State and Federal Adoption Assistance Funding

Children adopted from a State or state foster care  (not private adoption) may qualify for exceptional benefits and funding for treatment in a qualified program.   For example, California State-adopted children qualify through an application process within the county where the child was adopted.  Generally, once a case manager approves the funding, the child may be treated in a licensed program, utilizing licensed therapists, a non-lockdown, and a 501(c) 3 Non-Profit Organization. States differ on their extended benefits. If offered, contact the locale from which your child was adopted to begin the application process for funding.

• Department of Health and Human Services

• 🔗 Understanding Adoption Assistance Funding

• National Council for Adoption

• 🔗 A Guide to Adoption Subsidies and Assistance for Adoptive Parents

• California Adoption Assistance Funding

• • • California's adoption assistance funding program may cover a significant amount of funding for a residential treatment program when the need for exceptional care is approved. Contact the  CA County where the adoption took place.  Recent legislation in CA eliminates out-of-state placements for children adopted from the State of CA child welfare system.

• 🔗 https://www.cdss.ca.gov/inforesources/adoptions/adoption-assistance-program

Post-Adoption Grant Funding for Treatment

Post-adoption grants and crowdfunding options

• 🔗 Show Hope Adoption Funding

• 🔗 Lifesong for Orphans (Crowdfunding)

Independent Educational Plan (IEP) Funding

Parents are often unaware that high-level funding for a treatment school may be possible through a student’s IEP.

Sometimes, a local school district will transfer a student's  Independent Educational Plan (IEP),  and the funding attached to it,  from the district to a therapeutic boarding school to comply with the requirements listed in the IEP .  Parents may be required to demonstrate that the local district services do not meet the requirements of the IEP as it is written.  Establishing IEP funding in a treatment school setting can sometimes require the assistance of a Special Education Attorney.

🔗 Click Here to Read more about IEP Funding

Advocacy Resources

Council of Parent Attorneys & Advocates (COPAA)

• 🔗 https://www.copaa.org.

• The services of a Parent-Attorney may be found through a professional organization called COPAA, or the Council of Parent Attorneys and Advocates.  Search for an IEP or Special Education attorney licensed in your state on their website: https://www.copaa.org.  An educational attorney does not have to be licensed in your school district, just licensed in your State.  Hire an attorney, not an advocate or a consultant.

Wright's Law (Disability & Special Education Support)

• 🔗 https://www.wrightslaw.com

• See more about laws and disability rights for special education, disability, and IEPs at the Wrights Law website:  www.wrightslaw.com. Parents, educators, advocates, and attorneys come to Wrights Law for accurate, reliable information about special education law, education law, and advocacy for children with disabilities.

Crime Victim's Compensation

If your child was the victim of a crime, neglect, abuse, or other crimes, and a case was filed - even if there is no adjudication or determination of guilt - you may apply to the Crime Victim's Compensation Fund in the state where the crime was filed.  Crime Victim's Compensation is a reimbursement-style program that pays as a secondary to anything health insurance does not pay for related to treatment for the crime.  Compensation for medically necessary treatment can be substantial.

Funding Resources

National Association of Crime Victim's Benefits Boards 🔗 http://www.nacvcb.org/.

• Click on the STATE where the crime was filed.  Then click on the application to submit and complete the process.  Every state has a Crime Victims' Compensation Advocate who can help you through the process if needed.

Health Insurance

Single Case Agreement (SCA)

A Health Insurance Single Case Agreement (SCA) is a one-time contract between a health insurance company and a healthcare provider or facility. This agreement is typically made when a patient requires services from a provider outside the insurer's standard network. The SCA allows the patient to receive the necessary care from the out-of-network provider while the insurer agrees to cover the services, often at a negotiated rate.

Here are the critical elements of a Single Case Agreement:

• Out-of-Network Care: The SCA is often used when the patient’s needed care is unavailable within the insurer’s existing network of providers.- 

• Negotiated Rates: The insurer and provider agree on specific terms for the reimbursement rate for services rendered, which may differ from the provider's standard fees or the insurer's typical in-network rates.

• Well-defined Scope: Unlike long-term contracts with in-network providers, an SCA  is usually for a single patient and covers a specific treatment or period of care.

• Patient-specific: The agreement is tailored to meet the patient's needs, ensuring they receive necessary care even if the provider is not ordinarily accessible under the patient’s insurance plan.

Typical Scenarios for SCA

A patient needs highly specialized care only offered by a provider outside the insurer’s network. The patient requires urgent or ongoing care from a provider who does not participate in the insurer's network. By establishing an SCA,  insurers can ensure that patients receive critical care while controlling costs and providing some degree of reimbursement for services.

In-Network Programs

Private insurance policies require some level of medical necessity before coverage applies. Medical necessity includes threats to harm oneself, threats to hurt others, suicidal ideation or statements, or suicidal attempts.

Many programs and behavioral health networks that work at a high level with insurance are not long-term (see Newport Academy, Embark Behavioral Health, and others). Programs that work with private or State insurance offer a free verification of benefits. Some can go further and achieve pre-authorization or ask for a Single Case Agreement.

Once in a program, insurance providers require regular medical necessity reviews, and programs submit information and secure further authorizations  accordingly. Longer-term or extended coverage may be part of a SINGLE CASE AGREEMENT. Health providers will end treatment when insurance funding ends or create a cash-pay agreement for continued treatment.

Some programs that don’t directly bill for insurance can provide a superbill to submit to their insurer for the therapy portion of their child’s stay in a long-term program.

Coverage depends on your policy limits, deductibles, and terms of coverage.  Programs that work with private or State insurance offer a free verification of benefits. Some can go further and achieve pre-authorization.