Children S Bureau,Administration for Children and Families

Kathleen McHugh

Division of Policy

Children’s Bureau,Administration for Children and Families

1250 Maryland Ave., S.W., 8th Floor

Washington, D.C., 20024

Via the Internet: http://www.regulations.gov/

RE: Notice for Public Comment on the Title IV-E Adoption Assistance Program’s Suspension and Termination Policies

Dear Ms. McHugh:

On behalf of state public adoption and interstate professionals across the country, the Association of Administrators of the Interstate Compact on Adoption and Medical Assistance (AAICAMA), respectfully submits these comments in response to the “Notice for Public Comment on the Title IV-E Adoption Assistance Program’s Suspension and Termination Policies” issued by the Administration for Children and Families (ACF) on March 31, 2015.

AAICAMA is astate association whose primary mission is to develop, promote and facilitate efficient and effective state policies and practices that ensure the receipt of vital support services for special needs adopted children. Member states have legally joined the Interstate Compact on Adoption and Medical Assistance (ICAMA) to coordinate the interstate receipt of adoption support and medical benefits to strengthen permanency. We appreciate the opportunity to provide comments to the Children’s Bureau on this Notice for Public Comment regarding the issue of title IV-E adoption assistance suspension and termination policies.

AAICAMA held three meetings with its members toseek state recommendations on the best policies, processes and practicesthat could be put in place if states had the authority to suspend title IV-E adoption assistance payments. The key issue raised was the receipt of payments by the adoptive parent(s) when the adopted youth no longer lives in their home.

The following represents the response of 43 states to the two specific questionsand thegeneral request for comments posed by the Children’s Bureau inthe Notice. AAICAMA will respond to each of the two questions in order and then respond to the general invitation to comment onthe title IV-E adoption assistance program as a whole.

Question Number 1:

A. Should jurisdictions have authority to suspend adoption assistance payments under any circumstances?

B. If so, what specific circumstances should be the basis for suspension?

1. A. Authority to suspend adoption assistance payments.

AAICAMA members agree that jurisdictionsshouldhaveauthority to suspend adoption assistance payments in certain circumstances. However, states were also clear thatsuspension should be limited and judiciously appliedto the suspension and/or reduction of title IV-E adoption assistance payments only.The title IV-E adoption assistance agreement would remain in effect throughout any period of suspension.

A suspension of only the adoption assistance payment preserves a child’s eligibility for federal adoption assistance and ensures the continued receipt of Medicaid throughout any period of suspension. Children adopted from foster care are a particularly vulnerable group who have experiencedsignificant life trauma and have increasedphysical, developmental and mental health issues as a result. Medicaid providesessential medical and mental health services in-state and interstateto these children and is invaluable to their health and well-being.

Discussion

First and foremost,AAICAMA members wish to emphasize that in the vast majority of adoptions, adoptive parents use adoption assistance payments appropriately for the care of their adopted special needs child, as directed and intended by the Title IV-E Adoption Assistance Program. States estimate that the percentage of adoptive families in this category is approximately 95%. Thesituations in which parents may not use funds appropriately are predominantly when the youth is living outside the adoptive home andcomprise only approximately 5%of all adoptions supported by title IV-E.

The title IV-E adoption assistance program, by providing financial and medical assistance needed to secure resource families and defray the costs of raising children with special needs, enables permanency for children who might otherwise spend their childhood in foster care. The value of this federal program in promoting permanency and positive lifeoutcomes and insaving public child welfare dollars[1] cannot be overstated.States wish to preserve the federal adoption assistance program and its benefitsand requests that the Children’s Bureau grant states the tool of suspension in order to maintain children’s safety andbenefits and strengthen the “forever families” all have worked so hard to create.

Statesare askingfor the ability to suspend payments when it is determined that a youth is living outside the home and/or there is reason to question the youth’s safety and well-being. States need greater flexibility and authority to safeguard adopted children who move out or are forced out of the adoptive home. The only option currently available to the IV-E agency in instances when states question whether parents are providing any financial support is to seek to terminate adoption assistance. However, this penalizes the youth, potentially places the youth at increased risk of neglect, and results in the loss of Medicaid, a critical benefit for this population.

AAICAMA understands and respects the autonomy of adoptive families, but also recognizes that ensuring the safety and well-being of a child receiving adoption assistance is an appropriate concern ofthe state child welfare agency. Consequently, AAICAMA supports and believes that states should have the authority toinvestigate the safety of child who is living outside the adoptive home and whether the adoptive parent is continuing to provide adequate support for the child. This authority would allow states to protect the welfare of a child and ensure that public funds are being used appropriately. Having the authority to suspend adoption assistance paymentsin certain, limited situations would offer states a tool to achieve both of these goals.

