Out-of-Home (OOH) Placements  

Policy

ACL 26-07, WICs 16121.5, 16121(b)(2), 16121(c)(3), MPP 45-806.2

For purposes of this topic, the term "child" includes all AAP-eligible children and non-minors (NMs).

Out-of-home placements occur when a child is placed in OOH care to treat a condition that the County (Post-Adoption Social Worker (SW)) determined exists. The SW shall conclude that the child would have been placed in the same out-of-home care facility if the child had not been adopted. There must be a plan to return the child to the adoptive family, and the adoptive family should actively participate in the reunification process. The SW must determine if the placement facility is:

  • Necessary to meet the child’s needs
  • Has the appropriate state license
  • Able to appropriately meet the child’s needs
  • The appropriate rate classification level to meet the child’s needs.

 The county financially responsible for making the AAP payment is also responsible for providing mental health assessments and services.

Note: When the AAP parents place a child with a relative within or out of California, the benefits will continue to go to the adoptive parents. AAP parents cannot authorize payments to a relative or to anyone not named on the AD 4320.

Differences Between the OOH In-State and OOH Out-of-State (OOS) Placements

  In-State OOS
Duration An episode may last up to 18 cumulative months. An episode may last for 12 cumulative months, and an extra 60 days for transitioning the child home.
Frequency Based on subsequent episodes or conditions. Once per the entire duration of the AAP case.
Adoptive Parent Responsibilities   Adoptive parents must also provide proof of licensing and accreditation to the SW and provide verification that the OOH placement meets requirements.

OOH In-State Placements

WIC 16121(b)

Payment may be made on behalf of an otherwise eligible child in a state-approved group home (GH), short-term residential therapeutic program (STRTP), or residential care treatment facility if the SW has confirmed that the placement is necessary for the temporary resolution of mental or emotional problems related to a condition that existed before the adoptive placement. When an out-of-home placement is needed, the placement is defined as an “episode.” Episodes are limited to an 18-month cumulative period. Subsequent authorizations for payment for a facility placement (mentioned above) may be based on an eligible child’s subsequent specific episodes or conditions. The cost of the placement is paid directly to the provider. If the cost of the OOH placement is below the California STRTP rate, the family may be issued a refund for the difference.  A new Adoption Assistance Program Agreement (AD 4320) is also required when the child or youth is placed out-of-home and when the child or youth returns to the adoptive parent’s home. 
While it is the responsibility of AAP parents to pay for the facility, Santa Clara County’s policy is to issue the benefits directly to the provider.
Upon the child’s return to the adoptive parents’ home, a new AD 4320 must be signed reflecting the AAP benefit amount. A new AAP 2 is provided to the Social Services Benefits Specialist (SSBS), not to exceed the state-approved foster family home rate, eligible SCI rate, or dual agency rate, and any applicable supplemental rates.
Note: Voluntary placements must be reassessed when the youth turns 18 during the out-of-placement episode. A new episode can be approved before the current episode has expired.

Note: Voluntary placements must be reassessed when the youth turns 18 during the out-of-placement episode. A new episode can be approved before the current episode has expired.

In-State Placements

In addition to the "Policy" and the above section, the following applies to in-state placements:

  • The DFCS Post-Adoption SW Supervisor (SWS) must approve the placement before the adoptive parents place the child.
  • The duration and payment amount of the episode must be documented on the Payment Instructions Adoption Assistance Program (AAP 2). The SW will provide a new AAP 2 to the SSBS to cover the out-of-home placement.
  • The AAP rate shall not exceed the rate paid for an STRTP.
  • The OOH placement may be approved for up to 18 months per episode or condition.

OOH Out-of-State (OOS) Placements

 WIC 16121.5, 42 USC 672

AAP payments can be made for an otherwise eligible child placed in an out-of-state (OOS) residential treatment facility if one or more adoptive parents live in the state where the treatment facility is located. The SW must also confirm that placement in an OOS residential treatment facility is necessary to temporarily address the child's or non-minor's mental, behavioral, or emotional health needs and must relate to a condition that existed before the adoptive placement. OOH placements made outside California should only be arranged as part of a plan for the child’s return to the adoptive family, with the adoptive parents actively involved in the reunification plan. The DFCS post-adoption SWS must approve the placement before the child is placed.

