STATE OF FLORIDA

DEPARTMENT OF CHILDREN AND FAMILIES

TALLAHASSEE, September 6, 2005

CF OPERATING PROCEDURE NO. 175-71

 

Family Safety

 

TITLE IV-E FOSTER CARE AND ADOPTION SUBSIDY

 

 

This operating procedure establishes guidelines for determining eligibility and utilizing Title IV-E funding in Child Welfare/Community Based Care (CW/CBC) Programs.

 


            (Signed original copy on file)


LUCY D. HADI
Secretary

 

 

 

 

SUMMARY OF REVISED, DELETED, OR ADDED MATERIALS

 

This publication has been revised to incorporate policy clarifications regarding “removal home”, add a section regarding administrative claiming for Foster Care Candidacy, and to revise the Child in Care Medicaid and Title IV-E Application and the Adoption Assistance Screening Worksheet.

 

 

 


CONTENTS

                                                                                                                                                     Paragraph

Chapter 1 – GENERAL REQUIREMENTS

            Purpose.................................................................................................................................. 1-1

            Scope..................................................................................................................................... 1-2

            Legal Authority........................................................................................................................ 1-3

            Background............................................................................................................................ 1-4

            CW/CBC Services Funded with Title IV-E............................................................................. 1-5

            Federal Reimbursement......................................................................................................... 1-6

            Medical and Social Services.................................................................................................. 1-7

            Child Support Collections....................................................................................................... 1-8

            Vouchering............................................................................................................................. 1-9

            Coding and Maintenance of Current Eligibility Status.......................................................... 1-10

            File Retention........................................................................................................................ 1-11

            Confidentiality....................................................................................................................... 1-12

 

            Attachment 1 to Chapter 1:  Title IV-E Terms and Definitions

 

Chapter 2 – TITLE IV-E STATE PLAN COMPLIANCE

            Overview................................................................................................................................ 2-1

            The Adoption and Safe Families Act of 1997 (ASFA)........................................................... 2-2

            Maintaining Title IV-B Compliance......................................................................................... 2-3

            Provisions of the Multiethnic Placement Act (MEPA) and
                        the Interethnic Adoption Provision (IEAP).................................................................. 2-4

            Compliance Review............................................................................................................... 2-5

 

Chapter 3 – FOSTER CARE SERVICES

            Title IV-E Application.............................................................................................................. 3-1

            Responsibility for Screening and Completing the Application............................................... 3-2

            Notice of Case Action............................................................................................................ 3-3

            Title IV-E Technical and Financial Requirements.................................................................. 3-4

            Judicial Requirements............................................................................................................ 3-5

            Removal Home...................................................................................................................... 3-6

            Removal Episode................................................................................................................... 3-7

            Title IV-E Eligibility and Claiming FFP.................................................................................... 3-8

            Dual Eligibility – Determining Title IV-E Eligibility When a
                        Child Receives Third Party Benefits.......................................................................... 3-9

            Voluntary Foster Care.......................................................................................................... 3-10

            Children of Minor Parents in Foster Care............................................................................ 3-11

            Adjudicated Delinquents or Status Offender Children......................................................... 3-12

            Title IV-E Reimbursement for Child-Caring/Child-Placing Agencies................................... 3-13

            Title IV-E Administrative Costs............................................................................................. 3-14

            Foster Care Candidacy........................................................................................................ 3-15

 

            Attachment 1 to Chapter 3:  Child in Care Medicaid and
Title IV-E Application (CF-ES 2626A)

            Attachment 2 to Chapter 3:  Instructions for Form CF-ES 2626A

            Attachment 3 to Chapter 3:  Declaration of U.S. Citizenship/Qualified
Non-Citizen Status

            Attachment 4 to Chapter 3:  Title IV-E Foster Care Checklist

Chapter 4 – PUBLIC ASSISTANCE

            Overview of Program Requirements..................................................................................... 4-1

            The Role of Economic Self-Sufficiency Services and
                        CW/CBC in Determining Title IV-E Eligibility............................................................. 4-2

            Eligibility Determination.......................................................................................................... 4-3

            Complete Review of Eligibility................................................................................................ 4-4

            Partial Eligibility Review......................................................................................................... 4-5

            Reviewing Eligibility of the Child When There is a Temporary Break
                        in Licensed Out of Home Care Placement................................................................ 4-6

            Medicaid Eligibility for Title IV-E Children – General Policies and Procedures..................... 4-7

            Medicaid Eligibility for Non-Title IV-E Children...................................................................... 4-8

            Independent Living................................................................................................................. 4-9

 

            Attachment 1 to Chapter 4:  Consolidated Need Standard

            Attachment 2 to Chapter 4:  Deprivation of Parental Support and Care

 

Chapter 5 – ADOPTION SERVICES

            Title IV-E Federal Adoption Assistance.................................................................................. 5-1

            Universal Title IV-E Eligibility Requirements.......................................................................... 5-2

            Categorical Eligibility Requirements for Title IV-E Adoption Assistance............................... 5-3

            Documentation of Eligibility for Title IV-E Adoption Assistance............................................. 5-4

            The Adoption Assistance Agreement..................................................................................... 5-5

            Non-Recurring Adoption Expenses........................................................................................ 5-6

            Reasonable Efforts To Place a Child Without Providing Adoption Assistance...................... 5-7

            Fair Hearings for Denials of Title IV-E Adoption Assistance.................................................. 5-8

            Disallowance of Title IV-E Adoption Assistance for Children Who Are Adopted
                        by Biological Parents Whose Parent Rights Have Been Terminated........................ 5-9

            Concurrent Payments of Title IV-E Adoption
                        Assistance and Supplemental Security Income (SSI)............................................. 5-10

            Medicaid Coverage for Title IV-E Eligible Children.............................................................. 5-11

            Disruption/Dissolution of Placement in the Adoptive Parents’ Home.................................. 5-12

            Making a Decision To Terminate or Continue Title IV-E Adoption Assistance.................... 5-13

            Continuation of Title IV-E Adoption Assistance
                        Payments for a Child Whose Adoptive Parents Are Deceased.............................. 5-14

            Private Agency Participation in Title IV-E Adoption
                        Assistance, Medicaid and Non-Recurring Adoption Expenses............................... 5-15

            Inter-Jurisdictional Barriers................................................................................................... 5-16

            Responsibilities of Department and Other State Agencies in Interstate Adoptions............. 5-17

            International Adoptions......................................................................................................... 5-18

 

            Attachment 1 to Chapter 5:  Adoption Subsidy Title IV-E
Eligibility/Screening Worksheet (CF-FSP 5146)

            Attachment 2 to Chapter 5:  Title IV-E Adoption Subsidy Checklist

 

 


Chapter 1

 

GENERAL REQUIREMENTS

 

1-1.  Purpose.  This operating procedure establishes policy and procedures for determining Title IV-E eligibility for children in licensed out of home care and adoption assistance; for maintaining Title IV-E eligibility after initial determination; and for reporting, tracking, and claiming funds.

 

1-2.  Scope.  This operating procedure applies to all staff within the department and contracted and subcontracted agents of the department involved in the process of determining and maintaining Title IV-E eligibility.  This includes child protective investigators, case managers for in-home services, out of home care, and adoption services, revenue maximization specialists, child welfare legal services attorneys, Economic Self-Sufficiency Child in Care public assistance specialists, and staff responsible for data management and fiscal operations.

 

1-3.  Legal Authority.

 

            a.  Sections 471, 472, 473, 474, 475, of the Social Security Act; 42 United States Code (U.S.C.) 671, 672, 673, 674, and 675.

 

b.  Public Law 96-272, Adoption Assistance and Child Welfare Act of 1980, and amendments; Public Law 103-382, Multiethnic Placement Act of 1994, Title IV, Part E, Public Law 105-89, Adoptions and Safe Families Act of 1997 and Public Law 106-169, Chafee Independent Living Act of 1999.

 

            c.  Federal Administration for Children and Families:  information memoranda; policy interpretation questions; policy announcements; letter responses.

 

            d.  Title IV-E State Plan:  Foster Care and Adoption Assistance.

 

            e.  Title IV-A (AFDC) State Plan in effect on July 16, 1996.

 

            f.  42 CFR, Subpart 435.115, Individuals deemed to be receiving AFDC.

 

            g.  45 CFR, Parts 1355 through 1357, Foster Care Maintenance Payments, Adoption Assistance and Child and Family Services.

 

            h.  45 CFR 233.110, Foster Care Maintenance and Adoption Assistance.

 

            i.  Section 409.166, Florida Statutes (F.S.).

 

            j.  Chapter 65C-16, Florida Administrative Code.

 

1-4.  Background.

 

a.  The Adoption Assistance and Child Welfare Act of 1980 was enacted on June 17, 1980.  Title IV of the Social Security Act was amended and a new Part E, Federal Payments for Foster Care and Adoption Assistance, was created.  Title IV-E provided for a phased repeal of Section 408 of the Act, which provided authority for federal matching of state foster care (FC) payments under the Title IV-A, Aid to Families with Dependent Children Foster Care Program (AFDC-FC).

 

b.  On October 1, 1982, the Title IV-E foster care program replaced the existing Title IV-A (AFDC) foster care program.  Although Title IV-E is not part of AFDC, an eligible child must meet all of the criteria for AFDC eligibility, which were in place on July 16, 1996.

 

            c.  The Adoption and Safe Families Act was enacted on November 19, 1997.  The main purpose of the act was to ensure the safety, permanency and well being of children in out -of-home care placements.

 

1-5.  CW/CBC Services Funded with Title IV–E.  CW/CBC claims Title IV-E funds for eligible children placed in fully licensed Title IV-E eligible facilities and for adoption assistance for special needs children in approved adoptive homes.  The types of eligible licensed placements that qualify include foster family care homes, foster family group homes, medical or therapeutic foster homes, shelter homes or facilities, public facilities with 25 beds or less, and private (non-profit, or for profit) licensed child-caring/child-placing institutions.  Placement and care responsibility for eligible children must be with the department and its contracted agent.

 

1-6.  Federal Reimbursement.  [42 U.S.C. 672(b), (c); 42 U.S.C. 673(a)(1)(B); 42 U.S.C. 675(3)(4); 45 CFR 1356.21,1356.40 and 1356.41]  States may receive federal reimbursement (also known as Federal Financial Participation – FFP) for eligible costs:

 

            a.  Foster Care Maintenance Payments.  Title IV-E payments are made to licensed out-of-home care providers to cover:

 

(1)  The cost of (and the cost of providing) food, clothing, shelter, daily supervision, school supplies, a child’s personal incidentals, liability insurance with respect to the child, and reasonable travel to the child’s home for visitation; and

 

            (2)  In the case of residential group care, the reasonable costs of administration and operation of such facility necessary to provide the items noted under paragraph (1) above.

 

b.  Adoption Subsidy Payments.  Title IV-E payments are made to the adoptive parent(s) in amounts specified in the adoption assistance agreement (see Chapter 5, Adoption Services).  Maintenance adoption subsidy payments to the adopting parents and Medicaid benefits for the child become available at the point the adoption assistance agreement is signed by all parties and the child is placed in the adoptive home.

 

(1)  The basic monthly adoption maintenance payment  shall not exceed the published standard foster care board rate for the child’s age at the time the maintenance adoption payment determination is being made.  An additional amount may be added to the child’s basic subsidy under special circumstances pursuant to Chapter 65C-16, Florida Administrative Code (FAC).

 

                        (2)  The Adoption Assistance Agreement must be renewed annually.

 

(3)  The adoption assistance payment is terminated when the child reaches 18 years of age, if the parents cease to have legal responsibility for the child, or when it is determined that the child is no longer receiving support from the parents.

 

c.  Non-Recurring Adoption Expenses.  One time payments may be made to adoptive parents or providers for items and services related to a special needs adoption.  Payments for non-recurring items and services are not restricted to Title IV-E eligibility or to receipt of a subsidy.

 

            d.  Administrative Costs.  Costs deemed necessary for the administration of the Title IV-E State Plan are reimbursable.  Title IV-E administrative costs include allocable operational, overhead and staff costs.

 

                        (1)  Operational costs include office supplies, postage, business equipment, insurance, and allowable attorney fees.

 

                        (2)  Overhead and staff costs include salaries, fringe benefits, and payroll taxes.

 

            e.  Federal Reimbursement Rates.

 

                        (1)  Administrative costs:  50%.

 

                        (2)  Foster Care Maintenance and adoption subsidy payments:  varies annually based on the Federal Medical Assistance Percentage (FMAP) rate.

 

                        (3)  Training costs:  75% of the department’s designated pre-service training program.

 

1-7.  Medical and Social Services.  [42 U.S.C. 672(b) and (h); 42 U.S.C. 673(b)(1)(2) and (3)(B); 42 CFR 435.115]  Any child for whom Title IV-E Foster Care and Adoption Assistance payments are made is deemed eligible for Titles XIX (Medicaid) and XX (Social Services).

 

1-8.  Child Support Collections.  [42 U.S.C. 671(a)(17)]  Public Law 98-378 added a new section 471(a)(17) to the Social Security Act requiring states to take all appropriate steps to establish support obligations on behalf of a child receiving Title IV-E foster care maintenance payments.  Also amended were sections 454 and 458, which require states to collect and distribute child support for foster care cases.  The federal Office of Child Support Enforcement (OCSE) implemented these requirements by issuing new regulations at 45 CFR 302.52, effective October 1, 1984.

 

1-9.  Vouchering.  Vouchering for all payments for Title IV-E eligible children must be done through the Integrated Child Welfare Services Information System (ICWSIS), using procedures detailed in the ICWSIS manual.  Expenditures must be coded in accordance with the Accounting Procedures Manual, 3 APM, Chapter 2, for draw down of Federal Financial Participation (FFP).  (See the Accounting Procedures Manual, 3 APM 2, and the ICWSIS manual for detailed instructions.)

 

1-10.  Coding and Maintenance of Current Eligibility Status.  The eligibility of all children in care (or receiving in-home services) must be accurately entered and maintained in the Integrated Child Welfare Services Information System (ICWSIS) and HomeSafenet (HSn).

 

            a.  The following eligibility type codes must be used in ICWSIS as applicable:

 

                        (1)  50 – Eligible for Title IV-E (no Title IV-E payments being made).

 

                        (2)  51 – Eligible for Title IV-E (Title IV-E payments being made).

 

                        (3)  52 – Ineligible for Title IV-E.

 

                        (4)  53 – Title IV-E Eligibility not determined.

 

                        (5)  15 – SSI Recipient (Non-Title IV-E).

 

                        (6)  14 – Title IV-E/SSI Eligible (board payment; claiming Title IV-E).

 

                        (7)  13 – Title IV-E/SSI Eligible (no Title IV-E board payment; claiming SSI).

 

b.  Eligibility Values in HomeSafenet.  Each child’s eligibility must be recorded in HSn and must coincide with the eligibility value recorded in ICWSIS, as applicable.  The eligibility values and definitions for use in HomeSafenet are incorporated in the HSn Workbook.  The HSn Workbook may be viewed or downloaded from the following Internet address:  http://hsn2.dcf.state.fl.us/doc/index.asp.

 

1-11.  File Retention.  All Title IV-E foster care and adoption assistance records must be retained for at least seven years beyond case closure.  Therefore, the department shall make and keep records of all cases brought before it and shall preserve the records for seven years after the last entry (case closure).  After receiving authorization from the Department of State, the record may then be destroyed and identifiers from automated records may be expunged.

 

            a.  Circumstances, which require retention beyond the seven-year period, include:

 

                        (1)  Claim(s), negotiation(s), audit(s), or other action(s) initiated but not concluded; or,

 

                        (2)  Information/documentation pertaining to lost benefits; or,

 

                        (3)  Adoption Records – the “record copy” for adoption records, either automated or microfilm (or paper prior to microfilming), shall never be destroyed; or,

 

(4)  An adoption assistance file that contains ongoing Title IV-E adoption subsidy eligibility documentation.  An adoption assistance file must be maintained for every child who receives or is expected to receive a Title IV-E adoption subsidy, medical subsidy, or Medicaid.  The file must be maintained for at least three years beyond the child’s 18th birthday.  Since the adoption file and the foster care file will be combined and prepared for permanent filing and will be sealed after the adoption finalization, the information which documents the child’s initial and ongoing adoption assistance eligibility must be maintained in a separate file.  (Refer to Attachment 2 to Chapter 5, Title IV-E Maintenance Adoption Assistance Checklist, for file documentation requirements.)

 

NOTE:  See pamphlet CFP 15-7 for other applicable retention periods.

 

b.  Availability of Closed Foster Care and Adoption Records for the Purpose of Federal and State Audits.  (Chapter 63.162, F.S.; Section. 471 (a)(8)(D), SSA; ACYF-PA-85-02).  In order for the state to claim Title IV-E funding, access must be given to foster care and adoption records (including sealed foster care and adoption records), in the event of a federal Title IV-E eligibility review.  According to federal policy, if requested records cannot or are not made available for reviews, all payments made on behalf of the children whose records have not been made available for reviews and associated administrative costs will be disallowed.

 

1-12.  Confidentiality.  [42 U.S.C. 671(a)(8), et al.]  Federal regulations require that the use of or discussion of confidential information regarding Title IV-E be limited to purposes directly related to the administration of the program.  Therefore, confidential information shall always be handled responsibly.

 

 


Title IV-E Terms and Explanations

 

          TERM

EXPLANATION

Adoption

 

The act of creating the legal relationship between parent and child where it does not exist, thereby declaring the child to be legally the child of the adoptive parent(s) and their heir at law; and entitled to all rights and privileges and subject to all objections of a child born to such adoptive parents in lawful wedlock.

 

Adoption Assistance

Payments and services provided to a special needs child and his/her adoptive family, as specified in the adoption assistance agreement.  Such assistance may include maintenance adoption subsidy, Medicaid and reimbursement of non-recurring expenses associated with a finalized adoption.

 

Aid to Families with Dependent Children  (AFDC)

 

Financial assistance funded under Title IV-A of the Social Security Act and provided to children who are deprived of the support and care of one or both parents; and, meet certain technical and financial requirements. Commonly referred to as “welfare” or “cash assistance”.

 

 

Under the Personal Responsibility and Work Opportunity Act of 1995, AFDC was discontinued and replaced by the Temporary Assistance to Needy Families (TANF) Block Grant.  However, Title IV-E eligibility is based on previous AFDC eligibility criteria in the Title IV-A State Plan that was in effect on July 16, 1996.

 

Consolidated Need Standard (CNS)

 

 

The 1989 Florida Legislature set the Consolidated Need Standard as the amount recognized by the Federal Poverty Income Guidelines.  The CNS takes into consideration certain basic needs of applicants and recipients.  These include food, household supplies, personal care items, transportation, clothing, and utilities.  (See Attachment 1 to Chapter 4.)

 

Department

 

The Department of Children and Families.

 

Date of Entitlement

The date on which the state becomes entitled to claim federal reimbursement.

 

Deprivation

 

Deprivation means that a child is living without the support and care of one or both parents due to continued absence from the home because of death, separation, divorce, or incarceration; or incapacity, unemployment or underemployment.  (See Attachment 2 to Chapter 4 for more information.)

 

Entity

 

Any organization or agency (e.g. a private child placing agency) that is separate and independent of the state agency; performs Title IV-E functions pursuant to a contract or subcontract with the state agency; and receives Title IV-E funds.

 

Foster Care Maintenance
Payments

 

Payments to cover the cost of (and cost of providing) food, clothing, shelter, daily supervision, school supplies, personal incidentals, liability insurance with respect to a foster child and reasonable visitation.  In the case of institutional care, the term includes the reasonable costs of administration and operation of the facility, which are necessary to provide the items listed in the preceding sentence.

 

·          Food – actual food costs, kitchen and dining room operational costs including personnel, equipment and supplies associated with planning meals, ordering, preparing, and serving food, clean-up work, and the costs of planned meals away from the institutions.

·          Clothing – Children’s personal wardrobe, including initial and replacement clothing.  Expenses incurred in the upkeep of children’s clothing, including staff and supplies on ground, and for services provided off grounds, such as repairs, mending, dry cleaning, alterations, etc.

·          Shelter costs – Living Space (both indoor and outdoor) used by children, including rent or building use allowance.

-           Furniture and upkeep – for items related directly to shelter space used by the children, e.g. living room, dining room, and bedroom equipment , furniture and furnishings, such as draperies, blinds, rugs, bedding, linens, etc.

-           Fuel and utilities for space used by the children, e.g. heat, air conditioning, electricity, telephone, etc.  if these item costs are not charged as part of the rent.

-           Routine maintenance and upkeep of property and equipment used in daily living activities of the children.  This includes staff and supplies for janitorial services, maintenance, and minor repairs to grounds and equipment.

·          Daily Supervision

-           Family Foster Home – payment may include day care or babysitting for a foster parent who is working while the child is not in school.  Foster parents may not be reimbursed in the form of a salary for the expense of ordinary parental duties.”  (p. 50, House of Representatives, Report No. 96-900, April 23, 1980.)

-           Institution payment includes the reasonable costs of administration and operation of the institution which is required to provide the items described in foster care maintenance costs; costs for daily supervision includes day-to-day direction and supervision.

-           Recreation Costs  (which clearly substitutes for “daily supervision”) includes but is not limited to such items as reading materials, athletic equipment, games, and dues for youth clubs, scouts, community centers, etc.; children’s admission fees or tickets to sporting, entertainment or cultural events.  The cost of staff necessary to provide supervision to ensure the wellbeing and safety of the children on and off campus are allowable even if the event has recreational components. (Reference: ACYF– PA-82-01, PIQ-87-02)

·          School Supplies – Includes school supplies such as activity fees, class dues, paper, pens, books, calculator and other miscellaneous costs.

 

 

·          Personal Incidentals – includes but is not limited to medicine chest supplies, personal hygiene items – combs, brush, toothbrush, soap, shampoo/conditioner, hair dryer, deodorant, haircuts, and other sundries and incidentals. (These costs are normally included as part of the overall per diem rate.)

·          Liability Insurance (with respect to the child.)

·          Travel and Transportation – costs associated with child’s visitation with parents is allowable.

·          Cost of Providing – In both family and institutional foster care, the costs of providing items listed in the definition of maintenance payments may be included in the maintenance payment.  Costs of providing may include the costs of activities performed by staff in fulfilling the role of providing daily supervision of IV-E eligible children, e.g. cottage parents or social working providing routine supervision.

 

Medicaid

 

Medical assistance funded under Title XIX of the Social Security Act that provides basic health care to various coverage groups.

