Title IV-E Adoption Assistance

Parents who are thinking about or are in the process of adopting a child with special needs from foster care should know about adoption assistance (also known as adoption subsidy). Federal and state adoption assistance programs are designed to help adoptive parents meet children’s varied, and often costly, needs. Adoption assistance may provide monthly maintenance payments, medical assistance, and other support, often until the child turns 18 or even 21. The state is required to enter into an agreement with the adoptive parents if the child qualifies for assistance.


Children can qualify for federal Title IV-E adoption assistance or state (non-IV-E), assistance but not both. A child’s background and special needs determine if the child will receive support and if that support will be federally or state funded. If a child is IV-E eligible, the federal government reimburses the state at least half of the subsidy cost, depending on the state.


State Adoption Assistance Programs

Children who don’t qualify for Title IV-E adoption assistance often qualify for non-IV-E or state adoption assistance from the state that had custody of the child. The state will also decide if the child is eligible for Medicaid benefits or some other medical coverage.

Families planning to move or adopt a child from out of state need to be proactive, check out the guidelines for receiving services and/or Medicaid in the state where they will reside, and apply as soon as they can. It is also important for parents who are considering a move to check out the availability of services in the area where they hope to move. A child could qualify for services, but not receive them if the area does not have the medical and mental health professionals to provide those services.


Below is an explanation of the factors that define a child with special needs:

Special Needs Determination

To be considered a child with special needs, a child must meet all three of the criteria below:

  1. The state has determined that the child cannot or should not be returned to the birth parents’ home.
  2. The state has found a specific factor or condition, or combination of factors and conditions that make the child more difficult to place for adoption. Each state sets its own special needs definition, which may include the child’s ethnic background; age; sibling group status; medical condition; or physical, mental, or emotional disabilities.
  3. The state has made a reasonable, but unsuccessful, effort to place the child without providing adoption assistance. Making “a reasonable effort” may mean the adoption agency has asked for the assistance of an adoption exchange to help find a family for the child or referred the child to an agency that specializes in placing children with special needs. An exception is made to this requirement if making the effort to locate a family is not in the best interest of the child. For example, if the child has a significant emotional bond with foster parents who want to adopt or a relative is willing to adopt, it is not in that child’s best interest to look for other adoptive parents who could adopt without support.

Child Welfare Services Transformation

Best Outcomes for Children and Families

Do you have a complaint regarding services being provided to a child by a state agency? Please submit your complaint by phone (1-800-206-1957) or an electronic submission form here with the South Carolina Department of Children's Advocacy.