 

WIC 16121.5(b)(2)

In addition to the "Policy" and the section above, OOS placements must: 

  • Be licensed and in good standing or otherwise approved and in good standing by the applicable state or tribal authority
  • Be eligible as a Title IV-E funded placement in the state in which it is situated 
  • Provide an integrated program of specialized, intensive, and trauma-informed care, supervision, services, support, and treatment that are short-term and operate 24 hours a day
  • Have a trauma-informed therapeutic focus to treat a child’s mental health, behavioral health, emotional health, and attachment needs
  • Have a mental health clinic program. 

Duration of payment for OOH OOS placements

AAP may cover the costs for a total of 14 months, two of which are for transitioning purposes, for the entire duration of the child’s AAP case. 
AAP payments may be approved for up to a 12-month cumulative period if one or more adoptive parents reside in the state where the placement occurs. The AAP payment documented in the signed AD 4320 can continue for up to an additional 60 calendar days (for transition purposes). 

Role of Adoptive Parents:

When adoptive parents living outside California decide to contract with an out-of-home placement provider in the state where they live and place their child in that placement, they are private pay consumers, and the adoptive parent makes all decisions regarding that placement. Out-of-home placement contracts for placements outside California are between the adoptive parents and the out-of-state placement provider. The county may not act on behalf of the adoptive parents to obtain an out-of-home placement outside California for the AAP-eligible child. 
The adoptive parents may request that the SW increase the child’s total monthly negotiated AAP rate to cover placement costs. When the SW determines that the placement qualifies for approval, they and the adoptive parents will review and renegotiate the child’s total monthly negotiated AAP rate.

Adoptive parents must also provide proof of licensing and accreditation to the SW and provide verification that the OOH placement is:

  • Licensed or otherwise approved by the applicable state or tribal authority
  • In good standing
  • Eligible as a Title IV-E funded placement
  • An STRTP or Qualified Residential Treatment Program (QRTP) (42 USC 672: Foster care maintenance payments program).

Non-Minors Up to Age 21

AAP may cover the costs of an OOH OOS placement for an eligible non-minor if the following are met: 

  • The extension of AAP benefits to age 21 has been approved, and an amended AAP agreement has been executed
  • All eligibility requirements for out-of-home placement outside California, paid by AAP, are met. 

Ineligible OOS Placements

AAP will not cover the costs of the following placements outside of California:

  • Wilderness programs
  • Boot camps
  • Detention facilities 
  • Any facility mainly used for the detention of youth who are involved in the juvenile justice system, academies, or schools, including, but not limited to, boarding schools and military schools
  • Adult facilities. 

Existing OOH OOS Placements

For AAP agreements in effect before June 30, 2025, payments may continue until the terms of the AAP agreement are met. Adoptive parents may negotiate up to an additional 60 calendar days for the purpose of transitioning the child/NM home. AAP may not cover any subsequent out-of-home placement outside California if the adopted child has been placed in an out-of-home placement outside California for 12 months or longer for the duration of the child’s AAP case. 

Required Forms

The FC SSBS must obtain the following forms from the adoption SW for the out-of-state placement when not placed with the ICAMA process:

  • Payment Instructions: Adoption Assistance Program (AAP 2) with the duration of the episode.

Note: For ICAMA placements, refer to Interstate Compact on Adoption and Medical Assistance (ICAMA).

OOH OOS Placement Rates

The child’s or NM’s total monthly negotiated AAP rate shall not exceed the lesser amount of either: 

  • The STRTP rate
  • The rate determined by the rate-setting authority in the state in which the out-of-state residential treatment facility is located. 

If the cost of an out-of-home placement outside California is less than the maximum allowable rate, adoptive parents may negotiate to receive up to the eligible AAP basic rate, in addition to the rate paid to the provider. See the examples below:

  1. The maximum AAP rate is determined to be $15,000, adoptive parents negotiate a rate of $14,000 with the out-of-home placement provider, and the eligible AAP basic rate is $1,500, the adoptive parents may receive $1,000, and the provider may receive $14,000. The child’s total monthly negotiated AAP rate may not exceed the maximum allowable AAP coverage amount of $15,000. 
  2. The maximum AAP rate is determined to be $15,000, adoptive parents negotiate a rate of $13,000 with the out-of-home placement provider, and the eligible AAP basic rate is $1,500, the adoptive parents may receive $1,500, and the provider may receive $13,000. The child’s total monthly negotiated AAP rate may not exceed the maximum allowable AAP coverage amount of $15,000. 