1.B. Specific circumstances that should be the basis for suspension.

States do not support any type of automatic trigger for suspension of adoption assistance payments. Rather, states wish to have the authority and discretion to assess the totality of the youth’s circumstances on a case-by-case basis to determine if a suspension of adoption assistance payments is warranted and in the best interest of the child.

Statesbelievethat suspension should be able to be considered under the followingcircumstances:

Youth enters foster care, is incarcerated, or is in juvenile detention

Youth is “re-homed” (anon-legal placement)

Youth is in the physical custody of or living withperson(s) other than adoptive parent(s) with whom the state agency holds a title IV-E adoption assistance agreement and receives little or no financial support from the adoptive parent(s)

Adoptive parents do not respond to repeated agency attempts to clarify youth’s location, safety/circumstance

Adoptive parent(s)fail to provide the agency with confirmation of the title IV-E eligible youth’s school attendance as required under federal law.

Discussion

States identified the number one circumstance for suspension as being that of a youth living outside the home with littleor no parental support, either under the responsibility and care of a public agency (e.g. in foster care, juvenile detention, or incarcerated), or informally with another caregiver (e.g. biological parent(s), relative, family friend, or youth’s friend, etc.)

States emphasize that these circumstances are to be seen as “red flags” that merit the need forstate inquiryintothe youth’s situation and should NOT serveas an automatic trigger for the suspension of title IV-E adoption assistance payments. The states’ overriding and immediate concern is for the safety and well-being of the youth and all actions must be taken with the best interests of the child in mind and not as a punitive response to the actions or inactions of the adoptive parent(s).

States are asking for the authority to “check in” on a youth if they receive information that questions whether the adoptive parent(s) has kept the title IV-E agency apprised of circumstances that impact a youth’s continued title IV-E eligibility or affect the payment amount. In situations involving a child living outside the adoptive home, states would like to send a written request for information that requires a parental response if repeated phone attempts to contact the adoptive family fail. States would like to include a provisionexplaining this process in the adoption assistance agreement.

Question Number 2:

1. If suspension was to be permitted, what processes should be required in connection with suspension?
2. What processes should be required for reinstatement?

1. A. Processes to be requiredin connection with suspension.

AAICAMA recommends that any possible suspensionbegin with an individual, agency assessment of the specific youth and the adoptive family’s situation and must consider the totality of the circumstances. An individual assessmentshould be central to the suspension process and different assessments and state interventions may be required depending on the type and frequency of the youth's absence from the adoptive home. An assessment can also quickly exclude those cases that do not merit further inquiry.

As a part of the agency assessment of a youth’s circumstances, states would like the authority to require the adoptive family to demonstrate whether and how adoption assistance payments are being spent for the benefit of the youth when a youth is out of the home.The conversation with the adoptive parent(s) can serve to help states to engage with families and, if necessary,to facilitate a renegotiation in the payment amount to reflect the child’s level of need.

States recommend the following, three-step processto implementsuspension:

1. Allow states to institute a written request for update when it is learned or suspected that a youth’s safety or well-being is in question.If families do not respond to the initial written request, states would follow up with phone calls to the family to inquire as to the needs and well-being of the youth.
2. If adoptive parents do not respond to the initialrequest or the follow-up phone calls,states would like to send asecond writtennotice (e.g., Request for Information/Possible Suspension) to adoptive parents that indicates that the information requested is required and that a suspension of benefits may result if no information confirming the youth’s safety and welfare is received.
3. If adoptive parents do not respond to the phone calls and written requests for information confirming the youth’s safety and well-being, states request the ability to send a Notice of Suspension that explains that the adoptive family has not responded to the state’srepeated phone attempts to contact the family or to the two, written requestsseeking information to confirm a youth’s safety and well-being and that the youth’s title IV-E payment benefit may be suspended.

States should be free to craft the language of the requests and notices, but AAICAMA recommends that states include a request that the adoptive family detail the reason that the youth is not living in the adoptive home and what steps the family has already taken to address this. Additionally,AAICAMA suggests the request include information on how long the youth has been living outside the adoptive home and indications ofthe youth’s emotional, physical and scholastic well-being.The adoptive family must be able to provide the name, phone number and relationship to the youth of the new caregiver and assure the state that the family understands that the youth remains eligible to receive Medicaid during the suspension period.

Discussion

The majority of states endorse a multi-pronged approach to the suspension process. States would like to:

1. Strengthen and clarify the language in the title IV-E adoption assistance agreement to permit for suspension under certain, specified circumstances.
2. Allow IV-E agencies the ability to create and implement written notices that require parental response when a youth’s safety and well-being are indicated to be at risk.

