The ndbookortKentucky Cabinet for Health and Family ServicesDepartment for Community Based Services

Thank you for your commitment to children through adoption.Please use this handbook as a general reference guide to theservices available. The provision of services offered in Kentuckyis contingent upon the needs of the child and approval throughregional Department for Community Based Services staff.The information in the handbook reflects current State and Federallaws and guidelines, which may change periodically. All changes orupdates are on the electronic version of the handbook availableelectronically.

Table of ContentsIntroduction 4What are the special needs criteria? 4What is a reasonable efforts determination? 5What if my child is denied adoption assistance? 5What is Adoption Assistance and how is it funded? 6What is the Adoption Assistance Agreement? 8Does my child qualify for medical assistance? 8What if my child has extraordinary medical needs? 9Nonrecurring Expenses 14What if a change occurs? 14When does adoption assistance begin? 15What is annual contact? 16What are the training requirements? 16What are statutory benefits? 19What if I failed to request adoption assistancebefore finalization of the adoption? 20How will adoption assistance affect my income tax? 21Adoption Tax Credit 22What if I move? 22When does adoption assistance end? 23What is temporary discontinuance? 24Does Adoption Assistance continue beyond age 18? 25What are Post Adoptive Placement Stabilization Services (PAPSS)? 26What is the Tuition Waiver for Foster and Adopted Children? 28The Tuition Waiver is applicable for undergraduate study only. 29What is the Education Training Voucher? 30What is the Chafee Independence Program? 31Resource Information 32

IntroductionKentucky’s Adoption Assistance program began in 1972 withlegislation designed to eliminate barriers that could prevent theadoption of “special needs” children by adoptive parents whomay be financially unable to meet the needs of the children. TheAdoption and Safe Families Act (ASFA) passed in 1997 placedmore emphasis on permanency for children and eliminated someof the barriers to adoption for children waiting for families. Safety,permanency and well-being are the key principles of ASFA, andeach state is held accountable for the permanent placement ofchildren.Kentucky’s legislature has implemented laws and regulations,including KRS 199.555, KRS 199.557, 922 KAR 1:050, and 922 KAR1:060, to allow the Department for Community Based Services(DCBS) to provide post adoptive services and assistance to theadoptive parents of children who are in Kentucky’s foster careprogram who meet the special needs criteria. Children in fostercare have histories of loss, trauma, medical and emotional issues.What are the special needs criteria?To qualify for adoption assistance, a child must meet the followingcriteria:1. The state has determined a child in foster care cannot orshould not be returned to their biological parents, because acourt has granted a voluntary termination of parental rights(TPR), or an involuntary termination of parental rights (TPR),or the parents are deceased.2. One or more of the following "special needs" definitions mustbe met: Child has a physical or mental disability; Child has an emotional or behavioral disorder; Child has a recognized/documented risk of physical,mental, or emotional disorder; Child is a member of a sibling group, consisting of two(2) or more children, in which the siblings are placedtogether;4

Child has had a previous adoption disruption or multiple(more than one) placements; Child is a member of a racial and/or ethnic minority groupand is two (2) years old or older; or Child is age seven (7) or older and has a significantemotional attachment or psychological tie to his/her fosterfamily and the Cabinet has determined that it would be inthe child’s best interest to remain with the family.3. The child is eligible if the child meets the requirements forSupplemental Security Income (SSI) benefits and determinedby the state to be a child with special needs prior tofinalization of the adoption.There are no additional criteria that a child must meet to beeligible for Title IV-E adoption assistance when the eligibilityis based on a special needs child meeting SSI requirements.Specifically, in this situation is it irrelevant how a child isremoved from his or her home or whether the state hasresponsibility for the child’s placement and care.What is a reasonable efforts determination?In all cases, it must be determined that reasonable efforts havebeen made to place a child without the need for adoptionassistance. However, there are exceptions including:1. The child has significant emotional ties to the prospectiveadoptive parents (i.e., foster parent) because they have hadthe child(ren) in their home for an extended period, or thechild has emotional ties to another person who has hadconsiderable influence in his/her life.2. The child was registered with the Special Needs AdoptionProgram (SNAP) in order to recruit an adoptive family asthere was no waiting Kentucky family available; or3. The child was referred to two or more families who were notaccepting of the child because of the severity of the child’sissues.What if my child is denied adoption assistance?If DCBS denies adoption assistance for your child and you feel5

