We completed the adoption of a 5 year old severely medically needy and catastropically impaired child in February, 2010 subject to an adoption subsidy agreement that was signed in August 2009, prior to the implementation of the VEMAT.  Additionally, we are in the process of adopting a second severely medically needy child with a proposed adoption date to be scheduled sometime before the end of the calendar year.  We are encouraged that the proposed revisions to the VEMAT will address the lack of equitable subsidies for children in the medically needy category.  However, we believe the proposal must also provide guidance on how the VEMAT will apply to prior adoptions, including adoptions that were completed and subsidy agreements that were entered into prior to the implementation of the VEMAT.