 

Need

 

Refers to the financial need of the child and/or family. 

 

Out-of-Home/
Out-of-home care

 

Twenty-four hour out-of-home care for children placed away from their parents or guardians and for whom the department has placement and care responsibility.

 

Reimbursability

 

The ability to claim federal reimbursement based on the child and family meeting all eligibility requirements, in addition to the child’s placement in an eligible, licensed home or facility.

 

Removal Home

 

The family setting from which the child was first legally removed, including a relative’s or non-relative’s home if such person had assumed and continued to exercise day to day responsibility for the care and control of the child, prior to court involvement.

 

NOTE:  Foster care is provided by someone other than a biological or legal parent. (See paragraph 3-6 of this operating procedure for further clarification.)

 

Specified degree of relationship

 

 

 

 

 

 

 

 

 

The following relatives meet the specified degree of relationship for the purposes of this operating procedure (this includes the legal side of kinship even if the marriage ended in death or divorce):

 

-           Mother

-           Father, legal or biological  (Note:  A non-judicial determination of paternal relationship must be made on the natural, biological father or his relatives as listed herein.)

-           Brothers, sisters (including those of half blood)

-           Aunts, uncles, nieces, nephews

-           Grandparents, great-grandparents

-           First cousins (and 1st cousins once removed)

-           Stepfather, stepmother, stepbrother or stepsister.

-           (Note: The parent of a stepparent is not a specified relative.)

-           Person who legally adopts a child, as well as the natural and other legally adopted children and other relatives of the adopted parents, as long as they are within the specified degree.

-           Legal spouses of any persons named in the above groups even though the marriage terminated by death or divorce.

-           Individuals of preceding generations as denoted by prefixes such as grand, great, and great-great.

 

Termination of Parental Rights (TPR)

 

A legal proceeding which terminates the parents’ rights to their child and frees the child for adoption. Also referred to as a permanent commitment.

 

Voluntary Placement

 

An out-of-home care placement requested by the parents or legal guardians of the child without court involvement.

 

Voluntary
Relinquishment

Permanent commitment of child by the parent(s) to the department or to a child placing agency for the purpose of adoption.


Chapter 2

 

TITLE IV-E STATE PLAN COMPLIANCE

 

2-1.  Overview.  States receiving federal funds must have an approved Title IV-E State Plan that establishes program guidelines for the funding source.  State Plan requirements include certifications by the agency that it will have a program that conforms to the statutory provisions of Title IV-E – Public Law 96-272 (Adoption Assistance and Child Welfare Act of 1980 and amendments) and Public Law 105-89 (Adoptions and Safe Families Act of 1997).  Once an approval of the State Plan has been received from the Regional Office of the Administration for Children and Families, the state will be eligible to make claims for federal reimbursement under provisions of Title IV-E of the Social Security Act.  Thus, this chapter sets forth state plan requirements and certifications that must be met for State Plan compliance.

 

2-2.  The Adoptions and Safe Families Act of 1997 (ASFA).  ASFA was designed and intended to reform the current child welfare system and balance the safety, permanency and well being requirements for children in out-of-home care.  Key provisions of the law include:

 

a.  Safety of the Child.  The new legislation makes it clear that the safety and health of the child must be the paramount concerns that underlie all child welfare decisions and services.  ASFA requires that the court evaluate the department’s reasonable efforts in light of the child’s health and safety. 

 

b.  Reasonable Efforts.  ASFA further defines and clarifies “reasonable efforts” to prevent the child’s removal (preserve families), to reunify the child and family and to make and finalize an alternate permanent placement when reunification is not possible.  “Reasonable Efforts” refers to the exercise of reasonable diligence and care to provide services to the child and family while ensuring the health, safety and permanence of the child.  Judicial determinations of reasonable efforts must be explicit and made on a case-by-case basis.  Following are the options that are in a judicial finding:

 

                        (1)  Reasonable efforts must be made to maintain the family unit and prevent the unnecessary removal of the child from his/her home, as long as the child’s safety is assured.

 

                        (2)  Reasonable efforts must be made to effect the safe reunification of the child and family. Reasonable efforts to finalize an alternate plan may also be made concurrently with reasonable efforts to reunify. 

 

(3)  When it is determined that reunification is not possible, reasonable efforts must be made to place the child in another planned permanent home (i.e. “reasonable efforts to finalize the permanency plan” – REFPP) and the steps necessary to finalize the permanent placement of the child must be documented.  For example, when the permanency goal is adoption, at a minimum, documentation must include child-specific recruitment efforts, such as the use of state, regional and national adoption exchanges.

 

(4)  Reasonable efforts to prevent the removal and to reunify are not required if a court has determined that there were “aggravated circumstances.”  Aggravated circumstances are referred to as “egregious conduct” in Chapter 39.806(1)(f)(g) F.S.  Specifically, “aggravated circumstances” include abandonment, torture, chronic abuse and sexual abuse.  Reasonable efforts are not required if the parent has:

 

                                    (a)  Murdered or committed voluntary manslaughter of another sibling of the child; or,

 

                                    (b)  If the parent has aided, abetted, attempted, conspired or solicited to commit such a murder or voluntary manslaughter; or,

 

                                    (c)  If the parent has committed felony assault resulting in serious bodily injury to the child or another sibling; or,

 

                                    (d)  If the parental rights of the parent to a sibling have been involuntarily terminated.

 

c.  Permanency of the Child.  Since out-of-home care is a temporary setting, ASFA includes a number of provisions that set time limits for making permanency planning decisions for the child, and that promote the adoption of children who cannot safely return to their homes.  Following are permanency requirements to comply with ASFA legislation.

 

(1)  A permanency hearing must be held:

 

(a)  No later than 12 months after a child enters out-of-home care and every 12 months thereafter as long as the child is in out-of-home care.  The first 12-month permanency hearing is calculated from the date that the court places the child into out-of-home care.  Subsequent permanency hearings are to be held 12 months from the last permanency hearing.

 

NOTE:  When a case plan with a goal of reunification is extended beyond the 12-month hearing, the case plan must include the steps being taken to locate an adoptive home or other permanent living arrangement as cited in section 39.621, F.S. – legal guardianship, long-term custody to a relative or non-relative, custody on a permanent basis to a foster parent with or without guardianship or another planned permanent living arrangement

 

                                    (b)  Within 30 days after the court’s determination that reasonable efforts to reunify are not required.

 

(2)  The permanency plan for a child must include whether and when the child will be returned to the parent(s), placed for adoption or placed with a permanent guardian, and  document the steps necessary to finalize the permanent placement of the child.

 

(3)  A petition to terminate parental rights must be filed for all children who have been in out of home care for 15 out of the most recent 22 months, except in specified circumstances.  (Refer to Section 475(5)(E), SSA, and CFOP 175-90 for more details.)

 

(4)  A petition must be filed for termination of parental rights when a child is determined to be an abandoned infant, or when the court has found that the parent has committed murder, voluntary manslaughter, or felony assault resulting in serious bodily injury to the child or to another sibling of the child or the parental rights of the parent to a sibling have been terminated involuntarily (“aggravated circumstances”).

 

            d.  Health care insurance coverage must be provided for all special needs adoptions.  Medicaid is the vehicle for this requirement.

 

            e.  Procedures must be in place for criminal records checks for prospective foster and adoptive parents to be conducted prior to the time a child is placed with the prospective parents.  (Also see ss. 435.045, Florida Statutes.)

 

f.  Plans for effective use of cross-jurisdictional resources to facilitate timely adoptive or permanent placements must be in effect.  A state receiving Title IV-E funds may not deny or delay the placement of a child for adoption when an approved family is available outside the jurisdiction responsible for handling the child’s case.  The opportunity for a fair hearing must be granted to an individual who alleges denial of adoption approval due to the fact that they reside outside of the jurisdiction responsible for placing the child.  Loss of Title IV-E funds will occur when the state fails to grant an individual an opportunity for a fair hearing.

 

g.  Case plans must assure that the child will receive safe and proper care and that services provided to all parties meet the goals established for the child and family.  This includes a discussion of the appropriateness of the services provided to the child under the plan.

 

            h.  Any child, age 16 or over, must have a written description of programs and services that will assist them in the preparation of transitioning from foster care to independent living.

 

i.  The foster parent of a child and any pre-adoptive parent or relative caregiver are to be notified of all review hearings and be given an opportunity to be heard at permanency hearings and all other judicial review hearings held on behalf of the child in their care.

 

2-3.  Maintaining Title IV-B Compliance.  [42 U.S.C. 671(a)(16); 675(5) (A), (B) and (D); 45 CFR 1356.21(f), (g); 39.601, 39.701, F.S.]  Title IV-E also requires that the state maintain compliance with all Title IV-B protections for children in out-of-home care.  These protections include:

 

            a.  A current case plan must be in effect and developed according to ss. 39.601 Florida Statutes.

 

            b.  Timely judicial reviews of the child’s case.

 

(1)  The initial judicial review must be held no later than 90 days after the date of the disposition hearing or after the date of the hearing at which the court approves the case plan, whichever occurs earlier; but in no event shall the review be held later than 6 months after the date of the child’s removal from the home.

 

                        (2)  Judicial reviews must be conducted every 6 months thereafter, or more frequently if the court deems necessary.

 

c.  The court must review the child’s status to determine the safety of the child, the continuing necessity for and the appropriateness of the placement, the extent of compliance with the case plan and the extent of progress made toward resolving the issues necessitating the child’s placement in out of home care, and to project a likely date of return to his/her home.  If the child is returned home, the court must also ensure the child is safely maintained in the home.  When the case plan goal is not reunification, a likely date that the child will be placed for adoption or with a legal guardian must be projected at the judicial review hearing.  See ss 39.701, F.S. for judicial review requirements.

 

d.  If the department and the court have established a formal agreement that includes specific authorization for particular cases, the department may conduct administrative reviews instead of the judicial reviews for children in out-of-home care.  The following guidelines must be followed:

 

                        (1)  Notices of such administrative reviews must be provided to all parties.

 

            (2)  An administrative review must not be substituted for the first judicial review, and in every case the court must conduct a judicial review at least every six months.

 

                        (3)  Any party dissatisfied with the results of an administrative review may petition for a judicial review.

 

2-4.  Provisions of the Multiethnic Placement Act (MEPA) and the Interethnic Adoption Provision (IEAP).  [45 CFR 1355.38; 422(6)(a) and 471(a)(18), SSA]

 

a.  While Title IV of the Social Security Act has always prohibited discrimination based on race, color or national origin, the Multiethnic Placement Act of 1994 and the Interethnic Adoption Provisions of 1996, focus attention on foster and adoptive placements.  These acts were congressional attempts to move children through the foster care system, to eliminate biases in foster care and adoption placements and aid in the recruitment, training and utilization of foster and adoptive parents from every race, color and national origin.  The ultimate goal of MEPA is to decrease the length of time that children wait to be adopted and to ensure that children are expeditiously placed in permanent and safe homes.  Beginning January 1, 1997, neither the department or its contracted agents that receive funds from the federal government and are involved in adoption or foster care placements may:

 

                        (1)  Deny to any person the opportunity to become an adoptive or foster parent on the basis of race, color, or national origin of the person, or of the child involved; or,

 

                        (2)  Delay or deny the placement of a child for adoption or into foster care, on the basis of race, color, or national origin of the adoptive or foster parent or the child involved.

 

b.  Placement Guidelines.  The child’s placement for adoption or foster care must not be denied or delayed on the basis of race, color, or national origin of the prospective adoptive or foster parent of the child involved.  In order to insure that MEPA requirements are not violated the following are recommended guidelines for placement.

 

                        (1)  Assess the individual placement needs of the child by taking into consideration the child’s individual needs and best interests.

 

                        (2)  Assess the available families’ ability to meet the specific needs of the child by considering:

 

(a)  The capacity of  the prospective family to meet the child’s emotional, psychological, educational, developmental and, medical needs, including those related to the child’s racial, ethnic and/or cultural background, as appropriate.

 

                                    (b)  The prospective family’s feelings, capacities, preferences and attitude as they relate to their ability to nurture a child of a particular background.

 

                                    (c)  The prospective family’s expressed preferences and interests regarding their ability to foster or adopt a child of a particular background.

 

                                    (d)  The prospective family’s ability to cope with the particular consequences of the child’s developmental history and to promote the development of a positive self-image.

 

                                    (e)  The family’s ability to nurture, support and reinforce the racial, ethnic or cultural identity of the child and to help the child cope with all forms of discrimination that the child may encounter.

 

(3)  The final selection should be made by identifying which family is most likely to meet all of the child’s needs.  Since no two families are the same, there is usually at least one distinguishing factor in a family’s ability to care for a particular child; however, race, color or national origin cannot be the distinguishing factor.

 

                        (4)  Other Guidelines.

 

                                    (a)  The department or its contracted agents may not honor a request by the biological parent(s) regarding placement preferences for their child based on race, color or national origin.

 

                                    (b)  Religious preferences are not covered in MEPA, unless a particular religion discriminates based on race, color or national origin.

 

(c)  MEPA does not prohibit kinship or relative placement preferences.  The exception is when the child’s placement is delayed while an extended search is made for a suitable relative that will take the child when another family is available and can meet the child’s needs.

 

                                    (d)  The case file must document the steps taken to identify an appropriate foster or adoptive placement for the child and reason(s) for the selection of a particular family.

 

c.  The Department of Health and Human Services (DHHS) makes it clear that MEPA violations include denials overtly based on race, color or national origin, as well as using other arbitrary and prohibitive standards.  Prohibitive standards include those related to age, income, education, family structure and size or ownership of housing, when they do not have an impact on the ability of the prospective family to meet the needs of the child.

 

            d.  Diligent Recruitment.  MEPA requires states to recruit potential families that reflect the ethnic and racial diversity of children needing foster and adoptive placements.  DHHS recommends that states develop recruitment plans that:

 

                        (1)  Focus on developing a pool of potential foster and adoptive parents that are willing and able to foster or adopt the children needing placement;

 

(2)  Are both general and targeted.  General recruitment activities make use of radio, television and print media to disseminate information.  Targeted recruitment activities include dissemination of information in specific communities, the development of partnerships with community and religious groups to make waiting children more visible and to identify and support prospective adoptive and foster parents; and,

 

                        (3)  Provide potential foster and adoptive parents with information about the characteristics and needs of the available children, the nature of foster care and adoption and supports available to foster and adoptive parents.

 

2-5. Compliance Reviews.  [42 U.S.C.1320a-1a; 45 CFR 1355.32, 1355.33, 1355.34]

 

a.  ASFA Compliance.  The Administration for Children and Families (ACF) will conduct full child and family service reviews (CFSR) in each state to assess compliance with Titles IV-B and IV-E state plan requirements.  These reviews consist of a statewide self-assessment and an on-site review related to specific outcomes for children and families.  ACF will determine the state’s substantial conformity by its ability to achieve indicated outcomes in the following areas.

 

                        (1)  Child Safety.

 

(a)  Children are first and foremost protected from abuse and neglect; and,

 

                                    (b)  Children are safely maintained in their own homes whenever possible and appropriate.

 

                        (2)  Permanency.


(a)  Children have permanence and stability in their living situations; and,

 

                                    (b)  The continuity of family relationships and connections is preserved for children.

 

                        (3)  Child and Family Well-Being.

 

                                    (a)  Families have enhanced capacity to provide for their children’s needs; and,

 

(b)  Children receive appropriate services to meet their physical and mental health needs.

 

b.  Title IV-E Compliance.  [45 CFR 1356.71]  The Administration for Children and Families will conduct Title IV-E eligibility reviews in each state.  The purpose of the reviews is to assess the state’s compliance with Title IV-E eligibility criteria and to provide technical assistance to ensure the proper application of Title IV-E criteria.  Following are the criteria that will be used to assess Title IV-E eligibility for out-of-home care (also refer to Chapter 3 of this operating procedure).

 

                        (1)  Judicial determinations – “contrary to the welfare” and “reasonable efforts.”

 

                        (2)  Voluntary Placement Agreement with appropriate judicial determinations within 180 days from the date the agreement was signed by all parties.

 

                        (3)  Placement and care responsibility vested with the department.

 

                        (4)  AFDC eligibility (July 16, 1996 criteria) of the family and child at removal based on meeting the financial and technical requirements.

 

                        (5)  Ensure that the child is in a fully licensed home or facility.

 

                        (6)  Licensing file has complete licensing history.

 

                        (7)  Documentation of compliance with safety requirements.

 

                        (8)  The focus will be Title IV-E foster care maintenance payments.  The cases to be sampled will be pulled from Adoption & Foster Care Analysis & Reporting System (AFCARS).

 

            c.  MEPA Compliance Reviews.

 

(1)  The Administration of Children and Families and the Office of Civil Rights will jointly play a role in the compliance and enforcement of MEPA requirements.  MEPA provides two vehicles for enforcement of its prohibitions against discrimination in adoption or foster care placement. 

 

                                    (a)  First, any individual aggrieved by an action he/she believes constitutes discrimination has a right to bring action seeking equitable relief in a United States District Court of appropriate jurisdiction. 

 

                                    (b)  Secondly, a violation may be identified through compliance reviews of Federal Financial Participation (FFP) such as ASFA, Title IV-E, Medicaid, etc.

 

                        (2)  The critical elements to consider for compliance with the intent of MEPA law and the Interethnic Adoption Provisions are:

 

(a)  No delays or denials in placing children who need adoptive or foster homes.  Children cannot linger in out of home care until a family is found for them that meets or matches the race, color, or national origin of the child to the family.  There should be no predetermined placement preferences or priorities based on race, color, or national origin.  For example, the department or its contracted agent must not establish a routine set of placement preferences where race, color or national origin are factors in placement decisions.  Discrimination directed towards adults who wish to serve as foster or adoptive parents, towards children who need safe and appropriate homes or towards communities or populations that have been under-utilized as a resource for placing children will constitute a violation of the MEPA requirements.

 

(b)  Consideration of race, color or national origin must be routinely narrow.  Consideration of these factors must be done on an individualized, case-by-case basis where special circumstances indicate that such consideration is warranted.  Additionally, the consideration must be narrowly tailored to advance the child’s best interests, in light of a specific prospective adoptive or foster care parent’s capacity to care for the child.  An example given by the federal office in this instance may be a child of the age of consent and the child refuses or does not want to be placed in a setting other than one of his/her own race.  The child’s CW/CBC case manager should have further discussions with the child to point out the consequences of his/her decision, such as indefinitely lingering in out-of-home care and the child’s need for permanence and long term family connections.

 

(c)  The child’s best interests must be the paramount concern when seeking a placement for the child.  An assessment of the prospective foster or adoptive family’s capacity to meet the individual needs of the specific child is an essential element in making a placement decision.

 

(d)  Diligent recruitment of potential foster and adoptive parents that reflect the ethnic and racial diversity of the children for whom foster and adoptive homes are needed is both a legal requirement and “best practice” when making a placement decision.

 

 


*(See also, FAC 65C 19)

 

Chapter 3

 

FOSTER CARE SERVICES

 

3-1.  Title IV-E Application.  [42 U.S.C. 671(a)(1); 672(a)(2) and (4)]  The Child in Care Medicaid and Title IV-E Application (form CF-ES 2626A, Attachment 1 to this chapter) must be completed within five (5) working days of the child’s entry into out-of-home care.  The Declaration of Citizenship form (CF-ES 2058) must be completed and attached to the CF-ES 2626A.  Each zone/region/district must establish processes to ensure the timely completion and processing of the Child in Care Medicaid and Title IV-E Application.  The processes should include gathering demographic, financial and household composition information.

 

3-2.  Responsibility for Screening and Completing the Application.  Zone/region/district/CBC guidelines will address who has primary responsibility for completion of the Child in Care Medicaid and Title IV-E Application for the Title IV-E determination.  The completed form must be submitted to the Child In Care (CIC) unit in the Office of Economic Self-Sufficiency (ESS) for determination of Title IV-E and Medicaid eligibility.

 

3-3.  Notice of Case Action.  When a child’s eligibility is determined, a Notice of Case Action is generated by the Child in Care worker (CIC) that declares the eligibility or ineligibility of the child for Title IV-E and Medicaid.  The Notice of Case Action will be a manually written notice (form CF-ES 2629) and will include, at a minimum the child’s name, case number, eligibility status, Medicaid number, basis of eligibility determination (i.e. how deprivation and financial need met), and date of next redetermination. 

 

            a.  Approval or Denial.

 

                        (1)  If the application is approved, the CIC worker issues a Notice of Case Action to the person who signed the application.  A copy of the notice is kept in the child’s file and must be available for audit purposes.

 

(2)  If the application is denied, the CIC worker issues a Notice of Case Action to the person who signed the application.  The notice indicates the reason(s) for denial, informs the applicant of his/her right to a fair hearing and provides the name of the person to contact to request a fair hearing.  A copy of the notice is kept in the child’s file and must be available for audit purposes.

 

            b.  Hearings.  When an individual is not satisfied with the action taken on his/her application, the individual may make a request for a hearing before a state hearing officer.

 

                        (1)  Request for a Hearing.

 

                                    (a)  A hearing request must be made within 90 days of the receipt of the Notice of Case Action.

 

                                    (b)  The request must be submitted to the CW/CBC office responsible for handling the case.

 

(c)  The request may be either written or verbal.  If written, it must be signed and dated, and include a statement explaining the need for a hearing.  If verbal, the individual taking the request should record the information including his understanding of the reason for the request.  CW/CBC staff are permitted to assist the requester with the hearing request.

 

                                    (d)  The hearing request must be date-stamped to indicate the day of receipt by the department.  This confirms that the request was received within the 90-day limit.

 

                                    (e)  When the hearing request is received, the unit supervisor must forward the request and a brief statement explaining the need for the hearing to:

 

Department of Children and Families

Office of Appeal Hearings (OSIH)

1317 Winewood Boulevard

Tallahassee, FL 32399-0700

 

                                    (f)  A copy of the hearing request and a statement must be filed in the child’s file for documentation purposes.

 

(g)  When the CW/CBC supervisor receives the hearing request, arrangements are made immediately for an interview with the requester to determine if the issue can be resolved at the local level.  The supervisor reviews the case record prior to the interview to evaluate the original decision for accuracy.  The interview includes discussion of the requester’s complaint and dissatisfaction.  If the supervisor determines that the agency made an error, corrective action must be immediately taken.

 

(h)  After the supervisory interview, the requester may withdraw or continue with the hearing request.  If the request is withdrawn, a signed, written withdrawal statement is obtained and forwarded to the Office of Appeal Hearings within two (2) working days and a copy filed in the child’s file.

 

                        (2)  Hearing Process.  The hearing officer notifies the requester of the time and place of the hearing and conducts the hearing.

 

                                    (a)  Written notification is sent to the requester and the department of the date, time and place of the hearing. 

 

(b)  When the zone/region/district is advised of any hearing decision, zone/region/district administration submits a report to the Central Office CW/CBC Policy Support Unit.  The report advises of the hearing request and the outcome of the hearing.  A copy of the final order must accompany the report.

 

                                    (c)  Priority is given to hearing decisions that require action to authorize payment(s).

 

3-4.   Title IV-E Technical and Financial  Requirements.  [42 U.S.C. 671(a)(1); 672(a), (c), (d), (e), (f), (g); 675(5) & (6); ACYF-CB-PIQ 99-01; 45 CFR 233.20(a)(2); 45 CFR 1356.71(d)(iii); 45 CFR 1356.21]  At the time of removal, the child must meet AFDC technical and financial eligibility requirements, according to the Title IV-A State Plan in effect on July 16, 1996.  If a child was eligible to receive AFDC at the time of removal, he/she has met the financial and technical criteria for Title IV-E eligible (do not confuse AFDC with temporary cash assistance or TANF).

 

a.  Technical requirements include Florida residency, citizenship or qualified non-citizen status, specified degree of relationship, age, and deprivation; welfare enumeration (SSN) is a Medicaid requirement.  (Refer to Chapter 4 of this operating procedure for more detailed information on technical requirements.)

 

            b.   Financial requirements include:

 

                        (1)  Asset Limit.  Neither the child nor the family may have an accumulation of more than $10,000 in countable and accessible assets.

 

(2)  Income Limit.  First, the family must not have gross income, less appropriate income disregards, in excess of the Consolidated Need Standard (CNS).  If the family is eligible, the child must not have income in excess of 185% of the board rate.  (See Attachment 1 to Chapter 4 for CNS amounts.) 

 

3-5.  Judicial Requirements.  [45 CFR 1356.21(b)(2) and (c)]

 

            a.  Contrary to the Welfare” Judicial Finding.

 

                        (1)  A judicial finding of “contrary to the welfare” must be made at the first court hearing that approves/sanctions the removal of the child from the home.

 

                                    (a)  Effective March 27, 2000, in order to meet Title IV-E requirements, a “contrary to the welfare” finding must be in the first court order that sanctions the child’s removal from his/her home.

 

(b)  For removals prior to March 27, 2000, a petition must have been filed with the court containing “contrary to the welfare” or “best interest” language no later than six months from the date the child last lived with a specified relative.  When the petition is filed within six months of the removal of the child from a specified relative, the ability to claim federal funds is preserved until the judicial finding of “contrary to the welfare” is obtained.  However, Title IV-E funds must not be claimed prior to the judicial finding – court order – of “contrary to the welfare”.

 

EXAMPLE:  A child is removed from his/her mother on March 2, 2000.  A petition with “contrary to the welfare” language is filed with the court on August 26, 2000.  A judicial finding (court order) of “contrary to the welfare” is obtained on September 15, 2000.  Title IV-E may be claimed beginning September 15, 2000 (provided all other eligibility requirements are met) because the petition with the appropriate language was filed with the court within six months of the child’s removal from a specified relative.

 

(2)  There  must be a written finding/court order that remaining in the home is “contrary to the welfare” of the child or that placement in out of home care is in the “best interest” of the child.  Judicial findings must be made on a case-by-case basis per the individual circumstances of the child.  The “contrary to the welfare” finding suggests that the child’s current situation is not safe or suitable and is not in the child’s best interest.  Acceptable substitutions that will meet the “contrary to the welfare” and “best interest” judicial finding requirement for Title IV-E include but are not limited to:

 

                                    (a)  The child has no parent, guardian, or legal custodian to provide for his/her care and supervision.

 

                                    (b)  The release of said child (back to the “contrary to the welfare” home) will present a serious threat of substantial harm to the child.

 

                                    (c)  The parent, guardian, or legal custodian is not willing to take custody of the child.

 

                                    (d)  A manifest danger exists that the child will suffer serious abuse or neglect if he/she is not removed from the home.

 

                                    (e)  The conflict that exists cannot be resolved by delivery of services to the family during the continuous placement of the child in the parent’s home.

 

                                    (f)  Remaining in the home would be inimical to the welfare of the child.

 

(3)  Court orders that reference a state law to substantiate judicial determinations are not acceptable even if state law provides that a removal must be based on a judicial determination that remaining in the home would be contrary to the child’s welfare or that removal can only be ordered after reasonable efforts have been made.  In keeping with this mandate the following statements are not acceptable “contrary to the welfare” language.

 

                                    (a)  The child’s removal was pursuant to the intent of Chapter 39, Florida Statutes.

 

                                    (b)  The child was removed according to criteria provided by law.

 

                                    (c)  There is probable cause to believe the child is dependent.

 

(4)  Courts have the authority to enter a nunc pro tunc order to supply, for the record, something that actually occurred but was omitted from the record through inadvertence or mistake.  However effective March 27, 2000, nunc pro tunc orders may not be used to pre-date the performance of an act to a time before it actually occurred.  Therefore, if the required judicial determination is not included in the appropriate court order, a transcript of the court proceedings is the only other documentation that will be accepted to verify that the required judicial determination has been made.  Documentation to back up this finding must be placed in the child’s file.

 

(5)  When children are placed in licensed out-of-home care pursuant to a voluntary licensed placement agreement, that agreement stands in the place of a court finding of “contrary to the welfare” for the first 180 days.  (Refer to paragraph 3-10 of this operating procedure for more information about voluntary placements.)  Title IV-E federal claiming may begin on the first day of voluntary licensed placement if all parties have signed and if all eligibility criteria are met.  For any child who is placed voluntarily, the court must determine within 180 days of the agreement that it is in the best interest of the child to remain in a licensed out of home placement.  The clock begins on the date of the signature or the date of the child’s placement, whichever is first.  If a “contrary to the welfare” finding is not obtained from the court within 180 days, the child is not Title IV-E eligible beyond the first 180 days and federal claiming must cease.  If the “contrary to the welfare” order lacks “reasonable efforts” language, the child will not be eligible until that language is obtained per guidelines listed below.

 

b.  Reasonable Efforts” Judicial Finding.  At the time of removal, court must make a judicial finding that the department has made reasonable efforts to: prevent the unnecessary removal of the child or that reasonable efforts were not required.  If the child remains in out of home care for more than twelve months, the court must also make a finding that reasonable efforts have been made to reunite the child with his/her family OR make and finalize alternate permanency plans in a timely manner when reunification is not possible.

 

                        (1)  For a child to be initially eligible for Title IV-E funding, federal law requires the courts to make a finding in regard to the child’s removal that:

 

                                    (a)  Reasonable efforts were made to prevent or eliminate the need for removal of the child; or,

 

                                    (b)  No efforts at the time of removal could have ensured the child’s safety in the home; or,

 

                                    (c)  No reasonable efforts are required to prevent the removal or to reunify the family.

 

(2)  Effective March 27, 2000, in order for the child to be Title IV-E eligible, the “reasonable efforts” finding should be in the first court order removing the child from his/her home.  However, if the first court order sanctioning the child’s removal does not contain the “reasonable efforts” language, a court order with such language must be obtained no later than 60 days from the date of the removal.  Title IV-E claiming cannot begin until this judicial finding is made.  If the judicial finding is not made within 60 days of the removal, the child will not be Title IV-E eligible for the current removal episode.  Prior to March 27, 2000, Title IV-E claiming could begin whenever the “reasonable efforts” judicial determination was made, provided all other requirements were met.

 

(a)  Reasonable efforts were made to prevent or eliminate the need for removal, as long as the child’s safety can be assured.  The court, after hearing the evidence, must make a written finding that the department’s efforts to eliminate the need for removal were reasonable.

 

(b)  The provision of services at the time of the removal could not have ensured the child’s safety in the home.  The court, after hearing the evidence, must make a written finding that the lack of the provision of preventative services was reasonable and that the removal of the child from the home was the only means of ensuring his/her immediate safety. 

 

(c) Reasonable efforts to prevent removal or to reunify family are not required when a court of competent jurisdiction determines that the parent subjected the child to “aggravated circumstances” as defined in s.39.806(1)(e)-(i), F.S., or when the parent has committed crimes named in the Child Abuse Prevention and Treatment Act.  When this finding is made the department must have a permanency hearing within 30 days of this judicial finding and present a permanency plan for the child at the hearing.  Reasonable efforts must be made to place the child in a timely manner according to the permanency plan and to complete the steps necessary to finalize the permanent placement.  This “reasonable efforts” finding may be made at the shelter hearing or any other hearing when such evidence is presented to the court.

 

(3)  In order for the child to continue to be Title IV-E eligible there must be a judicial finding that reasonable efforts were made to finalize the child’s permanency plan within twelve months of the child’s removal from home.  Subsequent reasonable efforts findings must be made no later than twelve months from the reasonable efforts finding as long as the child is in out-of-home care.

 

(a)  A judicial finding must be made as a result of this hearing that the department/CBC made (or is making) reasonable efforts to finalize the permanency plan for the child.  The judicial finding is made based on the permanency plan that is currently in effect, which may be reunification, adoption, or another planned permanency arrangement.

 

(b)  Failure to obtain this initial judicial finding of reasonable efforts to finalize the child’s permanency plan and subsequent findings as described above makes the child ineligible for Title IV-E.  The child remains ineligible until such a judicial determination is made.  Once such a determination is made, IV-E reimbursement may resume.

 

3-6. Removal Home.  [Department of Health and Human Services (DHHS), Departmental Appeals Board Decision – DAB No. 1485; Section 472(a)(1),SSA]  The “removal home” refers to the home in which the Title IV-E eligibility determination is based.  It is also known as the “contrary to the welfare home.”

 

a.  In order for the child to be Title IV-E eligible, he/she must have been living with and removed from a specified relative.  The same specified relative must satisfy the requirements of  “living with” and “removed from”.  The child must have lived with that specified relative some time within the six month period prior to the removal.

 

            b.  For Title IV-E purposes, “home” is tied to the presence of an adult who has taken on the daily care and supervision of a child.  A child may be removed from a variety of situations and still qualify for Title IV-E, including, for example:

 

                        (1)  A hospital, following either birth or an illness or injury;

 

                        (2)  A homeless shelter;

 

                        (3)  A car or other vehicle; or,

 

                        (4)  A tent or other temporary shelter.

 

            c.  When identifying the removal home of the child, the following must be considered:

 

            (1)  The child must be physically removed from the “contrary to the welfare” home.

 

                                    (a)  When a child is removed from a parent by the court, that parent’s home is considered the removal home. 

 

(b)  If the parent made arrangements for someone else to provide the daily care and supervision of the child and the child is subsequently removed from that person, that home becomes the removal home.  (Legal custody of the child is not considered an issue when determining the removal home.)

 

(c)  If the Department or authorized agent takes custody of a child then immediately arranges for the child to live with the other legal parent, no removal has occurred.  Therefore, this is considered a “living arrangement” and not a removal/placement in out of home care.  (If the child is subsequently “removed” from this living arrangement, a removal/shelter order must be obtained to the effect that reasonable efforts were made to prevent the removal and that it is contrary to the child’s welfare to remain in this home.)

 

            (2)  The court must give the department the responsibility for placement and care of the child.

 

            (3)  The child must have lived with the parent or other specified relative from whom he/she is removed during the six month period preceding the removal.

 

(4)  When a child has been placed by a parent with a relative or non-relative caretaker without departmental or court intervention and the child has resided in this home for LESS than six months, the child may be constructively removed from the custodial parent and “placed” with the relative or non-relative caretaker by the department.  For instance the relative/non-relative caretaker may report to the department that the parent has “abandoned” the child and as a result, the child is “removed” from the parent (by filing a shelter petition) and the child remains with the same caretaker.  This is considered a constructive removal; the parent’s home is considered the “contrary to the welfare home” in constructive (paper) removals. 

 

(5)  When a child has been placed by a parent with a relative without departmental or court intervention and has been in the home of a relative for MORE than six months at the time the court or department become involved, then a physical removal from that relative’s home must occur to meet Title IV-E eligibility.  In this instance, the removal home has shifted to that of the relative.  However, if the child had been placed with a non-relative for MORE than six months before court or department intervention, he or she would not be eligible for IV-E, as the child has not resided with a specified relative within the six-month period prior to removal.

 

3-7.  Removal Episode.  A “removal episode” refers to the period of time that begins with the child’s removal (physically, judicially or voluntarily) and includes one or more subsequent placements in out-of-home care settings.  The beginning of the removal episode establishes the time frames for developing the case plans, obtaining reasonable efforts to finalize the permanency plan, and conducting judicial reviews and permanency hearings.  A removal episode ends when a child is:

 

            a.  Reunified with his/her parent(s); this does not include returned for a trial home visit.  A trial home visit is considered a “step in the reunification process”, unless it extends for more than six months without a judicial extension; or,

 

            b.  Legally adopted (finalized); or,

 

            c.  Permanently placed in the home of a relative or non-relative and the department and court involvement ceases.

 

3-8.  Title IV-E Eligibility and Claiming FFP.  [472(b), SSA; 45 CFR 1356.21] 

 

            a.  When the child’s initial eligibility for Title IV-E is determined based on the technical, financial and judicial requirements, the child must be placed in a Title IV-E eligible facility prior to claiming federal reimbursement.

 

                        (1)  Eligible Facilities.  Eligible facilities are those that are fully licensed (per Florida Administrative Codes 65C-13, 65C-14 and 65C-15):

 

                                    (a)  Shelter Homes.

 

                                    (b)  Family Foster Homes.

 

                                    (c)  Group Homes.

 

(d)  Child Caring Or Child Placing Agency Homes.  The department must have a contract with the agency for making and/or supervising placements.  Title IV-E foster care payments cannot be made directly to a for-profit agency, the payments must go directly to the foster home parents or through the public or private non-profit child placing or child caring agency.

 

                                    (e)  Public facility with 25 beds or less.

 

                        (2)  Ineligible Facilities.  Ineligible facilities include:

 

                                    (a)  Public facilities with more than 25 beds.

 

                                    (b)  Detention/locked facilities.

 

                                    (c)  Training schools or youth camps.

 

                                    (d)  Hospitals – medical or psychiatric.

 

(3)  Court Ordered Placement.  Title IV-E reimbursement must not be claimed when the court orders a child’s placement with a specific licensed provider or facility.  To be eligible for Title IV-E foster care maintenance payments the child’s placement and care responsibility must lie with the department and its contracted agent.  Once a court orders a placement with a specific provider without the recommendation of the department, the court has assumed the department’s placement and care responsibility.

 

b.  Once a child’s eligibility for IV-E is established, the eligibility remains in effect until one of the following occurs:  1) the child turns age 18; 2) the child becomes legally married with no annulment of the marriage; 3) the removal episode ends.

 

c.  The child’s eligibility may temporarily end when one of the following occur:  1) deprivation ends; 2) child’s income or assets exceed established limits; 3) child is in an ineligible placement; or, 4) failure to obtain a judicial finding of reasonable efforts to finalize the child’s permanency plan within 12 months of removal and every 12 months thereafter.

 

                        (1)  Deprivation.

 

(a)  For a child to be continuously Title IV-E eligible, deprivation must exist throughout the removal episode.  If the factors of parental deprivation change, IV-E eligibility during the period of change may be affected.  For instance, if the parents are separated at the time of removal but later reunite, the factor of deprivation may not continue to exist.  A deprivation screening should again be completed. If the parents again separate, the factor of deprivation exists and eligibility resumes.

 

                                    (b)  When a child was initially removed from someone other than the parents, that is the home which is considered in establishing deprivation.  Only if both parents move into that home will deprivation cease to exist.

 

                        (2)  The child will be ineligible for Title IV-E in any month in which the child’s income and/or assets exceed limits.

 

(3)  The child is ineligible for Title IV-E for any month she/he is in an ineligible facility (see paragraph 3-8a(2) above).  However, if the child is in an eligible facility whose license expires during the month, IV-E reimbursement may be claimed for the full month, provided all other eligibility factors are met.  If the facility remains unlicensed, IV-E reimbursement must not be made beginning the following month.  Title IV-E reimbursement may resume when the facility becomes fully licensed.

 

(4)  When a judicial finding of “reasonable efforts to finalize the permanency plan” is not made within 12 months of removal (or within 12 months of the previous REFPP finding), the child becomes ineligible beginning with the month after the finding is due and remains ineligible until the finding is made.

 

3-9.  Dual Eligibility – Determining Title IV-E Eligibility When a Child Receives Third Party Benefits.  [42 U.S.C. 673(a); ACYF-PA-94-02]  A child may receive either Supplemental Security Income (SSI), Social Security survivor’s benefits (SSA), Veteran’s Administration (VA) or Railroad Retirement (RR) benefits and still be eligible for Title IV-E.  Therefore a title IV-E eligibility determination must be made for children receiving third party benefits.  When the child receives SSA, VA or RR benefits, the child’s cost of care may be shared between Title IV-E and the federal benefit received and should be pursued when appropriate.  However, if a child is receiving SSI benefits, cost sharing with Title IV-E is not an option and a determination must be made regarding which federal benefit will be claimed for the child’s cost of care.  When deciding which benefit to claim, the decision must be based on what is in the child’s best interest and not solely in consideration of maximizing federal dollars.

 

a.  If the child is determined to be dually eligible for Title IV-E and SSI and the agency elects to become representative payee of the child’s SSI benefits to offset the cost of care, the department will code the child’s maintenance expenditures as non-Title IV-E and offset the child’s cost of care with the SSI benefits.  The associated administrative costs are IV-E reimbursable.  The appropriate ICWSIS code to use is “13”  (Title IV-E /SSI Eligible – no Title IV-E board payment, claiming SSI) and the HSn code is “Title IV-E Eligible/Non-Reimbursable”.

 

b.  If the agency elects to claim Title IV-E for the child’s cost of care, the Social Security Administration must be notified that the child’s cost of care (board payment) is paid via Title IV-E benefits and of the monthly amount of the foster care board payment.  The Social Security Administration will then deduct the Title IV-E benefit from the child’s SSI payment and forward balance to the representative payee.  Both the board payment and the administrative cost would be charged to Title IV-E and the coding in HSn and ICWSIS would be Title IV-E eligible/reimbursable.

 

NOTE:  When a child receiving SSI benefits enters shelter care, the Social Security Administration should be contacted to have the SSI benefit suspended.  When the child is adjudicated dependent and ordered into foster care placement (disposition hearing), the department or CBC agency must notify the Social Security Administration and apply to become the child’s representative payee.

 

3-10.  Voluntary Foster Care.  [Section 472(b) and (d); 475 (5) SSA; PL 96-272, Section 102(a) 2; IM-88-12; 45 CFR 1356.21(9)(e) and (f); 42 U.S.C. 672 (d) & (f)] 

 

a.  When there are no abuse or neglect issues involved, a parent(s) or legal guardian may sign a voluntary foster care agreement with the department for the temporary placement of a child in foster care.  Title IV-E may be claimed for the first 180 days of the child’s placement if the child and family meet the eligibility criteria.  A signed Voluntary Foster Care (Licensed) Agreement must be executed and be available in the child’s case record.  The agreement must contain the signature of the parent(s) or legal guardian(s) and the department representative and the date the agreement was signed.  If the signings occurred on different dates, the date of the final signature is the agreement date.  Financial need and deprivation of parental care or support must exist at the time of the voluntary placement in licensed foster care in order for the child to be IV-E eligible.  The staff person receiving the voluntary placement must annotate detailed information about the parent(s)’ living situation and the removal home.

 

b.  In order to continue Title IV-E eligibility, within 180 days from the date of the voluntary licensed placement, a judicial finding must be made to the effect that the placement in out of home care is in the child’s best interest.  If the judicial finding is not made within the first 180 days, the child will not be IV-E eligible for the remainder of the removal episode.

 

3-11.  Children of Minor Parents in Foster Care.  [Sections 472 and 473, SSA]  A child living with his/her minor parent in a licensed foster family home or a child-care institution is not considered to be in “foster care” if the minor parent’s child has not been legally removed from the parent pursuant to a voluntary licensed placement agreement or a judicial determination.  The Omnibus Budget Reconciliation Act of 1987 made it possible for the needs of the child living with a minor parent in the same licensed foster home to be included in the Title IV-E payment being made on behalf of the minor parent.

 

a.  Effective March 27, 2000 separate Title IV-E foster care maintenance payments cannot be made for children of minor parents (unless the child has been legally removed from the minor parent).  The minor parent’s foster care board payment may be increased to cover the foster care maintenance costs of a child of a minor parent when the parent and the child are in the same licensed foster home or facility.  The “contrary to the welfare” status is absent if the child remains in the “contrary” home with the parent.  However, if the child is removed or separated from the minor parent, the needs of the child must no longer be included in the maintenance payment of the minor parent.  In such cases, the child’s eligibility for Title IV-E out-of-home care will be based on the child’s current and individual circumstances.

 

            b.  A child whose cost of care in a licensed foster home or facility is covered by the Title IV-E foster care payments made with respect to the minor parent is also eligible for Title XIX Medicaid.

 

3-12.  Adjudicated Delinquents or Status Offender Children.  [Sections 406(a) and 407 (as were in effect on July 16, 1996), 472, and 475(4) and (5), SSA; ACYF-PIQ-82-10; ACF-PIQ 88-03; ACYF-PIQ-91-03]  Title IV-E has specific eligibility factors that must be met in order to claim Title IV-E reimbursement for adjudicated delinquent or status offender children in out-of-home care.  Eligibility in the case of adjudicated delinquents and status offenders rests on two factors:  (1) eligibility of the child, and (2) the type of facility in which the child is placed.  Following are the eligibility criteria needed to make a Title IV-E claim.

 

a.  There must be a physical removal of the child from his/her home.  A juvenile court must make a judicial finding that it is in the child’s “best interest” to be removed from his/her home, or that it is “contrary to the welfare” for the child to remain in the home or that the child is a “threat to himself.”  However, if the court order only indicates that the child is “adjudicated delinquent” or that the child is a “threat to the community”, such language does not satisfy the requirement for a determination that continuation in the home would be contrary to the child’s welfare.  The judicial determination must be made in the first order that results in the removal of the child from the home.

 

b.  There must be a judicial finding that reasonable efforts were made to prevent the removal of the child from his/her home.  The court may make the reasonable efforts finding at any time or within 60 days of the removal.  Title IV-E funds cannot be claimed until the reasonable efforts judicial finding occurs.  Effective March 27, 2000, the judicial finding on reasonable efforts must occur within 60 days of the removal to be eligible for Title IV-E.

