the benefits the child will receive.

Adopting a Child from Another State

In a public foster care adoption, the determination of eligibility for adoption assistance and the adoption assistance agreement will come from the state with custody of the child (the adoption assistance state).  In the case of a child who is not in the custody of a state but who is eligible for adoption assistance, the determination of eligibility for assistance and the adoption assistance agreement will come from the prospective adoptive parents’ state.  

Adoption assistance benefits typically include a monthly cash payment and medical assistance through Medicaid plus nonrecurring adoption expenses (a one-time payment to assist with approved expenses incurred in the adoption). (For more information on Title IV-E and state-funded adoption assistance, see the Eligibility and Benefits for Federal Adoption Assistance fact sheet.)

Monthly Adoption Assistance Payments

Maintenance payment rates vary by state, and most states use their own assistance rate structure (rather than the receiving state’s structure) to set a maintenance payment level for a child when placing for adoption in another state. Some states, however, will use a higher or a lower rate structure depending on the circumstances.  For example, if a state has a high cost of living, it will often have a higher rate structure than a state with a lower cost of living.  Sometimes states will base their payments for a particular child on the rate structure of the state in which the child will be living.

Since maintenance payments reflect the child’s specific needs and the family’s circumstances, a few states will factor the lower or higher cost of living of a child’s resident state into its determination of a maintenance payment amount.


Medicaid is a federal/state health insurance program administered by the states and overseen by the federal government. Children who qualify for Title IV-E adoption assistance are automatically eligible for Medicaid in all states. Children who do not qualify for Title IV-E but who are eligible for state-funded adoption assistance may receive Medicaid but are not automatically eligible.

Most states provide Medicaid to state-funded children who live in the state, but have an adoption assistance agreement with another state.  This is known as COBRA reciprocity.  However, four states currently do not offer this reciprocity.  Please see the Association of Administrators of the Interstate Compact on Adoption and Medical Assistance (AAICAMA) web site for a listing of state COBRA and COBRA reciprocity policies.

Once prospective adoptive parents and an agency enter into an adoption assistance agreement, the state’s administrator of the Interstate Compact on Adoption and Medicaid Assistance (ICAMA)—known as the Compact Administrator—will send ICAMA forms establishing the child’s basis for assistance, Medicaid eligibility, and a copy of the adoption assistance agreement.  The state where the child lives receives this information and initiates the receipt of Medicaid in the state for all eligible children.

Non-Recurring Adoption Expenses

Parents who adopt children with special needs may be eligible for a one-time reimbursement for qualifying adoption expenses from the adoption assistance state. States are able to set the amount, up to $2,000, of the maximum reimbursement and the procedure for reimbursement.  The reimbursement may cover expenses incurred for adoption fees, agency supervision of the adoption placement, court costs, attorney fees, travel, food, and lodging expenses, physical and psychological exams, birth certificate fees, and other expenses related to the legal adoption of a child with special needs.  Parents must enter into an agreement with the adoption assistance state for either reimbursement or direct payment of non-recurring adoption expenses.

Moving to Another State After Adoption

The greatest impact of an interstate move will be on the Medicaid services available in the new state.  All states have a Medicaid program, but specific Medicaid services vary from state to state. Other adoption assistance benefits may also be state specific.  Parents should check with the Adoption Program in the child’s adoption assistance state to determine if any other benefits, in addition to Medicaid, would be affected by a move.  Adoption assistance state contacts are listed at the top of each state’s profile.

Monthly Maintenance Payments

An interstate move, or any move, should not affect the receipt of a child’s adoption assistance payment.  Parents should notify the adoption assistance state of the move to ensure that payments are received by the child in the new location.

In some cases an interstate move may, however, affect the amount of a maintenance payment. Some families may seek to increase the payment if they move to a state with a high cost of living.  Since maintenance rates are negotiated between the parents and the adoption assistance state based on the child’s needs and the family’s circumstance, families can ask to renegotiate the adoption assistance agreement and change the maintenance rate if either needs or circumstances change.  However if you are already receiving the maximum adoption assistance from the paying state and they don’t look at the receiving state’s rate structure, than there is nothing to renegotiate (See NACAC’s fact sheet on Renegotiating Adoption Assistance Agreements.)

And on the flip side, Alaska asks parents to reduce the maintenance payment if the new state has a lower rate structure or cost of living (although parents have a right to say no).


Children who receive Title IV-E adoption assistance will continue to receive Medicaid in their new state of residence. As stated earlier, children with state-funded adoption assistance are likely to receive Medicaid in the state but may not if their state does not have COBRA reciprocity.

The child’s Medicaid must be transferred to the new state of residence. Before they move, parents should contact state adoption assistance staff to arrange the transfer of the child’s Medicaid to the new state.

Because states vary in some of the services they provide under their Medicaid program, a service that a child was receiving from a state’s Medicaid program may not be a service included in another state’s program. Federally mandated services must be provided in every state. One mandatory service under Medicaid is Early and Periodic Screening, Diagnosis and Treatment (EPSDT).  If a child is found to have a need that is deemed medically necessary to be met, the child can receive the service, even if the service is not available under a state’s Medicaid plan.  (Please see AAICAMA’s EPSDT Factsheet for more information, available on the AAICAMA website at

Families who are moving to a new state should be proactive. They should request that Medicaid be established as soon as possible, and make sure that they have notified the child’s adoption assistance state of an impending move and given that state all the necessary contact information. In addition, parents should ensure that their child has an adequate supply of prescription drug until services can be established and providers found in the new state.

Interstate Compact on Adoption and Medical Assistance (ICAMA)

The Interstate Compact on Adoption and Medical Assistance (ICAMA) was created to facilitate the transfer and receipt of adoption assistance benefits between states. The Association of Administrators of the ICAMA is a national network of administrators who work cooperatively to ensure that adopted children adopted with special needs receive medical and other benefits when children are placed interstate or an adoptive family moves after adoption.  As of 2016, 49 states and the District of Columbia are members of the ICAMA.  

For contact information on ICAMA compact administrators, please see the AAICAMA web site or call 202-682-0100 x 269.  

Categories: Adoption Assistance

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