Medical Support
Medical support is a provision of a support order that may include some or all of the following: providing private health insurance coverage for the child or reporting available health insurance coverage; paying cash medical support; sharing responsibility for the child's uncovered health care expenses; or paying a specified dollar amount determined by the court for health care expenses that have been or will be incurred.
Cash Medical Support Overview
The new federal medical support regulations became effective July 21, 2008, revising federal requirements for establishing and enforcing the medical support obligations in child support enforcement program cases receiving services under Title IV-D of the Social Security Act. The changes: require all child support orders in the IV-D program provide some form of medical support for the child, even when health insurance is not available to either parent; redefine reasonable cost private health insurance; and require private health insurance to be accessible, as defined by the State.
In compliance with the new federal regulations, the Ohio laws regarding medical support have also changed. The Ohio Revised Code continues to require all child support orders to order the obligor and/or obligee to obtain and/or maintain available private health insurance coverage that is reasonable in cost, and adds the requirement in all child support orders for the obligor to pay cash medical support during any period when the child is not covered by private health insurance as ordered in the child support order.
In order to accommodate the new cash medical support obligation, child support orders will now contain two child support obligation amounts, an amount when health insurance is provided and an amount when health insurance is not provided, and the additional cash medical support obligation. The Ohio Department of Job and Family Services (ODJFS) Office of Child Support has revised the JFS 07719 "Administrative Order for Child and Medical Support" to accommodate the new obligations. Click here to view language for orders for child support and medical support based on the language contained in the JFS 07719.
The child support guidelines worksheets have also been revised to calculate the cash medical support obligation.
When the obligor's annual gross income is less than 150% of the federal poverty level for an individual (e.g., $15,600 in 2008), the cash medical support obligation will be $0.00. Otherwise, this obligation will be the lower of five percent of the obligor's annual adjusted gross income or the amount from the ODJFS United States Department of Agriculture (USDA) Cash Medical Support Schedule.
The formula outlined in the United States Department of Agriculture Expenditures on Children by Families (U.S. Department of Agriculture Center for Nutrition Policy and Promotion. Miscellaneous Publication No. 1528-2006) for the Estimated Annual Health Care Expenditures on a Child by Husband- Wife Families, Urban Midwest is used to determine the amounts on the Cash Medical Support Schedule. Detailed information on the formula is available by following this link.
Private Health Insurance Coverage
In order for a person to be ordered to provide private health insurance coverage for the child, the private health insurance must be reasonable in cost and accessible. Either parent (the custodial or non-custodial parent) may be ordered to provide private health insurance coverage for the child.
REASONABLE COST Prior to July 21, 2008, private health insurance was considered reasonable in cost when it was offered through the person's employer, regardless of how much the coverage actually cost.
As of July 21, 2008, reasonable cost means the annual cost of the health insurance to a parent does not exceed five percent of the annual gross income of the parent. In applying the five percent to the cost, the cost is the difference between self-only and family coverage.
Under certain circumstances (upon request by the person with an administrative child support order, upon order of the court with a court child support order), a person may be ordered to provide private health insurance coverage for the child even when the annual cost to add the child to the health insurance plan exceeds five percent of the person's annual gross income.
ACCESSIBLE Private health insurance is accessible when primary care providers are located within thirty miles of the child's residence. The court or a child support enforcement agency (CSEA) may extend the thirty mile standard when residents in the child's immediate geographic area typically travel greater distances for primary care services. The court or CSEA may also add the requirement that the private health insurance plan includes primary care providers that are accessible via public transportation when the custodial parent is fully dependent on public transportation.
Private health insurance is presumed to be accessible unless one of the parties alleges that it is not. When this happens, the court or CSEA will make a determination that the coverage is or is not accessible.