that the denial was unjust based upon the special needs of thechild, you have the right to a fair hearing. You may contact yourworker, and/or the Ombudsman’s office, within 30 days of thedenial. The Service Appeal Request form (DPP-154) is completedto request a fair hearing and can be provided by a worker or theOmbudsman’s office. The worker or the Ombudsman’s office canalso assist with completing the form.What is Adoption Assistance and how is it funded?Adoption Assistance is a resource to assist adoptive families withmeeting the special needs of the children they adopt.The monthly subsidy is a set monthly payment normally equal (orshould be equal) to the Department for Community Based Servicefoster care per diem for the child. The monthly subsidy can neverexceed the amount of the DCBS foster care rate for the specificchild.The type of subsidy that your child receives is found on the topright corner of the Adoption Assistance Agreement (DPP-1258).The monthly subsidy is available from two funding sources:A. Federal Funds – Title IV-E EligibleThere are four (4) ways a child can be eligible for Title IV-Eadoption assistance:1. The child is eligible for Aid to Families with DependentChildren (AFDC) and meets the definition of a child withspecial needs. Adoption assistance eligibility from a child’s AFDC eligibilityis determined on the child meeting the criteria at the timeof removal. The Fostering Connections to Success andIncreasing Adoptions Act of 2008 will gradually de-linkAFDC eligibility requirements related to Title IV-E fundedadoption assistance. By 2018 all special needs children infoster care will be Title IV-E eligible.ooThe state must determine that the child meets thedefinition of a child with special needs prior to6

finalization of the adoption. The method of removalhas the following implications for AFDC eligible childrenfor Title IV-E adoption assistance: If the child is removed from the home as the resultof a judicial determination and must indicate that itwas contrary to the child’s welfare to remain in thehome; or If the child is removed from the home as the resultof a voluntary placement agreement, the child mustreceive Title IV-E foster care payments to be eligiblefor Title IV-E adoption assistance. Children placed as the result of a voluntaryplacement agreement where Title IV-E foster caremaintenance payments are not paid are not eligibleto receive Title IV-E adoption assistance.2. The child is eligible if the child meets the requirementsfor Supplemental Security income (SSI) benefits and isdetermined by the state to be a child with special needs priorto finalization of the adoption.3. There is no additional criteria for a child to be eligible for TitleIV-E adoption assistance when eligibility is based on a specialneeds child meeting SSI requirements. Specifically, in thissituation is it irrelevant how a child is removed from his or herhome or whether the state has responsibility for the child’splacement and care.4. A child is eligible for Title IV-E adoption assistance if, priorto the finalization of the adoption, the child’s parent was infoster care and received Title IV-E foster care maintenancepayment that covered both the minor parent and the childof the minor parent and it is determined by the state tomeet the definition of a child with special needs. There is noadditional criteria to be met in order for a child to be eligiblefor Title IV-E adoption assistance if the child’s eligibilityis based on his/her minor parent’s receipt of foster care7

maintenance payment while placed with the minor parentin foster care. As with SSI, there is no requirement that achild must have been removed from the home, pursuantto voluntary placement agreement, or because of a judicialdetermination.5. A child is eligible due to prior Title IV-E adoption assistanceeligibility and meets the definition of a child with specialneeds. In the situation where a child is adopted and receivesTitle IV-E adoption assistance, but the adoption later dissolvesor the adoptive parents die, a child may continue to beeligible for Title IV-E adoption assistance in a subsequentadoption.Since Title IV-E adoption assistance eligibility need not bereestablished in such subsequent adoptions, the mannerof a child’s removal from the adoptive home, includingwhether the child is voluntarily relinquished to an individualor a private agency, is irrelevant.B. State Funds – NON Title IV-EThis assistance is available to all special needs children who donot qualify for Title IV-E funded adoption assistance and wereplaced for adoption by the Department for Community BasedServices (DCBS).What is the Adoption Assistance Agreement?The Adoption Assistance Agreement (DPP-1258) is a form signedby the family and Cabinet representatives outlining the monthlysubsidy and extraordinary expenses that are available to theadoptive family upon signing the DPP-1258 and DPP-1258C.Does my child qualify for medical assistance?A Kentucky Medical Assistance Card is available for all childrenwho have an Adoption Assistance Agreement (DPP-1258). Theadoption subsidy medical card is approved when the adoptionfinalizes and the child’s agency case is sealed. Adoptive parents8