 

            c.  The child must be dependent and the child’s family must meet AFDC eligibility as described in paragraph 3-4 of this operating procedure.

 

            d.  The placement and care of the child must be the responsibility of the department.

 

e.  The child must be placed in a licensed emergency shelter home or licensed foster family home, a licensed private child caring agency, or a public facility with 25 beds or less.  However, foster care costs in any facility operated primarily for the detention, care or treatment of children who have been found or are alleged to be juvenile delinquents are not eligible for Title IV-E reimbursement.  The two key questions that should be asked in determining if a facility is operated primarily for detention purposes are (1) is it a physically restricting facility? and (2) would it be operational without a population of children who have been adjudicated delinquent?

 

f.  An otherwise Title IV-E eligible child, initially placed in a detention facility, may become Title IV-E eligible and reimbursable when transferred to a licensed facility which meets the Title IV-E requirements listed in paragraph 3-8a(1) above.  The initial order removing the child from the home must contain “best interest” or “contrary to the welfare” judicial language and reasonable efforts language must be in the removal order or obtained within 60 days of removal.  Since Title IV-E cannot be claimed for children in detention facilities the “clock” for calculating when to comply with the requirements for developing case plans, holding judicial reviews, and permanency hearings, and the TPR provisions begin when the child is placed in licensed foster care.

 

3-13.  Title IV-E Reimbursement for Child-Caring/Child-Placing Agencies.  [Section 472(b) and (c), SSA]

 

a.  Title IV-E foster care maintenance payments must be made directly to the foster family or child-care institutions from the department or through the public or private nonprofit child-placing or child-caring agency with which the department contracts for making and/or supervising placements. 

 

b.  Title IV-E reimbursement is not available for foster care maintenance payments made

through a for-profit child-placing or a for-profit child-caring agency.

 

            c.  Title IV-E payments may not be made for children placed in licensed public (governmental) facilities serving more than 25 children. 

 

d.  Title IV-E payments may not be made for children placed in: detention facilities, forestry camps, training schools, hospitals or any other facility operated primarily for the detention of children who are determined to be delinquent.

 

3-14.  Title IV-E Administrative Costs.  [Section 471(a)(15) and (16), 472, 474 and 475(4), SSA; 45 CFR 1356.60; ACYF-PA-87-05 and ACYF-CB-PI-01-109]  The department may claim certain administrative costs necessary for the administration of the Title IV-E state plan.  The state cost allocation plan identifies which costs are allocated and claimed under Title IV-E.

 

            a.  The determination and re-determination of eligibility, fair hearings and appeals, rate setting and other costs directly related to the administration of the Title IV-E program are allowable administrative costs.

 

b.  Reimbursement for eligibility determination activities is limited to costs involved in the actual verification and documentation of eligibility.  These include positive as well as negative eligibility determinations.  The activities of staff whose responsibilities extend beyond eligibility determination for Title IV-E must be allocated to the appropriate program.

 

c.  Other allowable administrative costs include such activities as recruitment and licensing of foster homes and institutions, training and other activities that are not directly linked to the eligibility of children.  The administrative costs for these activities must be allocated in a manner that assures that each participating/benefiting program is charged its proportionate share of costs.  The allocations may be determined by case count of Title IV-E eligible children in relation to all children in foster care under the responsibility of the state Title IV-E state plan or on some other equitable basis. 

 

d.  Title IV-E reimbursement (FFP) for the administrative costs associated with a Title IV-E eligible child placed in an unlicensed (relative or non-relative) foster home may be charged to Title IV-E while the department is in the process of licensing the home.  FFP for maintenance cost may also be claimed once the home is fully licensed.

 

e.  Costs that are not reimbursable under Title IV-E include those costs incurred for social services, which provide counseling or treatment to the child, the child’s family or foster family to remedy personal problems, behaviors or home conditions.

 

3-15.  Foster Care Candidacy.  (Section 471 (a)(15)(i), SSA; 45 CFR 1356.21(e) and (g); DAB Decision No. 844 and 1428)  Title IV-E administrative costs may be claimed on behalf of children the department has determined to be reasonable candidates for foster care.  A “candidate” for foster care is defined as a child who is at serious/imminent risk of removal from his/her home as evidenced by the department’s pursuit of removal or the provision of services (reasonable efforts) designed to prevent the removal.

 

a.  The Department of Health and Human Services (DHHS) has identified three acceptable methods of documenting that the department/agency’s involvement with the family is for the purpose of removing the child from his/her home or making reasonable efforts to prevent the removal.  One of the three methods listed below must be used to document the child’s candidacy status:

 

(1)  A defined case plan that clearly indicates that, absent the preventive services identified in the case plan, foster care (out-of-home) is the planned arrangement (goal) for the child.  A case plan is a written document (as described in Florida Statutes 39.601), developed jointly with the parents/legal guardians that includes a description of the services offered and/or provided to prevent removal; or,

 

(2)  A completed Child in Care Medicaid and Title IV-E Application supplemented by documentation that the child is at serious risk of removal from his/her home.  This documentation may be in the form of an abuse investigative decision summary or a child safety assessment detailing the home situation that causes the child to be at serious risk of removal; or,

 

(3)  Evidence of the initiation of court proceedings to remove the child from his/her home.  This evidence may be in the form of a shelter petition filed with the court, a court order or a court transcript of the proceedings/hearing related to the child’s removal.

 

            b.  A departmental employee must make the determination of the child’s foster care candidacy status.  Each departmental zone and CBC agency(ies) must outline local processes for timely candidacy determination and input into HSn.

 

                        (1)  The Foster Care Candidacy Documentation Form must be completed by the child’s case manager/designee with appropriate documentation attached.

 

                        (2)  The form and documentation must be submitted to the designated departmental district/region or zone employee for a determination of candidacy.

 

                        (3)  The form must then be returned to the initiator of the form for input of the candidacy status into HSn and for filing in the child’s case file and/or audit file.

 

            c.  The child’s status must be recorded in HSn on the Person Eligibility screen as:

 

                        (1)  Foster Care Candidate; or,

 

                                               (2)  Non-Foster Care Candidate

 

d.  The child’s continued candidacy status must be reviewed at least every six month by reviewing and documenting the effectiveness of the services provided and the child’s continued risk of removal.  When it is determined that the child is no longer “at serious risk of removal from his/her home”, he/she is no longer a foster care candidate.  The change in status may be the result of:

 

                        (1)  The child’s removal from home and placement in out of home care; or,

 

                        (2)  Effective implementation of services/reasonable efforts to prevent the child’s removal resulting in reduced risk of harm to the child.

 


 

Child in Care

Medicaid and Title IV-E Application

Date of Application: __________

District/Region/Zone: _________

CBC Agency: _______________

 

 

Child’s Name: ______________________________________________

 

AKA: _____________________________________________________

 

DOB: _____________ SS#: _____________________ If no SS#, date # applied for: ________________________

 

Place of Birth: ____________________________________     Gender: ____ Male     ____ Female

 

Race: (Circle Code)  A Asian/Pacific Islander    B Black, not Hispanic   H Hispanic   I American Indian/Eskimo

                              SE Southeast Asian  T Other    W White, not Hispanic

 

Citizen: ___ Yes     ___ No; If child is not a citizen, is child a qualified non-citizen?  ____ Yes   ____ No; If child is a

 

qualified non-citizen, list status and attach document verifying such status _________________________________

 

NOTE: The Declaration of Citizenship Form (CF-ES 2058) must be completed and attached.

 

Marital Status  ____ Never Married   If other than “Never Married” indicate status: ___________________________

 

Child Pregnant?  ___ Yes    ___ No   If “Yes”, expected date of delivery: ___________________________________

 

Questions

Check &/or Write in Response

1a.

Is the child in care as the result of a court ordered removal?

If yes, Date of hearing: ___________________________

Court Case #: ________________

Date of child’s removal: _________________________________________

If no, skip to Question 2a.

____Yes

____ No

1b.

Does the removal order contain a judicial finding that supports the concept that remaining in the home is “contrary to the welfare” of the child or that the removal is in the child’s “best interest”?

____ Yes

____ No

 

Type of Order:

_____Shelter/Detention Order

 

_____Disposition Order

 

_____Order for Modification of  Placement

 

_____ Other________________________

 

______ Order of Change of Custody

 

______ Delinquency

 

______ Voluntary Placement

1c.

Does the same order contain a judicial finding regarding “reasonable efforts” to prevent the removal of the child from the home?

 

____ Yes

____No

 

If “No”, was there another order issued within 60 days of removal with a finding of reasonable efforts to prevent removal?

 

 

____Yes

 

____No

 

 

Date of Order: _________________________

 

 

 

Type of Order: _________________________

 

2a.

Was the child removed as the result of a Voluntary Placement Agreement?

 

____ Yes

____ No

 

If yes, is the Voluntary Placement Agreement signed by the parents (or legal guardians) and a representative of the Department?

 

If “No”, child is not IV-E eligible.

 

____ Yes

 

____ No

 

2b.

If child has been in out of home care for more than 180 days, was a hearing held prior to the 180th day that sanctioned the child’s continued placement in out of home care?

 

____ Yes

 

____No

2c.

If yes, list date of hearing: ___________________

 

 

Did the hearing result in a judicial finding to the effect that it is in the child’s “best interest” to remain in out of home care?

 

____ Yes

 

____No

 

3a.

Who was child removed from? _______________________________

Relationship: _____________________________________________

 

Removal Home Address: ____________________________________
________________________________________________________

______ Two Parents in the home

______ One Parent in the home

______ Parent(s) absent, other specified relative in the home 

_____ Parent(s) in home,  one    

            disabled, un/underemployed

_____ Parent(s) deceased

_____ Parent(s) absent, non-specified relative in the home

3b.

Is child deprived of parental care/support?  Explain: ___________________

_____________________________________________________________

_____ Yes

____ No

3c.

Describe the circumstances that led to the removal of the child from his/her home (abuse, neglect, family conflict, etc): ______________________________________________________________________________________
__________________________________________________________________________________________

 

3d.

Who was living in the child’s home at the time of removal?  List all members of the household.

Name

Relationship

DOB

SSN

Gender

Race

Citizenship

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4a.

Has the child previously been removed from his/her home and placed in out of home care via a court order or voluntary placement agreement?

____ Yes

____ No

 

Who was child previously removed from? ___________________________

Relationship: _________________________________________________

Address: ____________________________________________________
                                             
   Street Address
____________________________________________________________

         City                                                               County                                                              State

 

 

 

4b.

If yes, did the previous removal episode end?

If yes, when? __________________________

____ Yes

____ No

4c.

 If yes, how did the removal episode end (i.e. was case closure achieved via reunification with a parent, adoption, long term placement with a relative or non-relative, etc.)? _____________________________________________

__________________________________________________________________________________________

Type of Court Order: _____________________________   Date of Order: _______________________________

4d.

Note: If the child has had more than one previous removal episode, complete the additional removal history summary  (page 6)

 


 

Title IV-E Income Test for Removal Family and Child

 

5.

Total monthly income of the Parent(s) and Child:

 

 

 

Earned Income

 

5a.

Father

Employer: _________________________

Address: __________________________

__________________________________

# of hours worked

per month:

 

________________

 

Earnings

per month:

 

$_______________

 

Mother

Employer: _________________________

Address: __________________________

__________________________________

# of hours worked

per month:

 

________________

 

Earnings

per month:

 

$___________

 

 

 

 

 

 

 

 

Total Earned Income

$_________

 

Unearned Income

 

 

 

 

Father

Source of Income: __________________________

Monthly Amount:
$_________

 

Mother

Source of Income: __________________________

Monthly Amount:
$_________

 

 

 

 

5b.

 

Total Parental Income

 

$ _______

5c.

Child’s income:

                                              

 

 

 

 

 

 

.

Earned:

Source of Income: _______________

Monthly Amount:
$_________

 

Unearned:

Source of Income: _______________

Monthly Amount:
$_________

5d.

 

Child’s Total Income

 

$ _______

5e.

Sibling(s)’ income:

 

Name: _______________________

 

Name: ______________________

 

 

*Use additional sheets if necessary.

Source of Income:

 

 

 

Source of Income:

_______________

Monthly Amount:

$__________

 

 

Monthly Amount:
$__________

 

5f.

 

TOTAL ASSISTANCE GROUP INCOME

 

$ _______

5g.

Is the family’s income less than the Consolidated Need Standard for the family size?

 

_____ Yes

 

_____ No

5h.

Is child’s total income less than 185% of the standard foster care board rate?  (Board rate x 1.85 = __________)

 

_____ Yes

 

_____ No

 


 

 

Third Party Benefits for the Child

6a.

If the child receives 3rd party benefits – SSI, SSA survivor/dependent benefits, VA benefits, etc. - has paying agency been notified of the child’s shelter/foster care placement?

 

____ Yes

 

 

____ No

 

___N/A

 

6b.

If “No”, contact paying agency and make application for DCF/agency to become representative payee, as appropriate.

6c.

If child does not already receive 3rd party benefits, does his/her circumstances indicate that an application should be initiated?

 

_____ Yes

 

_____ No

6d.

If “Yes” to question 6c. contact the appropriate agency to initiate application process, if in child’s best interest.

 

Date of Contact: _________________________ (if applicable)

 

 

Family/Child Assets

 

 

7a.

Does family have any assets?

_____ Yes

_____ No

 

If “Yes”, list type of asset, dollar value and financial institution type and name of person owning asset, when applicable:

 

Asset Type               Institution Name/Type                   Value                Name

_________             _____________________          $ _______        _______________

_________             _____________________          $ _______        _______________

_________             _____________________          $ _______        _______________

 

7b.

Total assets for family:

 

$ ________

 

7c.

Are family’s total assets less than $10,000?

____ Yes

____ No

8a.

Does child have his/her own assets?

____ Yes

____ No

 

If “Yes”, list type of asset, dollar value and financial institution type, when applicable:

 

Asset Type               Institution Name/Type                   Value              

_________             _____________________          $ _______       

_________             _____________________          $ _______       

_________             _____________________          $ _______       

 

8b...

Total assets for child:

$ __________

8c.

Does child have a Trust Fund? (not referring to “Master Trust” Fund)

 

____ Yes

____ No

 

If “Yes”, what type of Trust Fund? __________________________

How were funds acquired? ______________________________________________

Who is Trustee of the funds? ____________________________________________

Are funds available to the child?   ___ Yes     ___ No;

If “No”, these funds should not be counted in child’s total assets.

 

 

8d.

Are total assets for child less than $10,000?

____ Yes

____ No

9a.

Does the child meet the AFDC criteria that were in effect as of July 16, 1996 at the time of removal from the home?

 

Note: This is specifically referencing the former AFDC program that was in effect prior to Welfare Reform.  Therefore, if the child was removed from a “WAGES”/TANF eligible household, s/he is not automatically eligible for Title IV-E.

 

 

____ Yes

 

____ No

9b.

Describe/summarize the “AFDC” criteria which makes the child potentially IV-E eligible:

 

 

 

 

 

 

 

 

 

 

Child’s Placement Information

10a

Is the child placed in a fully licensed out of home care setting?

 

Date Placed: _________________

 

Name: ____________________________________

Address: __________________________________
               __________________________________
Type Setting: ______________________________

 

_____ Yes

____ No

10b.

Licensing Dates:

Effective Date(of most recent license): _______________         Expiration Date: _____________

10c.

Monthly Board Rate: $ __________________

 

 

 

 

 

Based on information gathered child is:

 

***  _________ Potentially Eligible        __________ Potentially Ineligible?

 

Comments (use this section to provide further explanation as needed): _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

 

 

(Print) Name of Person Completing Form: __________________________________________________________

 

Signature of Person Completing Form: ___________________________________________ Date: ____________

 

Unit Mailing Address: __________________________________________________________________________

 

Unit Telephone #: ______________________________ Unit Fax #: ______________________________________

 

Address Medicaid Card to be mailed to: ____________________________________________________________

 

Date Form Sent to ESS CIC: _________________________________

 

 

*** The Office of Economic Self-Sufficiency, Child in Care Staff, will make the determination of Title IV-E eligibility.

 

 

 


REMOVAL HISTORY SUMMARY (CONT.):

 

 

Has the child had more than one previous removal from his/her home and was he/she placed in out of home care via a court order of voluntary placement agreement?

____ Yes

____ No

 

Who was child previously removed from? ___________________________

Relationship: _________________________________________________

Address: ____________________________________________________
                                             
   Street Address
____________________________________________________________

         City                                                               County                                                              State

 

 

 

 

If yes, did the previous removal episode end?

 

If yes, when? ______________

____ Yes

____ No

 

 If yes, how did the removal episode end (i.e. was case closure achieved via reunification with a parent, adoption, long term placement with a relative or non-relative, etc.)? _____________________________________________

___________________________________________________________________________________________

Type of Court Order: _____________________________________________

 

 

Has the child had more than one previous removal from his/her home and was he/she placed in out of home care via a court order of voluntary placement agreement?

____ Yes

____ No

 

Who was child previously removed from? ___________________________

Relationship: _________________________________________________

Address: ____________________________________________________
                                             
   Street Address
____________________________________________________________

         City                                                               County                                                              State

 

 

 

 

If yes, did the previous removal episode end?

 

If yes, when? ______________

____ Yes

____ No

 

 If yes, how did the removal episode end (i.e. was case closure achieved via reunification with a parent, adoption, long term placement with a relative or non-relative, etc.)? _____________________________________________

___________________________________________________________________________________________

Type of Court Order: _____________________________________________

 

 

 

Has the child had more than one previous removal from his/her home and was he/she placed in out of home care via a court order of voluntary placement agreement?

____ Yes

____ No

 

Who was child previously removed from? ___________________________

Relationship: _________________________________________________

Address: ____________________________________________________
                                              
   Street Address
____________________________________________________________

         City                                                               County                                                              State

 

 

 

 

If yes, did the previous removal episode end?

 

If yes, when? ______________

____ Yes

____ No

 

 If yes, how did the removal episode end (i.e. was case closure achieved via reunification with a parent, adoption, long term placement with a relative or non-relative, etc.)? _____________________________________________

___________________________________________________________________________________________

Type of Court Order: _____________________________________________

 


 

CHILD IN CARE

PARENT INFORMATION

 

Child’s Name: _________________________________________________________________

 

 

Mother’s Name: ______________________________________ SSN: _____________________

 

Date of Birth: ________________________ Place of Birth: ______________________________

 

Alias: ________________________________________________________________________

 

Address: ______________________________________________________________________

 

Employer: ___________________________________ Employer’s Phone #: ________________

 

Employer Address: ______________________________________________________________

 

Unearned Income: ________________ Source: _______________________________________

 

 

Father’s Name: ______________________________________ SSN: _____________________

 

Date of Birth: ________________________ Place of Birth: ______________________________

 

Alias: ________________________________________________________________________

 

Address: ______________________________________________________________________

 

Employer: ___________________________________ Employer’s Phone #: ________________

 

Employer Address: ______________________________________________________________

 

Unearned Income: ________________ Source: _______________________________________

 

 

·       Is paternity an issue for this child?                                                            _____ Yes     _____ No

(Answer “Yes” if CSE needs to establish paternity for this child.)

 

·       Does either parent have health/medical insurance?                                _____ Yes     _____ No

If “Yes”, Name of Insurance Carrier: ____________________________________________________

Address of Insurance Carrier: ______________________________________________________

      Name of Policy holder: _______________________________________________________________

Policy Number: ____________________________________________________________________

·          Does the policy include the child?                                                           ______ Yes    _____ No

·       Were the parents ever married to each other?                                        ______ Yes    _____ No

If “Yes”, date of marriage: __________________________   Place: __________________

 


Instructions for Child in Care Medicaid and Title IV-E Application

Date of Application

Enter date the form is being completed.

District/Region/Zone

Enter all that apply.

CBC Agency

Enter the name of the CBC agency, when applicable.

DEMOGRAPHICS

Child’s Name

Enter the child’s full legal name; also enter “nicknames” and any other names used on the AKA line.

DOB

Enter the child’s date of birth.

SS#

Enter the child’s social security number.  If not available, use a pseudo number (child’s first initial, X, last initial and DOB - mmddyy)

If no SS#, date # applied for

Enter date application for SSN submitted to the Social Security Administration

Place of Birth

Enter city and state of birth as listed on the birth certificate.

Gender

Check male or female.

Race Code

Circle child’s race code.

Citizen

Check “Yes” if child is a citizen; if not a citizen “Yes” if child is a qualified non-citizen; if a qualified non-citizen, list status and attach documentation of non-citizenship status.

Also complete and attached CF-ES 2058 - Declaration of Citizenship

Marital Status

Check never married if child has never been married; otherwise indicate status - married, divorced, marriage annulled; additional comments may be made in the “Comments” section. If child was previously married and the marriage was annulled, attach documentation of annulment.

Child Pregnant

Check appropriate box; if child is pregnant indicate expected date of delivery.

QUESTIONS

Judicial Requirements

1a.

Court Ordered Removal

Check appropriate response; if “Yes” enter date of hearing, Court Case # - from court order, date of removal from home. If “Yes”, complete 1b. and 1c, draw line through questions 2a., 2b. and 2c. then skip to question 3.

If “No”, skip to Question 2a.

1b.

Contrary to the Welfare

Check appropriate response; If “Yes”, check type of order.

If “No” child is not IV-E eligible for current removal episode

1c.

Reasonable Efforts

Check appropriate response; if “No”, indicate if RE finding was in another order issues within 60 days of removal.  Indicate date and type of order. 

If “No”, to both, child is not IV-E eligible for current removal episode.

2a.

Voluntary Removal

Respond to questions 2a. through 2c. only if child removed as result of a voluntary placement agreement; otherwise, draw a line through these questions. Check appropriate response; if “Yes” indicate if Voluntary Placement Agreement signed by parents or legal guardians and a representative of the Department of CBC agency; complete date signed by all parties.  If “No” and if child was not removed judicially as indicated in 1a. above, child is not in a removal episode.

2b.

Court Hearing

 

 

Indicate whether child has been in out of home care for 180 days or more.

Check appropriate response regarding judicial finding.

 

2c.

Date of Hearing

If “Yes” list date of hearing that sanctions the continued removal of the child if “No”, child is not Title IV-E eligible after the 180th day of this removal episode.

Removal Information

3a.

Removal Home

List who child was removed from - name and relationship.

Enter removal home address.  Also indicate parental circumstances.

3b.

Deprivation

Indicate if child is deprived; and explain.  If “No”, child is not eligible for current removal episode.

