Michigan Department Of Human Services Adoption Subsidy Program www.michigan.gov

Medical Subsidy Adoption Medical Subsidy is intended to assist with paying for services related to the treatment of physical, mental or emotional conditions that are certified by the Adoption Subsidy Office. Applications can be made prior to the adoption or any time up to the child’s 18th birthday (Form: Parent’s Request for Medical Subsidy For An Adopted Child 1341 A)

Adoption Subsidy Program By the Numbers Approximately 27, 000 active support subsidy cases Approximately 13, 900 active medical subsidy cases (with support subsidy) Approximately 1,100 active medical subsidy cases (without support subsidy)

Medical Subsidy Program Key Points Medical Subsidy is not Medicaid or an insurance DHS is payer of last resort (use of Private health insurance, Medicaid, Children’s Special Health Care Services, Local and intermediate school districts, Other public resources.) Services covered by the Medical Subsidy must be necessary to treat a certified condition Payments for services require prior approval from the Adoption Subsidy Program (i.e. ongoing case workers)

Types of Services covered under the Medical Subsidy Outpatient Counseling Assisted Care Services (Physical Care Services & Behavioral Services Temporary Out-Of-Home Placement (16 days max) Placement Outside the Family Home Travel Expenses Educational Services (speech therapy, physical therapy, occupational therapy, tutoring) Summer Camps Dental Services (Orthodontic treatment) Durable Medical Equipment Medical Supplies and Prescriptions (Prescriptions, Glasses/Contact Lenses & Incontinence Supplies)

Outpatient Counseling Outpatient mental health and related services are those psychological, psychiatric, counseling, psychotherapy, or other similarly defined services for evaluation and/or treatment of emotional/mental conditions certified eligible by the Adoption Subsidy Program Office.

Outpatient Counseling Requirements Child must have an approved medical Subsidy from the Adoption Subsidy Office. Service must be necessary to treat certified conditions. DHS is payer of last resort ( use of Private health insurance, Medicaid, Children’s Special Health Care Services, Local and intermediate school districts, Other public resources). Does NOT require prior authorization but child must have a certified emotional condition approved by Adoption Subsidy Office.

Assisted Care Services (Physical Care Services & Behavioral Services) Adoption medical subsidy may pay for assisted care services in certain cases. There are two types of assisted care services: physical care services and behavioral services.

Physical Care Services Physical care services are assistance in caring for the special physical condition(s) of a child (e.g., quadriplegia, tube feeding, ostomy care, oxygen dependency, severe multiple impairments).

Physical Care Services Requirements Child must have an approved medical Subsidy from the Adoption Subsidy Office. Service must be necessary to treat certified conditions. DHS is payer of last resort ( use of Private health insurance, Medicaid, Children’s Special Health Care Services, Local and intermediate school districts, Other public resources.) Parents must seek prior authorization by the Adoption Subsidy Office. Requires a written medical treatment plan related to a physical condition that has been certified by the Adoption Subsidy Program Office. A written caregiver plan must be provided, which includes the specific treatment and times needed. The service provider is qualified by education, training or experience, as determined by the Adoption Subsidy Program Office, and is not a member of the immediate household.

Behavioral Services Behavioral services are short-term training of the child and/or parent(s) in modifying the child's behavior that is related to the child's mental or emotional condition that has been certified by the Adoption Subsidy Program Office prior to service.

Behavioral Services Requirements This service is not intended for care of the child in the parent's absence. Payment for behavioral services will be made at a rate set by the Adoption Subsidy Program Office for a maximum twelve month period. Child must have an approved medical Subsidy from the Adoption Subsidy Office. Service must be necessary to treat certified conditions. DHS is payer of last resort ( use of Private health insurance, Medicaid, Children’s Special Health Care Services, Local and intermediate school districts, Other public resources. Parents must seek prior authorization by the Adoption Subsidy Office. A treatment plan needs to be submitted to the Adoption Subsidy Office for review. The treatment plan will need to include: an assessment of the behavior problems, a statement of intervention techniques to be utilized, and expected outcomes at the end of the treatment period. The treatment plan needs to be created by a licensed physician, psychologist, limited or licensed master social worker. The author of the treatment plan is responsible for training and supervision of the service provider.

