State adoption subsidy programs date back at least 20 years, when U.S. laws first offered a federal match for state subsidy costs. PAS programs have been planned and implemented much more recently. State adoption program mangers interviewed indicated that the choice of services to be included in PAS programs was influenced by the views of adoptive parents and by reports of successful program models implemented elsewhere. None reported that the services offered by PAS programs were chosen to complement those supported through subsidies or other service systems. However, it is clear that PAS programs are only one resource by which adoptive families can access services. Among the five case-study states, for example, only Texas included residential care in its PAS program, but other states supported residential treatment for adopted children through their Medicaid program or through another state agency. Other states may choose to adjust adoption subsidy rates to help parents purchase these services.
States have a variety of options with which to support adoptive families.
States have considerable latitude in providing subsidies and other supports to adoptive families. Basic AAP subsidies are capped at 100% of the states foster care rate. However, the amount of support that adoptive families receive from the state depends on a range of policies that extends beyond subsidy amounts. Specific policies, such as restrictions on Medicaid access for children who are not eligible under Title IV-E or restrictions on the funding or reimbursement of respite care, will significantly affect the level of support received by some families.
Many factors limit the degree to which PAS programs and subsidies can substitute for one another. Some services offered by PAS programs, such as information and referral or support groups, cannot be purchased by individuals. Other services, such as counseling, could be accessed by families who purchase them with their own insurance or subsidy funds; however, families may be unable to find professionals with expertise in adoption-related issues except within the PAS program. In states where subsidy decisions are made at the county level, state adoption offices have little or no influence on the extent to which they can be adjusted. Substantial disparities among counties have been observed in these states (Avery, 1998). Thus even a generous subsidy program would not completely negate the need for a statewide PAS program.
It is equally true that PAS programs often will not be a satisfactory substitute for what families would purchase for themselves with subsidies. As discussed earlier, PAS programs vary substantially in terms of what services are offered, and a states program may not include the specific services needed by a family. Many families need services at a higher level of intensity or for a longer duration than available through the PAS program, or they prefer to choose their own providers and service settings.
If subsidies are to be a meaningful component of the support package offered to adoptive families, they must be sufficiently flexible to respond to families needs as their circumstances change and generous enough to meet what may be substantial needs. However, states vary significantly with respect to policies that determine the amount of subsidy support and their flexibility.