3c.

Removal circumstances

Describe home situation that led to child’s removal.

3d.

Household Information

List individuals living in the home at the time of the child’s removal - name, relationship to child, DOB, SSN, Gender, Race and Citizenship status.

4a.

Removal History

Note: This question is specifically referring to “removal episodes”, not “placements” within a removal episode.

Indicate if child has previously been removed and placed in out of home care.

If “Yes” enter name of person child removed from, relationship to child and the removal address - street address, city, county and state.

4b.

Removal History (cont.)

If child previously removed, check “Yes” if removal episode ended; and if applicable enter date the previous removal episode ended.  If “No”, child is still in a removal episode and IV-E eligibility will be based on that removal episode.

4c.

Removal History (cont.)

Explain how the previous removal episode ended - reunification, adoption, etc.  Enter type of order that ended removal episode.  Enter date of order.

4d.

Removal History (cont.)

If child has had more than one previous removal episode, complete page 6 (make additional copies of the page, if necessary)

Family Income:          Note: Parental Income is to be entered only if child was removed from one or both parents.

5a.

Earned Income

Enter earned income information for parent(s) in the removal home - Employer’s name and address, # of hours worked per month, total earned income for the month.

Enter total earned income for the parent(s)

 

Unearned Income

Enter unearned income information for parent(s) in the removal home - source and amount of income per month.

Enter total unearned income for the parent(s)

5b.

Total Parental Income

Enter total amount of earned and unearned parental income.

5c.

Child’s Income

Enter amounts for child’s income - earned, unearned and source of income.

5d.

Total Income for Child

Enter the total amount of income for the child.

5e.

Income for siblings

Enter income information for siblings in the home.

5f.

Total Income for Assistance Group

Add totals from 5b, 5d, and5e – enter amount.

5g.

Total income less than Consolidated Need Standard (CNS)?

Indicate if assistance group income is less than the CNS for the family size.

5h.

Child’s total income less than 185% of Foster Care Board Rate?

Indicate if the child’s income is less than 185% of the standard board rate.

6a.

Third Party Benefits for the Child:

Indicate if the agency paying third party benefits have been notified of the child’s placement in out of home care.  Check “N/A” if the child does not receive 3rd party benefits.

6b.

Notification

If “No” to question 6a. the paying agency must be notified so that the department or the CBC agency can make application to become representative payee of the child’s 3rd party benefits.

6c.

Third Party Benefits Application

If the child is not receiving 3rd party benefits, does his/her circumstances indicate that an application should be made – circumstances include child having a disability, parents deceased or parent(s) receiving 3rd party benefits due to a disability, retirement, etc.

6d.

Third Party Benefits Application

If “Yes” to question 6c. contact should be made to the appropriate agency to initiate an application for 3rd party benefits.  Enter date of contact, when applicable.

Family Assets

7a.

Family Assets

Indicate if family, including child, has assets; if “Yes”, list all  assets and value.

7b.

Total assets

Indicate total assets for family.

7c.

Assets below $10,000

Indicate if total family assets are less than $10,000.

If “No”, child may not be Title IV-E eligible for this removal episode. The CIC staff will make final determination.

Child’s Assets

8a.

Child’s assets

Indicate if child has his/her own assets.

If “Yes”, list type(s) and value

8b..

Total assets

Indicate if child’s total countable assets are less than $10,000.

If “No”, child may not be Title IV-E eligible for this removal episode. The CIC staff will make final determination.

8c.

Trust fund, other than a Master Trust fund account?

Indicate if child has a Trust Fund. (not referring to the Master Trust)

If “Yes”, list type of trust fund.

Indicate how funds were acquired and who is the trustee of the trust account.

8d.

Assets below $10,000

Indicate if the child’s total assets are less than $10,000. If no, child may not be IV-E eligible for this removal episode.  The CIC staff will make the final determination.

AFDC Criteria

9a.

1996 AFDC criteria

Indicate if child meets the 1996 AFDC criteria.

9b.

 

Summarize the AFDC factors that make the child potentially IV-E eligible – deprivation, financial need, specified relationship.

Placement

10a.

Fully licensed placement?

Indicate if child’s placement is fully licensed, date child was placed in home/facility, name and address of foster parents/facility and type of setting.

If home/facility is not fully licensed, child’s cost of care is not IV-E reimbursable in this placement.

10b.

Dates of licensure?

List licensing dates.

10c.

Monthly board rate?

Enter monthly board rate being paid for child.

 

Potential Eligibility?

Indicate if child is potentially IV-E eligible

ESS/CIC will make the eligibility determination based on information on 2626a.

Comments

.  Use this section to provide additional information/explanations if necessary.  Also use this section to indicate what steps can be taken or what other documentation can be obtained and provided to determine IV-E eligibility for the child.

CW/CBC Information

Enter name of person completing form, sign and date; enter mailing address, telephone and facsimile numbers; mailing address for Medicaid card.

Enter date that completed form is forwarded to ESS/CIC.

Removal History Continued, if applicable

Enter removal history information for each previous removal episode.

Refer to instructions for questions 4a. through 4d.

 

 

ABSENT PARENT INFORMATION

Complete the parent information for each of the child’s parents for Child Support Enforcement purposes.

 

 

 

 


 

DECLARATION OF UNITED STATES CITIZENSHIP/

QUALIFIED NON-CITIZEN STATUS

 

I certify, under penalty of perjury, by signing my name below, that I am a United States Citizen or Qualified Non-Citizen Immigration Status.  (Adult household members must sign the statement for members under 18 years of age.  In the absence of an adult household member, the applicant may sign for non-adults.)

 

ADULT HOUSEHOLD MEMBERS

Check One

Name (Print)

Signature

Date

                      Qualified

Citizen               Non-Citizen           

 

 

 

 

r  *Verified by:

__________

r  INS FORM:

 ___________

 

 

 

r  *Verified by:

___________

r  INS FORM:

 ___________

 

 

 

r  *Verified by:

___________

r  INS FORM:

 ____________

 

CHILDREN HOUSEHOLD MEMBERS

Check One

Name (Print)

Signature

Date

                      Qualified 

Citizen               Non-Citizen           

 

 

 

r  *Verified by:

__________

r  INS FORM:

 ___________

 

 

 

r  *Verified by:

__________

r  INS FORM:

 ____________

 

 

 

r  *Verified by:

__________

r  INS FORM:

 ___________

 

 

 

r  *Verified by:

__________

r  INS FORM:

 ____________

 

 

 

r  *Verified by:

__________

r  INS FORM:

 ____________

 

A copy of the document used to verify US Citizenship of Qualified Non-Citizen Status must be in the child’s case file, unless the parent or guardian makes the declaration by signing and dating this form.

 

* Indicate document used to verify US Citizenship: BC - Birth Certificate; BVS - Birth Verification Screen;

BR - Birth Record/Hospital; BTC - Baptismal Certificate; USP - U.S. Passport; Other:_______________

*The INS document used to verify Qualified Non-Citizen status must be listed. (Refer to Qualified Non-citizen status documentation requirements.)

 

Signature of parent or legal guardian: _________________________________    Date:______________

 

Witness signature if

anyone signs with an “X”:___________________________________________ Date:______________

 

Authorized Representative’s Name (Print):________________________________________________

 

Authorized Representative’s Signature:__________________________________     Date:____________

 

 

 

 

CF-ES 2058, Sep 2005

 


TITLE IV-E FOSTER CARE CHECKLIST

 

Judicial Removal:

q  Shelter Petition (contains information on removal situation and documents who child lived with at time of removal)

q  Shelter Order – must contain “contrary to welfare” and reasonable efforts to prevent removal” language

 

Voluntary Removal (temporary, licensed out-of-home foster care placement):

q  Voluntary Placement Agreement (CF-FSP 5004), (Date signed: ________)

q  Court order within 180 days of voluntary placement agreement that contains “contrary to welfare” language

 

SSI-Related Documentation:

q  If applicable, award letter from the Social Security Administration or other documentation/proof of eligibility

 

AFDC/Eligibility-Related Documentation:

q  Copy of original Child in Care Medicaid and Title IV-E Application (CF-ES 2626A)

q  Notice of Case Action/Communication Form (CF-ES 2629)

q  Initial eligibility determination dated:__________

q  12 month annual review dated:________________

q  Proof of Citizenship Status (Acceptable Documentation: Birth certificate, Declaration of Citizenship, INS documentation) Per ESS, the Declaration of US Citizenship form must be attached to the 2626a form

q  Copy of Social Security Card or proof of application

q  Documentation that child lived with a specified relative within 6 months of removal

q  Income and Asset supporting documentation

q  Documentation of deprivation and financial need at removal

q  Documentation of deprivation and financial need at annual redetermination

q  Documentation of continuous IV-E reimbursability throughout the duration of removal episode (Parents reunited or separated; child aged out; child moved into a licensed or unlicensed placement; changes in child’s income, etc.)

q  Child in Care Eligibility Review and Communication Worksheet (CF-ES 2694)
(If applicable, changes dated: ________, _________, _________)

q  Declaration of Citizenship (CF-ES-2058)

 

Court Documentation:

q  Modification Orders of Placement/Change

q  Dependency Petition(s)

q  Adjudication Order(s)

q  PDR/PDS

q  Evidence that involved parties were notified of all court hearings pertaining to child (parents, foster parent guardian ad litem, etc.)

q  Initial Case Plan

q  Case Plan Updates

q  Order Approving Case Plan

q  Judicial Review Social Study Report(s)

q  Judicial Review Order(s)

q  Judicial Determination Order with “Reasonable Efforts to finalize Permanency Plan” language (12 months from removal (Dated:__________)

q  Subsequent Judicial Determination order of “Reasonable Efforts to finalize Permanency Plan” (Dated:___________)

q  Petition for TPR

q  TPR Order on all parents

 

Licensing Documentation:

q  Placement History with copies of provider license for each placement

q  If applicable, Child-placing agency license

q  Criminal Background Screenings

q  National/Federal: (Date completed:___________)

q  State: (Date completed:_____________)

q  Local: (Date completed:_____________)

 

Generic Documentation:

q  If applicable, notarized Designation of Client Money and Property (CF-FSP 5222) and monthly or quarterly transactions/balance statements

q  Payment History (ICWSIS)

q  HomeSafenet Eligibility input

 

 


Chapter 4

 

PUBLIC ASSISTANCE

 

4-1.  Overview of Program Requirements.  [42 U.S.C. 606(a), 607 in effect on July 16, 1996, 672]

 

a.  Title IV-E program requirements are similar in many respects to those of the former Aid to Families with Dependent Children (AFDC) program.  A child’s eligibility will be based on Florida’s Title IV-A State Plan in place on July 16, 1996.  However, there are certain important differences in these two programs, which will be discussed in this chapter.  (Also see paragraph 4-3b of this operating procedure for a comparison of the specific factors for AFDC and Title IV-E.)

 

b.  In order for the state to receive Title IV-E funding, the child in out-of-home care must meet eligibility criteria discussed in Chapter 3 of this operating procedure and certain AFDC related technical and financial requirements at the time of removal.

 

NOTE:  The AFDC policy also applies to Title IV-E adoption assistance.

 

4-2.  The Role of Economic Self-Sufficiency Services and CW/CBC in Determining Title IV-E Eligibility.  [42 U.S.C. 606, 607, 672; ACYF-CB-PI-97-01]  The Title IV-E eligibility program is jointly administered by the CW/CBC Program Office and Economic Self-Sufficiency Services Program Office. The CW/CBC staff is responsible for collecting and documenting all necessary information and the Child-In-Care (CIC) Economic Self-Sufficiency Specialist (ESS) is responsible for making an eligibility determination based on the information provided by the CW/CBC staff.

 

            a.  The responsibilities of Zone/Region/District CW/CBC staff include:

 

(1)  Completion of the Child in Care Medicaid and Title IV-E Application (CF-ES 2626A) to document eligibility factors for each child entering licensed out of home care.  The information collected for Title IV-E is based on the child’s removal home circumstances.  CW/CBC staff shall attach the following information to the completed form:

 

                                    (a)  The Declaration of United States Citizenship/Qualified Non-Citizen Status form (CF-ES 2058).

 

                                    (b)  A copy of any documentation of qualified non-citizen status, and any other available information which would assist the economic self-sufficiency specialist (ESS) in determining the child’s eligibility, as necessary.

 

                        (2)  Submission of the application and supporting documentation to the appropriate CIC-ESS for an eligibility determination.

 

                        (3)  Forwarding the Eligibility Review and Communication Worksheet with information that will affect ongoing eligibility to the CIC-ESS when complete or partial eligibility determinations are due.

 

            b.  The responsibilities of Zone/Region/District CIC economic self-sufficiency staff include:

 

                        (1)  Determination of the child’s initial eligibility for Title IV-E funding and Medicaid within the established cash assistance application time standard.

 

(a)  The child’s eligibility will be determined by a CIC-ESS using the Child in Care Medicaid and Title IV-E Application.  This form is specifically designed to capture the information necessary to process a Title IV-E eligibility determination using a paper referral process rather than the traditional interactive interview process.  Cases processed by the CIC-ESS are put in a “confidential” caseload and access (including inquiry) is restricted to the assigned CIC worker, the back-up worker(s), the unit supervisor and designated zone/region/district and central office staff.

 

(b)  Once the eligibility process has been completed by the CIC-ESS, the CW/CBC staff will be notified via a written Notice of Case Action of the disposition of the child’s application or a request for additional information.  Under the FLORIDA system, the shelter, Foster/Adoptive Parent address  should be listed on AICI so all Florida Medicaid Management Information System (FMMIS) notices and  the Medicaid card will be sent to the address of the shelter or foster home where the child resides.  The only exception to this is if the child resides in a hospital, in which case the notices as well as the Medicaid card will be sent to the CW/CBC staff who completed the application.

 

                        (2)  Determination of child’s continuing eligibility for Title IV-E and Medicaid through complete reviews, and scheduled and unscheduled partial reviews;

 

                        (3)  Maintenance of a separate case record which contains complete information needed to establish eligibility for the program; and,

 

(4)  Communication with the CW/CBC staff when additional information is needed to establish the child’s eligibility; and following up such request with the appropriate CW/CBC unit supervisor if this information is not received within 10 days.

 

                        (5)  Completion of exparte reviews and application of continuous Medicaid policy when appropriate.

 

(6)  Initiation of any action upon learning of the change independently; the CIC-ESS must act on the information and request additional information from CW/CBC as appropriate.  A Notice of Case Action will be sent to CW/CBC advising of the changes and reason(s) for the change.

 

                        (7)  Re-construction of eligibility when a Title IV-E eligibility determination was not previously processed.

 

4-3.  Eligibility Determination.  [P.L. 104-193; P.L. 105-33; 42 U.S.C. 670, 672, 673]

 

a.  Initial Eligibility Determinations by Economic Self-Sufficiency Services.  The CIC-ESS must determine initial eligibility for Title IV-E and Medicaid.  If the assistance group is found to be ineligible at a later date and time, CW/CBC shall be informed in writing within 10 days.  The process for determining Title IV-E eligibility is two fold:

 

(1)  Eligibility of the Family.  The CIC-ESS determines if the family (including the child) met the AFDC eligibility requirements in effect on July 16, 1996 at the time of the child’s removal or voluntary placement in licensed out of home care.  To build a Title IV-E case, the child’s family information, as it is recorded on the Child In Care Medicaid and Title IV-E Application is added to the child’s FLORIDA case.

 

                                    (a)  If eligibility of the family cannot be established, the application for Title IV-E must be denied.

 

(b)  The FLORIDA system is used by the CIC-ESS to process this information employing the AFDC cash assistance standard filing unit policies and cash assistance technical and financial eligibility criteria. Both the child and the family are assessed for AFDC eligibility.

 

                        (2)  Eligibility of the Child.  If the family meets the technical and financial eligibility requirements, the child’s individual eligibility must be determined

 

                                    (a)  If eligibility of the child is established, the application shall be approved.  See paragraph 3-4a(1) on what actions to take when the application is approved.

 

                                    (b)  If eligibility of the child cannot be established, the application is denied.  See paragraph 3-4a(2) for further information on what actions to take when Title IV-E is denied.

 

(3)  Eligibility of the Minor Parent and His/her Child(ren).  When the minor parent retains custody of his/her child(ren) and the child(ren) remains in the same home as the minor parent, the board payment to the foster parent is increased to cover the needs of the minor parent’s child(ren).  The eligibility of the minor parent’s child(ren) is not a condition of the increased payment.  It is the parent’s eligibility that allows this increase to meet the minor parent’s child(ren)’s needs.  Only the income and assets of the minor parent are counted.

 

NOTE:  If the minor parent is not Title IV-E eligible, he/she has an option of including the child(ren) on the CIC case for Medicaid coverage or applying for cash assistance and Medicaid assistance for the child(ren).  The CIC-ESS will determine the child(ren)’s eligibility for cash assistance with information provided by CW/CBC staff.  Caution must be used in these cases to ensure that CW/CBC is not providing an enhanced payment to the foster parent to compensate for the additional costs to the foster parent.  The CIC-ESS shall consult with CW/CBC prior to authorizing cash assistance.

 

            b.  Comparison of the Temporary Cash Assistance(TCA)and Title IV-E Application Process.  Refer to the following chart for a comparison of the AFDC cash assistance and Title IV-E application process.

 

COMPARISON OF AFDC CASH ASSISTANCE AND TITLE IV-E

ADMINISTRATIVE

FACTOR

TCA

TITLE IV-E

Application Form

 

ACCESS Application form or web based application Completed by the Primary Information Person (PIP) and signed by PIP.

 

Processed on the FLORIDA system by an ESS. 

 

CIC Medicaid and Title IV-E Application (2626a) completed by CW/CBC staff.

 

The CIC-ESS processes the CIC Medicaid and Title IV-E Application using the FLORIDA system.

 

Declaration of Citizenship (form CF-ES 2058)

 

Included on the application form.

Form completed by CW/CBC staff.

 

Face-to-Face Contact

 

Face-to-Face contact required with payee or authorized representative, unless waived due to hardship.

 

Same for family and child: 
No face-to-face contact with the family, child or foster parent.  No face-to-face interview required with CW/CBC.  All case processing is done from the CIC Medicaid and Title IV-E Application.  All contacts with family, child, and foster parent made by CW/CBC.

 

Application Time Standard

 

45 days from the date of application.

 

Same.

Date of Entitlement

 

The date of entitlement for cash assistance is the date of authorization or 30 days from the date of application, which ever is sooner.

 

The date on which the state becomes entitled to federal reimbursement.  The date of entitlement may be as early as the date of the removal if all eligibility criteria are met including appropriate wording on the removal court order.

 

Additional Information Needed

 

Requested from the payee and, if not provided application is rejected.

 

The CIC-ESS requests in writing or telephones the CW/CBC staff to obtain the required information.

 

If CW/CBC does not reply within 15 days of the request for additional information, the CIC-ESS must contact the CW/CBC staff supervisor to obtain the information.

 

If required information cannot be obtained, the application must be rejected.  However every effort must be made to determine the child’s eligibility.

 

Complete Eligibility Reviews

Processed every 6 or 12 months depending on the case type.

 

Processed every 12 months. 

 

Ten Day Notice Requirement

 

A person receiving assistance must be given or mailed written notification 10 calendar days in advance of action to cancel or reduce the cash assistance grant.

 

The 10-day adverse action notice requirement does not apply.

 

The CIC-ESS must notify CW/CBC in writing promptly, but no later than 30 days, of any months in which ineligibility or reduction in the funding rate occurs even if retroactive.  The IV-E claim for applicable months will be adjusted by CW/CBC.

 

Complete Eligibility Review Form

 

The payee completes an ACCESS or web based application.   

 

The CW/CBC counselor completes the Eligibility Review and Communication Worksheet (2694) or CIC Medicaid and Title IV-E Application form (2626a).  No face-to-face contact is required with the counselor.

 

Any changes in the income, assets or placement status of the child must be reported within 10 days.

 

The CW/CBC staff must notify the CIC-ESS when the judicial determination for Reasonable Efforts to Finalize the Permanency Plan (REFPP) is overdue.

 

Note: The child becomes ineligible for Title IV-E beginning the month after the REFPP is due.

 

The family situation is reviewed only to the extent that deprivation must continue to exist.

 

 


SPECIFIC TECHNICAL ELIGIBILITY CRITERIA

FACTOR

TCA

Title IV-E

Age

 

Children must be under 18 years of age or under age 19 and a full time student in a secondary school or it’s equivalent. 

 

Children must be under 18 years of age.

Residence

 

Assistance group must reside in Florida and intend to remain

 

The child resides in a licensed setting.  Florida residence requirements do not apply.  Child may be placed in out-of-state foster home.  The state of residence is responsible for Medicaid for a Title IV-E child.

 

Citizenship

 

Each individual must be:

 

U.S. citizen, or

 

a qualified /eligible non-citizen according to current TANF policy.  (NOTE: This criteria does not apply to children whose initial adoption

assistance agreement was signed prior to August 22, 1996.)

 

Same

 

Filing Unit

Siblings and parents of the child living in the home must be included in the assistance group, if otherwise eligible.

 

Each child is a separate filing unit.

 

Living in the Home of a Parent or Other Specified Relative

 

Child must reside in the home of a parent or other relative within the specified degree of relationship during the month of application and thereafter.  Refer to CFOP 165-22, Chapter 1400.  Child born to a mother who was incarcerated or does not plan to bring the baby home from the hospital is not eligible.

 

Child must have resided in and was removed from the home of a parent or other specified relative.

 

Child born to mother who was incarcerated or does not plan to bring baby home from hospital is considered to be living in the home of the parent and potentially eligible.

 

Deprivation

 

Refer to Attachment 2 to Chapter 4.

 

Child(ren) must be deprived of support or care of one or both parents due to death, incapacity, unemployment, continued absence because of divorce, separation, or desertion.

 

Deprivation based on unemployment is determined if the parents have countable income less than the payment standard.

 

Deprivation does not exist if parents reside together, even if apart from the child unless they meet the factor of incapacity, unemployment, desertion, legal prohibition against living with child or one or both parents cannot legally enter the U.S. 

 

Child must be deprived of support or care of one or both parents due to death, incapacity, unemployment, or continued absence because of divorce, separation or desertion.

 

Deprivation based on unemployment is determined using unemployed principal wage earner and hours work criteria, based on the pre-1996 AFDC state plan.

 

Must look at home of specified relative in which child was living at the time the child was removed from the home.  If one or both parents were absent from that home, deprivation exists.  This occurs even if parents reside together, but apart from the child.

