The reader should recognize that efforts to improve the establishment and enforcement of medical child support need to be viewed in the current context of high health care costs, a declinein employer-provided health insurance coverage (which is the foundation of the current medical childsupport system), an increase in the share of health insurance costs borne by employees, and a largenumber of children who are uninsured. This report provides alegislative history of medical support provisions in the CSE program, describes current policy withrespect to medical child support, examines data on medical child support, and discusses some of theissues related to medical child support. Medical support is the legal provision of payment of medical, dental,prescription, and other health care expenses for dependent children by the noncustodial parent. Itcan include provisions to cover health insurance costs as well as cash payments for unreimbursedmedical expenses. The requirement for medical child support is a part of the child support order,and it only pertains to the parent's dependent children. Activitiesundertaken by the state CSE agencies to establish and enforce medical support are eligible for federalreimbursement at the general CSE matching rate of 66%. (4)
According to federal regulations (45 CFR 303.31), for both families who have assigned their medical support rights to the state and families who have applied for CSE services, the CSE agencymust:
(1) Petition the court or administrative authority to include in the child support order health insurance that is available to the noncustodial parent at reasonable cost in new or modified childsupport orders, unless the child has satisfactory health insurance other than Medicaid;
(2) Petition the court or administrative authority to include medical support whether or not --(a) health insurance at reasonable cost is actually available to the noncustodial parent at the timethe order is entered; or (b) modification of current coverage to include the child(ren) in questionis immediately possible;
(3) Establish written criteria to identify cases not included under the previous two provisionswhere there is a high potential for obtaining medical support based on -- (a) evidence thathealth insurance may be available to the noncustodial parent at a reasonable cost, and (b) facts,as defined by state law, regulation, procedure, or other directive, which are sufficient to warrantmodification of the existing support order to include health insurance coverage for a dependentchild(ren);
(4) Petition the court or administrative authority to modify child support orders for cases thatare likely to have access to health insurance to include medical support in the form of healthinsurance coverage;
(5) Provide the custodial parent with information pertaining to the health insurance policywhich has been secured for the dependent child(ren);
(6) Inform the Medicaid agency when a new or modified court or administrative order for childsupport includes medical support and provide specific information to the Medicaid agencywhen the information is available;
(7) If health insurance is available to the noncustodial parent at reasonable cost and has notbeen obtained at the time the order is entered, take steps to enforce the health insurancecoverage required by the support order and provide the Medicaid agency with the necessaryinformation;
(8) Periodically communicate with the Medicaid agency to determine if there have been lapsesin health insurance coverage for Medicaid applicants and recipients; and
(9) Request employers and other groups offering health insurance coverage that is beingenforced by the CSE agency to notify the CSE agency of lapses in coverage. (8)
The medical child support process requires that a state CSE agency issue a notice to the employer of a noncustodial parent, who is subject to a child support order issued by a court oradministrative agency, informing the employer of the parent's obligation to provide health carecoverage for the child(ren). If thedependent child(ren) is eligible for coverage under a plan, the plan administrator is required to enrollthe dependent child(ren) in an appropriate plan. The plan administrator also must notify thenoncustodial parent's employer of the premium amount to be withheld from the employee'spaycheck. Most policymakers agree that health care coverage must beavailable, accessible, affordable, and stable. 105-200 stipulated that a medical child support incentive payment system be developed -- thathas not yet happened. Further, although the National Medical Support Notice was promulgatedDecember 27, 2000 and became effective on March 27, 2001, as discussed below, only half of thestates are using it. 104-193 ), which required inclusionof health care coverage in all child support orders established or enforced by CSE agencies, it isgenerally agreed that the establishment and enforcement of medical support has remainedinadequate.
Medical child support is the legal provision of payment of medical, dental, prescription, and other health care expenses of dependent children. It can include provisions to cover health insurancecosts as well as cash payments for unreimbursed medical expenses. According to 2001 ChildSupport Enforcement (CSE) data, 93% of medical child support is provided in the form of healthinsurance coverage. The requirement for medical child support is apart of all child support orders(administered by CSE agencies), and it only pertains to the parent's dependent children. Activitiesundertaken by CSE agencies to establish and enforce medical child support are eligible for federalreimbursement at the CSE matching rate of 66%.
The medical child support process requires that a state CSE agency notify the employer of a noncustodial parent who owes child support, that the parent is obligated to provide health carecoverage for his or her dependent children. CSE agencies notify employers of a medical childsupport order via a standardized federal form called the National Medical Support Notice. The planadministrator must then determine whether family health care coverage is available for which thedependent children may be eligible. If eligible, the plan administrator is required to enroll thedependent child in an appropriate plan, and notify the noncustodial parent's employer of thepremium amount to be withheld from the employee's paycheck.
Although establishment of a medical support order is a prerequisite to enforcing the order, inclusion of a health insurance order does not necessarily mean that health insurance coverage isactually provided. According to CSE program data, in 2001, only 49% of child support ordersincluded health insurance coverage, and the health insurance order was complied with in only 18%of the cases. Most policymakers agree that health care coverage for dependent children must beavailable, accessible, affordable, and stable. Since 1977 and sporadically through 1998, Congresshas passed legislation to help states effectively establish and enforce medical child support. TheNational Medical Support Notice, mandated by 1998 law and promulgated in March 2001, wasviewed as a means to significantly improve enforcement of medical child support -- to date onlyabout half the states are using the Notice. The 1998 law also called for an advisory body to designa medical child support incentive which would become part of the CSE performance-based incentivepayment system -- a recommendation was made to Congress in 2001 to indefinitely delaydevelopment of a medical child support incentive mainly because it was argued that the appropriatedata was not yet available upon which to base such an incentive.
Improving the establishment and enforcement of medical child support has been hampered to some extent by factors such as high health care costs, a decline in employer-provided healthinsurance coverage, an increase in the share of health insurance costs borne by employees, and thelarge number of uninsured children. This report provides a legislative history of medical supportprovisions in the CSE program, describes current policy with respect to medical child support,examines available data, and discusses some of the issues related to medical child support. Thisreport will not be updated.