It is recommended that agency assessments include an understanding of how assistance payments arebeing spent on behalf of the youth. This inquiry can serve to engagethe adoptive parents andtofacilitate a renegotiation of the payment amount when and if appropriate.Thetitle IV-E agency could discuss a comprehensive list of the family’s expenditures on health insurance,dental care, clothing, food, personal items and entertainment to determine if and at what leveladoptive parents are providing physical, emotional, personal and scholastic support. States have largely used this approach in state-funded adoption assistance cases and found that it is effective in getting the attention of adoptive families when a youth’s safety and well-being are in question and inobtaining parental concurrence to a reduction in the assistance payment amount duringperiods of lesser need.

2.B. Processes that should be required for reinstatement.

AAICAMA members recommend the following processes to reinstatetitle IV-E adoption assistance payments after a suspension:

1. Adoptive parents must respond to a state, title IV-E agency’s request for information. If the youth is not living in the adoptive home, then the parent(s) must fully inform the state agency of the length of time the youth has been outside the adoptive home, the youth’s current living arrangement and their safety and well-being. If the youth is living in the adoptive home, the parent(s)can verify this. If the youth/family no longer wishes to live together, parent(s) should indicate the plan for the youth'ssafety and well-being.
2. States recommend a conversation or meeting with all participants involved to develop a plan to ensure the youth’s welfare and safety and continued receipt of the benefit of the adoption assistance payments and Medicaid. To strengthen permanency, states should respond to a family’s need for assistance and provide or connect family to the post permanency services necessary to meet the needs of the youth in order to resolve the conditions that caused the out of home circumstance, when possible.

General Request

More generally, we invite title IV-E agencies and other stakeholders to share their broader concerns about the title IV-E adoption assistance program that are unrelated to suspending or terminating adoption assistance payments.

AAICAMA is pleased that the Children’s Bureau is inviting comment on the efficiency and effectiveness of the title IV-E adoption assistance program and presents the following,four (4)issues listed below.

Topic 1. Title IV-E Adoption Assistance, Successors to the Agreement

Issue: Youth eligible for title IV-E adoption assistance who suffer the death of an adoptive parent(s) or dissolution of an adoption do not have the right to continue to receive benefits under the title IV-E adoption assistance agreement held with that adoptive parent. AAICAMA understands that the child in this situation does not lose their eligibility for title IV-E, but the child doeslose the support of the assistance payment and the security of Medicaid. Under the title IV-E Guardianship Assistance Program (GAP), it is permissible to name a successor guardian such that the youth not only preserves title IV-E eligibility,but also continues to receive benefits under the program that preserve the youth’s safety, health and well-being. Currently, youth eligible for title IV-E adoption assistance do not have this safeguard.

Regarding the provisions found in P.L. 113-183, the new “Successor Guardian” provision (Section 207), AAICAMA is seeking clarification of the law’s implications for youth eligible for title IV-E adoption assistance. States’ generalunderstanding of current federal law is that when a youth eligible for title IV-E adoption assistance loses their adoptive family due to the death of an adoptive parent or a dissolution, the youth also loses all federal, adoption assistance unless and until the title IV-E agency finalizes a subsequent adoption.

AAICAMA Request:The Children’s Bureau create an issuance to clarify the law regarding the continued ability of title IV-E adoption assistance recipients to receive benefits during the period following a death or dissolution and prior to a subsequent adoption finalization or guardianship as follows:

• Clarify that language on successor adoption already exists: Provide clarity that current, federal law and policy already allows for successor adoptions without the requirement that a child reenter state custody and that payments for adoption assistance can be made on behalf of the child prior to finalization of the new adoption.
• Issue identical language on successor adoption and successor guardian under title IV-E: Identical language on successor adoptions and successor guardianship should be issued when guidance on the successor guardian provision is released.

Topic 2: Loss of Medicaid Eligibility by Adoption Assistance Recipients at age 18 re: Application for Supplemental Security Income (SSI)

Issue: Children holding federal adoptionassistance agreements under title IV-E are eligible for title XIX Medicaid by virtue of their IV-E eligibility until at least the age of 18 (or age 21 if the youth has a mental or physical handicap that warrants the continuation of title IV-E). Under current Social Security Administration (SSA) policies, youth receiving adoption assistance must wait until the month prior to their 18 birthday before applying for SSI.

All children need health care services to ensure their health and well-being and youth eligible for adoption assistance have an increased need for uninterrupted access to health services. However, under current SSA policy, there is a minimum of a three month gap in their ability to apply for and receive SSI after they reach their 18th birthday. This means that a youth whose eligibility for title IV-E adoption assistance ends at 18 will also lose the Medicaid that accompanies it and will suffer at least a three month loss of Medicaid while they wait to for adetermination of SSI eligibility.