should report any name, social security number, and/or addresschanges to the Child Benefits Worker.Medicaid eligible children receiving adoption assistance areassigned to a Managed Care Organization (MCO), which is aMedicaid managed care health maintenance organization (HMO)for physical health care. The worker will submit the AdoptionAssistance Update/Service Plan for Physical Health when theadoption is finalized. MCO organizations covering statewide areAnthem, Aetna Better Health, Humana CareSource, Passport andWellCare. Any difficulties in obtaining services (including dental,vision, and pharmacy) or payment for medical services should bedirected to member services of the MCO your child is assigned.Changes in MCO companies can be made within 60 days of thefinalization of adoption, or during the annual open enrollmentperiod.MCO Contact Information:AnthemPhone: 1 (800) 880-2583Aetna Better Health Phone: 1 (888) 604-6106Humans CareSourcePhone: 1 (800) 833-6917PassportPhone: 1 (800) 578-0603WellCarePhone: 1 (877) 389-9457What if my child has extraordinary medical needs?Extraordinary medical expenses are only available for childrenplaced for adoption by DCBS. These are expenses related to achild’s “special needs” which existed PRIOR to the adoption, andwhich are not reimbursable by private insurance, the medicalcard, or any other resource.The services are utilized as the last resort when ALLother services have been exhausted. The resources arecontingent upon DCBS approval.9

A co-pay may be required based on the family’s income. Thefamily’s worker can assist with co-pays, eligibility requirements,and identifying the services available. A verifiable receipt andservice provider contact information is required to be submittedfor reimbursement of these services. Your co-pay will be deductedfrom each monthly receipt that is submitted for payment. (Forexample: A receipt is submitted for 100 and if you have a 10%co-pay you will be reimbursed 90).The Regional Billing Specialist processes payments for theseservices.Services covered by the extraordinary medical program MAYNOT include the following: School tuition Home school expenses Gymnastics Housecleaning services Equine therapy Summer camp Computers and computer software (An exception in anamount not to exceed 1,000 for a one-time purchase forseverely physically disabled children may be approved) Fences Swimming pools Major home renovations Vehicles to transport children Routine medical expenses (This includes physician visitsunrelated to the child’s special needs) Over the counter drugs Hospitalizations Dentistry or Orthodontia (Unless, prior to adoptionfinalization, there is a medical need with documentationfrom a physician) Funeral expensesServices covered by the extraordinary medical program MAYinclude the following: Orthodontia - the co-payment is 50% of the cost. A dentist10

or physician, prior to the adoption finalization must verifythe medical need. Any orthodontia need diagnosed afterfinalization of adoption will be the responsibility of theadoptive parent. Transportation - If mileage for treatment needs, such asfor therapy or medical appointments, exceeds the yearlymileage rolled into the foster care rates, it may be covered.The local billing clerk or subsidy worker can providecurrent reimbursement rates. Childcare services - Childcare services are available to bothfull-time and part-time working parents. A co-paymentmay be required based upon the adoptive parents’income. The worker facilitates DCBS payment of childcareservices for working parents. For non-working parents,the Recruitment and Certification (R&C) worker submits arequest for childcare to the Service Region Administrator(SRA) or designee that includes documentation from aqualified professional of therapeutic need for the service.This documentation must be submitted yearly. Childcareservices are paid by the adoptive parents and reimbursedonly with a paid receipt verified from the childcareprovider. Adoptive parents must provide verification ofemployment annually. The rate of reimbursement is basedon the age of the child and certification of the providerin accordance with the childcare regulations. Childcarereimbursement ends upon the child reaching age 13,unless documentation from a medical/mental healthprofessional stating the diagnosed need for continuanceof the childcare is provided. This documentation mustbe submitted every 6 months to your worker. Approvedchildcare rates cannot exceed the rates established bythe Division of Child Care in Kentucky AdministrativeRegulation 922 KAR 2:160.The current childcare rates can be found ximunPaymentRateChart.pdf11

