May/June, 1998Recruitment News -

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 IV-E 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 conditions 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/behavioral 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 expertise prior to coming to Subsidy?

I am pleased to work in an arena that supports Michigan's outstanding effort to place special needs children in adoptive homes. Since I joined the Adoption Services Program in December, 1997 as Program Manager for the Adoption Subsidy Unit, I have been learning about Adoption and Adoption Subsidy. I expect to continue learning from colleagues in the Adoption Subsidy Unit and the Adoption Services Program, from adoption workers in the field, and from adoptive families.

I have a B.S. 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.

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 themselves. 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 while 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.

Could This Be You?

The Adoption Subsidy Office staff recently developed the following description of their favorite adoption worker. (They wanted our readers to know that many workers are already their "favorite" workers!) The Subsidy staff's favorite worker:

Makes sure the parent understands exactly what adoption subsidy support and medical support covers and what the limitations are.
Fully informs parents of support and medical subsidy procedure/policies.
Fills out forms correctly and completely.
Calls for clarification rather than guessing what information is needed.
Submits all necessary documentation the first time.
Responds timely to phone messages and requests for documentation.
Verifies the accuracy of the name and social security number entered on the Payment Request form (FIA 1344)
Sends all required opening paperwork including: the Payment Request form (FIA 1344), the closing 626, and the Order of Placement.
Tells parents that Adoption Support Subsidy checks are mailed not from our office, but from the Department of Treasury. They are mailed between the first and seventh day of each month. The Adoption Subsidy Unit does not have information about the status of a specific check until the 10th day of each month.
Researches and follows policy.
Tells parents to call them (not the subsidy office) if they have a question.

Public Act 172 Brings Changes to Adoption Policy

Public Act 172 went into effect March 31, 1998. Section 4b (2) of this law states "if no adoptive family for a child has been identified within 90 days after the entry of an order of termination of parental rights, the supervising agency shall submit the necessary information for inclusion of the child in the directory of children" (Michigan Adoption Resource Exchange Photolisting book).

To meet the mandates of this law, the Michigan Family Independence Agency, Adoption Division, has amended its adoption policy to reflect this portion of the law. FIA Service Manual Item 732 now reads:

Local FIA offices and private agencies will receive from the MARE office a 90 Day Photolisting Registration Notice one to two months after a child has been made an MCI ward or permanent court ward. This 90 day notice is to alert staff that unless an adoptive family is identified for the child within 90 days of permanent wardship, that child is to be registered for photolisting in the MARE book.

The following action is to be taken 90 days from termination of parental rights:

1. If an adoptive family is identified for the child, No documentation is required to be sent to the MARE office at this time.
If an adoptive family is not identified for the child, the CHILD ENTRY FORM-FOR CHILD APPEARING IN MARE BOOK (For Recruitment Purposes) accompanied by a clean, well-defined photograph of the child is to be sent to the MARE office to be used for the monthly photolisting book.

Note: The purpose of photolisting is a recruitment aid to assist in locating an adoptive family for a child. Photolisitng is not to be used if a family is identified or to achieve a higher reimbursement rate for adoptive placement.

The new law will effect those children who are made permanent wards on or after March, 31, 1998. MARE began sending the 90 Day Photolisting Registration Notices in mid-May, after receiving data from the state reflecting changes or additions of cases that occurred in April. For children who do not have an identified family but for whom the permanent wardship date is before 3/31/98, registration at 90 days is optional.

Registration at 90 days is only mandatory for those children who do not have identified families. If a child has been matched with a family (foster, relative or recruited) no action is required at 90 days. MARE will continue to generate a "Registration Notice" approximately five months after permanent wardship alerting the agency responsible for adoption planning of the upcoming 182 due date. For private agencies, sanctions can occur when documentation is sent after the 182 day due date. FIA cases that go beyond 182 days without receipt of proper documentation by MARE will be reported to FIA Zone Managers for review.

The intent of Public Law 172 is to identify and recruit for those Michigan children who do not have a identified families, in a timely but realistic time frame. This law, coupled with Michigan's adoption tracking and review system make our state one of the leaders in serving adoption eligible children.