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State budget cuts and a change in Medicaid coverage have saddled some families who have adopted special-needs foster children with unexpected expenses and difficult choices.

As of July 1, Medicaid no longer covers "therapeutic supervision" costs for in-patient mental health treatment. At the same time, state budget cuts reduced a supplemental subsidy fund that the Division of Child and Family Services used to help parents with such expenses.

"Now the state is going back to adoptive parents and asking them to make up the difference in cost," said Jennifer Gardner, president of the Utah Foster/Adoptive Families Association. "It is just hard when these were the state's kids to begin with."

The funding changes impacted an estimated 40 to 50 children statewide who receive adoption subsidies, said Staci Ghneim, deputy director for DCFS. At least 12 were returned to state custody because their families could not afford the added expense.

One of Natalie's three adopted children is among them.

She and her husband adopted two brothers as infants; both were exposed to methamphetamine during their mother's pregnancy. At the time they adopted the second boy, the couple also adopted an older sibling.

The couple had a simple motive when they adopted three children from state foster care: They wanted to help.

But Natalie says she feels let down — even misled — about the children's needs and the state's ability to help her family meet them. The two boys have since been diagnosed with autism. But the biggest challenge has come with the older sibling, whom they returned to state custody recently because of severe — and undisclosed, Natalie says — behavior problems.

The state "so desperately wants you to take them," said Natalie, who The Salt Lake Tribune has agreed not to identify by her real name because she feared repercussions for speaking out. "They knew we were up against it and promised we would get whatever help we needed — treatment this and treatment that — and that they were not going to leave us alone with these kids."

This summer, as the situation reached a crisis, the family sought mental health treatment for the older child and were told they would have to pay up to $1,500 a month for that care.

Unable to afford that option, they were given two choices: Accept in-home services for the child or return the child to state custody and pay child support. They chose the second option.

"There is no doubt [the child] can never be back in our home," said Natalie. "What is so hard for me is never have they considered the other therapy I have had to provide for our biological children who had been threatened with death from this child."

The state garnishes her husband's wages to collect the child support; the family still receives an adoption subsidy — which matches the amount collected in child support — that they use to help cover the child's foster care. "Here we are five years after saying we wanted to be foster parents with three very special-needs kids and four others who are resentful of all we have to do to keep this family afloat," she said. "I don't know how this happened."

The family has until March to determine if they want to be reunited with the child, Natalie said, but "we know that is an impossibility."

Gardner said she is hearing from more families with stories like Natalie's.

"I don't know if it is because resources are stretched or kids are more troubled so that problems are cropping up more often," she said.

Liz Rivera, a Utah Foster Care Foundation trainer, said families are required to attend several workshops aimed at educating them about what to expect as foster parents, and later as adoptive parents.

"We try to bring in people who have fostered and adopted so they can talk about how they dealt with" challenges, she said. But, "Once you adopt, this is your child as if this child had been born to you."

Parents are told that a child's needs may be unknown; at worst, they may have serious or even severe problems, typically reflected in the child's file.

But in the midst of an adoption, optimism reigns.

Marty Shannon, DCFS' adoption program manager and an adoptive parent herself, said, "We try to prepare people as much as we can, but we only know what we know and we don't know what will come up later."

"The children have issues that are more complicated and intense so even when you think you are prepared to give everything they need, over the years it drains you," Shannon said. "Because you feel so drained, you feel unprepared and you blame the state for that."

To help families who take children with special needs, the state still offers post-adoption services that can include a caseworker, in-home services or help finding community services, Medicaid and an adoption subsidy.

"That is a our formal commitment to these families," Ghneim said.

DCFS has opted to try to keep current supplemental subsidy intact, reducing the amount given in new grants.

"We don't have as much of that at time when we need more of it," Shannon said. Caseworkers have tried to connect parents with community resources for children's mental health treatment needs "so they didn't have to come back into DCFS." But it's a tough situation, she said.

"There isn't anyone in our position who doesn't feel horrible about it but I don't know what we can do," she said. "I feel really bad. I feel people take on challenging children and are getting hit in two directions."