ICAMA provides the administrative structure by which states adhere to the Consolidated Omnibus Budget Reconciliation Act (COBRA). ICAMA also is the mechanism by which the provision of Medicaid to children with state-funded adoption assistance is facilitated when such children move from state to state. Each ICAMA member state has a designated point of contact and follows the ICAMA protocol to ensure that eligible adopted children receive Medicaid in their states of residence. Currently, 47 states and the District of Columbia are members of ICAMA, including Virginia. Non- member states include New York, Vermont and Wyoming.

COBRA, passed by Congress in 1995, made two changes to Title XIX Medicaid affecting children with special needs who are adopted. COBRA mandated that states of residence provide Medicaid to all children adopted with Title IV-E adoption assistance agreements. It also provided states with the option of extending Medicaid coverage to children adopted pursuant to state-funded adoption assistance agreements.

COBRA made significant changes with respect to medical coverage for adopted children with special needs. It did not provide an administrative mechanism by which provision of Medicaid across state lines would be facilitated. Each state's Medicaid program differs. Information required, benefits and coverage may vary. ICAMA provides standard forms and procedures that meet federal and state requirements.