Review of Eligibility for Adoption Assistance for
Child/Youth Turning 18, 19, and 20 Years Old
Child’s Name: / D.O.B. / TFACTS ID #
County: / Current Funding Source: / IV-E State Funded Fostering Connections IV-E
Child’s Adoption Assistance Rate / Regular Special Extraordinary / Rate Amount
Effective Date of Initial Adoption Assistance Agreement
This form must be completed before a child/youth turns 18 years old and at each year after the 18th birthday until the case is terminated. Eligibility for State Funded and Title IV-E Fostering Connections Adoption Assistance for children/youth 18, 19, and 20 years old is based on continuous full time school enrollment and attendance. Breaks in full time attendance and enrollment will disqualify the child/youth for continued eligibility. The only exception is in instances where the educational institution considers the break to be normal or customary for the school year.
Section 1. Complete the following section for a child/youth receiving State Funded Adoption Assistance:
a. Answer below for Adoption Assistance Agreement initiated prior to October 1, 1997.
Question: Is the child/youth attending any accredited school full time?
Yes - If yes, documentation from the accredited school must be attached and included in the Adoption Assistance file and the case can remain open.
No - If no, the Adoption Assistance case must be closed effective the day of the child/youth turning 18 years old or if the child/youth is past the age of 18, the Adoption Assistance case should be closed, effective the last date the child/youth attended any accredited school full-time.
b. Answer below for Adoption Assistance Agreement initiated on or after October 1, 1997 through February 29, 2008.
Question: Is the child/youth attending high school full time?
Yes- If yes, documentation from the high school must be attached and included in the Adoption Assistance file and the case can remain open.
No If no, the Adoption Assistance case must be closed effective the day of the child/youth turning 18 years old or if the child/youth is past the age of 18, the Adoption Assistance case should be closed, effective the last date the child/youth attended any accredited school full-time.
c. Answer below for Adoption Assistance Agreements initiated on or after March 1, 2008.
Question: Is the child/youth under the age of 19 and attending high school full time?
Yes- If yes, documentation from the high school must be attached and included in the Adoption Assistance file and the case can remain open until the child/youth reaches the age of 19 or graduates from high school AND at least age 18, whichever occurs first.
No- If no, the Adoption Assistance case must be closed effective the day of the youth’s 18th or 19th
birthday or the date the child/youth last attended high school full-time.
Section 2. Complete the following section for a child/youth whose Adoption Assistance Agreement was initiated on or after October 1, 2010, is receiving Title IV-E Fostering Connections Adoption Assistance, AND was 16 or older at the time of adoption.
Question: Does the child/youth meet one or more of the IV-E Fostering Connections requirements?
a. Is the child/youth under the age of 21 and enrolled in and attending high school, GED, or other equivalency program full time? Yes No
b. Is the child/youth under the age of 21 and enrolled in an institution that provides post-secondary or vocational education? Yes No
c. Is child/youth under the age of 21 and determined incapable for employment or attending school due to a documented medical condition? Yes No
¨ The Adoption Assistance subsidy can remain open if the child/youth meets one or more of the requirements AND a response of “yes” has been indicated for one or more of the Fostering Connections requirements listed above. Professional documentation from the school or treating licensed professional must be attached and included in the subsidy file and the Adoption Assistance can remain open.
¨ If the child/youth does not meet any of the Fostering Connections requirements listed above, the Adoption Assistance case should be terminated effective the day of the child/youth turning 18 years old; the last day the child/youth attended high school, GED or an equivalency program full-time; the last day the child/youth attended post-secondary or vocational school; or, when it is determined that the child/youth is capable of working or attending school.
¨ If the child/youth is approaching their 18th birthday and does not meet one of the above Fostering Connections criteria (a-c) or ceases to meet one of the above criteria (a-c) after their 18th birthday, then the child/youth may be evaluated for eligibility for non-applicable Title IV-E Adoption Assistance if at the time of adoption finalization the youth also met the Standard Title IV-E Adoption Assistance criteria. See “Section 4” or “Section 5” below.
