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In addition to PAS programs, the federal Adoption Assistance Program (AAP) provides an important source of support for services needed by adoptive families through cash assistance, commonly known as subsidies. States also have the option of offering material support to adoptive families through a range of other measures that provide access to needed services. The RTI team’s interviews found little evidence that PAS programs incorporated material support into their planning. Rather than compensating for limited support, strong PAS programs often were accompanied by relatively generous subsidies and other forms of support. However, adoptive families may lack adequate information about the supports available to them.
State adoption subsidy programs date back at least 20 years, when U.S. laws first offered a federal match for state subsidy costs. PAS programs have been planned and implemented much more recently. State adoption program mangers interviewed indicated that the choice of services to be included in PAS programs was influenced by the views of adoptive parents and by reports of successful program models implemented elsewhere. None reported that the services offered by PAS programs were chosen to complement those supported through subsidies or other service systems. However, it is clear that PAS programs are only one resource by which adoptive families can access services. Among the five case-study states, for example, only Texas included residential care in its PAS program, but other states supported residential treatment for adopted children through their Medicaid program or through another state agency. Other states may choose to adjust adoption subsidy rates to help parents purchase these services.
States have a variety of options with which to support adoptive families. |
States have considerable latitude in providing subsidies and other supports to adoptive families. Basic AAP subsidies are capped at 100% of the state’s foster care rate. However, the amount of support that adoptive families receive from the state depends on a range of policies that extends beyond subsidy amounts. Specific policies, such as restrictions on Medicaid access for children who are not eligible under Title IV-E or restrictions on the funding or reimbursement of respite care, will significantly affect the level of support received by some families.
Many factors limit the degree to which PAS programs and subsidies can substitute for one another. Some services offered by PAS programs, such as information and referral or support groups, cannot be purchased by individuals. Other services, such as counseling, could be accessed by families who purchase them with their own insurance or subsidy funds; however, families may be unable to find professionals with expertise in adoption-related issues except within the PAS program. In states where subsidy decisions are made at the county level, state adoption offices have little or no influence on the extent to which they can be adjusted. Substantial disparities among counties have been observed in these states (Avery, 1998). Thus even a generous subsidy program would not completely negate the need for a statewide PAS program.
It is equally true that PAS programs often will not be a satisfactory substitute for what families would purchase for themselves with subsidies. As discussed earlier, PAS programs vary substantially in terms of what services are offered, and a state’s program may not include the specific services needed by a family. Many families need services at a higher level of intensity or for a longer duration than available through the PAS program, or they prefer to choose their own providers and service settings.
If subsidies are to be a meaningful component of the support package offered to adoptive families, they must be sufficiently flexible to respond to families’ needs as their circumstances change and generous enough to meet what may be substantial needs. However, states vary significantly with respect to policies that determine the amount of subsidy support and their flexibility.
The five case-study states offered substantial flexibility in their subsidy programs. All permitted establishment of deferred subsidies, which allowed families who did not require a subsidy at the time of adoption to request one at a later date if circumstances changed. In addition, all five states noted that subsidies could be renegotiated as family circumstances changed. Among the case-study states, Oregon appeared to be the most proactive in this way, sending an annual letter to all families receiving a subsidy to remind them to contact the state office if their circumstances have changed such that they require more (or less) support.
Adoptive parents lacked necessary information on subsidies. |
Flexibility in policy is of limited value unless adoptive families understand what resources may be available to them and how they can be accessed. In four of the five states, adoptive parents participating in focus groups expressed considerable frustration and confusion related to subsidies. They described themselves as confused as to how subsidy levels were set and the extent to which parents can influence their provision.
Parents in one group believed that subsidy levels were set by the state and were not negotiable. This confusion is notable because parents participating in these focus groups all were involved to some extent with the state’s PAS program. Thus they could be expected to be better informed, and more able to resolve questions of this sort, than other adoptive parents. One parent suggested that parents receive a “bill of rights” during the home study period that explains what they can ask for and do to obtain subsidies that meet their needs. The Oregon Adoption Assistance Handbook provides an example of such a document, including definitions of eligibility criteria, Title IV-E eligibility, the application process, Medicaid eligibility, and provisions for appeals.
For states to garner federal participation in a subsidy award, the award must be no higher than the state’s foster care rate. Some states have low foster care rates, and others have state laws that limit subsidies to the basic foster care rate rather than a higher rate paid for special-needs children or children in treatment foster care or group care. States that are constrained from offering generous subsidies could compensate by offering strong PAS programs. Or states that have flexibility around the amount of subsidies paid might allow families to use subsidies to purchase services in the marketplace.
The case-study states offered generous adoption support in addition to strong PAS programs. |
Data on state adoption support policies compiled by the North American Council on Adoptable Children (NACAC) suggest that in the five case-study states, strong PAS programs are accompanied by relatively generous subsidies and other supports. However, case study data did not reveal any suggestion of a planned effort to coordinate the various forms of support to which families have access. Although strong advocates for adoptive families are likely to find a variety of ways to pursue their goals, their efforts may be moderated by the organizational and political complexity of programs, agencies, and funding streams involved.
| Items | Case-Study States | ||||
|---|---|---|---|---|---|
| Description | Georgia | Massachusetts | Oregon | Texas | Virginia |
| Provisions of “special needs” definitions that met or improved upon federal definition | Medical condition or handicap | Ethnicity or minority race, age, medical condition or handicap, high disability risk | Ethnicity or minority race, medical condition or handicap, need for placement with foster parents | Ethnicity or minority race, medical condition or handicap | Ethnicity or minority race, age, medical condition or handicap, need for placement with foster parents, sibling group, high disability risk |
| Basic AAP subsidy amount: | |||||
|
67% | 81% | 61% | 94% | 63% |
|
106% | 100% | 100% | 95% | 106% |
| Specialized AAP (SAAP) as a percentage of specialized foster care rate | 100% | Not available | 100% | State does not pay SAAP | State does not pay SAAP |
| Medicaid eligibility for state-subsidized children | Under certain conditions | Yes | Yes | Yes | Under certain conditions |
| Nonrecurring adoption expense amount | $2,000 | $400 | $2,000 | $1,500 | $2,000 |
| Availability of Title XX services for children receiving AAP subsidies | IV-E AAP recipients only | No | Yes | Yes | Yes |
| Special service subsidies availability | When funds available, public agency children only | Yes | Yes | Yes | Yes |
| Respite care funded or reimbursed | Yes | No | Yes | Yes | Yes |
| Residential treatment paid for | Yes | No | Yes | Yes | Yes |
| Deferred AAP agreements offered | Yes | Yes | Yes | Yes | Yes |
| Subsidized guardianships possible | No | Yes | Yes | No | No |
| Similar treatment for public and private agency adoptions | Yes | If IV-E eligible | Yes | No | Yes |
| AAP subsidies for children over 18 years | Yes | Yes | No | Yes | Yes |
| AAP administration | County | Statewide | Statewide | Statewide | Local offices |
| AAP = Adoption Assistance Program Source: Bower and Laws, 2002. |
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