MEDICAL SUPPORT

CS 482P Securing a Medical Insurance Provision in the Support Order

01/90 Revised 04/13/18 Training Completed 04/27/18

45 CFR 303.31; 42 U.S.C. 652(f); U.C.A. 30-3-5, 30-3-5.4, U.C.A. 62A-11-103(2), 62A-11-304.2, 62A-11-326, U.C.A 63G-4-102, U.C.A. 78B-12-102(6), 78B-12-111, 78B-12-212; R527-201

 

 

Federal Regulations

 

Federal regulations found at 45 CFR 303.31(b)(1-4), 42 U.S.C. 652(f), U.C.A. 30-3-5 and 30-3-5.4, and R527-201 require the Office of Recovery Services/Child Support Services (ORS/CSS) to:

 

1.            Petition the court or administrative authority to include a medical support provision in the order if the custodial parent (CP) does not have satisfactory medical insurance for the child(ren).

a.                   45 CFR 303.31:

(b) The State IV–D agency must:

(1) Petition the court or administrative authority to -

(i) Include health care coverage that is accessible to the child(ren), as defined by the State, and is available to the parent responsible for providing medical support and can be obtained for the child at reasonable cost, as defined under paragraph (a)(3) of this section, in new or modified court or administrative orders for support; and

(ii) Allocate the cost of coverage between parents.

(2) If health care coverage described in paragraph (b)(1) of this section is not available at the time the order is entered or modified, petition to include cash medical support in new or modified orders until such time as health care coverage, that is accessible and reasonable in cost as defined under paragraph (a)(3) of this section, becomes available. In appropriate cases, as defined by the State, cash medical support may be sought in addition to health care coverage.

 

b.                  42 U.S.C. 652(f) Regulations:

The Secretary shall issue regulations to require that State agencies administering the child support enforcement program under this part enforce medical support included as part of a child support order whenever health care coverage is available to the noncustodial parent at a reasonable cost. A State agency administering the program under this part may enforce medical support against a custodial parent if health care coverage is available to the custodial parent at a reasonable cost, notwithstanding any other provision of this part. Such regulation shall also provide for improved information exchange between such State agencies and the State agencies administering the State medicaid programs under subchapter XIX of this chapter with respect to the availability of health insurance coverage. For purposes of this part, the term “medical support” may include health care coverage, such as coverage under a health insurance plan (including payment of costs of premiums, co-payments, and deductibles) and payment for medical expenses incurred on behalf of a child.

 

c.                   U.C.A. 30-3-5:

(1) When a decree of divorce is rendered, the court may include in it equitable orders relating to the children, property, debts or obligations, and parties. The court shall include the following in every decree of divorce:

(a) an order assigning responsibility for the payment of reasonable and necessary medical and dental expenses of the dependent children including responsibility for health insurance out-of-pocket expenses such as co-payments, co-insurance, and deductibles;

(b) (i) if coverage is or becomes available at a reasonable cost, an order requiring the purchase and maintenance of appropriate health, hospital, and dental care insurance for the dependent children; and

(ii) a designation of which health, hospital, or dental insurance plan is primary and which health, hospital, or dental insurance plan is secondary in accordance with the provisions of Section 30-3-5.4 which will take effect if at any time a dependent child is covered by both parents' health, hospital, or dental insurance plans;” (Emphasis added.)

 

d.                  U.C.A. 30-3-5.4:

(1) For purposes of this section, "health, hospital, or dental insurance plan" has the same meaning as "health care insurance" as defined in Section 31A-1-301.

(2) (a) A decree of divorce rendered in accordance with Section 30-3-5, an order for medical expenses rendered in accordance with Section 78B-12-212, and an administrative order under Section 62A-11-326 shall, in accordance with Subsection (2)(b)(ii), designate which parent's health, hospital, or dental insurance plan is primary coverage and which parent's health, hospital, or dental insurance plan is secondary coverage for a dependent child.

(b) The provisions of the court order required by Subsection (2)(a) shall:

(i) take effect if at any time a dependent child is covered by both parents' health, hospital, or dental insurance plans;

 

                e.            R527-201-6:

“1. Notice to potentially obligated parents: The notice to potentially obligated parents shall include a provision that an administrative or judicial proceeding will occur to:

a. order either parent to purchase and maintain appropriate medical insurance for the children, and

b. order both parents to pay cash medical support. This notification shall be provided when either of the following conditions is met:

a. the state initiates an action to establish a final support order or to adjust an existing child support order; or

b. the state joins a divorce or modification action initiated by either the custodial or the non- custodial parent.”; and,

 

2.            Develop criteria to pursue modification of a support order and include a medical insurance provision in child support cases with existing orders which:

a.            Do not include health insurance coverage for the dependent child(ren); and,

b.            Have a high potential for obtaining medical support. 