Tutoring – The rate may not exceed 25.00 per hour andtwo (2) hours per week. Co-payment may be requiredbased on family income. The child must be in a specialeducation classroom, grade level two or more years behindchronological age or be receiving special instruction in aregular classroom.Documentation of the need and unavailability of servicesis required from school (this may include the child’sindividual education plan (IEP) or a note from the teacher).Tutoring services must be provided by qualified personneland by someone other than an immediate family member.The qualifications of the tutor must be verified. Eyeglasses - A co-payment may be required. Respite Care - One (1) day of reimbursed respite care perchild, per month, is included in the per diem for childrenapproved for the Basic or Advanced rate; therefore,families receiving these rates are not eligible for additionalrespite reimbursement. Children approved for MedicallyFragile or Care Plus Home rates may be approved for two(2) respite days per child per month. Children approved forthe Specialized Medically Fragile rate may be approved forthree (3) respite days per month per child. Respite is notcumulative and respite days must be submitted monthlyfor reimbursement. Mental health services - Services including counseling,expressive (art) therapy, behavioral therapy, physicaltherapy, occupational therapy, and speech therapy, mayrequire a co-payment. A Medicaid vendor MUST be utilizedfirst. Medication - A co-payment may be required. Special Equipment - A co-payment may be required.Co-payments for Extraordinary Medical may be requiredbased upon the family’s income. The Extraordinary MedicalCo-payment scale is based upon 100% of the Federal FiscalYear estimated Kentucky income. The family’s adjusted12

gross income is utilized to determine the co-paymentamount. The co-payments will be deducted from themonthly receipt.Resources through Medicaid and private insurance,if applicable, must be utilized before requests forextraordinary medical expenses are approved forreimbursement.The Extraordinary Medical Co-Payment Scale is basedupon 100% of the Federal Fiscal Year estimated Kentuckyincome. The family’s adjusted gross income is utilized todetermine the co-payment amount. The co-pays as of June30, 2017 are:FamilySize0% co-pay10% co-pay15% co-pay2 47,657 &Under 47,658 to 71,486 71,487 to 95,315Over 95,3163 58,817 &Under 58,872 to 86,672 86,673 to 115,563Over 115,5644 70,084 &Under 70,085 to 105,126 105,127 to 140,168Over 140,1695 81,290 &Under 81,291 to 121,935 121,936 to 162,580Over 162,5816 92,511 &Under 92,512 to 138,767 138,768 to 185,023Over 185,0247 94,613 &Under 94,614 to 141,920 141,921 to 189,227Over 189,2288 96,716& Under 96,717 to 145,074 145,075 to 193,432Over 193,4339 98,818 &Under 98,819 to 148,227 148,228 to 197,636Over 197,63710 100,921 &Under 100,922 to 151,382 151,383 to 201,843Over 201,84420% co-payCo-payment rates may change and should be verified throughregional DCBS staff.13

Nonrecurring ExpensesThese expenses are one-time reimbursements to offset thecosts of adopting a child in foster care with special needs.The child must meet the Kentucky special needs criteria anda reasonable effort must be made to place the child withoutadoption assistance. These expenses cannot have been paid byany other source and the adoptive parent must incur expenses.The maximum amount cannot exceed 1,000.00 per child. Therequest for nonrecurring adoption assistance must be submittedand approved prior to finalization of the adoption.Examples of allowable expenses up to 1,000.00 per child includethe following: Court costs and attorney fees Home study expenses, including physical and/orpsychological exams Post-placement costs Transportation, food, and lodging costs related to theadoptive placement and/or the adoption finalizationprocess, limited to amount allowed by the Kentucky StateTravel regulations. Transportation can also be reimbursedby regional foster care funds through a special expenserequest to the SRA.Families may choose to have the Cabinet pay their attorneydirectly. This should be indicated on the Nonrecurring AdoptionExpenses Agreement form (DPP-1258A).What if a change occurs?If there is a change needed for the monthly subsidy, orextraordinary medical expenses, the family’s subsidy worker maybe contacted. The worker will schedule a meeting to discussavailable options. Other DCBS services may be available, aswell, to support the adoptive placement and can be consideredon a case-by-case basis. If a change is needed the worker willsubmit a request for renegotiation for consideration/approvalby the Service Region Associate (SRA) or designee. If approved,14

a new Adoption Assistance Agreement form (DPP-1258) willbe required to be signed by the family. The revised payment orreimbursement of expenses cannot begin until all signatures aresecured.If there are any changes to the adoption subsidy, other thanchildcare rates, a new DPP-1258 or DPP-1258C must becompleted and signed by the adoptive parent(s) and DCBS staff.When does adoption assistance begin?Pre-adoptive assistance begins the day the Adoption PlacementAgreement form (DPP-195) is signed, or on a later date if thefamily did not request adoption assistance at that time, andcontinues until the day the adoption is finalized. You must sign anAdoption Placement Agreement form (DPP-195) prior to receivingpre-adoption assistance. The Adoptive Assistance Agreement(DPP-1258) is signed at this time as well.Post-adoptive assistance begins the day of the adoptionfinalization. An Adoption Assistance Agreement (DPP-1258) mustbe signed before the adoption is finalized in order to receive postadoptive assistance. Once the Adoption Assistance Agreement(DPP-1258) is in effect, it will continue until child is no longereligible or until a new agreement is signed.Extraordinary Medical payments begin upon the signing of theAdoption Placement Agreement (DPP-195) and the ExtraordinaryMedical Expenses Agreement (DPP-1258C).NOTE: Adoptive parents become responsible for makingchildcare payments from the date the Adoption PlacementAgreement is signed. DCBS will no longer pay the childcareprovider directly. Childcare receipts must be submitted monthlyfor reimbursement from this point forward.The regional billing specialist processes the payments for preadoptive assistance and extraordinary medical expenses andreimburses those to the family. All extraordinary expenses require15

a verifiable receipt submitted with the service provider’s contactinformation. ALL RECEIPTS ARE TO BE SUBMITTED MONTHLY withthe service provider’s contact information.All post-adoptive assistance payments are set up throughan automated system generated automatically each monththrough Central Office Division of Administration and FinancialManagement (DAFM), and processed the 3rd Monday of eachmonth.Payments are not considered lateuntil after the last working day ofthe month. If the payment is lost, ornot received, the worker or regionalbilling specialist can be contacted tocheck on the status of the payment.What is annual contact?Adoptive families will be contacted annually. Families will needto complete the annual contact form and return it to the localDCBS office. Financial information (i.e. income verification)is required only for families receiving extraordinary medicalexpense reimbursement. The co-pays are determined with thisinformation. Verification of employment may be required forfamilies receiving childcare.What are the training requirements?To receive a Basic rate for a child in the monthly subsidy program,the adoptive parent(s) must successfully complete fifteen (15)hours of preservice training.The Basic Medically Complex rate is available to adoptive parentswho have successfully completed twelve (12) hours of initialspecialized medically complex training, beyond the preservicetraining and hold certification in infant, child and adult CPR andFirst Aid. In addition, the adoptive child must be designated asmedically complex due to:16

1. Significant care needs related to a serious illness or conditiondiagnosed by a health professional that may become unstableor change abruptly, resulting in a life-threatening event;2. A chronic condition that is expected to be life-long andprogressive and to require extensive services;3. An acute, time-limited condition requiring additionaloversight; or4. A severe disability that requires the routine use of medicaldevices or assistive technology to compensate for the lossof a vital body function needed to participate in activities ofdaily living and significant and sustained care to avert deathor further disability.The Medically Complex Degreed rate is available to the followinglicensed health professionals adopting a child designated asmedically complex: physician, physician assistant, advancedpractice registered nurse, or registered nurse under thesupervision of a physician. Health professionals must successfullycomplete the initial twelve (12) hours of specialized medicallycomplex training beyond the preservice training requirement andhold certification in infant, child and adult CPR and First Aid.A Specialized Medically Complex rate is available to adoptiveparents who meet the training and CPR and First Aid certificationrequirements for medically complex homes; and adopt a childwho meets specialized medically complex criteria, beyond thebasic medically complex level due to a required higher level ofmedical care or oversight, which may also include behavioral oremotional needs related to the medical condition.A Degreed Specialized Medically Complex rate is available toadoptive parents who meet the training, and CPR and First Aidcertification requirements for medically complex homes andare a licensed physician, physician assistant, advanced practiceregistered nurse, or registered nurse under the supervision ofa physician. Degreed specialized medically complex adoptiveparents provide care for a child designated as specialized medicalcomplex requiring a higher level of medical care or oversight,17