If the cost of an out-of-home placement outside California exceeds the maximum allowable rate, adoptive parents may negotiate up to that rate. They will be responsible for any difference that AAP may not cover. See the example below. 

The maximum AAP rate is $15,000. If the adoptive parents negotiate a rate of $16,000 with the out-of-home placement provider, they will be responsible for the $1,000 difference that AAP may not cover. The child’s total monthly negotiated AAP rate may not exceed the maximum allowable AAP rate, $15,000. 

The AAP payment:

  • Is specifically for the AAP child/NM
  • May not be used for any other purposes
  • May not be transferred to the accounts of the provider to fund services for anyone but the AAP child/NM.

Other Funding Sources

Adoptive parents may use other funding sources to cover the costs of an out-of-home placement outside California, through the County Office of Education or the Medi-Cal program. Adoptive parents will need to check with their state Medicaid program to see whether it will cover the cost.

California Necessities Index (CNI) Increase

The annual CNI is not automatically applied to the OOH OOS rate. The provider must request the increase from the adoptive parents. The CNI increase applies only to the California STRTP rate when it is issued as the OOH OOS rate. The parents will then request the increase from the SW, who will complete a new AAP 2 and send it to the SSBS for processing. The SSBS will then send an NA 791 reflecting the new rate to the parents and the SW.

Medi-Cal/Medicaid Coverage

When a child/NM resides outside California, the Interstate Compact on Adoption and Medical Assistance (ICAMA) process must be completed to ensure continued medical coverage. Medi-Cal/Medicaid coverage may be used to cover placement costs. If Medi-Cal/Medicaid and AAP funding are used concurrently, AAP may not cover the same services that Medi-Cal/Medicaid pays for. 

Request Approval or Denial

When the OOH OOS placement request is approved,

The SW will:

  • Complete the Payment Instructions Adoption Assistance Program form (AAP 2) and forward it to the SSBS.

The SSBS will: 

  • Process the AAP 2 and send the approval Notice of Action Form (NA 791) to the adoptive parents and the SW.


When the OOH OOS placement request is denied,

The SW will:

  • Complete the AAP 2 to deny the request and forward it to the SSBS.

The SSBS will: 

  • Process the AAP 2 and send the denial NA 791 to the adoptive parents and the SW.

When the OOH OOS Placement Ends

  • Between 60 and 70 days before the placement end date, the SSBS will complete and send an NA 791 to the adoptive parents and the SW to notify them that the placement will end. 
  • If the SW approves the adoptive parent's additional 60-day request (for transitioning purposes), the NA 791 should include the new end date.
  • The SW will send an updated AAP 2 (reflecting rate change) to the SSBS.

Involuntary Placements

In an Involuntary Placement situation (the child/youth becomes court dependent under DFCS or JPD), the child has been removed from the AAP parent’s home. The AAP parent is still entitled to receive the basic AAP rate for the child. The basic rate is intended for the AAP parent(s) to maintain a bed or bedroom for the child, provide transportation to see the child, and cover any incidentals the child may need while in the facility, etc. The new placement of the child is paid out of a Foster Care case. When the AAP case remains open and benefits are continued, a referral to the Department of Child Support Services (DCSS) is necessary for the Foster Care case.

In the case of a ward (602’s/450’s), if another agency pays for the out-of-home placement, the maximum AAP benefits must be either:

  • The age-related, State-approved basic foster family home care rate
  • The adoptive parent’s actual share of cost for support of the child, whichever is greater, but not to exceed the foster family home rate the child would have received.

The adoptive parent(s) may continue to receive AAP benefits whether or not they are participating in family reunification services. However, the county may collect child support payments from the adoptive parent, but only up to the amount of AAP benefits paid to the adoptive parents.

Note: Agency approval and oversight of AAP benefits is not required, nor may the county request a list of expenditures or an accounting of how the AAP benefits are used to meet the child’s/youth’s needs.

 

Related Topics

Adoption Assistance Program [EAS 35325 - 35352.2]