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Iowa State Subsidy Profile August 2008 State Subsidy Contact Person Tracey Parker NACAC Subsidy Representatives (parent/volunteer) Angela Stark Rick and Jean Hess
Adoption subsidies are available for children with special needs. Federal subsidies were created by Congress (through Public Law 96-272—the Adoption Assistance and Child Welfare Act of 1980) to encourage the adoption of special needs children and remove the financial disincentives to adoption for the families. Children may receive a federally funded subsidy under Title IV-E or a state-funded subsidy as per state guidelines. Below we have outlined information related to definitions of special needs, benefits available, and procedures in your state. 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 each state’s subsidy program are available on our web site at www.nacac.org. If you have additional questions, please call the North American Council on Adoptable Children (NACAC) at 651-644-3036 or our subsidy help line at 800-470-6665, or e-mail us at adoption.assistance@nacac.org. If you have state-specific questions, please call your State Subsidy Contact Person or the NACAC Subsidy Representative (listed above) for more information. Adoption Resources on the Web: http://www.dhs.state.ia.us/dhs2005/dhs_homepage/ Iowa’s state-specific medical assistance links: http://www.cms.hhs.gov/medicaid/stateplans/toc.asp?State=IA and http://www.dhs.state.ia.us/dhs2005/dhs_homepage/ Iowa’s adoption assistance links: Iowa does not have an adoption assistance link, but provides information on special needs adoption: http://www.dhs.state.ia.us/dhs2005/dhs_homepage/ 1. What specific factors or conditions does your State consider to determine that a child cannot be placed with adoptive parents without providing financial assistance? ("What is your State definition of special needs?") 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:
Note: Children must be legally free for adoption, in the guardianship of the state of Iowa, county, or a child-placing agency licensed by the state immediately prior to adoption to be eligible for adoption assistance. 2. What are the eligibility criteria for the State-funded adoption assistance program? In order to be eligible for state-funded adoption assistance, a child must meet be a special needs child as defined above, legally free for adoption, and in the guardianship of the State of Iowa, the county, or a child placing agency licensed by the state immediately prior to adoption. 3. The maximum basic monthly adoption assistance maintenance payment in Iowa is: Basic rates:
Note: When funds are available, rates are maintained at 65 percent of the USDA estimate of the cost of raising a child in the Midwest. The subsidy payment amount is negotiated between the family and the DHS adoption worker, based on the needs of the child and the family’s ability to meet these needs. Specialized rates: A new methodology has been established for determining family foster care “difficulty of care” maintenance payments that is based on an assessment of the child’s emotional, behavioral, and physical care needs. This method will apply to all placements made on or after January 1, 2007. Children in placement before January 1, 2007, will remain at the current payment rate for the duration of the placement. These rates determine the rates paid when the child is placed in an adoptive placement.
(Iowa Code Section 234.6, chapter 156) 4. Specialized rates are based on the extraordinary needs of the child, and/or the additional parenting skill needed to raise the child. If Iowa offers these rates, the criteria used to define them are as follows:) Children specifically defined as having physical, mental, or emotional problems are eligible for a special monthly maintenance allowance. The specialized care allowance is determined while in foster care and is based on the completion of a behavioral needs assessment. This additional payment must be authorized while the child is in foster care prior to the adoptive placement. 5. Parents can receive payment or reimbursement for certain nonrecurring adoption expenses directly related to the finalization of an adoption. Below are the allowed expenses and the limit per child. Reimbursable nonrecurring adoption expenses include reasonable and necessary adoption fees, court costs, attorney fees and other expenses that are directly related to the legal adoption of a special needs child. The maximum reimbursement for attorney fees is $700, plus filing fees not to exceed $200. This amount is in state law and DHS does not have the authority to grant exceptions to provisions in state law. 6. What Medicaid services are available in Iowa? A child that is eligible for adoption subsidy is also eligible for Medicaid services. The state contact person is Donna Harris, 515-281-3112. 7. Children who have federally funded (Title IV-E) subsidy are automatically eligible for Medicaid benefits. However, it is the state's decision whether state-funded (non-Title IV-E) children are eligible for Medicaid benefits inIowa. Below is information on the Medicaid benefits available for state-funded children. The Department provides Medicaid to all children in adoptive placements for whom the state has financial responsibility. Non-IV-E-eligible children who move to Iowa from other states may be federally eligible under another Medicaid coverage group. Non-IV-E children for whom Iowa has financial responsibility receive Medicaid services funded by state dollars. 