Wednesday, July 25, 2012

Level of Care in Foster Children; Another Issue in the Negotiation of Adoption Assistance

The question of the child's level of care is becoming more and more significant in the  negotiation of adoption assistance and in hearings involving disagreements over the amount of adoption assistance.  The payment a child actually received or would receive in a foster home suitable to their level of care at the time of the most recent negotiation sets the limit on the amount of adoption assistance that is eligible for federal financial participation (FFP).  The foster care payment a child actually received or would receive is based largely on the child's level of care.

Interestingly, this issue is connected to the current  dispute over the incorrect claim of Dan Shook of ODJFS that adoption assistance payment rates may not exceed the foster care rates of county agency foster homes.  Last week, I realized that I had overlooked Paragraph (E)(2) of OAC 5101:2-49-05 and so, I believe, had Mr. Shook.  Paragraph (E)(2) states:

To determine the amount the FCM payment would have been if the child had been placed in a foster home operated by the PCSA, the PCSA shall:

(2) Determine the amounts of any special, exceptional or intensive needs difficulty of care payments, clothing payments, school supplies, and other allowable FCM payments which are not part of the daily or monthly foster care board rate,. . . ."  

Three points are relevant here.

1.     In order to determine the child's foster care payment rate would be at the time of the most recent negotiation of adoption assistance, one most consider the child's level of care and determine if the level of care indicated a specialized foster home (treatment, therapeutic).  If the child were already in a treatment, therapeutic or other foster care setting prior to adoptive placement, then the question is answered.

2.     If a specialized level of care is warranted either by the child's actual placement in a treatment or foster home or is indicated by an assessment of the child's level of care, then level of support in the foster home becomes the maximum amount of adoption assistance that is eligible for FFP.

3.     If there are no agency foster homes that are suitable for children with specialized or "difficulty of care" needs, then the rate the child would receive in the treatment home affiliated with a private service provider would set the maximum amount of adoption assistance that would be eligible for FFP.

The use of objective level of care instruments, interpreted by qualified, unbiased professionals, could provide an effective means of establishing the practical ceiling on the amount of adoption assistance that could be negotiated in any given case. 


Specialized "difficulty of care" definitions of foster care can be found in OAC rule 5101:2-47-18.  It appears, however, that few counties use these definitions. Instead, they employ their own level care criteria.  There are not standard tools for assessing a child's level of care currently in use.

Adoptive parents and advocates need access to individual county's level of care instruments and criteria as well as the foster care payments that are associated with each level of care.  Without that information, adoptive parents and agencies find themselves arguing about the scope of possible adoption assistance payments, unless the child is placed for adoption from a specialized foster home that is consistent with the child's level of care.

Information on levels of care exists. It needs to be collected and compiled. ODJFS, the Ohio Association of Child Caring Agencies (OACCA), as well as individual counties are possible sources.  Once this information is available, there is need for a method of determining how the level of care criteria apply to a given child.