December 22, 2022

Adoption Assistance for Children with Special Needs Adopted Domestically


Any waiting family associated with Nightlight Christian Adoptions long enough, will inevitably receive an email from Nightlight requesting consideration of a domestically born child who, because of significant special medical needs, is considered harder to place. Baby Saylor diagnosed with schitzencephaly, Baby Michael diagnosed with Prader Willi syndrome, and Baby Tommy diagnosed with microcephaly are just a few of the babies who were spotlighted in these emails. These babies, all with serious lifelong special medical needs, received placement through Nightlight with loving adoptive families.

There is a lot to seriously consider before accepting placement of a child with special medical needs. Much more than this blog can cover. The following is information about Adoption Assistance, the medical coverage and financial assistance available to adoptive families accepting placement of a special needs child, and the process of applying for Adoption Assistance when adopting privately.

The Adoption Assistance and Child Welfare Act of 1980 provided the first federal subsidies to encourage the adoption of children who would otherwise remain in long-term foster care by removing the financial obstacles related to adopting a child with “special needs”. Benefits commonly include monthly cash payments, medical assistance, reimbursement of nonrecurring adoption expenses and post adoption support services. There is a common misconception that Adoption Assistance, also known as adoption subsidies, is only granted to children adopted from foster care. This is not true. Adoption subsidies are available to any child adopted domestically, whether through foster care or private domestic adoption, who meets the definition of “special needs”. In a nutshell, a “special need” can be thought of as any obstacle keeping a family from accepting the placement of a child. A significant, lifelong medical need is one type of these obstacles. The largest criteria of what identifies a child as being “special needs” is the same throughout the US, but there are some varying smaller criteria among states.

Adoption Assistance is provided through two levels. One is through the federal level (called Title IV-E) and the second is through the state or county level (called Non-Title IV-E).  A child cannot qualify for both. The benefits can vary among states, especially the benefits provided on the state or county level. In private adoption, when a child has never been in foster care, Adoption Assistance, whether IV-E or non-IV-E, is overseen by the county or state public social services agency where the adoptive family resides, even when the child was born in another state. Waiting families can be proactive by researching the Adoption Assistance guidelines and services offered by their state. Here is a helpful website with additional state information:

The Adoption Assistance determination process, for a child placed through private adoption, begins by applying for Supplemental Security Income (SSI) disability benefits for the child.  The SSI disability application should be processed through the SSI office in the county where the adopting family resides. For more information on this application process please see:

If the child is approved for SSI disability benefits, he/she automatically qualifies for Adoption Assistance on the federal level (Title IV-E), and for Medicaid. Children approved for SSI disability benefits will begin receiving SSI benefits immediately and benefits will be retroactive to the date the application was submitted. Benefits include monthly cash aid and state medical coverage. This can feel like a win to adopting parents, but it is important that they continue and complete the Adoption Assistance application process, to receive Adoption Assistance. There are income guidelines for SSI benefits and once the adoption is finalized, the SSI benefits will be adjusted according to the adoptive family’s income. The adoptive family could experience a significant decrease in benefits.

If the child does not qualify for SSI disability benefits, they still may qualify for non-Title IV-E Adoption Assistance on the state or county level, and special medical coverage offered by the state.

The next step, for either SSI determination outcome, is to apply for Adoption Assistance through the public social services agency in the adopting parents’ state. Depending on the state, this may be at the county or state level. Most states or counties process very few adoption assistance applications for private adoptions and may not be familiar with the process. The National Council for Adoption website previously referenced has information about who can assist in your state.

Lastly it is important that adopting families not finalize the adoption until the Adoption Assistance has been approved. Once an adoption is finalized, it is nearly impossible to successfully obtain adoption assistance, especially on the federal level.

Like any government funded subsidy, there is never a guarantee it will last forever; however, in in my fifteen years as an adoption professional, Adoption Assistance on the federal level (Title IV-E) has only increased. The availability of Adoption Assistance should not be overlooked in private domestic adoption. The application and eligibility determination process may appear complicated, tedious, and lengthy, but the benefits are substantial. The benefits may provide all the financial difference in a waiting family’s ability to accept placement of a child with a special medical need.

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