Temporary Out-Of-Home Placement (16 days max) Payment requirements for temporary out-of-home placement are: Prior authorization by the Adoption Subsidy Program Office based on a local office worker’s written recommendation. The temporary out-of-home placement is consistent with a treatment plan developed for the child by one of the following professionals; a licensed physician, psychologist, or limited or licensed master social worker. The temporary out-of-home placement is not less than 24 or more than 72 consecutive hours. The placements are not to exceed 96 hours per month. The maximum number of hours in a 12-month period cannot exceed 384 hours (16 days). Daily subsidy payment rates for temporary out-of-home placement are set by the department.

Placement Outside the Family Home Short-term treatment outside the family home can be covered as a last resort when treatment goals are not being achieved in the family setting. Adoption medical subsidy policy limits the amount of coverage to six months. Approvals will not be granted for periods of more than six months and may be granted for lesser periods of time. The goals of placement outside the family home are to address the child’s emotional and behavioral problems, strengthen the adoptive family, and to facilitate the reunification of the child with his/her adoptive family. In order to meet these goals, it is required that adoptive parents be actively engaged in the treatment of their child. Parental involvement may include participation in family therapy, family weekends, and home visits.

Placement Outside the Family Home Requirements Memo/Application from adopted parents/agency requesting funding for placement. Child must have an approved medical Subsidy from the Adoption Subsidy Office. Service must be necessary to treat certified conditions. DHS is payer of last resort ( use of Private health insurance, Medicaid, Children’s Special Health Care Services, Local and intermediate school districts, Other public resources.) Parents must seek prior authorization from the Adoption Subsidy Office. The goal is family reunification. Assessing the least restrictive placement to meet child’s needs. All community resources must be exhausted. MiTeam meeting scheduled for approval.

Travel Expenses The medical subsidy program does not routinely pay for travel expenses. In excess of 30 miles round trip, and Necessary for the treatment of a certified condition, and is not included in the child’s DOC rate for adoption support subsidy.

Travel Expenses Requirements Child must have an approved medical Subsidy from the Adoption Subsidy Office. Service (travel) must be necessary to treat certified conditions. DHS is payer of last resort ( use of Private health insurance, Medicaid, Children’s Special Health Care Services, Local and intermediate school districts, Other public resources.) Parents must seek prior authorization from the Adoption Subsidy Office.

Educational Services (speech therapy, physical therapy, occupational therapy, tutoring) The Michigan Mandatory Special Education Act (Act 198, P.A. 1971) places responsibility for providing educational services to handicapped children with the Michigan Department of Education and local and intermediate school districts. The costs of private school tuition are beyond the scope of the adoption medical subsidy program. The Education costs and services such as speech therapy, physical therapy, occupational therapy, and tutoring can be covered under the adoption medical subsidy.

Educational Services (speech therapy, physical therapy, occupational therapy, tutoring) Requirements Child must have an approved medical Subsidy from the Adoption Subsidy Office. Service must be necessary to treat certified conditions. DHS is payer of last resort ( use of Private health insurance, Medicaid, Children’s Special Health Care Services, Local and intermediate school districts, Other public resources.) Parents must seek prior authorization from the Adoption Subsidy Office. Services require individual education planning (IEP) for Speech therapy, physical therapy, and/or occupational therapy. Services are limited to the same level as the services stated in the child’s current IEP document.

Summer Camps The adoption medical subsidy program may cover up to $500 per year for the cost of specialized treatment summer camp. The camp must provide specialized services related to a certified medical condition. An overnight camp must be licensed in the state where it is located. Adoption medical subsidy will not cover the costs of transportation to or from the camp.

Summer Camps Requirements Child must have an approved medical Subsidy from the Adoption Subsidy Office. Service (camp) must be necessary to treat certified conditions. Parents must seek prior authorization from the Adoption Subsidy Office.

Dental Services (Orthodontic) The adoption medical subsidy program does not cover routine dental care. For orthodontic conditions certified with effective dates after August 1, 2002, total lifetime payments through the adoption medical subsidy program will be limited to $3,500. Adoption medical subsidy will not pay for missed appointments.

