7 AAC 53.245 - Adoption and guardianship subsidy agreement and payment

(a) If the department determines that the adoptive parent or guardian cannot provide for the child's needs without financial assistance, the adoptive parent or guardian shall enter into a subsidized adoption or guardianship agreement negotiated with the department that

(1) includes the duration of the agreement, the amount of any subsidy payment, the nature and amount of any other payment, and services and assistance to be provided, including any nonrecurring adoption expense described in 7 AAC 53.255;

(2) provides that

(A) the agreement will remain in effect regardless of the state where the parent or guardian resides; and

(B) the department is financially responsible for providing specified medically necessary services if the services are not available in the state where the parent or guardian resides; and

(3) for adoption assistance under Title IV-E, includes a provision stating that the child is eligible for Medicaid services.

(b) Before making a decision to approve a subsidy or adoption assistance under this section, the department will require

(1) repealed 4/13/2011;

(2) repealed 4/13/2011;

(3) a copy of

(A) the court order terminating the parental rights of all parents; if a termination order was not issued because both parents were deceased, a separate order with that finding is required; or

(B) a stipulation regarding permanency signed by all parties, with a signed order from the state court approving the stipulation, including a determination by the court that the child cannot return home, and the parents' signed consent to adoption; and

(4) a home study approved by the department.

(c) The department will provide subsidized adoption and guardianship payments subject to the availability of appropriations from the legislature and the provisions of AS 25.23.210. An income eligibility requirement does not exist for a prospective adoptive parent or guardian in determining the child's eligibility for adoption or guardianship assistance payments. The amount of the payment will be determined through an agreement negotiated between a prospective adoptive parent or guardian and the department, taking into account the circumstances of the prospective adoptive parent or guardian and the needs of the child as described in this section. The amount of the subsidy will be negotiated under (d) of this section. The amount of the subsidy may be renegotiated to fit the child's changing special needs and the circumstances of the adoptive parent or guardian. However, the amount of the payment may not exceed the foster care payment that would have been paid by the department during the same period if the child were in a foster home.

(d) Factors that the department will consider in negotiating the amount of the subsidy include

(1) benefits received by the child that will continue after adoption or guardianship, including SSI and social security survivor benefits under 42 U.S.C. 401 - 434;

(2) unearned income received by the child as described in 7 AAC 53.230;

(3) child care if

(A) both adoptive or guardianship parents, or one parent in a single-parent household, are working, attending educational classes or training, or actively seeking work and no other household member is able to provide care for the child during the period of time that the adoptive parent or guardian is not available for the reasons set out in this subparagraph;

(B) the adoptive parent or guardian is unable to work, attend educational classes or training, or seek work without financial assistance for child care;

(C) the adoptive parent or guardian states that the need for the child care payment exceeds the limit of the subsidy amount and will cause financial hardship;

(D) child care costs are negotiated based on actual costs of care; the costs must be for a limited time, and will not exceed the rates which would have been paid in foster care; and

(E) the parent or guardian requests renegotiation of the subsidy if the child care is no longer needed during the period of time it is effective, or if the parent or guardian states that the family has a continued need after the child care portion of the subsidy expires; the parent or guardian is responsible for requesting renegotiation;

(4) cost of transportation that is extraordinary and required to meet the child's special needs, including transportation to medical or behavioral health appointments, or transportation to support cultural continuity for the child if a request for cultural continuity transportation is made 30 days in advance of the travel date; transportation costs under this section do not include

(A) travel less than 50 miles a week;

(B) costs covered by Medicaid or other health insurance;

(C) costs for more than one escort for a trip regardless of the number of children travelling;

(D) visits longer than three days in-state or five days out-of-state;

(E) international travel;

(F) lodging;

(G) travel for vacation or school trips;

(H) baggage fees, travel insurance, or any other fees associated with travel;

(I) ground transportation; or

(J) any out-of-state travel that is not court-ordered, other than travel within the limits set out in (D) of this paragraph;

(5) repealed 7/1/2022;

(6) repealed 7/1/2022;

(7) repealed 7/1/2022;

(8) repealed 7/1/2022;

(9) repealed 7/1/2022;

(10) behavioral health treatment if

(A) no Medicaid or insurance providers are available in the community in which the child resides;

(B) the therapeutic needs are determined to be medically necessary; and

(C) the adoptive parent or guardian states that the need for the behavioral health treatment is temporary, exceeds the limit of the subsidy payment, and will cause financial hardship; treatment costs may be negotiated based on actual costs and may not exceed six months' cost of treatment; and

(11) medical or dental expenses described in 7 AAC 53.240, if

(A) there is a documented cost of ongoing medical or dental care and treatment that is not met by Medicaid or other medical or dental insurance coverage; and

(B) the medical or dental needs are determined to be medically necessary to support provision of either one-time or ongoing expenses including

(i) extraordinary clothing or laundry needs;

(ii) costs of the purchase of special foods for a child who cannot eat a regular diet; and

(iii) special medical equipment, glasses, or other medically necessary items;

(12) repealed 7/1/2022;

(13) repealed 7/1/2022;

