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State CSE Program Flexibility to Improve Interoperability with Medicaid and CHIP


Published: November 4, 2010



DATE:November 04, 2010

TO:State Agencies Administrating Child Support Enforcement Plans under Title IV-D of the Social Security Act and Other Interested Individuals

SUBJECT:State Child Support Enforcement Program Flexibility to Improve Interoperability with Medicaid and CHIP


As a condition of receiving federal financial participation, the state IV-D agency must have an approved state plan describing the nature and scope of its Child Support Enforcement Program which meets all federal requirements.

The Child Support Enforcement Program plays a critical role in securing health care coverage for the children in its caseload through its medical support enforcement functions. Recently, children’s health care coverage options have been significantly strengthened through the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) (P.L. 111-3) and the Affordable Care Act (P.L. 111–148 and P.L. 111–152). While these laws do not amend Title IV-D of the Social Security Act (the Act), they enact policies that will substantially improve children’s health care coverage and establish parents’ shared responsibility for their children’s coverage.

CHIPRA reauthorized the Children’s Health Insurance Program (CHIP) and provided a significant amount of new funding as well as new policy resources to promote children’s enrollment in Medicaid and CHIP coverage. It preserves coverage for the millions of children who rely on CHIP today and provides the resources for states to reach millions of additional uninsured children. To support successful implementation of CHIPRA, on its first anniversary Secretary Sebelius announced “The Secretary’s Challenge: Connecting Kids to Coverage,” a five-year campaign that challenges leaders from all levels of government and the private sector to enroll the nearly five million uninsured children who are eligible for Medicaid or CHIP but are not enrolled.

As previously communicated in OCSE-AT-10-02, state IV-D agencies will not be penalized if OCSE is unable to certify that the state IV-D agency is in compliance with federal medical support regulations which were amended by a Final Rule published in the Federal Register on July 21, 2008 (73 FR 42416) and disseminated via OCSE-AT-08-08. This suspension provides relief to states by permitting them to avoid making new investments in medical support enforcement to comply with regulatory requirements that may soon become obsolete as OCSE develops further guidance.


OCSE plans to issue a Notice of Proposed Rulemaking in the next year to revise 73 FR 42416 to allow states to use the flexibility provided by sections 452(f) and 466(a)(19) of the Act. Further legislative or regulatory changes may be necessary to update medical child support policy.

The purpose of this new rule will be to provide states with the flexibility to improve interoperability between the Child Support Program and Medicaid and CHIP to be consistent with the goals of CHIPRA and the Secretary’s goal of enrolling all eligible uninsured children in Medicaid and CHIP by 2014. This will also provide states with flexibility to begin updating medical support policy and guidelines.

At this time state child support agencies have several options. They may:

  • update medical support policies to enhance collaboration with Medicaid and CHIP to improve enrollment of eligible children. This includes the option to define medical support to include private health insurance as well as other health care coverage such as Medicaid, CHIP, and other state coverage plans, and cash medical support; and/or
  • otherwise update medical support guidelines, including modifying the definition of “reasonable cost” as referenced in Section 452(f); and/or
  • continue current and planned medical support policies and practices.

In implementing any of these options, state IV-D agencies must continue to provide medical child support enforcement services in compliance with all statutory requirements, including Sections 452(f) and 466(a)(19) of the Act.

OCSE is pursuing corresponding changes to the federal reporting requirements. These requirements remain in effect although audits of medical support data are temporarily suspended.

RELATED REFERENCES: Sections 452(f) and 466(a)(19) of the Act, 45 CFR Parts 302, 303, and 308, AT-08-08, AT-08-14, AT-10-02

EFFECTIVE DATE: This action transmittal is effective immediately.

INQUIRIES: Please contact your ACF/OCSE Regional Program Manager if you have any questions.

Vicki Turetsky
Office of Child Support Enforcement

cc: ACF/OCSE Regional Program Managers
Tribal IV-D Directors

Archived: February 17, 2020

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