beyond the basic medically complex level, which may also includebehavioral or emotional needs related to the medical condition.A Care Plus rate is available to adoptive parents who successfullycomplete, beyond the preservice training requirement, twelve(12) hours of training in the following areas:1. Specific requirements and responsibilities of a care plus fosterhome;2. Crisis intervention and behavior management;3. De-escalation techniques;4. Communication skills;5. Skill development;6. Cultural competency;7. The dynamics of a child who has experienced sexual abuse orhuman trafficking; and8. The effect of substance use, abuse, or dependency by eitherthe child or the child’s biological parent.The adoptive child must also be designated as Care Plus due to:1. A diagnosed emotional or behavioral problem;2. Is due to be released from a treatment facility;3. Displays aggressive, destructive, or disruptive behavior;4. Is at risk of being placed in a more restrictive setting;5. Is at risk of institutionalization; or6. Has experienced numerous placement failures.Basic Advanced, Medically Complex Advanced, SpecializedMedically Complex Advanced and Care Plus Advanced ratesTo receive an advanced rate for a child in the monthly subsidyprogram, adoptive parent(s) must have been approved for 2 yearsand successfully completed thirty (30) hours of Cabinet approvedmandatory training within the first two years of approval in thefollowing categories: Trauma Informed Care - 12 hours Child Sexual Abuse - 12 hours Psychotropic Medications - 1 hour Behavior Management - 5 hours18

Birth to age 11Age 12 Care Plus HomeMedically ComplexSpecialized Medically ComplexBasicAdvancedDegreed 24.10 26.20 42.40 42.40N/A 26.40 29.40 47.40 47.40 59.80N/AN/AN/A 50.90 97.00Adoptive parent(s) are not required to attend additional annualtraining (unless their homes remains open for foster or adoptiveplacements).What are statutory benefits?1. Children eligible for or receiving “entitlements” (includingSocial Security, Black Lung Benefits, Veteran’s AdministrationBenefits, Retirement, Survivors, and Disability Insurance(RSDI) and Railroad Retirement) based on a birth parent’sdeath or disability, are eligible to receive the benefits afteradoption. The Social Security Administration (SSA) and otherbenefit agencies encourage adoptive parents to apply forentitlements after adoption finalization.(a) To be considered for benefits, the adoptive parents mustsign a release of information for the child. The RegionalChildren’s Benefits Worker (CBW), with the assistance ofthe Social Service Worker (SSW), will obtain the release ofinformation and submit it to the Central Office Children’sBenefits Coordinator for processing.(b) When a child receives both SSI (which is an entitlementbut is based on a child’s disability and is income tested)and adoption assistance, the SSI benefit is reduced “dollarfor dollar” by the amount of the monthly subsidy. Inalmost all cases, the amount of the subsidy exceeds theamount of the SSI.2. Children eligible for or receiving “entitlements” based on anadoptive or birth parent’s death or disability are eligible toreceive the benefits after adoption. The child may receive fullentitlement benefits and the adoptive parents may receive19

full subsidy payment. There is no “dollar-for-dollar” reductionin subsidy in these cases.3. Additionally, children may receive insurance settlements afteradoption from a biological parent without reduction of theadoptive parents’ subsidy.What if I failed to request adoption assistance beforefinalization of the adoption?This program consists of the following options depending onwhether the child was eligible for federal or state funds beforethe adoption was finalized:A. Federal Funds – Title IV-EFederal regulations (45CFR 1356.40 (b) (1)) require that theAdoption Assistance Agreement (DPP-1258) be signed and ineffect prior to the final decree of adoption. However, if theadoptive parents feel they wrongly have been denied benefits onbehalf of an adoptive child, they have the right to a fair hearing.Some allegations that constitute grounds for a fair hearinginclude: relevant facts regarding the child were known by the stateagency or child-placing agency and not presented to theadoptive parents prior to the finalization of the adoption; denial of assistance based upon a means test of theadopt

adoption subsidy medical card is approved when the adoption finalizes and the child’s agency case is sealed. Adoptive parents . 9 should report any name, social security number, and/or