Assessing the Field of Post-Adoption Services: Family Needs, Program Models, and Evaluation Issues. Analysis of Secondary Data. 2.5 Adoption Subsidy and Vendor Payments for Adoptive Families

11/01/2002

These analyses use data that record payments to adopted children (subsidies) or payment for services received by adopted children (vendor payments). These vendor payments may be used to purchase such services as respite care, therapeutic summer camp, and specialty mental health or educational services. Since the information is tracked by the adopted child's client ID number, the quality and completeness of the data are dependent on this data element. In North Carolina, adopted children receive a new client ID number after the adoption decree is final, making it impossible to track total expenses for children across their entire child welfare career. Thus, these analyses focus solely on the amount of assistance that a child receives after the final adoption decree.

Nearly all adopted children receive subsidies, which are generally stable over time.

Because 94 percent of the children in this analysis file received cash assistance payments at some point in time and these payments can only begin after the final adoption decree is entered, it is our assumption that the ID numbers represent payments to unique children and that a single child will not have two ID numbers while receiving cash assistance. To the extent that this assumption is incorrect, we may be over-counting the number of children receiving adoption assistance payment. A comparison of the number of foster children adopted in North Carolina in the past six years, 6,122, to the number of children with a final adoption decree in the last six years who are included in these assistance files, 6,182, suggests that there may be a few children with multiple ID numbers in the data files. These are probably not enough, however, to change the result of these findings in any major way.

Exhibit 11 summarizes the timing and amount of assistance received by adopted children in North Carolina since 1990. Almost all children with adoption assistance received cash payments (94%), and close to two-thirds (61 percent) also received additional assistance in the form of payments to vendors for therapeutic or medical services or nonrecurring costs of adoption. Half of the children started receiving cash payments almost immediately after the final decree. Within six months of the decree 96 percent had received their first cash assistance check. The average cash payment amount during this time period was $346 per month received for an average of 42 months. However, because most of these cases are still open, these averages may change over time since there are some increases in payments as children age. Very young children received average cash assistance payments equal to $315; the average payment for children between 6 and 12 years old was $364; for children older than 12 the average payment increased to $409.

Exhibit 11.
Summary of Adoption Assistance Program for Children in North Carolina
with Adoption Decree after December 31, 1989
  Number of Children
with benefits
Percent of total Amount/Time
Received adoption assistance 8,647 100%  
1 Cash assistance payments 8,108 94%  
Timing of 1st cash assistance payment
  within 1 month of adoption decree 4,054 50%  
  within 6 months of adoption decree 7,765 96%  
  Average # days between adoption decree & 1st cash payment     81 days
Pattern of payments
  No change in payment amounts over course of assistance 4,157 51%  
Still receiving payments as of Dec. 2001 7,807 90%  
  Payments terminated because child turned 18 413 5%  
  Payments terminated due to other reasons 427 5%  
Average number of months (to date, 12/2001) in which payments were received     42 mons.
Amount of payments
  Average cash payment amount     $346
  Minimum cash payment recorded     $1
  Maximum cash payment recorded     $415
  Average first cash payment amount     $319
  Average last cash payment amount     $367
  Average difference between first and last cash payments     -$32
  Average total amount of cash assistance received to date (12/2001)     $14,914
2 Vendor payments for other services 5,240 61%  
Timing of 1st payment
  within 2 months of adoption decree 2,620 50%  
  within 6 months of adoption decree 3,859 74%  
  Average #days between adoption decree & 1st vendor payment     255 days
Pattern of payments
  Average number of vendor payments received to date (12/2001)     4
Amount of payments
  Average total vendor payments to date (12/2001)     $1,423
  Minimum vendor payment recorded     $1

Slightly over half (51 percent) of children had no change in their subsidy amounts over the course of their assistance period. For the remaining children, many of them having been adopted for relatively short times, the increases were not substantial. This resulted in an average difference between the initial and last or most recent payment equal to $32. Exhibit 12 provides more detailed information about the length of time children receive subsidy payments in North Carolina in relation to subsidy increases. These analyses suggest that there are relatively few increases during the first few years of the subsidy and that the subsidy changes peak after four years.

Exhibit 12.
Patterns of Increases in Subsidy

Exhibit 12. Patterns of Increases in Subsidy.

The average time between the first cash payment and the initial increase is almost two years; however, this varies by the age and race of the adopted child, as shown in Exhibit 13. This exhibit suggests that older children are less likely to receive subsidy increases and that the initial increase does not occur as quickly as it does for younger children. This is not surprising since the most frequent type of increase in subsidy amount in North Carolina seems to be tied to the age of the child and appears to parallel the increases that other foster children receive  increases that become less frequent as the child ages. These analyses, however, are perhaps somewhat misleading, since older children actually have less time in which they are eligible to receive assistance. To account for differences in eligibility time, using survival analysis we calculate the probability that a child will receive an increase.