Section 3. Complete the following section for a child/youth whose Adoption Assistance Agreement was initiated on or after October 1, 2010, is receiving Title IV-E Fostering Connections Adoption Assistance, AND who was under the age of 16 at the time of adoption.
· The child/youth is no longer eligible for Title IV-E Fostering Connections Adoption Assistance. Proceed to sections 4, 5 OR 6 to evaluate the child/youth for non-applicable Title IV-E Adoption Assistance or State-funded Adoption Assistance.
Section 4. Complete the following section for non-applicable Title IV-E Adoption Assistance Agreements effective through June 30, 2012, to determine if the child/youth has a mental or physical disability/handicapping condition, which warrants the continuation of non-applicable IV-E.
OR
Complete the following section for a child/youth who was previously eligible for Fostering Connections Title IV-E Adoption Assistance whose Adoption Assistance Agreement was initiated on or after October 1, 2010 through June 30, 2012 to determine if they may be eligible for non-applicable Title IV-E Adoption Assistance if at the time of adoption finalization the child met the Standard Title IV-E Adoption Assistance criteria.
Question: Does the child/youth have a mental or physical disability/handicapping condition, documented by a licensed provider responsible for the care and treatment of the child/youth?
Yes- If yes, supporting documentation of the child/youth’s condition, on-going treatment needs, and participation from the treating professional must be included in the child/youth’s subsidy file and the adoption assistance record can remain open or the previously Fostering Connections Title IV-E Adoption Assistance Agreement may be revised to non-applicable Title IV-E. (For permanent conditions such as mental retardation, the documentation from the initial approval is sufficient. Current documentation must be attached for conditions that are not considered to be permanent).
No- REVISION - If no, the IV-E Adoption Assistance case must be revised effective the day of the child/youth’s 18th, 19th, or 20th birthday if it was determined that the child/youth no longer has a handicapping condition which warrants the continuation of non-applicable IV-E but the youth meets the criteria in Section 6 a, b, or c of this document to have their Adoption Assistance Agreement funded through State.
No- TERMINATION - If it is determined that the adoption assistance case will be terminated; the effective date for termination should be the day of the child/youth’s 18th, 19th, or 20th birthday.
¨ The child/youth may be evaluated for eligibility for State Funded Adoption Assistance. See “Section 6” below.
Section 5. Complete the following section for Adoption Assistance Agreements effective on or after July 1, 2012 to determine if the child/youth has a mental or physical disability/handicapping condition, which warrants the continuation of non-applicable IV-E Adoption Assistance.
OR
Complete the following section for a child/youth that was previously eligible for Fostering Connections Title IV-E Adoption Assistance, whose Adoption Assistance Agreement was initiated on or after July 1, 2012 to determine if they may be eligible for non-applicable Title IV-E Adoption Assistance if at the time of adoption finalization the child met the Standard Title IV-E Adoption Assistance criteria.
Question: Does the child/youth have a mental or physical disability/handicapping condition as defined below?
¨ Any disability or handicapping condition described by a qualified licensed provider, responsible for the care and treatment of the child/youth’s condition, as moderate or severe warrants the continuation of non-applicable Title IV-E Adoption Assistance; or
¨ Any disability or handicapping condition described by a licensed provider, responsible for care and treatment of child/youth’s condition, to substantially limit the child/youth in one or more major life functions warrants the continuation of non-applicable title IV-E Adoption Assistance.
Yes- If yes, supporting documentation of the child/youth’s condition, on-going treatment needs, and participation from a professional must be attached and included in the child/youth’s subsidy file and the non-applicable Title IV-E Adoption Assistance case can remain open or the previously Fostering Connections Title IV-E Adoption Assistance Agreement may be revised to non-applicable Title IV-E.
No- REVISION - If no, the non-applicable Title IV-E Adoption Assistance case or Fostering Connections Title IV-E Adoption Assistance case must be revised to State funded effective the day of the child/youth’s 18th, 19th, or 20th birthday, if the youth meets the criteria in Section 6 a, b, or c of this document.
