13.46.1 Continuation of Title IV-E Adoption Assistance After Age 18


​​​​​​​​​​​​​​​​​An adopted child may have a disability as determined by the Social Security Administration (SSA) or by a Cabinet for Health and Family Services (CHFS/Cabinet) medical review team (MRT) that allows for continuation of title IV-E adoption assistance after the age of eighteen (18). A disability includes the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s) and can be expected to result in death or last for a continuous period of not less than twelve (12) months.

​​​​​​​The Department for Disability Determination Services (DDS) MRT considers the following factors at least six (6) months prior to the youth’s eighteenth (18th) birthday to allow or deny a disability determination for an adopted child:

  • ​​​​​​​The youth’s medical history and medical testimony, including information relating to the alleged physical or mental disability, illness, or impairment as to whether the youth's ability to gain full-time employment or pursue opportunities within a state or federal education program are reduced; and 
  • The youth’s age, employment history, education, and effect of the physical or mental condition on the ability to care and support self.

Practice Guidance



The R&C worker:

  1. Contacts the family when the youth becomes age seventeen (17) to provide initial information concerning the SSA and/or MRT review process. A review is only applicable for title IV-E subsidy. Please see the Subsidy Extension due to Medical Disability Letter. 
  2. At the request of the adoptive family, provides the DPP-601 Referral for Determination of Disability to Continue IV-E Funded Adoption Assistance, MRT-15 Procedural Instructions, and MRT-15 Release of Information to the adoptive family for completion; 
  3. Requests that the adoptive family provide current (within one (1) year) supporting documentation including, but not limited to: 
    1. Educational testing; 
    2. Individual education plans (IEPs); 
    3. Medical records; or 
    4. Psychiatric hospital records;1
  4. Reviews the provided information and forwards the DPP-601, MRT-15, applicable supporting documentation, and a copy of the family's DPP-1258 Adoption Assistance Agreement to central office staff for consideration by the MRT. ​The R&C worker should contact​ the Adoption Services Branch at 502-564-2147 to obtain the name of a contact person and the mailing address for the required documentation submission. 
  5. Should take the following actions if a disability determination is denied: 
    1. Consult with Adoption Services Branch staff; 
    2. Refer the youth for further assessment when necessary; and 
    3. Follow procedures outlined in SOP 13.44 Discontinuance of Adoption Assistance. 
  6. Contacts the children’s benefits worker (CBW) to ensure continuation of Medicaid for the youth until age ​twenty-one (21) if a disability determination is approved. When the MRT makes a disability determination, a report is provided to the Adoption Services Branch. The Adoption Services Branch forwards the report to the R&C worker and the adoptive family. 2 
  7. Should discuss the following with the family if the SSA makes the determination that the child is disabled. 
    • Supplemental security income (SSI) is an entitlement benefit that is based on a child's disability and is income tested. Public Law 110-351 removed the means tested eligibility criteria for an applicable child. Adoptive parents should contact the SSA with any questions. 
    • If a child receives both SSI and adoption assistance subsidy, the SSI benefit will be reduced "dollar for dollar" by the amount of the monthly adoption subsidy. 3 
    • In most cases, the amount of the adoption assistance subsidy exceeds the amount of the SSI benefit. The adoption assistance subsidy is time limited, however, the SSI benefits may be available for the duration of the youth's life. Adoptive families should be advised to consider both outcomes when deciding which benefit to choose.4


  1. ​​​​The adoptive family should return the requested documentation six (6) months prior to the youth's eighteenth (18) birthday. 
  2. The Adoption Services Branch and the R&C worker should not discuss back payments with the adoptive family. The family should be advised to contact the Division of Administration and Financial Management (DAFM) branch manager with questions related to any back payment. 
  3. ​​​​​​​​​For children receiving adoption assistance under title IV-E who do not meet the criteria to be an applicable child, if those children receive both SSI (which is an entitlement, but is based on a child's disability and is income tested) and adoption assistance, the SSI benefit is reduced dollar for dollar by the amount of the monthly subsidy. In almost all cases, the amount of the subsidy exceeds the amount of the SSI.
  4. The adoptive family is responsible for applying for SSI.  This can be done by contacting the SSA or by starting an online application at The United States Socal Security Administration (ssa.gov)​