Maryland Kinship Care Health Consent Affidavit: DHS Form SSA 554 Explained

Form DHS/SSA/554 is the official Maryland document that gives a relative caregiver legal authority to consent to a child's healthcare. It is published by the Department of Human Services Social Services Administration and is the standard statewide instrument under Health-General Article § 20-105.

What the Form Requires

The affidavit asks you to declare, under penalties of perjury:

• The child's full name and date of birth
• Your name and relationship to the child (you must be related by blood or marriage within the fifth degree)
• That the child lives with you full-time, 24 hours a day, 7 days a week, at your Maryland residence
• The specific qualifying hardship — death, serious illness, drug addiction, incarceration, abandonment, or military deployment of the parent or legal guardian
• The parent's last known address (you must make reasonable efforts to inform them)

You do not need the parent's signature. The form must be signed and dated under oath in the physical presence of a commissioned notary public.

Where to File

The completed form goes to two places:

1. The DHS Social Services Administration — this is the official state filing
2. Every healthcare provider who treats the child — the pediatrician, dentist, urgent care clinic, and any specialists each need a copy on file

The healthcare affidavit works alongside the separate school enrollment affidavit under Education § 7-101(c). They serve different institutions — one for medical providers and DHS, one for the school district — but both require the same eligibility (relative within the fifth degree, full-time care, qualifying hardship).

What Treatment It Authorizes

A valid § 20-105 affidavit covers the full range of routine and preventive care: physicals, vaccinations, dental cleanings, prescription medications, diagnostic testing, specialist referrals, and outpatient procedures. Providers who treat the child in good-faith reliance on the affidavit are shielded from civil liability.

The affidavit also authorizes you to apply for the Maryland Children's Health Program (MCHP) — Maryland's Medicaid program for children under 19 — through Maryland Health Connection.

When It Does Not Apply

Three situations limit or void the affidavit:

• The parent objects. An explicit parental objection to a treating provider overrides your consent authority immediately.
• A court order exists. If a judge has assigned healthcare decision-making to another person, the affidavit is void.
• The child self-consents. Maryland law gives minors independent consent for certain treatments — substance abuse treatment, STI treatment, contraception, and (for ages 12 and up) outpatient mental health therapy. When the child consents on their own, the caregiver's affidavit is not required and the child controls confidentiality.

Annual Renewal and Change Reporting

The affidavit must be renewed annually. If the care arrangement changes — the child returns to the parent, the hardship resolves, or you move — you must notify DHS and the child's healthcare providers within 30 days.

For step-by-step instructions on completing this form alongside the school enrollment affidavit, including a medical intake prep sheet, see our Maryland School and Medical Consent Guide.

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