Adoption Subsidy is a vital component in the effort to place waiting children in permanent homes. MARE recently took the opportunity to talk with Kate Young, Program Manager for the Adoption Subsidy Office at the Family Independence Agency, about the work of the Subsidy Office, the status of Medical Subsidy and managed care, and ways for adoption workers to work efficiently with the Subsidy Office on behalf of adoptive families.

What does the Adoption Subsidy Unit do?

The Adoption Subsidy Unit determines eligibility for Adoption Support, Medical Subsidy Programs, and non-recurring costs related to adoption, and manages on-going support and medical subsidy cases. The unit is housed in the Adoption Services Division in the Central Office of the Michigan Family Independence Agency in Lansing.

We are a very busy unit with 10 permanent and 4 temporary staff. Between January 1 and April 30, 1998, we received 986 pre-adoptive requests for subsidy and 165 post-adoptive requests for Medical Subsidy. Approximately 220 new cases are opened each month. As of May 1, 1998, there were 14,720 cases on our case load.

Has the Michigan Department of Community Health taken over administering health delivery services?

No. The Medical Subsidy program continues to be housed in the Adoption Services Division in the Central Office of the Family Independence Agency. Funding for the program is included in the Executive Budget for the Family Independence Agency for the fiscal year beginning October 1, 1998.

Has the Medical Subsidy program moved entirely to a managed care system?

No, but we continue to move in that direction. Children receiving a federal support subsidy because they are Title IVE eligible are also automatically eligible for Medicaid until their 18th birthday. Many of these Medicaid-eligible children may also have an Adoption Medical Subsidy Agreement covering one or more medical conditions that existed prior to the adoption. The Adoption Subsidy program now requires parents to enroll children covered by a Medical Subsidy Agreement , and who are Medicaid eligible, in a Medicaid-funded Qualified Health Care Plan (managed care provider). The enrollment process is being carried out by Michigan Enrolls, a contractor for the Michigan Department of Community Health.

Children in the following situations are exempt from participation in a Medicaid QHCP:

• Children enrolled in Michigan Department of Community Health's Children's Special Health Care Services program;
• Children covered by their parent(s) private managed care program; and
• Children covered by a State Support Subsidy and a Medical Subsidy or only a Medical Subsidy.

When children are enrolled in a QHCP, our office requires parents to use those services for treatment of all conditions (except emotional conditions) covered by Medical Subsidy Agreement(s).

Is payment for emotional/behavioral condition still covered under Medical Subsidy?

The Qualified Health Care Programs (QHCP) provide up to 20 outpatient visits per year for emotional or behavioral problems. These services are available to Medicaid eligible children. This represents an expansion of services.

However, because mental health services currently available under the QHCP's are limited, children who are Medicaid eligible and who also have a mental health condition covered by a Medical Subsidy Agreement are not currently required to obtain mental health services from their QHCP. Therefore, payments for emotional/behavior conditions are still covered by the Medical Subsidy program.

The Department of Community Health is developing an enhanced mental health services package called the "Mental Health Carve Out." When services are available under the "Carve Out," the Adoption Subsidy program plans to phase in a requirement that parents use those services for Medicaid eligible children also covered by a Medical Support Agreement.

Section 306 of the Federal Adoption and Safe Families Act of 1997 calls for expanded health coverage for adopted children with special needs. Does this translate into any changes in the Medical Subsidy program in Michigan?

To comply with the Federal Adoption and Safe Families Act of 1997, we would like to extend health coverage (Medicaid coverage or something comparable) to children who receive State Adoption Support Subsidy and are not Title IV eligible.

Do you see any interesting trends in either state or national subsidy programs that workers should be aware of?

Recent changes in state and federal law underscore the importance of working collaboratively (state and local, public, and private) to provide permanency for children.

How long have you been in the Subsidy Office and what was your experience prior to coming to Subsidy?

I am pleased to work in an area that support Michigan's outstanding effort to place special needs children in adoptive homes. Since I joined the Adoption Services Program last December as Program Manager for the Adoption Subsidy Unit, I have been learning about Adoption and Adoption Subsidy. I expect to continue learning time from colleagues in Adoption Subsidy Unit and the Adoption Service Program, from adoption workers in the field, and from adoptive families.

I have a BS from Michigan State University. Before taking this position, I worked for seventeen years with the Domestic Violence Prevention & Treatment roles within the Family Independence Agency. I have experience working with private human service agencies, developing and implementing policy and training programs. In my free time I enjoy cooking, gardening, walking, biking, and reading.

What do you see as your greatest challenges? What is the mark you would like to leave on the subsidy program?

My goal is to provide respectful and timely adoption subsidy services to adoption workers who are working on behalf of adoptive families and to adoptive families. In my first few months I have concentrated on becoming acquainted with and fine tuning our internal processes that relate to certification, non-recurring expenses, case opening and case management.

In the certification area, I am pleased to report that since January 1st of this year, our turn-around time for determining eligibility for adoption subsidy has decreased from 56 days to 28 days. Our certification team has been working to clear up the backlog of requests for reimbursement of non-recurring costs. We are able to open payroll and Medicaid for children within a few days, and we have also been working on fine-tuning our payment process and addressing a backlog of bills.

Ongoing challenges include: developing mental health services under managed care programs that meet the needs of adoptive families; developing a transition plan for use of those services; and developing health coverage for all children in the Adoption Subsidy Program.

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The Michigan Adoption Recruitment Consortium

"Let us put our minds together and see what kind of future we can make for our children"
-- Chief Sitting Bull

This saying, so simple and yet powerful, was the catalyst for the Michigan Adoption Recruitment Consortium, or MARC.

For fiscal year 1997/1998, MARE received $30,000 to be used specifically for recruitment and retention of families for "waiting" children. These children -- African Americans, siblings, or Caucasian children over the age of six years -- typically wait the longest for permanency. In many cases, these children tend to "age out" of the system; that is, they turn 18 without ever finding a permanent family.

MARE realized this money could be used for many special recruitment events; therefore, four "regional" consortiums were established -- MARC North (Upper Peninsula and northern lower Michigan); MARC South (south and central lower Michigan); MARC East (specifically Wayne, Oakland and Macomb counties); and MARC West (western lower Michigan). Each individual consortium is autonomous, and comprised of both public and private adoption agencies who have voluntarily made a commitment to participate in the group effort. Individual consortiums may offer materials, trainings, information or other recruitment activities that are different and unique from other MARC consortiums. However, each agency involved is required to:

• Be actively involved in all consortium activities.
• Be supported by the agency's adoption supervisor and director.
• Make a goodwill effort to place waiting children.
• Agree to begin recruitment efforts for children as soon as they come into care, instead of waiting for them to be photolisted in the MARE book.
• Follow up with an interested family by phone and by mail within 48 hours of referral from the MARE office.
• Commit to beginning a family's homestudy within one month of initial contact, if the family so desires to proceed with a homestudy.

MARE is also providing MARC agencies with a pre-adopt or -foster training for families, based on the PATH (Parents As Tender Healers) curriculum.

The initial process for a family is simple: When MARE receives a phone call (or, infrequently, a written request) inquiring about adoption and waiting children, information is gathered about the family and what kind of child or children they are willing to consider. If the family is willing to consider the kind of child MARC agencies are committed to serving, this information is then disseminated to the appropriate consortium for follow-up. As noted above, agencies have made a commitment to following up with a family by phone and by mail within 48 hours of the initial referral (barring holidays or weekends). From there, families can decide to receive information about adoption and/or foster care, proceed with the homestudy process, or revisit the entire course of action at a later date.

If you are interested in adoption, foster care, or training, please give MARE a call at (800) 589-6273. We will be happy to refer you to a MARC consortium agency.