 

                45 CFR 303.31(b) states:

(3) Establish criteria, which are reflected in a record, to identify orders that do not address the health care needs of children based on -

(i) Evidence that health care coverage may be available to either parent at reasonable cost, as defined under paragraph (a)(3) of this section; and

(ii) Facts, as defined by State law, regulation, procedure, or other directive, and review and adjustment requirements under § 303.8(d) of this part, which are sufficient to warrant modification of the existing support order to address the health care needs of children in accordance with paragraph (b)(1) of this section.

(4) Petition the court or administrative authority to modify support orders, in accordance with State child support guidelines, for cases identified in paragraph (b)(3) of this section to include health care coverage and/or cash medical support in accordance with paragraphs (b)(1) and (2) of this section.

 

 

Medical Support Orders

 

Utah law found at U.C.A. 62A-11-326, 78B-12-111, and 78B-12-212(6) require all administrative and judicial child support orders which order current support to include the following language:

 

1.                   A provision requiring a parent to purchase and maintain medical insurance for the child(ren), if it is available at group rates.

a.                   U.C.A. 62A-11-326:

“In any action under this part, the office and the department in their orders shall:

(1) include a provision assigning responsibility for cash medical support;

(2) include a provision requiring the purchase and maintenance of appropriate medical, hospital, and dental care insurance for those children, if:

(a) insurance coverage is or becomes available at a reasonable cost; and

(b) the insurance coverage is accessible to the children; and

(3) include a designation of which health, dental or hospital insurance plan, is primary and which is secondary in accordance with the provisions of Section 30-3-5.4 which will take effect if at any time the dependent children are covered by both parents' health, hospital, or dental insurance plans.

 

NOTE:  If, at any point in time, a dependent child is covered by the health, hospital, or dental insurance plans of both parents, the health, hospital, or dental insurance plan of the parent whose birthday occurs first in the calendar year, shall be designated as primary coverage for the dependent child.  The health, hospital, or dental insurance plan of the other parent shall be designated as secondary coverage for the dependent child.  If this primary/secondary designation is specifically contested during an administrative establishment process, refer the case for judicial establishment.

 

If both parents were born in the same month, then the parent, whose birthday occurs first in the month, is designated as the primary coverage for the dependent child.  If both parents were born on the same day, then the parent whose birth year is first is designated as primary coverage for the child.  If both parents were born in the same year, then the parent whose insurance plan was in effect first is designated as primary coverage for the child.

b.                  U.C.A. 78B-12-111:

The court shall include the following in its order:

(1) a provision assigning responsibility for the payment of reasonable and necessary medical expenses for the dependent children;

(2) a provision requiring the purchase and maintenance of appropriate insurance for the medical expenses of dependent children, if coverage is or becomes available at a reasonable cost;

 

2.            That there is uniform language related to the coordination of health insurance benefits when a dependent child of the marriage is covered by both parent’s health insurance policies.

a.                   U.C.A. 30-3-5(b)(ii):

a designation of which health, hospital, or dental insurance plan is primary and which health, hospital, or dental insurance plan is secondary in accordance with the provisions of Section 30-3-5.4 which will take effect if at any time a dependent child is covered by both parents' health, hospital, or dental insurance plans;

b.                  U.C.A. 30-3-5.4:

(1) For purposes of this section, "health, hospital, or dental insurance plan" has the same meaning as "health care insurance" as defined in Section 31A-1-301.

(2) (a) A decree of divorce rendered in accordance with Section 30-3-5, an order for medical expenses rendered in accordance with Section 78B-12-212, and an administrative order under Section 62A-11-326 shall, in accordance with Subsection (2)(b)(ii), designate which parent's health, hospital, or dental insurance plan is primary coverage and which parent's health, hospital, or dental insurance plan is secondary coverage for a dependent child.

