|What part do adoption subsidies play in supporting post-adoption services?|
What we know: Adoption subsidies are a sizable and growing federal and state expenditure. We know only the broad outlines of subsidy distribution. Nationally, 88 percent of children adopted in 2000 received subsidies (DHHS, 2001c). The number of children receiving subsidies appears to be rising in tandem with increases in the number of adoptions; preliminary AFCARS data showed a 3 percent increase between 1998 and 2001 (Penelope Maza, personal communication, August 26, 2002). The proportion of adoptive families receiving subsidies may be lower for adoptions in the programs earlier years. A 1993 analysis found that substantial numbers of families who could have qualified for subsidies did not receive them (Sedlak and Broadhurst, 1993). This is significant in light of data indicating that families receiving subsidies are less likely to experience disruption (Berry and Barth, 1990).
State and county subsidy policies vary widely. A review by the North American Council on Adoptable Children found that states varied in both the generosity and flexibility of their subsidy policies. The review documented differences in the definition of special needs, basic and specialized subsidy rates, availability of deferred subsidy agreements and subsidized guardianships, and payment for residential and respite care (Bower and Law, 2002). Although there is not yet data with which to rigorously evaluate the relationship between adoption subsidy provision and the success of adoptions, the authors may be correct in asserting that the underuse and misuse of subsidies may discourage would-be adoptive parents and contribute to the incidence of disruptions. Even when state policies govern subsidy provision, variation in implementation may produce vastly different results. Between-county variability in subsidy provision may be nearly as great as state-to-state variability (Avery, 1998), and have similar consequences.
Very little has been done to examine changes in subsidies over time. These changes may be essential purchase post-adoption services and supports that help them respond to changing needs. Our analysis of administrative data from California and North Carolina found large differences between the two states in the likelihood that families will experience a change in subsidy amount at some point. Although most subsidy increases appear to be associated with periodic reviews or with administrative cost-of-living adjustments, an important proportion of changes are unrelated to review schedule. These changes appear to be associated, in part, with changes in childrens behavioral problems. A pattern of increasing frequency of subsidy changes often preceded initiation of residential care, suggesting that these changes could serve as a marker for families in need of supportive services. The likelihood and amount of subsidy changes were also found to be associated with parental characteristics (income and maternal education) as well as child characteristics. Higher income and more educated households received a disproportionate share of larger increases. This suggests that families ability to negotiate needed increases may play as substantial a part in subsidy determinations as financial need.
Moving forward: Better understanding is needed of both the determinants of state policy and their role within adoptive families. The substantial variations among states with respect to subsidy policies suggest that impacts on the adoption of children from foster care and the level of services available to them must certainly exist. More needs to be understood about which factors influence state policies on subsidies and other supports, and how federal reimbursement policies shape state decision-making. Given better administrative data, it would also be possible to more fully examine the relationship between subsidy levels and changes and time to permanency, adoption disruption, and displacement.
A variety of changes in adoption subsidy policies have been proposed in recent years, such as allowing subsidies to be higher than foster care payments or allowing subsidies to be used to pay for temporary residential treatment. These would be challenging to assess because they are governed by state statutory requirements. Waivers from standard Title IV-E funding schemes could be granted to test other cost-neutral approaches to delivering subsidies, but this would be very difficult to achieve, and the outcomes would probably be quite subtle.
At the family level, we can work to understand how subsidy increases are being used, whether they are being adjusted in ways that appear to be appropriate to family circumstances, the implications of current approaches to subsidy determination and re-authorization, and the interface between subsidies and PAS programs. Among the questions to be answered:
- What combination of subsidies and family resources are used to meet the needs of special needs children in different families?
- What kinds of events trigger activation of deferred subsidy agreements?
- Are subsidy increases for purchase of PAS, sufficiently timely and flexible to help families address pressing needs?
- To what extent could services purchased by subsidies be provided through PAS programs? When are subsidies more effective than PAS, and when are PAS more useful?