(e) An adoption or guardianship subsidy agreement must be signed and in effect before the adoption or guardianship is final. However, a subsidy may be approved for a child after the adoption or guardianship is final, regardless of whether the child is in department custody at the time of the adoption or guardianship, if a review under 7 AAC 54.500 or an evidentiary hearing under 7 AAC 54.510 indicates that

(1) relevant facts regarding the child were known by the department and were not presented to the adoptive parent or guardian before the adoption was finalized;

(2) the department's decision was based upon a means test of the adoptive parent's or guardian's income or other resources, or on a life choice made by the adoptive parent or guardian, including a decision to leave a job to stay at home with the child or return to school;

(3) the department's determination that the child is ineligible for Title IV-E adoption or guardianship assistance was made in error;

(4) the department failed to advise the adoptive parent or guardian about the availability of adoption or guardianship assistance for children in the state's foster care system;

(5) a decrease in the amount of adoption or guardianship assistance was made without the adoptive parent's or guardian's concurrence; or

(6) the department's denial of a request for a change in payment due to a change in the adoptive parent's or guardian's circumstances was made in error.

(f) The department will pay

(1) the negotiated monthly rate at the beginning of the month for which payment is intended; and

(2) on a scheduled payment basis according to the subsidy agreement.

(g) If an adoptive parent or guardian moves out of the state, the parent or guardian shall notify the department in advance.

(h) Subsidy payments terminate when a child reaches 18 years of age. However, the department may immediately terminate the agreement and cease making payments if the department determines that the

(1) adoptive parent or guardian is no longer legally responsible for the child; an adoptive parent or guardian is considered to be no longer legally responsible for the child if

(A) parental rights have been terminated;

(B) the child becomes an emancipated minor, marries, or enlists in the military; or

(C) the child becomes the legal responsibility of another individual through guardianship; or

(2) child is no longer receiving any support from the adoptive parent or guardian; for purposes of this paragraph, "any support" includes family therapy, tuition, clothing, maintenance of special equipment in the home, and services for the child's special needs.

(i) If the child is placed in out-of-home care, the department will not automatically suspend or terminate the subsidy payment. However, due to the change in the child's circumstances, the department may renegotiate the subsidy agreement, and will consider the specific needs of the adoptive child and family circumstances. A renegotiation under this subsection may include the

(1) termination of Title IV-E assistance; or

(2) reduction, suspension, or termination of a state subsidy.

(j) Repealed 4/13/2011.

(k) Before negotiations begin under this section, and after the department's determination of eligibility under this section, the department will notify an adoptive parent or guardian in writing of the right to request a review under 7 AAC 54.500 or an evidentiary hearing under 7 AAC 54.510.

(l) Factors that the department will not consider in negotiation of the amount of a subsidy include

(1) services that are covered by Medicaid;

(2) services that are covered through other department divisions or state departments;

(3) costs for goods or services for the child after the child turns 18 years of age; and

(4) costs associated with buying or improving the home or purchasing vehicles.

(m) When negotiating a subsidy the department will not include in any agreement payment for services to providers who are not enrolled in the Medicaid program under 7 AAC 105 - 7 AAC 160. If a qualified Medicaid provider is available, but a parent chooses that the child receive services from a provider that is not enrolled with Medicaid, those costs will not be included in a negotiated subsidy.

(n) For purposes of this section,

(1) if the child is a Medicaid recipient, the determination whether a service, supply, or prescription drug is medically necessary will be made under 7 AAC 105 - 7 AAC 160 (Medicaid coverage and payment);

(2) if the child is not a Medicaid recipient, the Department of Health will make the determination of medical necessity; the Department of Health will determine that a service, supply, or prescription drug is medically necessary if the Department of Health determines that a physician or other licensed health care provider, exercising prudent clinical judgment, would give the child the service, supply, or prescription drug for the purpose of evaluating, diagnosing, or treating an illness, an injury, a disease, or its symptoms; for the Department of Health to make a determination that a service, supply, or prescription drug is medically necessary, the provision of the service, supply, or prescription drug

(A) must be in accordance with generally accepted standards of medical practice; in this subparagraph, generally accepted standards of medical practice are standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community; otherwise the standards must be consistent with physician specialty society recommendations; the standards must be consistent with the views of physicians practicing in relevant clinical areas and any other relevant factors;

(B) must be clinically appropriate, in terms of type, frequency, extent, site, and duration, and must be considered effective for the patient's illness, injury, or disease;

(C) if the child is a Medicaid recipient, the determination whether a service, supply, or prescription drug is medically necessary will be made under 7 AAC 105 - 7 AAC 160 (Medicaid coverage and payment);

(D) if the child is a Medicaid recipient, the determination whether a service, supply, or prescription drug is medically necessary will be made under 7 AAC 105 - 7 AAC 160 (Medicaid coverage and payment);

Notes

7 AAC 53.245

Eff. 3/31/2005, Register 173; am 4/13/2011, Register 198; am 7/1/2022, Register 242, July 2022

Authority:AS 13.26.153

AS 25.23.210

AS 25.23.230

AS 47.14.100

AS 47.14.120