(b) The provisions of the court order required by Subsection (2)(a) shall:

(i) take effect if at any time a dependent child is covered by both parents' health, hospital, or dental insurance plans; and

(ii) include the following language:

"If, at any point in time, a dependent child is covered by the health, hospital, or dental insurance plans of both parents, the health, hospital, or dental insurance plan of (Parent's Name) shall be primary coverage for the dependent child and the health, hospital, or dental insurance plan of (Other Parent's Name) shall be secondary coverage for the dependent child. If a parent remarries and his or her dependent child is not covered by that parent's health, hospital, or dental insurance plan but is covered by a step-parent's plan, the health, hospital, or dental insurance plan of the step-parent shall be treated as if it is the plan of the remarried parent and shall retain the same designation as the primary or secondary plan of the dependent child."

 

NOTE:  The parent whose birthday occurs first in the calendar year will be designated as primary coverage for the dependent child.  The other parent shall be designated as secondary coverage for the dependent child.

 

(c) A decree of divorce or related court order may not modify the language required by Subsection (2)(b)(ii).

(d) Notwithstanding Subsection (2)(c), a court may allocate the payment of medical expenses including co-payments, deductibles, and co-insurance not covered by health insurance between the parents in accordance with Subsections 30-3-5(1)(a) and 78B-12-212(6).

(3) In designating primary coverage pursuant to Subsection (2), a court may take into account:

(a) the birth dates of the parents;

(b) a requirement in a court order, if any, for one of the parents to maintain health insurance coverage for a dependent child;

(c) the parent with physical custody of the dependent child; or

(d) any other factor the court considers relevant.

 

NOTE:  If both parents were born in the same month, then the parent, whose birthday occurs first in the month, is designated as the primary coverage for the dependent child.  If both parents were born on the same day, then the parent whose birth year is first is designated as primary coverage for the child.  If both parents were born in the same year, then the parent whose insurance plan was in effect first is designated as primary coverage for the child.

 

3.            That both parents are to share equally all reasonable and necessary uninsured medical and dental expenses, including deductibles and co-payments, incurred for the dependent children; and,

U.C.A. 30-3-5(1):             

When a decree of divorce is rendered, the court may include in it equitable orders relating to the children, property, debts or obligations, and parties. The court shall include the following in every decree of divorce:

(a) an order assigning responsibility for the payment of reasonable and necessary medical and dental expenses of the dependent children including responsibility for health insurance out-of-pocket expenses such as co-payments, co-insurance, and deductibles;

 

4.            That both parents are to share equally the out-of-pocket cost of the premium actually paid for the child(ren)’s portion of insurance by the parent ordered to maintain the insurance.  The child(ren)’s portion is a per capita share of the actual paid premium.  To determine the child(ren)’s portion, divide the premium amount by the number of persons covered under the policy and multiply that number by the number of children in the case to be covered. 

 

U.C.A .78B-12-212 Medical expenses states:

(1) (a) The court shall order that insurance for the medical expenses of the minor children be provided by a parent if it is available at a reasonable cost.

(b) The court shall, in accordance with Section 30-3-5, designate which health, hospital, or dental insurance plan is primary and which health, hospital, or dental insurance plan is secondary if at any time a dependent child is covered by both parents' health, hospital, or dental insurance plans.

(2) In determining which parent shall be ordered to maintain insurance for medical expenses, the court or administrative agency may consider the:

(a) reasonableness of the cost;

(b) availability of a group insurance policy;

(c) coverage of the policy; and

(d) preference of the custodial parent.

(3) The order shall require each parent to share equally the out-of-pocket costs of the premium actually paid by a parent for the children's portion of insurance unless the court finds good cause to order otherwise.

(4) The parent who provides the insurance coverage may receive credit against the base child support award or recover the other parent's share of the children's portion of the premium. In cases in which the parent does not have insurance but another member of the parent's household provides insurance coverage for the children, the parent may receive credit against the base child support award or recover the other parent's share of the children's portion of the premium.

(5) The children's portion of the premium is a per capita share of the premium actually paid. The premium expense for the children shall be calculated by dividing the premium amount by the number of persons covered under the policy and multiplying the result by the number of children in the instant case.

(6) The order shall, in accordance with Subsection 30-3-5(1)(b), include a cash medical support provision that requires each parent to equally share all reasonable and necessary uninsured and unreimbursed medical and dental expenses incurred for the dependent children, including but not limited to deductibles and copayments unless the court finds good cause to order otherwise.

