Adoption Respite Eligibility

What is Adoption Respite?

Respite care provides adoptive parents with a break from the constant demands of caring for their special needs adopted child (children). It may be used for planned activities or emergency situations.

Jump down to the Adoption Respite Billing Form »

 

Who is Eligible for Adoption Respite?

Adoption Respite is a service available to adoptive families for their subsidized adopted children. Each adopted child who is subsidized is eligible for 5 days of respite service per fiscal year at $17 per day. Adoption Respite is ONLY available to adopted children who receive adoption subsidy.

 

How is Respite Accessed? What is the timeframe?

• Each child is eligible for 5 days per fiscal year. The current fiscal year runs from July 1, 2012 to June 30, 2013. All Adoption Respite forms for this fiscal year must be submitted to IFAPA by July 10, 2013 in order to be processed for the 2013 fiscal year.
• When respite is needed, the adoptive parent selects their own respite provider, and makes necessary arrangements. To receive payment, provider must be an adult (over age 18).
• After respite care is provided, please complete our online form (see below) and submit directly to IFAPA.
• Payment will be made to the provider and will receive a copy of the Adoption Respite Billing Form with payment.
• IFAPA will process all payments within 5 working days of receipt.
• Payments to providers for this program are contingent upon continued Adoption Respite Program funding from DHS.

 

Who Do We Contact for More Information?

You may contact both the Iowa Foster and Adoptive Parents Association (IFAPA) and your adoption worker who handles your adoption subsidy case, for more information. IFAPA is responsible only for the payment of respite - not in locating providers.

 

Where Do We Receive Additional Respite Billing Forms?

To submit the form electronically, please complete the form listed below or to print a paper copy, click here.

To receive paper copies of this form in your mail, contact IFAPA (Phyllis Pierce) at 800-277-8145, ext. 4 or 515-289-4567, ext. 4 or e-mail her at ppierce@ifapa.org.

 

Adoption Respite Billing Form

Required fields - *

Information for Subsidized Adoptive Parents:

*Adoptive Parent(s) Names: Name(s) required.
(Include first and last names of all parents separated by a comma)

*Address: Address required.       *City: City required.

*State: State required.       *Zip Code: Zip code required.

*Daytime Phone: Daytime phone number is required.

Home Phone:

Email Address: Email address required.Invalid format.

Information for Person Providing Respite (must be 18 or older):

* Name of Person Providing Respite: Name required.

*Address: Address required.       *City: City required.

*State: State required.       *Zip Code: Zip code required.

*Daytime Phone: Daytime phone number required.

Home Phone:

Email Address: Email is required.Invalid format.

Respite care is being provided for the following adoptive children:

Name	Medicaid ID#	Age	Gender
Add at least one child.	A value is required.	0-12 months 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Please select an age.	M   F
		0-12 months 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21	M   F
		0-12 months 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21	M   F
		0-12 months 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21	M   F
		0-12 months 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21	M   F
		0-12 months 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21	M   F
		0-12 months 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21	M   F
		0-12 months 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21	M   F

 

Dates Requesting Respite

*Beginning date: Begin date required.       *Beginning Time: Begin time required.

*Ending date: End date required.       *End Time: End time required.

*Number of respite days completed: Please let us know how many days of respite you've completed.

*By initialling below I certify that the above Respite Services were provided during the time stated above and that the children receiving adoption respite have had a finalized subsidized adoption.

Please intial.

NOTE - If the form does not submit, please return to the top to verify ALL required fields are filled in.

IMPORTANT - Adoption Respite is a program available to adoptive families for their subsidized adopted children. Each adopted child who receives a subsidy is eligible to receive five days of respite care per fiscal year at $17 per day. After respite services have been provided, the adoptive parent should complete this form and submit to IFAPA. The current fiscal year for the Adoption Respite Program runs from July 1, 2012 to June 30, 2013. All respite days must be used during these dates and the completed form must be submitted to IFAPA no later than July 10, 2013. Please allow one week for processing.