 

If the Department has permanent commitment (TPR) of the child, deprivation is met by law.

 

Welfare Enumeration

 

Each member of the assistance group must provide Social Security Numbers or proof of application for a Social Security Number.

 

Child:  The CW/CBC staff must provide the child’s Social Security Number or proof of application for the number.  (A Medicaid requirement.)

 

Employment and Training

 

Individuals who do not meet one of exemptions listed in CFOP 165-22, Chapter 1400, must be referred to employment and training.

 

Not applicable.

 

Filing Unit

 

Siblings and parents of the child living in the home must be included in the assistance group, if otherwise eligible.

 

Family:  Same as cash assistance.

 

Child:  Each child is separate filing unit (even if siblings reside in the same foster home).

 

Child Support Enforcement

 

The payee must provide information to the ESS regarding the absent parent(s) and cooperate in establishing paternity, support, etc. unless good cause exists (see CFOP 165-22, Chapter 1400).

 

CSE determines good cause.

 

CW/CBC staff completes the absent parent information on the CIC Medicaid and Title IV-E Application.

 

Information provided by CW/CBC on the absent parents is available on FLORIDA for Child Support Enforcement’s action.

 

Good Cause: Same as cash assistance.

 

 

FINANCIAL ELIGIBILITY

FACTOR

TCA

Title IV-E

Asset Limit

 

$1000 for assistance group (AG).

 

Family and Child:  Cannot have combined value over $10,000.

 

Child:  Assets must be less than $10,000.

 

NOTE:  Money or properties in a master trust account or sub-account is not counted towards the asset limit.  Refer to CFOP 175-59.

 

Income

 

All earned and non-earned income is counted unless specifically excluded or disregarded. Non recurring lump sum payments are included assets in the month of receipt unless specifically excluded.

 

Family:  Same, except ineligibility on lump sum in month of initiation of court action results in a Title IV-E ineligible determination.

 

Child:  Only income actually received by or available to the child can be considered in the budget.  The income of the child’s parents and relative is not considered.

 

State collected child support or money collected by Fee Collections is not counted.  (Considered unavailable.)

 

Lump Sum ineligibility period is the number of months the child is ineligible based on dividing the lump sum income by the board rate.  Any remainder must be counted in the first month that eligibility resumes.

 

Budgeting

Prospective budgeting used.

 

Countable income with certain disregards must be less than the cash assistance payment standard.

 

Difference between payment standard and net countable income is amount of grant.

 

Family:  Countable income with a $90.00 earned income disregard must be less than July 16,1996 cash assistance consolidated need standards.

 

Child:  Use prospective budgeting.

 

Child’s gross income cannot exceed 185% of the child’s board rate.

 

 

            c.  Actions to Take When Initial Eligibility or Ineligibility Is Established.  Refer to the following chart to determine what actions are necessary when eligibility or ineligibility for Title IV-E benefits is determined.

 

When the application is:

 

            Then the CIC-ESS

Denied

Continues to process the case through the FLORIDA system, which is programmed to automatically assess the child’s eligibility for Medicaid as a Non-Title IV-E child.

 

Records all actions taken on the case in the running records comment screen (CLRC) on FLORIDA and fully explains the reason for IV-E denial.

Approved

Approves the assistance group and sends the manual Notice of Case Action to the CW/CBC unit informing of case disposition.

 

NOTE:  FLORIDA schedules the review at 12- month intervals

 

4-4.  Complete Review of Eligibility.  [42 U.S.C. 606(a), 607, 672]

 

a.  When the Complete Review of Eligibility Is Scheduled on IV-E Cases.  Once the initial determination of eligibility is completed, the eligibility of the family is not considered except in determining that deprivation continues to exist (unless the department has permanent commitment of the child).  However, continued eligibility of the child must be reviewed at 12-month intervals.  The due date of the complete review is computed based on the month the last complete review or application approval was done.  This review must be completed by the last day in the month for which it is scheduled. 

 

            b.  Factors of Eligibility That Must Be Reviewed. 

 

(1)  Eligibility requirements on the factors of continued deprivation, income, assets, and eligible placements apply as in the Title IV-E application process. The child’s income and assets are to be counted only.  However, there are some differences as discussed in paragraph 4-4c below.

 

(2)  Additionally, at the time of the annual eligibility review the child’s continued IV-E eligibility will also be based on whether a timely judicial determination (court order) that “reasonable efforts to finalize the permanency plan” (REFPP) have been made.  The initial REFPP finding is due within twelve months of the child’s removal from home; subsequent findings are due every twelve months thereafter as long as the child is in out of home care.  When such findings are not made timely, the child becomes ineligible for Title IV-E beginning with the thirteenth month and remains ineligible until the REFPP finding is made.

 

            c.  Comparison of the TCA  and Title IV-E Review Process.  The following chart compares the cash assistance and Title IV-E review process and explains the differences.

 

PROCESSING COMPLETE ELIGIBILITY REVIEWS - A COMPARISON

ADMINISTRATIVE

FACTOR

TCA

Title IV-E

Face-to-Face Contact

 

May be required annually.

 

No face-to-face contact required.

 

CW/CBC reports any changes in the child’s situation on form CF-ES 2694 that may  include:

    -Board Rate

    -Income and assets of the child

    -Any other changes in family status affecting eligibility (for example:  permanent commitment of the child to the department; or parents reunite and live together in the family setting in which the child was living at the time of removal from the home).

 

Additional Information Needed

 

Request from payee and, if not provided, cancel case.

 

The CIC-ESS requests in writing or telephones the CW/CBC staff to obtain the required information.

 

If the CW/CBC staff person does not reply within 10 days of request, PAS Supervisor contacts the CW/CBC Unit Supervisor to obtain the required information. 

 

Ten Day Notice Requirement

 

A person receiving assistance must be given or mailed written notification ten calendar days in advance of action to cancel or reduce the cash assistance grant.  This is done automatically by the FLORIDA system.

 

The 10-day notice requirement does not apply.

 

The CIC-ESS must notify the CW/CBC staff of any months in which ineligibility occurs even if retroactive.  The CW/CBC staff will adjust the Title IV-E claim for the applicable month.

 

 

TECHNICAL FACTORS

FACTORS

TCA

Title IV-E

Deprivation

Child(ren) must be deprived of support or care of one or both parents due to death, incapacity, unemployment, underemployment  or continued absence because of divorce, separation or desertion.

 

The IV-E child must be deprived of the support or care of one or both parents due to death, incapacity, unemployment, underemployment or continued absence because of divorce, separation or desertion.

 

 

Deprivation does not exist if parents reside together, even if apart from the child, unless they meet the factor of incapacity, unemployment, desertion, legal prohibition against living with the child; or one or both parents cannot legally enter the U.S. as specified in CFOP 165-22, Chapter 1400.

 

Regarding the family setting in which child was living at the point of removal from the home, if one or both parents are absent from that family setting, deprivation exists.  If parents reunite and live together, the child may become ineligible on the factor of deprivation.  However, if the parents reunite and deprivation is found to exist due to the incapacity or disability (SSI) of one or both parents, the child remains Title IV-E eligible.

 

 

 

If the department has permanent commitment of the child, deprivation is met.

 

The case is ineligible for IV-E for any months in which deprivation does not exist.

 

 

            d.  Actions to Take When Changes Occur In An Active Case.

 

WHEN the child

 

            THEN the CIC-ESS

is no longer Title IV-E eligible

Continues to process the case through FLORIDA and assess his/her eligibility for Medicaid as a non-title IV-E child.

 

Records all case actions on the running record comment screen (CLRC) and fully explains the reason for the IV-E cancellation.

Remains Title  IV-E eligible after a change occurs

Authorizes the change on FLORIDA.  A manual Notice of Case Action is sent to CW/CBC unit, advising of the child’s continued eligibility and the effective date.

 

Records all case actions on the running record comment screen (CLRC) and fully explains the reason for the change.

 

4-5.  Partial Eligibility Reviews.

 

            a.  Partial reviews of eligibility are completed when there are changes in the child’s situation affecting a factor of Title IV-E eligibility.  Examples of changes affecting Title IV-E eligibility include:

 

                        (1)  Placement into an unlicensed or provisionally licensed setting.

 

                        (2)  Child moves into ineligible living arrangement.

 

                        (3)  Child turns age 18.

 

                        (4)  Child’s parents begin living together in the same family setting in which the child was living at the time of the child’s removal from the home or voluntary placement.

 

                        (5)  Child’s income changes.

 

                        (6)  Child receives countable assets.

 

                        (7)  Child is discharged from foster care.

 

            b.  Partial reviews may be scheduled or unscheduled.  The CIC-ESS schedules a partial review on the Expected Change screen (AWEC) when aware of an anticipated change that may affect eligibility.

 

4-6.  Reviewing Eligibility of the Child  When There is a Temporary Break in Licensed Out of Home Care Placement.  [42 U.S.C. 671(a)(15), 672(a)(1)]  When a child temporarily leaves licensed foster care, then returns to a licensed out of home care placement, certain factors must be assessed to determine if the child’s return to licensed foster care is a continuation of the most recent removal episode OR is this a new removal.

 

            a.  In making this decision, the CIC-ESS determines the following based on information supplied by CW/CBC staff or contracted agent:

 

                        (1)  Is the child in licensed foster care?

 

            (2)  Is the original court order or voluntary licensed placement agreement still in effect in relation to the removal of the child from his/her home?

 

                        (3)  Is the child still under the placement and care responsibility of the department?

 

            b.  If all of these conditions are met, even though there has been a temporary interruption of the foster care placement, the eligibility of the child (for the removal month) should not be reviewed.

 

c.  If the child leaves out of home care and returns home (the home from which he/she was removed), the child is not considered to be in foster care status, even if the department maintains a supervisory role with the child and family.  In the event the child returns, but is later returned to foster care, a new determination of the child’s eligibility based on circumstances at the time of the new removal is required.

 

            d.  If the child leaves out of home or foster care to live with a relative:

 

                        (1)  The CIC-ESS must determine based on information from CW/CBC or contracted agent whether:

 

                                    (a)  The child remains in foster care status; or,

 

                                                                        (b)  Whether the home of the relative is now considered to be the child’s own home.

 

(2)  If it is determined that the child is still in foster care status, this is considered as a continuation of the removal episode, therefore the child’s eligibility status may remain the same.  If permanency has been achieved with the relative, a new determination of the child’s eligibility based on circumstances at the time of the new removal is required.

 

            e.  Trial home visits to a child’s home are not considered interruptions in the foster care status, unless the “trial home visit” lasts for more than six months without a court order extending the visit.

 

f.  If the child leaves the foster home and is placed in a state training school for a temporary period, and the removal court order is still in effect, a new determination of the family’s eligibility is not required when the child returns to the foster home.

 

NOTE:  When there has been a break in licensed foster care placement and child is being evaluated for continued IV-E eligibility status a determination must be made regarding licensing status of placement continued deprivation and financial need, and REFPP finding.

 

4-7.  Medicaid Eligibility for Title IV-E Children – General Policies and Procedures.  [42 U.S.C. 672(h), 673(b)(1)(B)(2)]  Children eligible under Title IV-E are “deemed” eligible for Medicaid.  The FLORIDA category for Title IV-E benefits is CICF; the related Medicaid category is MCFE.

 

            a  Initial Eligibility Determination by Economic Self-Sufficiency Services.

 

                        (1)  The responsibility of CW/CBC staff include:

 

                                    (a)  Requesting an eligibility determination by submitting the Child in Care Medicaid and Title IV- E Application to the CIC-ESS in the appropriate public assistance unit.

 

                                    (b)  Routing the completed CIC Eligibility Review and Communication Worksheet to the CIC-ESS worker indicating a change from emergency shelter to foster care in the child’s placement.

 

(c)  Annotating any other information on the CIC form that has changed since the Child in Care Medicaid and Title IV-E Application was last completed (i.e., demographic data, date of birth, absent parent information, etc.) and route to CIC-ESS staff.

 

                        (2)  The responsibilities of zone/region/district CIC ESS staff include:

 

                                    (a)  Determining  the child’s eligibility for the Title IV-E and Medicaid benefits.

 

(b)  Completing whatever steps are necessary to place the child on the FLORIDA system and authorize the Medicaid immediately upon notification that the child is in licensed out-of-home care.

 

                                    (c)  Entering the information on FLORIDA for use by Child Support Enforcement.

 

                                    (d)  Instituting Systematic Alien Verification Eligibility (SAVE) requirements for all non-citizen children in care of the department.

 

            b.  Medicaid Eligibility of Title IV-E Children Placed in Another State by Florida.  Federal regulations under the Consolidated Omnibus Reconciliation Act of 1985 (COBRA) require that the board payments for the department’s children placed out of state be paid by Florida.  However, the Medicaid must be paid by the receiving state.  The CIC-ESS determines eligibility for these children and notifies CW/CBC via a manual notice of the child’s eligibility for Title IV-E.  No Florida Medicaid card is generated for these children since the CIC-ESS indicates on the ACFC screen that the child has been placed in another state.  The state in which the child resides is responsible for generating Medicaid coverage for the child.

 

            c.  Medicaid Eligibility for Title IV-E Children Placed in Florida by Another State.

 

(1)  Federal regulations under the Consolidated Omnibus Reconciliation Act of 1985 (COBRA) require that Medicaid benefits be paid by the receiving state.  FLORIDA allows Medicaid eligibility for these children while providing no coverage under Title IV-E.  The FLORIDA ACFC screen collects information regarding the child’s Title IV-E placement in Florida by the other state.  No independent evaluation of the child’s eligibility is made.  The CIC-ESS will issue a Florida Medicaid card based on the sending state’s determination of child’s Title IV-E status.

 

(2)  A child does not have to reside in a licensed placement to be Medicaid eligible.  According to Child in Care policy, children who are eligible for Title IV-E are “deemed” recipients for Medicaid and no independent Medicaid determination is made.  Therefore, when the department or an agency becomes aware that a Title IV-E child has been placed in an unlicensed foster home in Florida, Medicaid for the child should be authorized with no independent evaluation.

 

(3)  In these cases, it is possible that the request for Medicaid may be made directly by the foster parent, a letter from the sending state, or through a request by the Interstate Compact liaison.  The CIC-ESS must take whatever steps are necessary to place the child on FLORIDA and authorize the Medicaid immediately upon notification that the child has entered the state.

 

            d.  Retroactive Medicaid Eligibility.  Refer to CFOP 165-22, Chapter 2000 for policies and procedures regarding retroactive Medicaid eligibility.

 

e.  Exparte Determination.  An exparte determination is the process by which the Medicaid eligibility of an assistance group or individual who is no longer under a particular coverage group is assessed to determine if eligibility exists under a different coverage group.  Refer to CFOP 165-22, Chapter 1200, Section 1235.00, Exparte Determinations.

 

4-8.  Medicaid Eligibility for Non-Title IV-E Children.  [409.903, F.S.]  If the child is ineligible for Title IV-E, then the child fails to meet eligibility requirements for the related Medicaid coverage (MCFE) on FLORIDA.  However, the FLORIDA system automatically processes eligibility for the next possible Medicaid coverage group in the “hierarchy” which is Medicaid for a non- IV-E child.  The FLORIDA code for this coverage group is MCFN.

 

            a.  The specific technical eligibility criteria for this Medicaid coverage group are:

 

                        (1)  Age.  The child must be under 21 years of age and not emancipated.

 

                        (2)  Residence.  The child resides in a licensed facility.

 

(3)  Citizenship.  U.S. citizen or a qualified/eligible non-citizen.  CW/CBC must complete a Declaration of Citizenship (form CF-ES 2058) and forward it to the CIC unit with the CIC-Medicaid and Title IV-E Application.  The CIC-ESS institutes SAVE requirements for all non-citizen children in care of the department.

 

(4)  Deprivation.  Not applicable.

 

(5)  Living in the Home of a Specified Relative.  Not applicable.

 

                        (6)  Filing Unit.  Each child is a separate filing unit.

 

(7)  Welfare Enumeration.  The child’s Social Security Number or CW/CBC statement that the application for a Social Security Number was filed and the date filed.

 

(8)  Child Support Enforcement.  CW/CBC must provide the CIC-ESS with information on the absent parent(s).  The CIC-ESS enters the information on FLORIDA for use by Child Support Enforcement.

 

            b.  Financial eligibility requirements for this Medicaid coverage group are:

 

(1)  Assets.  All assets count unless specifically excluded by policy in CFOP 165-22, Chapter 1600.  The CW/CBC staff are responsible for obtaining the information verifying the assets.  The verified information must be filed in the child’s case file. 

 

NOTE:  Money or property in a child’s Master Trust account or subaccount is excluded as countable assets.

 

(2)  Income.  All income (earned and unearned) of the child counts unless specifically excluded or disregarded by policy in CFOP 165-22, Chapters 1800 and 2600.  The CW/CBC staff or contracted agent is responsible for obtaining the information verifying income.  The verified information must be filed in the child’s case file.  NOTE: State collected child support or money collected by fee collections is considered unavailable and is not counted.

 

            c.  Income and asset limits by Medicaid coverage group are as follows:

 

            (1)  Medicaid for Non-Title IV-E Children in Foster Care (MCFN).  The child’s income must be below the current federal poverty level.  There is no asset test for this Medicaid group.

 

                        (2)  Medicaid under MEDS (MMI or MMC).  The child’s income must not exceed the current poverty level for the applicable age group.  There is no asset test in MEDS.

 

(3)  Medicaid Eligibility Under Medically Needy (NCFN).  FLORIDA supports this coverage group if the child is in FLORIDA living arrangement code 28, foster care status.  If the child’s income exceeds the income limit, the child is enrolled in Medically Needy with a share of cost.  The share of cost is the difference between the child’s adjusted income and the income limit for Medically Needy.  See CFOP 165-22, Chapter 2000.

 

d.  Medicaid Eligibility for Non Title IV-E Children Placed in Florida by Another State.  When a Non Title IV-E child is placed in Florida by another state the sending state is responsible the child’s Medicaid coverage.  Refer to CFOP 165-22, Chapter 1400, Section: 1415, Residency (1415.05.15 Interstate Placement (CIC).

 

e.  Exparte Determination.  An exparte determination is the process by which the Medicaid eligibility of an assistance group or individual who is no longer under a particular coverage group is assessed to determine if eligibility exists under a different coverage group.  Refer to CFOP 165-22, Chapter 1400, Section: 1414, Residency (1415.05.15 Interstate Placement (CIC).

 

4-9.  Independent Living.  [CFOP, 175-81, Subsidized Independent Living]  Subsidized Independent Living is a program for foster children age 16 or 17 who demonstrate an ability to handle independence.

 

            a.  The criteria for subsidized independent living as specified in s. 409.1451(3)(c), F.S., include:

 

                        (1)  Adjudicated dependent under chapter 39, F.S.;

 

                        (2)  Placed in licensed out of home care for at least 6 months prior to entering subsidized independent living;

 

                        (3)  Permanency goal of adoption, independent living, or long-term licensed care; and,

 

                        (4)  Is able to demonstrate independent living skills, as determined by the department/CBC, using established procedures and assessments.

 

b.  Medicaid is available for youth in the Subsidized Independent Living Program.  The Independent Living Grant is not considered income in determining the child’s eligibility for Medicaid.  Eligibility for Medicaid mirrors that of any other foster care child.

 

c.  Services for young adults formerly in foster care are described in s. 409.1451(5), F.S.  The law describes eligibility requirements and the service array.  Young adults formerly in foster care who are recipients of the services described in 409.1451(5), FS, are also eligible for Medicaid benefits.

 

 

 


CONSOLIDATED NEEDS STANDARD

 

SIZE

 

 

 

 

 

 

 

 

 

 

Eff.

7/96

7/95

7/94

7/93

7/92

7/91

7/90

7/89

7/88

6/87

1

645

623

614

581

568

552

524

498

480

458

2

864

836

820

786

766

740

702

668

644

617

3

1082

1050

1027

991

965

928

880

838

807

775

4

1300

1263

1234

1196

1163

1117

1059

1008

970

933

5

1519

1476

1440

1401

1361

1305

1237

1178

1134

1092

6

1737

1690

1647

1606

1560

1493

1415

1348

1297

1250

7

1955

1903

1854

1811

1758

1682

1594

1518

1460

1408

8

2174

2116

2060

2016

1956

1870

1772

1688

1624

1567

9

2392

2330

2267

2221

2155

2058

1950

1858

1787

1725

10

2610

2543

2474

2426

2354

2247

2129

2028

1950

1883

ADD*

218

214

207

205

199

188

179

170

163

158

 

*  For each additional member beyond 10 add this amount to the Consolidated Need Standard.

 

 

Revised December, 1997

 

 

 


Deprivation of Parental Care

 

One of the Title IV-E Foster Care eligibility factors is parental “deprivation”. The child must be deprived of the support or care of one of both parents.  Deprivation of parental support or care may exist in any of the following situations:

 

·          Parental absence from home

·          Parental unemployment or underemployment

·          Parental incapacity

 

Parental Absence from home may be due to any of the following:

·          Death

·          Separation or divorce

·          Desertion

·          Incarceration

 

-           If child is living with a relative at the time of removal, and one or both parents were absent from that home deprivation exists, even if the parents reside together in another location.

 

-           If the department has permanent custody as a result of termination of parental rights of the child, this factor is met.

 

Parental unemployment or underemployment

One parent must be determined to be the principal wage earner, i.e. the parent who earned the greater amount of income in the 24-month period prior to the child’s removal from the home.  The principal wage earner must also have sufficient work history – has worked six or more quarters within the last 13 calendar quarters.

 

-           Unemployment = not working

-           Underemployment = working less than 100 hours per month

 

Parental incapacity (of one or both parents):

 

Incapacity is established by one of the following:

 

·          Receipt of Social Security Disability (SSDA) or Supplemental Security Income (SSI) benefits on the basis of disability or blindness.

 

·          Parent has an emotional or psychological condition that prevents them from working or providing appropriate care and ensuring safety for their child.  Must have a psychological evaluation for documentation of this condition.

 

Documentation of incapacity:

 

       Parent has an illness or injury that lasts for at least 30 days.  Must have written verification from a medical professional describing the illness/injury and the expected length of time that it would take to resolve the problem.

 

Information for determining incapacity must be provided to the child in care specialist for a determination of incapacity (Medical Evidence for Incapacity – CFOP 165-22, 1430.20.50.50):  Medical sources of information for determining incapacity include hospitals (medical or psychiatric), Social Security Administration, Veteran’s Affairs Administration, Vocational Rehabilitation and/or Chiropractor.

