Legislation and Incentives for Medical Support Requirements


Publication Date: September 5, 1991



September 5, 1991


SUBJECT: Model Legislation and Incentives for Implementation of Medical Support Requirements

BACKGROUND: Federal regulations require IV-D agencies to petition for the inclusion of medical support as part of any child support order whether or not health insurance at reasonable cost is actually available to the obligor at the time the order is entered or modification of current coverage to include the child(ren) in question is immediately possible.

Regulations published on September 16, 1988 require an expansion of the universe of cases covered from new cases and those requiring modification for reasons beside medical support to include cases which require modification for purposes of medical support only. Cases to be targeted for such modification are cases that, according to State established criteria, have high potential for obtaining medical support.

ATTACHMENTS: Attached are model statutes from fifteen States designed to enhance the effectiveness and efficiency of medical support enforcement. Areas covered include employer responsibility, requiring courts to include health insurance coverage in child support orders, allowing signatures other than the policy holder (obligor) as authorization to process medical expense claims and providing for collection and enforcement of medical support utilizing remedies available for child support.

Also attached are examples from Minnesota and Wisconsin of incentives provided IV-D by Medicaid.

INQUIRIES : OCSE Regional Representatives.


Allie Page Matthews

Deputy Director

Office of Child Support Enforcement

Model Medical Support Legislation

Arkansas -In all orders for health insurance (HI), court shall include provision directing employer to deduct an amount sufficient to provide for premiums for health care coverage offered by the employer;

-The child cannot be denied coverage due to residency for any type of plan;

-Income withholding (IW) for health care has priority over all other legal process against income; under State law except IW for child support.

California -Authorizes district attorney (DA) to apply for an HI assignment. The assignment employers so served to comply by enrolling children in available HI plans.

-Requires court to order HI coverage upon application of either parent or DA.

Hawaii -Allows custodial parent (CP) signature as valid authorization to the insurer to process reimbursement payment to provider.

Illinois -Requires Immediate Wage Withholding (IWW) if needed to secure enrollment in HI plan available through employer.

Iowa -Proof of failure to maintain medical support constitutes a showing of increased need and provides a basis for establishment of a monetary amount for medical support;

-Authorizes State to modify administrative orders without provision for medical support to add such a provision;

-Allows CP or State signature as valid authorization to the insurer to enroll dependent in health benefit plan and to process medical expense claim of provider;

-If, within 15 days of the entry of a medical support order, the obligor has not provided written proof to the obligee and the State of the required coverage, a copy of the order is sent to the obligor's employer. The employee must forward a copy of the order to the insurer and request enrollment of the dependent. If the dependent is found eligible for enrollment, the employer withholds the amount of the premium from the obligor's wages.

-For purposes of enforcement, medical support is additional support which may be reduced to a dollar amount and collected through the same remedies available for collection and enforcementof child support.

Minnesota -Provides that the minor be named beneficiary of a group, employer or union policy or, if necessary, the obligor be required to either independently obtain coverage or be liable for medical expenses.

-Provides that a court order for insurance be forwarded to the employer or union if the obligor does not, within a reasonable period, show evidence of having obtained the coverage. The employer or union is then required to enroll the obligee in the ordered insurance plan and withhold premiums from the obligor's income or wages.


-Allows CP signature as valid authorization to the insurer to process reimbursement payment to provider;

-Proof of failure to maintain insurance constitutes a showing of increased need and provides a basis for modification of child support order.

Missouri -State is provided with contractual capability with any entity defined as an insurance company, health service corporation or HMO and self-insuring organization or business to obtain HI information on Medicaid recipients. Insurance companies and other defined entities required to cooperate in any data match request. Any entity which receives such a request shall provide the requested information in writing within 6 days of receipt. Failure to do so shall result in liability to the State for civil penalties of up to $l0 for each day thereafter. The court determines the amount of penalty to be assessed.

Nebraska -Authorizes appointment of referees to meet federal requirement to expedite establishment, enforcement, collection and modification of child, spousal and medical support;

New York -With privacy safeguards provided, State agency allowed to initiate data matches with all of the licensed insurance plans in the State. This also facilitates resource identification activities with several other insurance companies because State and county staff have access to payment and eligibility records for both clients any responsible relatives;

-Requires obligor to provide proof of coverage and furnish instruments to provider so provider can bill third party;

-Makes provision for directing the dependent's health insurance payments;

Ohio -State authorized to require third parties to participate in data matches when they are equipped to do so. Private firms are held harmless in privacy considerations;

-If obligor doesn't comply with order, employer is required to take whatever action is necessary to enroll the obligor in any available group HI and to withhold pay to cover the cost of coverage.

Oregon -Requires all HI policies provide that children not residing in a policyholder's or employee's household be eligible for coverage to the same extent as children residing with the policyholder or employee, so long as the obligor is under a legal obligation to support the "non-resident' children and providing there is no court order to the contrary.

-Requires employers to provide HI coverage information as part of quarterly wage reporting to employment security agency.

Texas -Court required to order HI;

-If HI not available through obligor or obligee employer, court may order obligor to provide HI to extent it is available from another source and affordable;

-If HI available from obligee's employer, court may order obligee to provide HI and obligor to reimburse the obligee.

Utah -State may administratively establish the amount of liability for past medical and dental expenses when an obligor has been made responsible for these costs under a previous judicial or administrative order and has failed to maintain such HI. State initiates a judicial or administrative proceeding to obtain a judgment for the specific amount of past medical expenses.

-Provides that a notice to enroll be mailed to the obligor's employer or union if the obligor has not, within l5 days of the mailing of a notice to enforce a medical support order, either provided proof of enrollment or unavailability of HI at reasonable cost. The employer or union meet must enroll the child either immediately or upon the next open enrollment period and, upon enrollment, deduct premiums from the obligor's wages and send payment directly to the insurer.

Washington -Provides for the co-endorsement of third party payments to prevent obligors from receiving payments due the State agency for paid medical services and not reporting the payments to the agency. It offers recourse to providers who should have received payments made to the insured.

Wisconsin -The employer is required to send health care payments withheld from wages to provider, insurer or plan within 10 days of payday.

Incentives to IV-D for Medical Support Activities

Minnesota -Legislation provides for an incentive to be paid to local IV-D agencies by the Medicaid agency for identifying information or enforcement of medical support provisions. The incentive is based on the ratio of the number of cases with coverage in effect divided by the number of cases with medical support in the support order. The rate ranges from $15 from each new case when the ratio is 50% or less, $20 for each new case when the ratio is between 50% and 79% and $25 for each new case when the ratio is 80% or above.

Wisconsin -Legislation authorizes Medicaid to make incentive payments to other agencies, including IV-D, which report HI information to Medicaid. The payment is $10 per person reported with a basic medical plan, a drug card plan or a dental plan, for a potential incentive of up to $30 per person. There are also incentives for reporting to the Medicaid agency any changes to lapses in insurance coverage.

NOTE: For copies of the individual State's bills, you may contact the National Training Resource Center at (202) 40l-9382.

Current as of: