What is Adoption Subsidy?
According to MDHHS Adoption Subsidy Programs, Pub-538:
Michigan has three adoption assistance programs to assist families who adopt eligible foster children up to age 18. The programs are funded by both federal and state funds and provide financial assistance including:
- Adoption Assistance - a monthly payment to assist with the expenses of raising an eligible child. Medicaid is also available for many children who receive adoption assistance.
- Non-recurring Adoption Expenses - reimbursement to adoptive parents up to $2,000 for specific expenses of adopting an eligible child.
- Adoption Medical Subsidy - reimbursement of approved expenses related to physical, mental, or emotional conditions that existed, or the cause of which existed, prior to adoption."
Applying for Adoption Assistance and Adoption Medical Subsidy is part of the adoption process. If you adopt a child through Fostering Futures, your adoption worker will help you fill out the paperwork that will determine if you qualify for Adoption Assistance and/or an Adoption Medical Subsidy. If you are approved, you will sign a contract with the State of Michigan which details your benefit, including what (if any) monthly payment you will receive, and what (if any) pre-existing conditions will be covered by Adoption Medical Subsidy.
Unfortunately, once your adoption is complete, Fostering Futures staff can not help you with Adoption Subsidy questions or problems. Families must contact the Adoption Subsidy office directly with any questions about the application process, the approval process, delays in getting approved, reasons for denial, etc.
ADVICE from FELLOW FOSTER PARENTS
Even though our staff is unable to directly help with Subsidy questions for a finalized adoption, we have gathered some advice and information from our adoptive families, for the purpose of helping other families as much as possible. We welcome additional advice, comments, or suggestions. Here is what our families have shared so far...
- Generally speaking, Medical Subsidy will only cover a treatment or procedure that for some reason is not covered by the child's medical insurance (either Medicaid or private insurance). You must demonstrate that you did try to bill insurance first, but that they either denied coverage, or you have exhausted your benefit for that particular benefit. For example: Many insurance programs will cover a certain number of psychotherapy sessions per calendar year; after you have billed insurance for the maximum number of visits they will cover, then Adoption Medical Subsidy should cover therapy for the rest of the year.
- Even though your child may qualify for Adoption Medical Subsidy coverage of certain conditions, you will need to submit a "Request for Pre-Approval" to have specific therapies and treatments covered. This is much like having an insurance policy, where the insurance company covers your condition, but requires "pre-authorization" of certain treatments or procedures.
To get Medical Subsidy to cover psychotherapy, you must submit paperwork to request Pre-Approval of coverage. This will only get you coverage for 5 months, or 20 sessions, whichever is less. Then you will need to apply again, requesting pre-approval for another 5 months/20 sessions. The pre-approval process can take some time, so one parent suggests that you apply at least 4-6 weeks before your current coverage runs out, in order to avoid having a lapse in coverage. You will be denied if your application does not meet ALL the criteria the subsidy office is expecting! Usually about 2-4 weeks after you submit your application, you will receive a response by mail, which will be either an approval letter, or a denial letter. A denial letter should include a reason for which you are being denied.
Do not just give up if you are denied! You just need to address the reason for denial, and apply again. This can be annoying at first, but once you address all the reasons they have to deny you, your pre-approvals should go more smoothly in the future. Anticipate any possible reasons for denial, and be sure you have it covered in your next application. One parent writes, "I always include a cover letter with my application form, which addresses each reason for which I had been previously denied. After a few cycles of denying and reapplying, I got it down, and since then, our applications have all been approved on the first try!"
Your application, whether sent by email or fax, should include four pieces:
- A cover letter which addresses all the subsidy criteria (more details below with a sample here)
- A completed and signed "Request for Prior Approval" (editable blank form here)
- An updated Treatment Plan from your child's therapist (stating why therapy should continue, and must be signed/dated)
- Documentation that Medicaid/Insurance coverage has been exhausted OR justification for not billing insurance first
If any of these pieces are missing or incomplete, they will deny you! Here are some bits of advice from other parents:
"Now that I finally have my cover letter down, I just copy and paste it into a new email each time, making minor updates as needed. I also have the kids' Prior Approval forms all filled out on my computer, and since that info never changes, I just print it out every 5 months, sign & date it."
"I used to submit my applications via fax, but kept running into problems with them "not receiving" it. Now I find submitting by email to be successful; I send the email to my subsidy worker, with a cc to their supervisor. This is helpful due to the high turnover of workers... if your previous worker leaves, at least their supervisor should get the application and forward it to the new worker."
Here are some things you may need to address in your cover letter:
- State the need and humanize your child. Make an argument that while your child has been receiving therapy, they are not "all better" and do still need to continue receiving therapy, as is documented in the attached TREATMENT PLAN from the child's therapist. Make the point that your child was approved for subsidy therapy coverage at the time of your adoption. Use your kiddos' first names; remind the workers these are real kids, not just "cases."
- If necessary, make an argument for why your child must see their particular therapist (list the therapists' qualifications, or point out they have established a rapport with your child). This is probably not necessary if you're going to CMH, but one family needed to address this in order for their kids to see a particular private-practice therapist.
- ADDRESS THE MEDICAID / INSURANCE ISSUE. If you don't address this to their satisfaction, they will definitely deny you. As stated previously, subsidy requires that you first bill Medicaid or any Private Insurance the child may have, before applying for Subsidy coverage. In your application, you need to EITHER demonstrate that you have already exhausted your insurance benefit for therapy OR give explanation / documentation if there is some reason why insurance can't be billed.
Another benefit provided by Michigan Adoption Subsidy is the Subsidy Tutoring Program. Adoption Subsidy will cover the cost of professional tutoring services (up to 5 hrs per week from a State-approved vendor) if your child meets ALL the following criteria:
- ADOPTED from foster care through the State of Michigan
- Grade 1-12, up to age 18
- Have a medically-diagnosed learning disability (i.e. Dyslexia, ADHD, PTSD, etc.)
- Have an IEP or 504 plan issued by their school OR is failing a grade
Following is a list of vendors we are aware of providing this service (please contact us with info on any other participating vendors):
If you are (or know of) another tutoring service, contracted through the State of Michigan to provide Adoption Subsidy Tutoring services, please contact firstname.lastname@example.org with information to add to this list!
IF YOU HAVE ANY HELPFUL TIPS, CONTACT INFO, INSTRUCTIONS, CORRECTIONS, OR ANYTHING YOU WOULD LIKE TO SHARE WITH OTHER FAMILIES ABOUT SUBSIDY, please contact Tammy to add it to this page. Call 734-481-8999 or email email@example.com.