 

 


*(See also, FAC 65C 16.013)

 

Chapter 5

 

ADOPTION SERVICES

 

5-1.  Title IV-E Federal Adoption Assistance.  [P. L. 96-272; P. L. 104-188; P. L. 105-89; 42 U.S.C. 673]

 

a.  Public Law 96-272, the Adoption Assistance and Child Welfare Act, provides federal matching funds for adoption assistance under Title IV-E of the Social Security Act.  The Title IV-E Adoption Assistance Program is for children with special needs who meet eligibility requirements for Aid to Families with Dependent Children (AFDC) or the Supplemental Security Income (SSI) program.  The federal adoption assistance program was designed to assist states in placing special needs children in adoptive homes, thereby achieving permanency for more children and reducing states’ foster care caseloads. 

 

b.  Under this program, the state of Florida provides maintenance adoption subsidy payments for special needs children and reimbursement to adoptive parents for non-recurring expenses incurred in the adoption process such as court costs and attorney fees.  All applicable non-recurring expenses are Title IV-E reimbursable regardless of the child’s IV-E eligibility status.

 

            c.  A child receiving Title IV-E maintenance adoption subsidy is categorically eligible for Medicaid coverage.

 

            d.  Maintenance adoption subsidy payments to the adopting parents and Medicaid benefits for the child become available at the point that the adoption assistance agreement is signed and the child is placed in the adoptive home.

 

e.  Public Law 104-188 added a State Plan requirement to the Social Security Act (section 471(a)(18) that prohibits the delay or denial of a foster or adoptive placement based on the race, color or national origin of the prospective foster or adoptive parents or the child involved.  The Social Security Act also includes a penalty structure and corrective action planning provision for violations. See Chapter 2 of this operating procedure.

 

f.  Public Law 105-89, the Adoption and Safe Families Act of 1997, requires states to assure the development of plans to make reasonable efforts to finalize the permanency plan for children and the effective use of cross-jurisdictional resources to facilitate timely permanent placements for children awaiting adoption.  When it is discovered that a state with responsibility for handling a case has denied or delayed the placement of a child for adoption when an approved family is available outside of its jurisdiction, the state is considered to be in violation of the provisions of the law and may be subject to penalties.  See Chapter 2 of this operating procedure.

 

g.  Public Law 105-89 also included a safety provision for children placed in foster and adoptive homes.  The provision requires that the department conduct a criminal records check on prospective adoptive parents prior to approving the adoptive family placement for a child.  This provision became effective October 1, 1998.  Also see Chapter 65C-16, Florida Administrative Code.

 

5-2.  Universal Title IV-E Eligibility Requirements.  [42 U.S.C. 673, 409.166, F.S., 65C-16, F.A.C.]  The Title IV-E adoption subsidy program has specific eligibility requirements that must be met prior to claiming federal reimbursement.  The requirements include the following:

 

a.  It must be determined that the child is one with “special needs” prior to the time the adoption petition is (was) filed.  The three criteria listed below must be met and be documented in the child’s file in order to meet the definition of a child with special needs:

 

                        (1)  A determination has been made that the child must not or cannot be returned to the home of the parents.  This is primarily accomplished through a Termination of Parental Rights (TPR) order; and

 

                        (2)  There exists a specific factor or condition that makes it reasonable to conclude that the child cannot be placed for adoption without providing adoption assistance.  The specific factors or conditions include a child who is:

 

                                    (a)  Eight years of age or older; or,

 

                                    (b)  Mentally retarded; or,

 

                                    (c)  Physically or emotionally handicapped; or,

 

                                    (d)  Of black or racially mixed parentage (at least one parent is black); or,

 

(e)  A member of a sibling group of any age, provided two or more

members of the group remain together for purposes of adoption; and

 

(3)  A reasonable, but unsuccessful, effort has been made to place the child with appropriate adoptive parents without providing adoption assistance.  Such an effort may include the use of adoption exchanges and referrals to specialized adoption agencies.  Exceptions to this requirement include: adoption by the child’s foster parent or relative caretaker due to the establishment of significant emotional ties to that foster parent/caretaker and other circumstances that are not in the child’s best interests.  However, the prospective adoptive parent(s) must be asked if they can adopt the child without provision of subsidy.  If the parent(s) respond that they cannot adopt without subsidy, the efforts to place without subsidy have been met. The specific factor(s) that make the child difficult to place and a description of the efforts to place a child without subsidy (or the exception) must be documented in the child’s case file.

 

            b.  Financial need of the child must be established.  The child cannot have more than $10,000 in total, countable assets; and the child’s income must be below 185% of the standard foster care board rate.

 

            c.  The child must be under the age of 18 years and not emancipated.

 

            d.  The initial adoption assistance agreement must be signed by all parties prior to the adoption finalization.

 

NOTE:  Initial requests for Title IV-E adoption assistance made after finalization of the adoption must be denied.  See paragraph 5-8 of this operating procedure.

 

5-3.  Categorical Eligibility Requirements for Title IV-E Adoption Assistance.  [ACYF-CB-PA-01-01]  In addition to the eligibility criteria listed in paragraph 5-2 of this operating procedure, a child must be eligible in one of the categories listed below.

 

a.  Child Meets Requirements For AFDC Eligibility (based on eligibility criteria in place on July 16, 1996).  When the child’s eligibility for adoption assistance is based on meeting the eligibility criteria for AFDC, his/her eligibility must be determined and documented at two intervals – at the time of the most recent removal from his/her home and at the time the adoption petition is filed.

 

NOTE:  While not a Title IV-E requirement, it is recommended that the child’s eligibility be confirmed and documented prior to child’s placement into the adoptive home.  An eligibility determination at this point ensures funding approval from the appropriate fund source.

 

                        (1)  Removal Circumstances.  The child’s latest removal from the home of a specified relative must be the result of a judicial determination (court order) or a voluntary placement agreement.

 

(a)  The court order removing the child from his/her home must be a judicial determination (order) to the effect that it was contrary to the child’s welfare (CTW) to remain in the home.  The CTW finding must be made in the first court order that removes the child from the home; when this does not occur the child is ineligible for Title IV-E adoption assistance.  The contrary to the welfare finding must be explicit and made on a case-by-case basis.  Nunc pro tunc orders, affidavits, and bench notes are not acceptable substitutes for a court order.  However, an official court transcript may be sufficient evidence that a “contrary to the welfare” judicial determination was made.

 

(NOTE:  For children whose most recent removal occurred prior to March 27, 2000, a petition must be filed with the court no later than six months from the date of the removal from a specified relative; the petition must be followed up with a court order indicating that it was contrary to the child’s welfare to remain in the home.)

 

                                    (b)  A child placed in licensed out-of-home care as the result of a voluntary placement agreement must have the following conditions met in order to be eligible for Title IV-E adoption assistance:

 

                                                1.  The child must be under the placement and care responsibility of the department or another public agency with which the department has a IV-E agreement.

 

                                                2.  Title IV-E foster care maintenance payments must have been made on his/her behalf.

 

                                                3.  When the child remains in foster care placement beyond 180 days, there must be a judicial determination made within the first 180 days of the voluntary placement agreement that it is contrary to the child’s welfare to return to his/her home.

 

                                    (c)  A child voluntarily relinquished for adoption is eligible for Title IV-E adoption assistance when the following conditions are met:

 

                                                1.  The child must be voluntarily relinquished to the department (or a public agency with which the department has a Title IV-E agreement) or to a private, nonprofit agency; and,

 

                                                2.  There is a petition to the court within six months of the time the child last lived with a specified relative; and,

 

                                                3.  There is a subsequent judicial determination (court order) to the effect that remaining in the home was contrary to the child’s welfare.  As such, the child will be treated as though s/he was judicially removed rather than voluntarily relinquished.

 

NOTE:  If the petition to remove the child from the home and the subsequent judicial determination do not occur, the child will not be considered judicially removed for the purpose of Title IV-E adoption assistance.  Furthermore, if the court merely sanctions the voluntary relinquishment, without making a determination that it is contrary to the child’s welfare to remain in the home, the child is not eligible for Title IV-E adoption assistance unless s/he meets the SSI criteria or is a child who received Title IV-E adoption assistance in a prior adoption.

 

(2)  Financial Need.  To meet the AFDC criteria, the child must be determined to be a “needy” child at the time of removal and at the time the adoption petition is filed.  Need exists at the time of removal if the resources available to the family are below $10,000 and if the family income is below the CNS for the family size.  After the child’s removal from the home, only the resources and income of the child are considered.  Hence, at the time the adoption petition is filed, the resources available to the child must be below $10,000 and the income must be below 185% of the foster care board rate.  Also see Chapter 4 to this operating procedure.

 

(3)  Deprivation.  Deprivation of parental support must be established at the time of removal and at the time the adoption petition is filed.  Deprivation exists in situations where there is an absent parent, an unemployed or underemployed parent, or a parent with a mental or physical incapacity to the extent that the parent cannot support or care for the child.  After a child has been determined to be deprived of parental support and care at the time of removal, the TPR order serves as documentation of deprivation at the time of the petition for adoption.  Also see Attachment 2 to Chapter 4 of this operating procedure.

 

b.  Child Is Eligible For Supplemental Security Income (SSI) Benefits.  A child is eligible for Title IV-E adoption assistance if s/he has been determined eligible for SSI prior to the time the adoption petition is filed.  The child’s eligibility for SSI must be documented in the case file by an award letter or other appropriate documentation from the Social Security Administration.  The nature of the child’s removal from his/her home is irrelevant in this situation.  The department must determine that the child is one with “special needs” prior to the time of the adoption finalization.

 

c.  Child Is Eligible As The Child Of A Minor Parent.  A child is eligible for Title IV-E adoption assistance in this circumstance if the child’s parent was in foster care and was receiving Title IV-E foster care maintenance payments that covered both the minor parent and the child at the time the adoption petition is filed.  However, if the child and minor parent have been separated in foster care prior to the time the adoption petition is filed, the child’s eligibility for title IV-E adoption assistance must be determined based on the child’s individual circumstances.  The department must determine that the child is one with “special needs” prior to the time of the adoption finalization.

 

d.  Child Is Eligible Due To Prior Title IV-E Adoption Assistance Eligibility.  In situations where a child is adopted and receives Title IV-E adoption assistance, and the adoption later dissolves or the adoptive parent(s) dies, the child continues to be eligible for Title IV-E adoption assistance in a subsequent adoption.  Prior to the finalization of the subsequent adoption the department must determine that the child is one with “special needs”.  Other eligibility factors must not be redetermined because the child is to be treated as though his/her circumstances are the same as those prior to his/her previous adoption.  (This criterion applies to children who are subsequently adopted after October 1, 1997).  The nature of the child’s removal leading to the subsequent adoption is irrelevant.

 

5-4.  Documentation of Eligibility for Title IV-E Adoption Assistance.

 

a.  The child’s eligibility for adoption assistance must be fully documented in the child’s case file.  Once the child is determined eligible for Title IV-E adoption assistance, the child remains eligible until s/he turns 18 or otherwise emancipate, the adoptive parents are no longer legally or financially responsible for the child or the child no longer receives support from the adoptive parents.  While redetermination of eligibility is not necessary, the adoption assistance agreement must be renewed annually per Florida Statutes, Chapter 409.

 

b.  Prior to adoption placement, a child must be screened for potential IV-E eligibility using the Adoption Subsidy Title IV-E Eligibility/Screening Worksheet (CF-FSP 5146).  This form must be completed by the CW/CBC staff or designee responsible for the case, reviewed and signed by the supervisor.  An employee of the department must review the form to determine if the child is one with “special needs” and determine if the child is eligible or potentially eligible for Title IV-E adoption assistance.  If as a result of this screening, a CIC eligibility determination is warranted, complete/update the 2626A form and forward to CIC for an initial IV-E determination or redetermination (per subsection 5-3(a) of this operating procedure).

 

c.  If the child is determined eligible based on meeting SSI criteria, all requirements for SSI benefits must be met and documented prior to the time the adoption petition is filed.  An award letter from the Social Security Administration is acceptable documentation of the child’s SSI eligibility.

 

d.  If the child is determined eligible due to being a child who was previously adopted and received IV-E adoption assistance, that previous IV-E eligibility for adoption assistance must be documented prior to the time the adoption petition is filed.  Documentation includes, but is not limited to: prior CIC Notice of Case Action, adoption assistance agreement indicating IV-E eligibility, payment history printout indicating payment of IV-E adoption assistance.

 

            e.  If the child is determined eligible due to being the child of a minor parent, this status must be documented prior to the time the adoption petition is filed. 

 

f.  If the child appears to be eligible for Title IV-E adoption assistance based on AFDC

criteria, a final determination of eligibility must be made by the Economic Self-Sufficiency Child in Care Specialist (CIC-ESS).  The child’s IV-E eligibility status must be documented at two intervals: at the time of the latest removal and at the time the adoption petition is filed.

 

                        (1)  Latest Removal.

 

                                    (a)  If the child was eligible for and received Title IV-E foster payments, a copy of the Notice of Case Action must be placed in the child’s adoption subsidy file to document IV-E eligibility at removal. 

 

(b)  If a determination for Title IV-E eligibility has not been made for the child (such as a child who has not been in licensed foster care, a child whose cost of foster care was paid via Title IV-A/EA, etc.) a Child in Care Medicaid and Title IV-E Application must be completed based on the removal home situation and submitted to the CIC-ESS.  The CIC-ESS will make an eligibility determination based on the information provided, document the finding, and send a manual Notice of Case Action to the assigned CW/CBC staff.  The Notice of Case Action must be filed in the child’s case record and be available for audit purposes.

 

(2)  When The Adoption Petition Is Filed.  The child’s continued financial need and deprivation must also be reviewed at the time the adoption petition is filed.  The CW/CBC staff or designee must complete the Child in Care Eligibility Review and Communication Worksheet (CF-ES 2694) informing the CIC-ESS of the child’s status (i.e., TPR) and of the income and assets available to the child so that financial need and continued deprivation can be reviewed.  The CIC-ESS will make an eligibility determination based on the information provided, document the finding, and send a manual Notice of Case Action to the assigned CW/CBC staff.  The Notice of Case Action must be filed in the child’s case record and be available for audit purposes.

 

NOTE: While Title IV-E federal regulations require that the child’s eligibility for IV-E adoption assistance be documented at the two intervals discussed above, it is also recommended that the child’s IV-E eligibility be documented prior to adoptive placement so that the appropriate fund source can be identified and indicated on the adoption assistance agreement.

 

g.  If after the initial screening, the child appears to be ineligible for Title IV-E adoption assistance a Child in Care Medicaid and Title IV-E Application must be completed based on the removal home situation and submitted to the CIC-ESS to confirm the child’s ineligibility.  The CIC-ESS must submit a Notice of Case Action to the counselor as documentation of the child’s ineligibility for Title IV-E adoption assistance.  The child’s Maintenance Adoption Subsidy (MAS) may be funded from other available funding sources, as appropriate.

 

h.  A current adoption assistance agreement documents the child’s eligibility for Title IV-E, Medicaid and other services agreed upon in the initial assistance agreement and must be signed and dated by all parties prior to authorizing adoption assistance payments.

 

i.  Documentation of the child’s eligibility for Title IV-E adoption assistance must be maintained and made available for audit purposes.  (The Title IV-E Adoption Subsidy Checklist has been developed as a documentation requirement guide; see Attachment 2 to this chapter.)

 

NOTE:  See Chapter 4 of this operating procedure for further details regarding CIC eligibility determinations.

 

5-5.  The Adoption Assistance Agreement.  [42 U.S.C. 675(3); 45 C.F.R. 1356.40(b), (e)]  Title IV-E Adoption Assistance is available on behalf of a child if s/he meets all of the eligibility criteria and the department enters into an adoption assistance agreement with the prospective adoptive family prior to the finalization of the adoption.  Florida’s Adoption Assistance Agreement (CF-FSP 5079) is designed to document the child’s eligibility type, the benefits to be provided, the amount of the benefits/assistance to be provided, and the duration of the agreement.  The following requirements must be met prior to making Title IV-E adoption assistance payments:

 

            a.  The child’s Title IV-E eligibility must be determined and documented on the fully executed adoption assistance agreement.

 

b.  The initial adoption assistance agreement should be signed and dated by the prospective adoptive parent(s) and a department employee at or prior to the time of placement in the adoptive home; but must be signed and dated by all parties prior to the adoption finalization.

 

(NOTE:  Title IV-E adoption subsidy payments must not be made prior to documentation of the child’s IV-E eligibility and prior to the adoption assistance agreement being signed by all parties.)

 

c.  The amount of the MAS must be specified in the agreement.  This amount shall be determined by taking into consideration the needs of the child and the circumstances of the adopting parent(s).  When negotiating the amount of the MAS, the amount must never exceed the foster care board payment that would have been paid for that child if the child resided in a foster family home.  (See Chapter 65C-16, F.A.C., for maximum allowable adoption subsidy payments.)  The amount of the subsidy may be readjusted periodically up to the maximum allowable payment for the child, or reduced, with the concurrence of the adoptive parents, to fit the changing needs of the child and the circumstances of the adoptive parent(s).  If, at the time the child is placed for adoption, the adoptive parent(s) choose not to receive subsidy for the child, they should be encouraged to sign the initial assistance agreement with $0 subsidy noted.  This preserves Title IV-E eligibility for the child in the event that in the future the adoptive parent(s) need subsidy to assist them in meeting the needs of the child.  However, if the family decides not to accept adoption assistance and declines to sign the agreement with $0 subsidy noted, all discussions regarding adoption assistance with the family must be fully documented in the child’s file.  The CW/CBC staff must request that the family sign a Disclaimer Statement (form CF-FSP 5172) indicating their decision to decline adoption assistance.  When the parents fail to enter into an adoption assistance agreement, the child will not be eligible for Medicaid benefits nor can the non-recurring adoption expenses be reimbursed.

 

d.  The nature and amount of any other payments, services and assistance to be provided, including non-recurring adoption expenses to be paid for expenditures incurred by the adoptive parent(s), must be specified in the adoption assistance agreement.  There is no requirement that a maintenance adoption assistance subsidy payment be made for the child to be eligible for Medicaid (Title XIX), social services (Title XX), or for the reimbursement of non-recurring adoption expenses.

 

e.  The Florida adoption assistance agreement has a duration of one year.  In order to maintain Title IV-E adoption assistance payments, Medicaid, and social services, the agreement must be signed and dated by the adoptive parent(s) and a department employee prior to or on the date of expiration of the agreement each year.

 

f.  Once the Adoption Assistance Agreement is signed and is in effect, adoption assistance can only be terminated under three circumstances.  These circumstances are (1) the child has reached the age of 18; (2) the parent is no longer legally responsible for support of the child; or (3) it is determined that the child is no longer receiving support from the parents.  (See paragraph 5-13 of this operating procedure.)

 

5-6.  Non-Recurring Adoption Expenses.  [42 U.S.C. 673(a)(1)(B)]

 

a.  A child need not be Title IV-E eligible in order for the department to enter into an agreement with the adoptive parent(s) for reimbursement of non-recurring adoption expenses.  Additionally, the child does not have to be under the responsibility for care and placement of the department.  The child must, however, meet the definition of a “special needs child” as defined in paragraph 5-2a(2) of this operating procedure.

 

b.  Non-recurring adoption expenses include reasonable and necessary adoption fees, court costs, attorney fees, and other expenses that are directly related to the legal adoption of the special needs child.  Other expenses that are directly related to the legal adoption of the special needs child include such costs as expenditures for physical examinations of the adoptive parents if required as part of the adoption application process; and reasonable travel expenses.  Reasonable travel includes costs for transportation, lodging and food for the child and the adoptive parents necessary to complete the placement or adoption process.  The non-recurring expenses must not have been incurred in violation of state or federal laws and have not been reimbursed from other sources or funds.

 

            c.  In order for the department to pay non-recurring adoption expenses, the following criteria must be met:

 

                        (1)  The initial adoption assistance agreement must specifically indicate the nature and estimated amount of the non-recurring expenses to be paid.

 

(2)  The maximum payment allowable for reimbursement of non-recurring expenses is limited to $1,000 per child.  Whether siblings are adopted, separately or together, each child is treated as an individual with separate reimbursement up to the maximum amount of $1,000 per child.

 

                        (3)  There shall be no income eligibility requirement for adoptive parents in determining whether payments for non-recurring expenses will be made.

 

(4)  Non-recurring expenses for the adoption of children in the custody of private adoption agencies are also reimbursable, if the child meets the special needs requirement as defined in paragraph 5-2a(2) of this operating procedure and an adoption assistance agreement is executed prior to adoption finalization.

 

(5)  The adoptive parents must provide the department with receipts or with requests for payment from service providers.  The adoptive parents shall be advised to hold such receipts until all are received so that a one-time payment covering all expenses can be made. 

 

                        (6)  Reimbursements must be made after the adoption is finalized.  Every effort must be made to complete these transactions within three months after the adoption finalization.

 

5-7.  Reasonable Efforts to Place a Child Without Providing Adoption Assistance.  (42 U.S.C. 673(c)(2)(A); 409.166(3)(b), F.S.)

 

a.  The Social Security Act requires that the department make “reasonable efforts” to place a child for adoption without adoption assistance.  However, it was not the intent of Congress that a child remains unnecessarily in foster care while the department/agency “shops” for a family, which might be less suitable but is willing to adopt the child without subsidy.  The best interests of the child should be the overriding factor even if another, suitable adoptive family has been identified that cannot adopt the child without a subsidy.

 

            b. Documentation of the reasonable efforts to place the child without subsidy include:

 

(1)  Registration of the child on the adoption exchange.  When the child is ready for adoption and a prospective family has not been identified, a list of potential families that are willing to adopt the child without subsidy should be sought from the adoption exchange.  If no such family is registered on the exchange, the results of the adoption exchange search must be documented in the child’s subsidy file.

 

(2)  Consideration of several families for placement of the child and documentation of the outcome(s) in the child’s case file.  The selection process must take into consideration the best interest of the child and not violate MEPA requirements.

 

                        (3)  Rationale to support the selection of the family of choice for the child, when that family cannot adopt the child without a subsidy.

 

c.  The exception to making the efforts described in paragraph b above is when the child is to be adopted by his/her foster parent or relative caretaker with whom he or she has established significant emotional ties.  However the foster parent or relative must be asked if they can adopt the child without subsidy.  If they cannot, the efforts to place without subsidy have been satisfied and must be documented in the child’s subsidy file.  Also refer to Chapter 65C-16, F.A.C.