8. What mental health services are provided by your State? Mental health services for children in Iowa are administered through the DHS Division of Mental Health and Developmental Disabilities and include the following examples: inpatient hospital, outpatient hospital, prescription drugs, intermediate care facilities, clinics, psychologists, community mental health centers, genetic consultation clinics, day treatment, partial hospitalization, Area Education Agencies, Psychiatric Medical Institutions for Children, rehabilitative services for children, Home & Community Based Services through waivers. Iowa’s mental health: http://www.dhs.state.ia.us/mhdd The Department redefined the scope of covered services to match the definition of rehabilitative services in federal regulations. The way remedial services are provided under Medicaid has changed to reflect a medical model of rehabilitation. Note: Not all services may be available in all cases. Contact your adoption assistance worker or medical assistance specialist for information regarding process, eligibility, availability, and duration of services. 9. Does your State provide additional finances or services for medical or therapeutic needs not covered under your State medical plan to children receiving adoption assistance? Iowa does provide additional finances or services for medical or therapeutic needs not covered under their state medical plan. Reimbursement is available to adoptive families for children receiving adoption assistance for outpatient counseling or therapy services not covered by the Medicaid program; medical services not covered by the Medicaid program, limited to additional health insurance premium amounts (due to a child's special needs) necessary to include the child in the family's coverage plan medical transportation not covered by Medicaid, and the family's lodging and meals, if necessary, when the child is receiving specialized care; for the subsidy special services.” Families must negotiate to have these services included in the Adoption Subsidy Agreement whenever the needs of the child or the family’s circumstances change by contacting their local DHS area office. Special Services Subsidy—A family's medical insurance, Medicaid, or any services available free of cost shall be used before the subsidy funds are expended. Special services reimbursement is provided for the following services: (1) outpatient counseling or therapy services not covered by the Medicaid program; (2) medical services not covered by the Medicaid program, limited to additional health insurance premium amounts (due to a child's special needs) necessary to include the child in the family's coverage plan; (3) medical transportation not covered by Medicaid, and the family's lodging and meals, if necessary, when the child is receiving specialized care; (4) supplies and equipment as required by the child’s special needs and unavailable through other resources; and (5) funeral benefits at the rate allowed for a foster child. Note: Any single special service and any special service delivered over a 12-month period costing $500 or more shall require prior approval from the adoption program manager before program funds are dispersed. Eligibility is based on the child’s special needs. Such subsidies can be provided for an eligible child even in cases where a maintenance subsidy is not needed. Note: Not all services may be available in all cases. Contact your adoption assistance worker or medical assistance specialist for information regarding process, eligibility, availability, and duration of services. 10. What types of post adoption services are available in your State and how do you find out more about them? Post adoption services in Iowa are administered by the Department of Human Services for children receiving adoption assistance and include the following examples:
The Iowa Foster and Adoptive Parents Association (IFAPA) provides post adoption support through the Resource and Information Specialist (RIS) Program. The goal of the RIS Program is to strengthen and support new adoptive families that adopt children with special needs. The RIS Program provides services confidentially and free of charge. For more information on IFAPA and its services, see the drop down boxes under Programs in the toolbar: http://www.ifapa.org or phone: 800.243.0756. Families can access services by contacting their local DHS office: Additional services may include the following:
The following services are also available to adoptive families that meet specific program eligibility requirements:
Respite Care—Five days of respite care per year are available to adopted children and their families. The Respite Program is administered by the Iowa Foster and Adoptive Parent’s Association (IFAPA)—800-277-8145 or 515-289-4567. Many private organizations offer a variety of respite options. See the ARCH National Respite Network Respite Locator Service, search by state to locate Iowa’s respite programs: http://www.respitelocator.org Note: Not all services may be available in all cases. Contact your adoption assistance worker or post adoption services specialist for information regarding process, eligibility, availability, and duration of services. 