Adoption Assistance Agreement - Minnesota Department Of Human Services (Page 2 of 8) in pdf

Ages 0-5

up to $247/month

Ages 6-11

up to $277/month

Ages 12-14

up to $307/month

Ages 15-17

up to $337/month

Ages 18-22

up to $337/month (if the agreement is extended to these ages under

Section VIII).

The basic maintenance needs payment will automatically increase as the child ages, unless the

adoptive parent(s) indicate in writing to the commissioner that they do not wish to receive such

increases.

Monthly Supplemental Maintenance Payment

A supplemental maintenance payment is in addition to the basic maintenance needs payment and

is available when a child has a diagnosed physical, mental, emotional, or behavioral disability

that requires care, supervision, and structure beyond that ordinarily provided in a family setting

for a child of the same age. The amount of payment for supplemental maintenance is based on the

severity of the child’s needs and the effect of the child’s needs on the adoptive family. The

certifying agency agrees to assess the child to determine eligibility for supplemental adoption

assistance using the Supplemental Adoption Assistance Needs Assessment form prescribed by the

commissioner.

The placing agency has assessed the child at the following supplemental level:

No supplemental level

Level III (up to $400/month)

Level I (up to $150/month)

Level IV (up to $500/month)

Level II (up to $275/month)

If changes in the child’s physical, mental, emotional, or behavioral condition occur which the

adoptive parent(s) believes may qualify the child for a supplemental maintenance payment or

change the level of supplemental maintenance payments for which the child qualifies, the

adoptive parent(s) may contact the county social service agency where the child resides in writing

so that the child can be reassessed. If the child resides outside of Minnesota, the adoptive

parent(s) may contact the placing agency to provide the reassessment.

Medical Care

Medical benefits as provided under Title XIX of the Social Security Act (Medicaid) will be

available to the child in accordance with the procedures of the state in which the child resides.

Children with Title IV-E Adoption Assistance Agreements will be provided Medicaid through

their state of residence. Children with state-funded Adoption Assistance Agreements have a

special need for medical or rehabilitative care. Children with state funded Adoption Assistance

Agreements who reside in Minnesota will be provided medical coverage through Medical

Assistance, Minnesota’s Medicaid program. Children with state-funded Adoption Assistance

Agreements who reside outside of Minnesota will be provided Medicaid through their state of

residence, if that state has reciprocity with Minnesota and the child meets the Medicaid eligibility

requirements in their state of residence. If there is not reciprocity or the child does not meet

Medicaid eligibility requirements in their state of residence, Medical Assistance will be provided

through Minnesota. Coverage is limited to providers authorized by Minnesota’s Medical

Assistance program and according to program rules in Minnesota.

Adoptive parent(s) who reside in Minnesota at the time the adoption is finalized agree to contact

the social service agency in the child’s county of residence immediately after adoption

finalization for instructions on enrolling the child in the Medical Assistance program. If the

adoptive parent(s) resides in a state other than Minnesota at the time the adoption is finalized, the

Page 2 of 8

Adoption Assistance Agreement - Minnesota Department Of Human Services Page 2

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