Exhibit 13.
Patterns of Subsidy Increases by Child Characteristics
  Average no. of months
between 1st payment and initial increase
Percentage with
at least 1 increase
Avg. no. of increases
for those with increase
Age (yrs) at 1st payment
  Birth - 5 19.4 59% 2
  6 - 12 24.5 44% 2
  13 - 17 26.9 18% 2
Male 22.1 46% 2
Female 22.6 45% 2
White 22.6 48% 2
Black 21.9 46% 2
Other minority 23.7 35% 2

Survival analysis techniques make maximum use of available data by including all eligible children in the analyses whether they have already received a subsidy increase or not. Since most of the study population are active cases, it is possible, even likely, that many of the children who have not yet received a subsidy increase will eventually receive one. Survival analyses estimate this likelihood by calculating the cumulative probability that the event of interest, in this case, increase in subsidy amount, occurs by specific time points. Exhibit 14 estimates the overall probability that an increase will occur at a given time after first subsidy receipt. Exhibits 15 and 16 provide this probability estimate for children by age and race, respectively.

Exhibit 14.
Probability of an Increase in Cash Assistance

Exhibit 14. Probability of an Increase in Cash Assistance.

Exhibit 15.
Probability of Increase in Cash Assistance, by Age

Exhibit 15. Probability of Increase in Cash Assistance, by Age.

Exhibit 16.
Probability of Increase in Cash Assistance by Race

Exhibit 16. Probability of Increase in Cash Assistance by Race

Children who receive subsidies at young ages are most likely to receive increases

The overall cumulative probability of an increase is depicted in Exhibit 14. During the first year of assistance about 20 percent of children are likely to receive an increase; by the two-and-a-half-year mark the probability increases to about 50 percent. The probability of an increase varies by both age and race, as shown in the following two exhibits. Children under five years of age were the most likely to have subsidy increases and to incur them more quickly as indicated by the slope of the curve. By the one-year mark there is an increase in subsidy amount for an estimated 30 percent of young children compared with 20 percent of 6- to 12-year-olds and 10 percent of teenagers. Four years after the initial subsidy payment approximately 10 percent of children adopted before age 5, 40 percent of adopted 6- to 12-year-olds, and almost 70 percent of those adopted as teenagers are receiving the same subsidy payment. Because teenagers are aging out of the adoption assistance programs, these results are not surprising.

Because many factors are related to the length of time until an increase occurs, survival analysis was used to examine the relationships. Exhibit 17 presents the results of a Cox proportional hazards model that analyzes the likelihood that a subsidy increase will occur while controlling for characteristics of adopted children and length of eligibility time. Race and age at initial payment are significantly related to the likelihood of a subsidy increase. Even though the model controls for the number of months of assistance, children who begin receiving adoption assistance before age five (the reference group) are much more likely to receive increased subsidy payments than older children. Other minority children are less likely to receive an increased subsidy than either white (the reference group) or black children.

Exhibit 17.
Likelihood of Increased Subsidy Amount
  B Sig. Exp (B) 95.0% CI Exp (B)
        Lower Upper
Gender -.014 .660 .986 .926 1.050
Race   .038      
White (reference group)         1.000
Black -.054 .115 .948 .887 1.013
Other minority -.146 .018 .864 .766 .975
Age 1st payment   .000      
0 - 5 yrs (reference group)         1.000
6 - 11 yrs -.614 .000 .541 .506 .579
12 - 17 yrs -1.100 .000 .333 .277 .399
Months of payments   .000      
0 - 36 (reference group)         1.000
37 - 72 .401 .000 1.493 1.366 1.632
73 - 108 1.406 .000 4.082 3.711 4.490
Over 108 1.568 .000 4.799 4.195 5.490
# Vendor checks   .000      
0 (reference group)         1.000
1 .061 .137 1.063 .981 1.152
2 - 10 .252 .000 1.287 1.188 1.395
Over 10 .158 .009 1.171 1.040 1.319

Analysis of vendor payments indicated that half of the children with a vendor payment had the first payment within two months of the adoption decree and 74 percent had first payment within six months of the decree. The average number of vendor payments per child was four, with amounts ranging up to $2,000. The analysis of these payments is complicated by the fact that children could receive these payments before and after the final decree, and thus payments for one child could be recorded under different ID numbers. Thus, it is likely that these numbers actually underestimate the amount of vendor payments incurred by an individual child.

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