No- TERMINATION – If it is determined that the adoption assistance case will be terminated; the effective date for termination should be the day of the child/youth’s 18th, 19th, or 20th birthday.
¨ The child/youth may be evaluated for eligibility for State Funded Adoption Assistance. See “Section 6” below.
Section 6. Complete the following section to evaluate if a child/youth that is no longer eligible for non-applicable Title IV-E Adoption Assistance may be eligible for State Funded Adoption Assistance.
OR
Complete the following section to evaluate a child/youth that was previously eligible for Fostering Connections Title IV-E Adoption Assistance but were under the age of 16 on the date the initial Adoption Assistance Agreement went in effect to determine if they may be eligible for State Funded Adoption Assistance.
a. Answer below for Adoption Assistance Agreements initiated prior to October 1, 1997.
Question: Is the child/youth attending any accredited school full time?
Yes- If yes, documentation from the school must be attached and the Adoption Assistance Agreement can be changed to State Funding. (This change must be documented in TFACTS).
No If no, the non-applicable IV-E Adoption Assistance case or Fostering Connections Title IV-E Adoption Assistance case must be closed effective the day of the child/youth’s 18th birthday or if the child/youth is past the age of 18, the Adoption Assistance case should be closed, effective the last date the child/youth attended any accredited school full-time.
b. Answer below for Adoption Assistance Agreements initiated on or after October 1, 1997 through February 29, 2008.
Question: Is the child/youth under the age of 21 and attending high school full time?
Yes- If yes, documentation from the school must be attached and the Adoption Assistance Agreement can be changed to State Funding until the child/youth graduates from high school. (This change must be documented in TFACTS).
No- If no, the non-applicable IV-E Adoption Assistance case or Fostering Connections Title IV-E Adoption Assistance case must be closed effective the day of the child/youth 18th birthday or if the child/youth is past the age of 18, the Adoption Assistance case should be terminated, effective the last date the child/youth attended high school full-time. .
c. Answer below for Adoption Assistance Agreements initiated on or after March 1, 2008.
Question: Is the child/youth under the age of 19 and attending high school full time?
Yes- If yes, documentation from the high school must be attached and the Adoption Assistance case can be changed to State Funding. (This change must be documented in TFACTS).
No- If no, the non-applicable IV-E Adoption Assistance case or Fostering Connections Title IV-E Adoption Assistance case must be closed effective the day of the child/youth’s 18th or 19th, birthday.
Check the appropriate status below:
Child/Youth remains eligible for State Funded Adoption Assistance.Child/Youth is no longer eligible for State Funded Adoption Assistance and the Adoption Assistance case will be closed effective
Child/Youth remains eligible for Title IV-E Adoption Assistance.
Child/Youth is no longer eligible for Title IV-E Adoption Assistance but is eligible for State Funded Adoption Assistance and the Adoption Assistance Agreement will be revised effective
Child/Youth is no longer eligible for Title IV-E Adoption Assistance and is not eligible for State Funded Adoption Assistance and the Adoption Assistance case will be closed effective
Child/Youth remains eligible for Title IV-E Fostering Connections Adoption Assistance
Child/Youth is no longer eligible for Title IV-E Fostering Connections Adoption Assistance but is eligible for non-applicable Title IV-E Adoption Assistance and the Adoption Assistance Agreement will be revised effective
Child/Youth is no longer eligible for Title IV-E Fostering Connections Adoption Assistance but is eligible for State Funded Adoption Assistance and the Adoption Assistance Agreement will be revised effective
Child/Youth is no longer eligible for Title IV-E Fostering Connections Adoption Assistance and the Adoption Assistance case will be closed effective
Approved By: / Date of Review:
Subsidy Specialist Supervisor
* Required supporting documentation must be attached.
Check the “Forms” Webpage for the current version and disregard previous versions. This form may not be altered without prior approval.
Distribution: RDA 2368
CS-0792, 01/14 Page 1