 

5-8.  Fair Hearings for Denials of Title IV-E Adoption Assistance.  [42 U.S.C. 671(a)(12)]

 

a.  Prospective adoptive parents must be informed of the availability of adoption assistance on behalf of special needs children.  In order to receive Title IV-E adoption assistance, the assistance agreement must be signed by all parties prior to the finalization of the adoption.  When the request for IV-E adoption assistance is made after the adoption finalization, the request must be denied and the family must be informed of their right to a fair hearing.  If the adoptive parents feel they have been wrongly denied benefits on behalf of an adoptive child, they must request a fair hearing within 90 days of notification of denial.  Some situations that may constitute grounds for a fair hearing include:

 

                        (1)  Failure of the department/agency to notify the prospective adoptive parents of the availability of adoption assistance for special needs children in out-of-home care.

           

                        (2)  Relevant facts regarding the child, the biological family, or other aspects of the child’s background are known by the department/agency but not presented to the adoptive parents prior to the finalization of the adoption.

 

                        (3)  The department/agency denies Title IV-E adoption assistance based upon application of a means test to the adoptive family.

 

                        (4)  Decrease in the amount of the adoption assistance without the concurrence of the adoptive parent(s)

 

                        (5)  Denial of a request for a change in the payment level due to a change in the adoptive parent’s circumstance.

 

b.  If the fair hearing officer determines that benefits have been wrongfully denied under the Title IV-E adoption assistance program, the effective date of the Title IV-E adoption assistance must not be earlier than the date the family requested assistance.  For cases in which there is no signed adoption assistance agreement, a new adoption assistance agreement must be completed, signed and dated with the current date.  A notation must be made showing the intention to revert to and to have the agreement effective as of the prior date.

 

c.  There are times when the department and the adoptive parents are in agreement that a Title IV-E adoption subsidy should have been paid.  In such cases, a trial-type evidentiary hearing would not be necessary.  However, in order to meet federal policy, the undisputed documentary evidence must be presented to the fair hearing officer for review, and a final determination made by the hearing officer must be submitted in writing.  The effective date of the Title IV-E adoption assistance must not be earlier than the date the family requested assistance.

 

5-9.  Disallowance of Title IV-E Adoption Assistance for Children Who Are Adopted by Biological Parents Whose Parental Rights Have Been Terminated.  [42 U.S.C. 673(c)(1)] 

 

a.  Children who are adopted by their biological parent(s) are not eligible for Title IV-E adoption assistance in that they do not meet all of the special needs criteria.  A special needs child is one who among other things cannot or should not return to the home of his/her parents.  While a child may meet the eligibility criteria for Title IV-E adoption assistance with the termination of parental rights order documenting that the child cannot or should not return to the parents, the placement of the child back into the home of the biological parent(s) nullifies such a determination.  Thus, a determining factor for Title IV-E eligibility would not be present and IV-E adoption assistance would not be available.

 

b.  While IV-E adoption assistance is not available, temporary cash assistance may be an appropriate form of assistance for such a family in this situation.  Temporary cash assistance is available to such family whether or not the biological parent adopted the child.  Although the legal relationship was severed by termination of parental rights, the child’s blood relationship to his/her family does not terminate.

 

5-10.  Concurrent Payments of Title IV-E Adoption Assistance and Supplemental Security Income (SSI).  [42 U.S.C. 673(a)(1)(A)(ii); 20 C.F.R. 404.2035 – .2045 and 416.635 – .645]

 

            a.  The adoptive parents of a disabled child may apply for both Title IV-E adoption assistance and SSI on behalf of the child, and if eligible, receive both forms of assistance after finalization of the adoption.

 

b.  Title IV-E eligibility must be determined prior to the signing of the initial adoption assistance agreement and documented on the initial assistance agreement.  The following steps must be taken when a child is IV-E eligible and receiving SSI:

 

(1)  For a child that is receiving SSI at the time of placement in the adoptive home, prior to the adoption finalization, the department/agency continues to be the payee for the child’s SSI benefit.  The maintenance adoption subsidy shall be paid from state funds and be offset by/deducted from the child’s SSI benefits, as this is considered the child’s cost of care.  The SSI benefits in excess of the maintenance adoption subsidy/cost of care, must be deposited into the child’s trust fund account.  Also refer to CFOP 175-59.

 

(2)  The initial adoption assistance agreement must be notated “Title IV-E” even though the adoption assistance expenditure will be paid out of non-Title IV-E funds until finalization.  This is necessary to ensure that the department does not collect revenue from both federal programs.  Thus, the expenditure type code shall be “411” in ICWSIS and “Non IV-E” in HSn until finalization.

 

NOTE:  For fiscal purposes and to document the reason for using a non-Title IV-E expenditure code, the following statement should be written at the top edge of the adoption assistance agreement “Child Welfare Vouchering System Coded NON-TITLE IV-E until Finalization.”

 

(3)  At finalization, the adoptive parents must be advised to contact the local Social Security Administration (SSA) office and apply to be the designated representative payee of the SSI benefit for their child and to inform the SSA of the maintenance adoption subsidy payments made on behalf of the child.  SSA will consider the adoptive parents’ income as part of the eligibility criteria for the child’s continued SSI eligibility.  If SSA determines the child to be SSI eligible based on the child’s continued disability and the income of the adoptive parents, then SSA will deduct the amount of the Title IV-E adoption assistance payment from the SSI benefit amount.  The difference will be the amount of the SSI benefit for the child to be paid to the adoptive parents.

 

                   Example:        $545.00    SSI benefit

                                          - 320.00    Title IV-E adoption assistance payment

                                          $225.00    SSI benefit for the child at finalization

 

                        (4)  At finalization of the adoption, the subsidy payments will be changed to Title IV-E, expenditure type code “400” in ICWSIS and “IV-E” in HSn.

 

                        (5)  After finalization of the adoption, the court’s direction should be sought regarding the money held in the child’s trust sub-account(s).  Also see CFOP 175-59.

 

(6) The child’s adoption counselor must explain to the adoptive family how Title IV-E and SSI work together so that the family can make an informed decision regarding receipt of one or both funding sources.  If the adoptive parents decline Title IV-E adoption assistance and choose only to receive SSI, an initial adoption assistance agreement shall still be completed, specifying $0 in the Title IV-E subsidy section.  This must be done in order to preserve Title IV-E eligibility if the adoptive parents later need assistance.  The assistance agreement must also be in place for the reimbursement of non-recurring adoption expenses.

 

5-11.  Medicaid Coverage for Title IV-E Eligible Children.  [42 U.S.C. 673(b)(1)]

 

a.  A child that has been determined eligible for Title IV-E adoption assistance is also eligible for Medicaid coverage, without regard to the family income.  Medicaid benefits become available at the point the adoption assistance agreement is signed and the child is placed in the adoptive home. 

 

b.  A child’s Medicaid eligibility must be re-determined every 12 months.  As long as the child has a current adoption assistance agreement in effect, he or she will remain eligible for Medicaid, without regard to family income.  At a minimum, the adoptions counselor or designee must inform the CIC-ESS via the Child in Care Eligibility Review and Communication Worksheet (CF-ES 2694) that the child is still in the adoptive placement and that there is a current adoption assistance agreement on file.  The CIC-ESS will complete the annual IV-E and Medicaid eligibility review and forward a Notice of Case Action to be filed in the child’s file.

 

NOTE:  If the Adoption Assistance Agreement lapses, the CIC-ESS must be notified.

 

c.  Title IV-E and Medicaid allows the child to receive Medicaid coverage anywhere in the United States.  This is especially valuable if a child receives Title IV-E adoption assistance from the state of Florida and then moves to another state.  In this situation, Florida will continue to pay the adoption subsidy; however, Medicaid coverage will be terminated in Florida and started in the child’s new state of residence.

 

d.  When a Title IV-E eligible child moves out of Florida, the adoption counselor must ensure that the parents have documentation that the child is Title IV-E eligible.  The adoption counselor shall assist the parents in locating the appropriate out-of-state agency in order to enroll the child in Medicaid in their new state of residence.  To further assist the parents, the adoption counselor may make contact with the out-of-state agency, as appropriate to expedite Medicaid coverage for the child in the new state of residence.

 

e.  If a child is not Title IV-E eligible and moves to another state, the parents, with the assistance of the department/agency, must contact the new state to ascertain whether that state will provide its Medicaid services to the child via the Interstate Compact on Adoptions and Medical Assistance (ICAMA).  If not, the child’s Florida Medicaid will continue.  The parent must locate a physician that will accept Florida Medicaid in the child’s new state of residence.  The physician must request and be approved as a Florida Medicaid provider, then submit an invoice to Florida for payment.  The parent must be advised and encouraged to obtain information and documentation necessary to process the medical claims.

 

f.  When the department/agency has agreed to pay for certain specified medical expenses, the adoptive parents shall be advised that Medicaid law requires (and per the adoption assistance agreement) that Medicaid service providers must be used when such are available in the family’s community.  The department must be contacted and approval given prior to selecting and using a non-Medicaid provider.  The adoptive parents must also be advised that failure to obtain such advance approval may result in the parent being totally responsible for payment to the non-Medicaid provider for the service.  When contacted for such approvals, the department/agency is required to explore all other available resources, including Medicaid providers and family insurance, before authorizing the use of a non-Medicaid provider.

 

5-12.  Disruption/Dissolution of Placement in the Adoptive Parents’ Home.  [P. L. 105-89; 42 U.S.C. 673(a)(4)(B)]  There are times when conflict arises in the adoptive home which necessitates the placement of the child into licensed out of home care.  When this occurs, a determination must be made whether to pay the foster care expenditures from Title IV-E or non-Title IV-E funds.  The following situations are provided as examples to assist in this determination:

 

a.  When the adoptive placement has not been legally finalized through the court, the child remains in the latest removal episode.  The same factors considered at the time of the child’s latest removal shall again be considered.  If, at the time of the most recent removal, the child was Title IV-E foster care eligible, the child shall again be Title IV-E eligible.  The CIC-ESS must be notified of the child’s placement status and of any other changes in the child’s circumstances.  Should the child continue to be Title IV-E reimbursable, foster care expenditures shall be coded Title IV-E.  If the child was not eligible at that point of his/her latest removal from home, more than likely eligibility would not exist at the time of the adoption disruption.  However, the Title IV-E screening process must be completed again, in case federal policy has changed or an error was made in the earlier eligibility determination.

 

            b. When a child enters foster care from a finalized adoption placement, the child’s eligibility for Title IV-E foster care is based on the child’s removal from the home of the adoptive parent(s). 

 

c.  However, in situations where a child is adopted and receives Title IV-E adoption assistance, but the adoption later dissolves or the adoptive parents die, the child may continue to be eligible for title IV-E adoption assistance in a subsequent adoption.  The only determination that must be made prior to the finalization of the subsequent adoption is whether the child is a child with special needs.  See paragraph 5-3d of this operating procedure.

 

5-13.  Making a Decision to Terminate or Continue Title IV-E Adoption Assistance.  [Social Security Act, section 473(a)(4)(B), ACYF-CB-PA-01-01]

 

            a.  Title IV-E adoption assistance payment must be terminated if the state determines:

 

(1)  That the adoptive parents are no longer legally responsible for the support of the child.  A parent is considered no longer legally responsible for the support of a child when parental rights have been terminated or when the child becomes an emancipated minor, marries, or enlists in the military; or,

 

(2)  That the child is no longer receiving any support from the adoptive parents.  “Any support” includes various forms of financial support.  The department/agency may determine that payments for family therapy, tuition clothing, maintenance of special equipment in the home, or services for the child’s special needs are acceptable forms of financial support.  If the parent(s) are visiting the child while the child is in out of home care, or paying child support or maintaining the home for the child’s return and the child’s case plan goal is reunification, the parents should be considered as providing support to the child.  Consequently, the department must continue the Title IV-E adoption assistance if it determines that the parent(s), are in fact, providing some form of financial support to the child; or,

 

                        (3)  That the child has turned age 18.

 

b.  The conditions listed in paragraph a above are the only basis in the Social Security Act for terminating adoption assistance payments on behalf of a child unless termination is requested or agreed to by the adoptive parents.  On the other hand, there is nothing to prevent the department/agency or court from requesting or ordering the parents to contribute toward the cost of the child’s care in the same manner as any other parents of children in an out of home care situation.

 

            c.  The following shall be considered when making a decision to continue or cease or suspend Title IV-E adoption assistance payments:

 

                        (1)  Do the adoptive parents continue to be legally responsible for the child? 

 

(2)  Do the adoptive parents continue to provide support in the form of clothing, personal items, family therapy, tuition, maintenance of special equipment in the home, or services for the child’s special needs, and in other ways exercise parental responsibility in terms of maintenance of the child’s home and planning for the future?

 

                        (3)  Are the adoptive parents involved in the child’s treatment and anticipate the return of the child to their home?

 

                        (4)  Is there a current adoption assistance agreement on file?

 

5-14.  Continuation of Title IV-E Adoption Assistance Payments for a Child Whose Adoptive Parents Are Deceased.

 

a.  In accordance with section 473 of the Social Security Act, Title IV-E maintenance adoption subsidy payments may be made only to a parent or parents who adopts an eligible child.  Both the Act and the Code of Federal Regulations specify that Title IV-E adoption assistance payments are made to adoptive parents who have entered into an adoption assistance agreement with the department.  This requirement precludes payments to persons other than the adoptive parents who have entered into such an agreement.

 

b.  If the adoptive parents designated a guardian or another relative to care for the child in the event of the parents’ death and the guardian or relative adopts the child, the procedures for determining eligibility under Title IV-E must be followed.  See paragraph 5-3d of this operating procedure.

 

5-15.  Private Agency Participation in Title IV-E Adoption Assistance, Medicaid and Non-Recurring Adoption Expenses.  [42 U.S.C. 673(b)(1); ACYF-CB PA 01-01] 

 

            a.  Children in the custody of private agencies and children adopted through an Independent Adoption may also be eligible for Title IV-E adoption assistance and Medicaid.

 

            b.  The eligibility requirements listed in paragraphs 5-2 and 5-3 of this operating procedure must be met in order for these children to be eligible for Title IV-E adoption assistance.

 

5-16.  Inter-Jurisdictional Barriers.  [Section 422 (b) (12), SSA]  The Adoption and Safe Families Act (ASFA) prohibits delays or denials of adoptive placements across state or county jurisdictions.  Any delays or denials will incur penalties in Title IV-E funding to the state.  This applies not only to the department but to public and private agencies as well.

 

5-17.  Responsibilities of Department and Other States Agencies in Interstate Adoptions.  If a state or contracted agency has responsibility for placement and care of a child, that state is responsible for entering into the adoption assistance agreement and paying the Title IV-E adoption subsidy for the child.  However, if the child is not under the placement and care responsibility of the department/ agency, the child welfare agency in the adoptive parents state of residence is responsible for determining whether the child meets the definition of special needs, entering into the adoption assistance agreement and paying the subsidy.  This is consistent with the way other public benefits are paid in other programs.

 

5-18.  International Adoptions.  [ACYF-CB PA 01-01] 

 

a.  The Federal adoption assistance program under Title IV-E was intended to assist states in placing children with special needs in the public foster care system with adoptive families.  As a result, the statutory requirements for Title IV-E are geared to needy children in public child welfare systems and are difficult, it not impossible, to apply to children who are adopted abroad.  Therefore, although the federal statute does not categorically exclude these children from IV-E participation, it is highly improbable that children brought into the United States from another country for the purpose of adoption, will meet the criteria established in section 473 of the Social Security Act for title IV-E adoption assistance eligibility.

 

            b.  The eligibility requirements listed in paragraphs 5-2 and 5-3 of this operating procedure must be met in order for these children to be eligible for Title IV-E adoption assistance.

 

            c.  Reimbursement of adoption nonrecurring expense may be made (per paragraph 5-6), if the child is determined to be a child with special needs as outlined in paragraph 5-2 of this operating procedure.

 


 

Adoption Subsidy

TITLE IV-E Eligibility/Screening Worksheet

 

Name of Person Completing Worksheet

 

Zone/region/district

County

CBC Agency

Child’s Adopted Name (if finalized)

 

Child’s ID# (SS#)

Child’s Date of Birth

Child’s Biological Name

 

Date Form Completed

 

 

COMPLETE THIS SECTION AFTER ELIGIBILITY SCREENING IS COMPLETED.

Is child eligible (or potentially eligible) for Title IV-E adoption subsidy?      Yes      No

       If no, why is child ineligible? 

________________________________________________________________________________________________________________________________________________________________

 

       What corrective action, if any, can be taken to make the child eligible?
________________________________________________________________________________________________________________________________________________________________

 

 

 

Instructions:  Check “Yes” or “No” in the box beside each question below and attach a copy of requested documentation, as appropriate.  If the answer to a question is “Yes” but documentation is not available, mark the answer “Yes” and make a notation that needed documentation will be gathered as soon as possible.  Complete Section 1 to determine if the child meets the entry-level criteria for Title IV-E adoption assistance.  If “Yes” is the response for each question in Section 1 proceed to the following six sections and fully complete the one that most appropriately fits the child’s situation. Do not screen a child as “ineligible” until EVERY effort is made to obtain missing documents.

 

 

SECTION 1: UNIVERSAL TITLE IV-E ELIGIBILITY REQUIREMENTS

 Yes

 

 Yes

 

 No

 

 No

 

A.   Is the child under 18 years of age and never emancipated?

 

B.   Has a court-ordered termination of parental rights (TPR) occurred?

      Date of court order for TPR:                                       

 

 

 

 

 

 Yes

 

 No

 

C.  Is there a factor or condition that makes the child difficult to place for adoption without provision of subsidy?

      If yes, check all that apply to the child:

       Black or of racially mixed heritage (one parent must be Black)

       Eight years of age or older

       Siblings placed together for adoption

       Mental Retardation

       Emotional handicap

       Physical disability

       Other clinically diagnosed disability

 

 

 

 

 

 Yes

 

 No

 

D.  Have efforts been made to place without subsidy?

      List efforts:                                                                                                              

      Or

       N/A; child has significant emotional ties to a foster parent or relative caretaker

Note:  See subsection 5-2a.(3) for details about efforts to place without subsidy.

 

 

 

 

 

 Yes

 

 No

 

E.   At the time of the placement in the adoptive home, did the child have $10,000 or less in total combined, countable or accessible assets?  (Do not count funds in the master trust account or funds that the child cannot access on his/her own.)

      Total amount of countable or child-accessible assets: $                           

      (Examples include funds that are in the child’s wallet or a piggy bank.)

     

NOTE:  If this form is being completed prior to the adoption placement, questions G and H must be addressed after placement.  If the adoption assistance agreement is not signed and dated by all parties prior to adoption finalization, the child is ineligible for IV-E adoption assistance.

 Yes

 

 No

 

F.  Is the initial adoption assistance agreement present in the file?

      Date of initial agreement:                                                             

 

 

 

 

 

 Yes

 

 No

 

G.  Is the initial adoption assistance agreement completed, signed and dated by both the adoptive parent(s) and a department employee?

 

SECTION 2:  SUPPLEMENTAL SECURITY INCOME (SSI) RECIPIENTS

 Yes

 

 No

 

Was the child receiving SSI at the time of placement for adoption or at the time the adoption petition was filed? 

 

 

 

 

 

 

 

 

 

Documentation of SSI eligibility from the Social Security Office must be in the case file.  Obtain documentation if it is not present in the case record.

If you answered “Yes” to the question above and to all of the questions in Section 1, the child is potentially Title IV-E eligible; submit screening worksheet to designated department employee.

If you answered “No” to the question above, proceed to Section 3

 

 

SECTION 3:  CHILD ELIGIBLE DUE TO PRIOR TITLE IV-E ADOPTION ASSISTANCE

NOTE:  This section applies to children subsequently adopted after 10-1-97.

 Yes

 

 No

 

A.   Was the child previously determined eligible for and had Title IV-E adoption assistance been paid on his/her behalf?

If you answered “Yes” to question 3A, answer question 3B.  If you answered “No,” proceed to Section 4.

 

 Yes

 

 No

 

B.   Was the date of subsequent adoption after 10-1-97?  If no, child is not eligible based on previous IV-E adoption assistance eligibility.

 

 

 

 

 

 

 

 

 

C.  Documentation of Title IV-E eligibility in a previous adoption includes:  previous Child in Care Notice of Case Action, previous Adoption Assistance Agreement that indicates IV-E eligibility, adoption assistance payment history document that indicates that IV-E payments were made on behalf of child or any other form of documentation that substantiates prior IV-E eligibility for and receipt of Title IV-E adoption assistance.

If you answered “Yes” to question 3B, and to all of the questions in Section 1, the child is potentially Title IV-E eligible; submit screening worksheet to designated department employee.

If you answered “No” to question 3B, proceed to Section 4.

 

 

SECTION 4:  ELIGIBILITY BASED ON BEING CHILD OF MINOR PARENT

 Yes

 

 No

 

Was child’s minor parent in foster care and were Title IV-E foster care maintenance payments made that covered both the minor parent and child at the time the adoption petition was filed?

 

 

 

 

Subsidy file must include documentation that shows that child’s cost of care was covered under the Title IV-E foster care payments of the minor parent.

If you answered “Yes” to the question above, and to all of the questions in Section 1, the child is potentially Title IV-E eligible; submit screening worksheet to designated department employee.

If you answered “No” to the question, proceed to Section 5, 6 or 7 below.

 

 

Sections 5, 6 and 7 pertain to AFDC-related eligibility criteria.  The Child in Care Medicaid and Title IV-E Application must be completed and submitted to the CIC-ESS for a final determination of IV-E eligibility.

SECTION 5:  INVOLUNTARY (Judicial) REMOVAL

 Yes

 

 No

 

A.   At the time of the latest removal, was the child living with and removed from the home of a specified relative?

      If yes, specify the degree of relationship:                                                                

                                                                                                                                        

 

 

 

 

 

 Yes

 

 No

 

B.   Does the first order removing the child contain “contrary to the welfare” language?  (The court order must also be signed and dated.)

      [NOTE:  (1) For removals prior to 3-27-00, see CFOP 175-71, paragraphs
3-2b(3) and (4).  (2) “Contrary to the welfare” is a concept.  The exact wording does not have to be stated in the order, as long as the removal order states that the child cannot safely remain in the home or that there is no relative that can provide care for the child.  (3) “Reasonable efforts” language is not a requirement for Title IV-E adoption assistance.]

 

 Yes

 

 No

 

C.  At the time of the child’s most recent removal, was there deprivation of parental support or care?

 

      Describe the family/household structure or living arrangements (i.e., who lived in the household/relationship of household members to the child)?