Some may think the placement of a child into an adoptive home finalizes the adoption, but there's still at least a few months of waiting for the courts to catch up and declare the adoption legally final. The process of adoption finalization may include post-placement supervisory visits from a case worker, who will provide a recommendation to the judge for the adoption to be finalized. Depending on the backlog of adoption paperwork, the finalization process can take a few months or more. If it's an infant adoption being approved and the birth mother didn't terminate her parental rights at the hospital, she may need to be present to finalize her terminated rights. Some states may require two hearings - an initial and final one. The initial hearing would be to go over the conditions of the adoption and to finalize any birth mother rights. The final hearing would be for the adoption finalization.
After adoption finalization, the adoptive parents will receive a certificate of adoption that can be used to get the child's new birth certificate made. The child's original birth certificate will be filed in a sealed adoption record with the state that in some states, may be retrieved at a later date. After receiving the new birth certificate, the child is legally under the complete parental responsibility of his or her adoptive parents and can now be added to his or her parents' health care and insurance policies.