 

 

Insurance Language Examples

 

Sometimes, it may be difficult to determine if the child support order has an appropriate medical support provision.  Below are examples of possible insurance language.

 

1.            Acceptable medical support order:

a.            “The father and the mother shall be responsible for maintaining insurance for the dependent child(ren) if it is available to either parent at a reasonable cost.”

b.            “The respondent (NCP) shall provide insurance for the minor child if it is available at a reasonable cost.”

c.             “The petitioner (CP) shall provide insurance for the minor child if it is available at a reasonable cost.”

 

                NOTE:  Regarding b and c:  If the ordered party is not carrying insurance but the other party is, there is still a valid medical insurance provision and it does not need to be modified.

 

2.            Unacceptable medical support order:

a.            The party ordered to carry medical insurance is receiving Medicaid and the order reads:  “The petitioner (CP) shall provide insurance for the minor child if it is available at reasonable cost.”

 

                NOTE:  The order must be modified to include NCP as a party responsible to carry insurance.

b.            Neither party is ordered to carry insurance, but the order reads:  “Petitioner (CP) and Respondent (NCP) are ordered to share the out of pocket expense of insurance.”

 

                NOTE:  An order must be established providing that the parties must carry insurance.

c.             The order is silent regarding medical insurance.

 

                NOTE:  An order must be established including all medical provisions.

 

If you are unsure of whether or not there is a valid order for insurance, you may consult with the Attorney General’s Office (AGO).

 

 

Establishing a Medical Support Order

 

Establish Medical Support Order:  State law found at U.C.A. 62A-11-304.2 provides specific authority for CSS to use the administrative process, known as the Utah Administrative Procedures Act (UAPA).  U.C.A. 78B-12-111 and 212 (see subsection CS 482.3 Medical Support Orders above) also provide a basis to establish child support orders which include a medical support order.

 

U.C.A. 62A-11-304.2 Issuance or modification of administrative order – Compliance with court order – Authority of office – Stipulated agreements – Notification requirements states:

(1) Through an adjudicative proceeding the office may issue or modify an administrative order that:

(a) determines paternity;

(b) determines whether an obligor owes support;

(c) determines temporary orders of child support upon clear and convincing evidence of paternity in the form of genetic test results or other evidence;

(d) requires an obligor to pay a specific or determinable amount of present and future support;

(e) determines the amount of past-due support;

(f) orders an obligor who owes past-due support and is obligated to support a child receiving public assistance to participate in appropriate work activities if the obligor is unemployed and is not otherwise incapacitated;

(g) imposes a penalty authorized under this chapter;

(h) determines an issue that may be specifically contested under this chapter by a party who timely files a written request for an adjudicative proceeding with the office; and

(i) renews an administrative judgment.

 

U.C.A. 63G-4-102 Scope and applicability of chapter:

(1) Except as set forth in Subsection (2), and except as otherwise provided by a statute superseding provisions of this chapter by explicit reference to this chapter, the provisions of this chapter apply to every agency of the state and govern:

(a) state agency action that determines the legal rights, duties, privileges, immunities, or other legal interests of an identifiable person, including agency action to grant, deny, revoke, suspend, modify, annul, withdraw, or amend an authority, right, or license; and

(b) judicial review of the action.

 

At the time you are establishing an administrative child support order, also establish an administrative medical support provision on all IV-A, Non-IV-A Medicaid, and Non-IV-A cases.

 

1.                   IV-A and Non-IV-A Medicaid Cases – If the CP and/or children are on Medicaid, it is not considered to be satisfactory medical insurance.  Therefore, you must obtain a medical support order regardless of the availability of medical insurance at the time the order is taken.

 

2.                   Non-IV-A Cases – Include the medical support language when you establish an order for the CP.

If there is a judicial order in the case and it is silent regarding medical insurance, do not administratively establish a medical support obligation.  In accordance with R527-201-6(2) which states:

“If a judicial support order does not include a medical support provision, ORS/CSS shall commence judicial action to include a medical support provision.” 

 

Determine if it is appropriate to send a referral packet to the Attorney General’s office to obtain a medical support provision in the order. 

 

NOTE:  Once a case meets the criteria for medical support enforcement, ORSIS automatically generates a medical document to every open employer for the parent(s).  To avoid sending multiple unnecessary medical documents, you must end all old employer records for the parent(s) before the case leaves pre-order.