Interstate Compact on Adoptions and Medical Assistance (ICAMA)
The ICAMA is a contract among member states and U.S. territories. The ICAMA ensures the delivery of Medicaid and other post-adoption services to Adoption Assistance Program (AAP)-eligible children when their families move across state lines. California joined the ICAMA under Welfare and Institutions Code Sections 16170-16177.
The AAP provides financial and medical benefits. The AAP is designed to make it easier for families to adopt special needs children, thereby providing permanent homes for children who would otherwise remain in foster care. For more information regarding the AAP in California, see Adoptions Assistance Program .
In 1980, Congress passed the Adoption Assistance and Child Welfare Act, Public Law (PL) 96-272, which established the AAP and provided federal funding for financial and medical assistance. Adoption Assistance Program-eligible children were automatically entitled to receive Medicaid from the state that entered into an adoption assistance agreement with the child’s family. In addition, PL 96-272 required states to protect the interests of adopted special needs children in interstate situations.
In 1985, the Consolidated Omnibus Budget Reconciliation Act (COBRA) required states to grant Medicaid eligibility to children whose families signed an adoption assistance agreement with another state. However, COBRA did not provide for implementation of this requirement. The COBRA also gave states the choice of providing Medicaid to non-federally eligible children receiving state adoption assistance.
In the mid-1980’s, the ICAMA was drafted to create a framework for the interstate cooperation originally envisioned in PL 96-272. The ICAMA provides uniformity and consistency of policy and procedures when either a special needs child is adopted by a family in another state or the adoptive family moves to another state. The ICAMA resolves the differences in each state’s Medicaid program. The ICAMA procedures ensure that statutory and program requirements are met. While ICAMA promotes reciprocity of medical services, not all states provide Medicaid coverage to non-federally eligible children who have a signed adoption assistance agreement from another state.
Currently, 42 states are members of the ICAMA, and each member state has an ICAMA Compact Administrator. This person works with both in-state and out of state officials to ensure the provision of benefits and services for adopted special needs children, to process the ICAMA forms, and to serve as an information resource. In California, the Deputy Director of the California Department of Social Services (CDSS), Children and Family Services Division, and the Deputy Director of the Department of Health Services (DHS), Medical Services Division, share these responsibilities.
The ICAMA administrators formed the Association of Administrators for the Interstate Compact on Adoption and Medical Assistance (AAICAMA). The AAICAMA provides technical and legal assistance, training, and information to adoption professionals regarding issues related to both interstate and intrastate adoptions. For further information, the AAICAMA may be contacted at:
810 First Street, NE, Suite 500
Washington, DC 20002
Phone (202) 682-0100
Fax (202) 289-6555
AAICAMA website: www.aaicama.org/cms/
FREQUENTLY ASKED QUESTIONS RELATED TO ICAMA
WHO ARE “SPECIAL NEEDS” CHILDREN?
They are children who are difficult to place for adoption because of their “special needs” characteristics: older age at adoption; emotional or behavioral problems; membership in a sibling group that needs to be placed together; race; and disabilities (such as developmental problems or serious medical conditions) Welfare and Institutions Code Section 16120.
WHAT IS AN ADOPTION ASSISTANCE AGREEMENT?
It is a written agreement between the adoptive parents and a state agency that identifies the financial assistance and/or services that will be provided to adoptive parents on behalf of their special needs child.
WHAT IS THE ADOPTION ASSISTANCE STATE?
The adoption assistance state is the one that signs the adoption assistance agreement regarding benefits to a particular child. It is sometimes referred to as the “sending” state.
WHAT IS THE RESIDENT STATE?
The resident state is the one in which the child currently lives. It is the state obligated to provide Medicaid.
WHEN DOES THE ICAMA APPLY?
The ICAMA applies to children:
- Who move across state lines after their adoption is finalized.
- Who are initially placed interstate for adoption.
- Who are in residential treatment in a state other than the adoption assistance state.
WHAT IS THE ICAMA PROCESS IN CALIFORNIA?
Responsibility for completing the ICAMA forms has been delegated to the counties and the CDSS Adoptions District Offices, which act for counties without a public adoption agency. The counties and the district offices complete ICAMA forms 6.01, 6.02, and 6.03 and submit them to the appropriate resident state. For further information, refer to ACIN No. I-29-02
WHAT DOCUMENTATION IS NEEDED IN THE ICAMA PROCESS?
- ICAMA form 6.01, “Notice of Medicaid Application and Eligibility.” This form notifies the resident state that a child having a signed adoption assistance agreement with a California agency has moved from California to that state and is eligible for Medicaid. This form provides information related to the child, his/her parents, eligibility, and current residence.
- ICAMA form 6.02, “Notice of Action.” This form notifies the parents that an application has been sent to their new state of residence on behalf of their child.
- ICAMA form 6.03, “Change of Status.” This form provides notice that an adoption has been finalized; that the child has reached the age of majority; that the family has moved to another address in state; or that the family has moved to another state. This form may be completed by either the adoption assistance state or the new state of residence.
- Copy of the adoption assistance agreement.
WHAT IS THE ICAMA FORM DISTRIBUTION PROCESS?
Outgoing ICAMA requests:
- The California sending agency sends to the new state of residence the original ICAMA form 6.01, a copy of the adoption assistance agreement and a cover letter. The cover letter summarizes the case; for example, the family has recently moved, or the child previously received Medicaid in their state under foster care.
- The California sending agency sends to the CDSS, ICAMA Deputy Compact Administrator a copy of the sent ICAMA form 6.01 and the adoption assistance agreement.
- The California sending agency sends to the parents ICAMA form 6.02, a copy of the ICAMA form 6.01 and the adoption assistance agreement.
- The originating state (either California or the new state of residence) retains the original ICAMA form 6.03, and submits copies to the recipient state, to CDSS, ICAMA Deputy Compact Administrator and to the parents.
Incoming ICAMA requests:
The sending agency sends a copy of its ICAMA package (ICAMA forms and adoption assistance agreement) to the DHS Medi-Cal Eligibility Branch. The DHS Medi-Cal Eligibility Branch then contacts the new county of residence to establish Medi-Cal eligibility.
WHICH STATES PROVIDE RECIPROCITY OF MEDICAL SERVICES?
Individual state information is provided on this website: www.aaicama.org/cms/
WHO ARE THE CALIFORNIA STATE ICAMA CONTACTS?
WHO ARE CALIFORNIA’S ICAMA COUNTY LIAISONS?
HOW CAN I LOCATE A STATE ADMINISTRATOR?
WHAT IS THE DIFFERENCE BETWEEN THE ICPC AND THE ICAMA?
The ICPC governs the placement of children across state lines in foster care, group homes, residential treatment facilities, preliminary adoptive placements, and certain non-agency placements with guardians or relatives. The purpose of the ICPC is to ensure that interstate placement of a child is not contrary to the welfare of that child. For more information regarding California’s administration of the ICPC, see Interstate Compact on the Placement of Children
The ICAMA facilitates the delivery of AAP services and benefits to special needs children with a signed adoption assistance agreement in interstate situations.
HOW DOES MEDICAID RELATE TO MEDI-CAL?
Medicaid is the federal medical assistance program authorized by Title XIX of the Social Security Act. Medicaid pays for medical services that are reasonable and necessary to protect life and prevent significant disability or serious deterioration of health of needy and low-income persons.
Medi-Cal is the name of California’s Medicaid health care program. It is supported by federal and state funds. Medi-Cal pays for a variety of medical services for children and adults with limited income and resources, and is administered by the California Department of Health Services. For more information regarding Medi-Cal, see Medi-cal Information .
WHOM DO I CONTACT IF I HAVE FURTHER QUESTIONS?
Out-of-State Placement Policy Unit
California Department of Social Services
744 P Street, M.S. 8-12-90
Sacramento, CA 95814