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VFA Policy Intern Blog: You Move, You Lose

You Move, You Lose 

By Michael Tuskey 

Published 8/4

In the United States, there are two primary ways the government supports adoption: federal (Title IV-E adoption assistance) and state (non IV-E adoption assistance). These programs aim to assist with the adoption of children who are classified as special needs which is having a condition that makes adoption more difficult. The main benefit of this assistance is that the child is enrolled into Medicaid, assuring them the treatment they need and maintaining that costs are not a burden for the adopting family. However; due to the interstate policy in Medicaid, states are refusing to provide this assistance for children adopted from another state or they cut access when a child moves from the state. Such conditions mean that adopting families, who find a child to call their own, can face ruinous medical cost simply because the child is not located in their original state. VFA stands against such ruinous policies, named “You Move, You Lose.”

Adoption Assistance began in 1980 with the Adoption Assistance and Child Welfare Act of 1980. The act allow for states to incentivize the adoption of special needs children through Medicaid funds in addition to the federal government expanding eligibility for children under Title IV-E. For children covered under Title IV-E, there is no issue with interstate movement because it is a federal program that covers the eligible 66% of special needs youth who can be adopted. For the 35% of children that are not covered under Title IV-E, they need states’ assistance in order to have medical coverage. The process of establishing coverage begins when an adoption agency and adopting family agree to the adoption of a special needs child. The parties sign an agreement in which the state provides Medicaid coverage to the child as long as the adoption assistance remains in effect. However; for families that are out of state, assistance is not guaranteed and the adopted children can only receive care form their home state. States argue that if a child is adopted in another state, they are not obligated to cover this child under Medicaid. If an adopted child’s family moves, the consequences could be dire if the child depends on state Medicaid.

This denial of coverage for children is not only wrong but also unconstitutional under the Privilege and Immunities Clause, Equal Protection Clause, and the very nature of the Constitution itself. The Privilege and Immunities Clause establishes a right to travel and permanent residents should not face any restrictions or penalties for traveling. By denying children adoption assistance because they were adopted from another state, states are clearly not treating the child as a permanent resident and violate the law. Under the Equal Protection Clause, states may not discriminate against citizens or create a hierarchy for care.  In reality, denying a child health coverage simply because of their out of state adoption means that the state does have a system of prioritization for health coverage. In hindsight, the fundamental of the Constitution is that states come together as one to form the United States where all are treated equal, no matter where they are from or where they go. Denying adopted children health coverage on account that they were not adopted in the state they currently reside in, goes against the principals of this country’s Constitution.

We live in a mobile society, where people move to and live in different states frequently. Laws need to be tailored to assure that such mobility is not penalized. For adopted children, they should not lose their access to Medicaid just because the adopting family is from another state. “You Move You Lose” policies are not only wrong but they go against the founding principles of the United States. VFA stands against states that reject out of state adoption assistance and urges those lawmakers to ensure children receive the care they need.






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