11. If the additional assistance (listed above in questions #8 -10) is to cover specific services (e.g., counseling/mental health services, respite care, etc.), must these services be explicitly identified in the adoption assistance agreement? Yes. 12. How are residential treatment costs covered (if at all) for adoptive families? What procedures must a family follow to receive these services? Inpatient residential treatment costs are not covered by the adoption assistance program. However, adoptive families may receive these services through the state's foster care program by initiating a voluntary placement agreement (for 30 days) if the family has no other resources. After 30 days, the child must be placed in state custody and under the jurisdiction of the juvenile court to continue receiving services. 13. A deferred adoption assistance agreement is one in which the initial monthly maintenance amount is $0. Does Iowa offer such agreements? Yes, Iowa offers deferred adoption assistance. When a child is eligible for adoption assistance, but assistance is not immediately needed by the child or family or when the child is at risk of being determined a child with special needs and assistance may be needed in the future, an Agreement to Future Subsidy (Form 470-0762) can be completed and retained by DHS for future reference. The adoptive family should also keep a copy of the Agreement to Future Subsidy, Form 470-0762, and a copy of the adoption petition and decree. These documents will be used by DHS as the basis for initiating the application for adoption assistance and negotiating an Adoption Subsidy Agreement in the future. For deferred adoption assistance, the adoption petition must contain language indicating that the child is at risk of developing problems in the future and the adoptive parents would desire financial assistance when the need arises. 14. Does Iowa operate a subsidized guardianship program? Iowa has been chosen to receive a Title IV-E waiver for subsidized guardianship. Through the waiver program eligible children will be randomly assigned to the control group or the eligible group to be considered for subsidized guardianship benefits. Programmatic Procedures 15. Who makes the final determination of a child's subsidy eligibility in Iowa? What roles, if any, do workers and administrators at the county, district, or regional level play in eligibility determination and/or assistance negotiation? The Department’s adoption worker and supervisor determine whether a child is eligible for subsidy. Decisions are made within 30 days of application. If a family and DHS cannot come to an agreement for the adoption assistance eligibility, the family may request a review of eligibility by a DHS administrator. 16. Will Iowa consider my family income to determine my child's eligibility for an adoption subsidy? No. Family income guidelines are not used to determine subsidy amounts. However, a child's unearned income (i.e., SSI) is used to offset the subsidy payment. The child’s unearned income does not automatically decrease the subsidy amount. When subsidy is negotiated between the DHS worker and family the child’s unearned income, the family’s resources, and the child’s needs are discussed to determine the child’s negotiated maintenance payment amount. Note: An administrative rule change has been drafted to discontinue the practice of automatically using the child's unearned income (SSI, trust funds, VA benefits, etc.) to offset the subsidy payment. It is anticipated that the rule change will be effective July 1, 2005. This change is being made to comply with federal rules regarding the subsidy program. In the interim, families can request the Director of Human Services to grant an exception to waive using the child's unearned income to offset the subsidy payment. During the subsidy negotiation process all of the family's resources will be considered. 17. When do subsidy payments begin? Adoption assistance payments and benefits may begin when the Adoption Placement Agreement and the Adoption Assistance Agreement is completed and signed by all parties. 18. Do children adopted from private agencies in Iowa receive the same subsidies as those children adopted from public agencies? Yes. Private agencies must provide documentation of eligibility to the state agency (DHS). 19. When my child turns 18, which benefits, if any, are available to our family? Subsidy payments and special services can continue until a child reaches age 18 or 21 for those persons with a diagnosed physical or mental disability. The subsidy agreement shall be reviewed when the child reaches the age of 17.5 years to determine whether the child is eligible to receive a subsidy through age 21 due to the child’s physical or mental disability. The child’s disability must be diagnosed by a physician, a qualified mental health professional, or a qualified mental retardation professional. The diagnoses shall be current within one year of the child’s 18th birthday.A child must be a dependent of the family to be eligible to receive assistance. 20. A child's adoption assistance agreement may be periodically reviewed by the state. What is the typical process used in Iowa? The biennial review of subsidy agreement was eliminated in July 2004. Families may request a review at any time when their circumstances or the child’s needs change. A review will be generated by DHS when the child is 17.5 years old to determine eligibility after the child’s 18th birthday until age 21. 