Dental Services Requirements Child must have an approved medical Subsidy from the Adoption Subsidy Office. The date of service is on or after the effective date of the adoption medical subsidy agreement Service (orthodontic ) must be necessary to treat certified conditions. DHS is payer of last resort ( use of Private health insurance, Medicaid, Children’s Special Health Care Services, Local and intermediate school districts, Other public resources. (i.e. The parent’s private health and dental insurance has been exhausted.)

Durable Medical Equipment The adoption medical subsidy program does not pay for structural changes, improvements to the home, or items that provide for the comfort, education or recreation of other family members. The adoption subsidy program does not purchase cars or vans.

Durable Medical Equipment Requirement Child must have an approved medical Subsidy from the Adoption Subsidy Office. Durable medical equipment must be necessary to treat certified conditions. DHS is payer of last resort ( use of Private health insurance, Medicaid, Children’s Special Health Care Services, Local and intermediate school districts, Other public resources (Trust Fund for Children with Special Needs). Prescribed by a physician to treat the condition certified by the Adoption Subsidy Program Office, and The least expensive alternative.

Medical Supplies and Prescriptions Medical Supplies include: Supply/prescription Glasses/Contact Lenses Adoption medical subsidy will pay for one pair of glasses or contact lenses per year if the child is covered by Medicaid. If the child does not have Medicaid, adoption medical subsidy will pay for up to two pairs of glasses or contact lenses in a calendar year. Incontinence Supplies (i.e. Diapers & pull-ups) Medicaid and Children’s Special Health Care Services must be used for diapers and pull-ups, or other incontinence supplies. If there are no other resources for those items, adoption medical subsidy will pay for diapers, pull-ups, or other incontinence supplies only when there is written documentation of a medical need and the child is four years of age or older.

Medical Supplies & Prescriptions Requirements Child must have an approved medical Subsidy from the Adoption Subsidy Office. Medical Supplies must be necessary to treat certified conditions. DHS is payer of last resort ( use of Private health insurance, Medicaid, Children’s Special Health Care Services, Local and intermediate school districts, Other public resources (Trust Fund for Children with Special Needs). The date of purchase is on or after the effective date of the adoption medical subsidy agreement.

How to access Medical Subsidy ? All Adopted children under Adoption Subsidy are assigned with an ongoing case worker. Ongoing case workers are assigned according to adopted parents last name (see packet for information). Parents can contact their worker with questions. Parents can make a written request for funding approvals to their workers .( Note: outpatient counseling and orthodontics do not require prior authorization but child must be approved with a certified medical condition by the Adoption Subsidy Office. Parents that are receiving Family Support Subsidy via CMH will not qualify for medical subsidy benefits.

Medical Certification Pre-Adoption: It is important for foster care workers and adoption workers to document medical conditions that child may have prior to adoption. The adoption worker can submit medical condition to the Adoption Subsidy Office by using the DHS 1341 Post- Adoption: Parents can make an application (DSH-1341 A) for new medical condition(s) up to the child’s 18th birthday.

Recap For the most part, the above services require: Child must have an approved medical Subsidy from the Adoption Subsidy Office. The services must be necessary to treat certified conditions. DHS is payer of last resort ( use of Private health insurance, Medicaid, Children’s Special Health Care Services, Local and intermediate school districts, Other public resources (Trust Fund for Children with Special Needs). Please contact your worker with questions.

References 1. DHS Public Website http://www.michigan.gov/dhs 2. Adoption Subsidy Manual: Post Placement – Use of the Adoption Medical Subsidy Program (AAM 640 pages 1-17) http://www.mfia.state.mi.us/olmweb/ex/aam/aam.pdf 3. Post-Adoption Parent Resources (Adoption Subsidy Payment Schedule & Electronic Funds Transfer (EFT) http://www.michigan.gov/dhs/0,4562,7-124-60126_7116_11423---,00.html\ 4. Adoption Subsidy Contact Phone Listing http://michigan.gov/documents/dhs/DHS-AdoptionSubsidy-Contacts_253834_7.pdf 5. Post Adoption Medical Request Form DSH 1341 A (PARENT’S REQUEST FOR MEDICAL SUBSIDY FOR AN ADOPTED CHILD) http://www.michigan.gov/documents/FIA1341A_9550_7.pdf 6. MICHIGAN’S ADOPTION SUBSIDY PROGRAMS, Information for Prospective Adoptive Parents http://www.michigan.gov/documents/DHS-Pub538_132926_7.pdf