21. Can adoption assistance agreements be modified if requested by adoptive parents? An adoptive parent can request a change in an adoption assistance agreement whenever the needs of the child or the family's circumstances change. Across-the-board increases in adoption assistance payments are made when the Legislature approves cost-of-living adjustments. To initiate a change in the agreement, the adoptive parent should contact, in writing or by phone, the adoption unit located in the DHS Area Office in which the family resides. There is no established format for the change request. The DHS worker that responds to the family will specify what documentation is needed to support the change in order to make a determination regarding the request. The family will be provided with the decision regarding the request via the Adoption Notice of Decision, Form 470-0745. Appeal procedures, also known as fair hearings, are included on this Notice and parents can follows the information provided in the event the family disagrees with the decision and seeks a fair hearing. Iowa’s county DHS: 22. What are the exact steps a family must go through to access the fair hearing/appeal process in Iowa? Adoptive parents can request a fair hearing whenever there is dissatisfaction with any action or failure to act with regard to an application for adoption services, services that the family is receiving, or because such assistance has been denied, reduced or terminated the family has the right to appeal (fair hearing). The request for fair hearing (also known as an appeal) must be in writing and sent or taken to the DHS office located in the family’s county of residence. There is no specified format required for the appeal request letter. To get a hearing the family must file an appeal within thirty calendar days or before the effective date on the notice, whichever is greater. The family may obtain assistance in formulating the appeal request from the local DHS office. The DHS will determine whether or not an appeal may be granted hearing. If a hearing is granted, the adoptive family will be notified of the time and place. If a hearing is not granted, the family will be notified in writing of the reason and the procedures for challenging that decision. If an appeal hearing is granted, the family may explain their disagreement or have someone such as a relative or friend explain the disagreement for them. An attorney may represent the family, but this representation is at the family’s expense. DHS will not cover attorney costs. The local county DHS office has information about legal services available to families that are based on a family’s ability to pay (known as a “sliding scale fee”). Families may also contact the Legal Services Corporation of Iowa, phone: 800-532-1275. For questions, families can call DHS collect, phone: 515-281-8774 or 515-281-3094. To locate DHS offices: 23. Families may request a subsidy after the finalization of an adoption under certain circumstances. Below is the process by which families access a subsidy after finalization. Families can apply for an adoption subsidy at the time of the adoptive placement or at any time before finalization of the adoption. After finalization, a family can request an administrative review to determine if: (1) facts determining the child’s eligibility were not presented before the adoption was finalized or (2) the child enters the county, is adopted, and meets the criteria of special needs. If these conditions exist, the family may begin receiving an adoption subsidy or payment for nonrecurring adoption expenses using state funds only.
24. How is the subsidy program operated and funded in Iowa? The program is state supervised and state administered, with workers in (regional and) service area offices throughout Iowa. This means that both policy and eligibility decisions are made by personnel at the state office. The subsidy program is funded with state and federal funds (IV-E). The federal contribution to Title IV-E-eligible children is 61.73 percent in Iowa. This is known as the Federal Financial Participation (FFP) rate. The remaining cost of the program is funded entirely with state funds. 25. Below are other programs that may delineate Iowa's adoption assistance program from others around the country. The special services available to adoptive families (see Question #9) may distinguish Iowa’s adoption assistance program from other state’s programs. A one-time payment can be made up to $500 per child when a sibling group of three or more is placed together. An amount not to exceed $2,000 per family may be authorized to reimburse expenses for transportation, lodging, or per diem related to preplacement visits. Iowa’s Education Training Voucher Program —Young people may be eligible for funding of up to $5,000 per year while in college or a vocational or technical training program. Requirements include: (1) You are 18, 19 or 20 years old, (2) You are in foster care or you were in foster care as a teenager and you are a U.S. citizen or qualified non-citizen, (3) You aged out of the foster care system at age 18 or were adopted from foster care with adoption finalization after your 16th birthday, (4) You have been accepted into or are enrolled in a degree, certificate or other program at a college, university, technical or vocational school and you show progress towards that degree or certificate. For more information, contact your caseworker or: Julie Molenburg, ETV Coordinator |
North American Council on Adoptable Children (NACAC)
970 Raymond Avenue, Suite 106
St. Paul, MN 55114
phone: 651-644-3036
fax: 651-644-9848
e-mail: info@nacac.org
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