OKDHS - OAC 340:25-5-168. Establishment of medical support

340:25-5-168. Establishment of medical support

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Revised 7-1-11

(a) Scope and applicability. Oklahoma Child Support Services (OCSS) refers to federal and state law for establishment of a medical support order per:

(1) Section 666 of Title 42 of the United States Code;
(2) Sections 302.33, 302.56, 303.7, 303.30, and 303.31 of Title 45 of the Code of Federal Regulations; and
(3) Section 6058A of Title 36, Sections 112, 118 through 118I, 118.2, and 119 of Title 43, and Section 237 of Title 56 of the Oklahoma Statutes. • 1

(b) Medical support provision of child support order. A child support order established by OCSS must contain a medical support provision. • 2

(c) Calculating the cost of medical support. To calculate the actual premium cost of health insurance, OCSS:

(1) deducts from the total insurance premium, the cost of coverage for the parent;
(2) deducts from the total insurance premium, the cost of coverage for any other adults in the household, when that cost information is available;
(3) divides the remainder by the number of dependent children covered; and
(4) multiplies the amount per child by the number of children in the child support case under consideration. • 3 & • 4

(d) Standards for medical support provision. When choosing a medical support provision, OCSS requests the court to apply the standards in (1) through (3) of this subsection.

(1) Health insurance must be reasonable in cost, meaning that the actual out-of-pocket premium cost paid does not exceed five percent of the gross income of the parent ordered to provide health insurance. • 3, • 5, & • 6
(2) Health insurance must be accessible, meaning the health care providers must be available to meet the child(ren)'s individual health care needs, and must be located no more than 60 miles one-way from the primary residence of the child(ren). • 5
(3) Health insurance must provide coverage for both routine and major medical expenses, including but not limited to: preventive care, office visits, hospitalization, and medication coverage in compliance with Oklahoma Insurance Department per OAC 365:10-5-3(14) and 10-5-5(f). Limited Insurance Coverage per OAC 365:10-5-5(k) does not satisfy this requirement. Annual deductibles must be reasonable and relate to the medical circumstances of the child(ren). • 5

(e) Exceptions to standards for medical support provision. When the parents agree or it is otherwise appropriate, OCSS requests the court make an exception to the standards for health coverage when:

(1) the reasonable cost of health insurance exceeds five percent of the gross income of the parent ordered to provide health insurance; or
(2) the closest insurance provider exceeds 60 miles one-way from the primary residence of the child(ren).

(f) Hierarchy of medical support provisions. The provision for medical support must be consistent with one of the priorities listed in (1) through (4) of this subsection. • 2

(1) Health insurance is provided through a parent's employer or other available group health insurance plan.
(2) No coverage is available under paragraph (1) of this subsection, and a private insurance policy or group health insurance is available to the child(ren) through another source, such as a third party custodian or spouse of a parent, OCSS seeks:
- (A) an order for the parent to provide health insurance when insurance is provided through the spouse of a parent; or
- (B) an order for the third party custodian to provide health insurance when insurance is provided through a third party custodian and the third party custodian has requested an order to provide the coverage.
(3) No health coverage is available under paragraphs (1) or (2) of this subsection, and alternative health coverage including, but not limited to, Indian Health Services (IHS) and Defense Eligibility Enrollment Reporting System (DEERS) is available to the child(ren).
(4) If none of the provisions in paragraphs (1) through (3) of this subsection are available at reasonable cost or are not accessible, the custodial person is required to make application for the child(ren) for health coverage through a government medical assistance program, such as SoonerCare (Medicaid).

(g) Health coverage preference. When health coverage meeting standards in subsection (d) of this Section is available to both parents, OCSS requests the court give priority to the preference of the custodial person.

(h) Exceptions to hierarchy. OCSS requests a cash medical order instead of an order for health coverage by the noncustodial parent under paragraphs (1) or (2) of subsection (f) of this Section when:

(1) the court determines an order for health insurance is inappropriate due to family violence concerns; or
(2) the obligor is an applicant for a governmental medical assistance program, such as Insure Oklahoma, State Children's Health Insurance Program (S-CHIP), or SoonerCare (Medicaid).

(i) Cash medical support.

(1) When paragraph (4) of subsection (f) of this Section is chosen as the provision for medical support, OCSS requests the court order cash medical support to be paid by the noncustodial parent(s) until insurance is provided under paragraphs (1) through (3) of subsection (f) of this Section.
(2) OCSS refers to the Cash Medical Income Guidelines Table as found in the child support computation form prescribed by OCSS and published by the Administrative Office of the Courts on the Oklahoma State Courts Network site per Section 120 of Title 43 of the Oklahoma Statutes to determine the cash medical support amount.
(3) OCSS computes a cash medical order by applying the Cash Medical Income Guidelines Table, using the combined gross income for the parents of the child in the case under consideration and the number of children in the instant case.
- (A) When the combined gross income is at or below the income amount for the number of children in the case, OCSS requests the court order a cash medical order at $0 per month.
- (B) When the combined gross income exceeds the income amount for the number of children in the case, OCSS computes the requested cash medical order by:
  - (i) multiplying the amount of $115, representing the average monthly cost of health care for an uninsured child(ren), by the number of children in the case that are not covered by insurance; and
  - (ii) prorating the result by the percentage of income for each parent.
- (C) The noncustodial parent's share of the cash medical amount is added to the child support obligation.
- (D) When neither parent is the obligor or noncustodial parent due to equally shared physical custody and the application of the parenting time adjustment, OCSS requests the court set cash medical support as follows:
  - (i) if the child(ren) receives SoonerCare or other governmental medical assistance, the parent who is not the applicant for governmental medical assistance is ordered to pay the cash medical support;
  - (ii) if the child(ren) does not receive SoonerCare or other governmental medical assistance, the cash medical amount is calculated for each parent and the amounts are offset. The parent owing the larger amount is ordered to pay the net cash medical support.
(4) Unless the parties agree or the court orders a greater amount, the prorated cash medical support amount must not exceed five percent of the gross income of the parent who is ordered to pay cash medical support.
(5) OCSS seeks cash medical support only as part of a prospective order for child support. OCSS does not include a cash medical support amount in a judgment for support for a prior period per OAC 340:25-5-179.1.
(6) In a child support modification action, OCSS requests a cash medical support order be effective the first day of the month following the date the modification order is entered.

(j) Termination of cash medical support.

(1) When OCSS receives notice that the parent ordered to pay cash medical support has enrolled the child(ren) in health insurance, OCSS sends a Notice of Proposed Termination of Cash Medical Support to all parties in the case by regular mail. When a party believes the child(ren) is not actually covered by health insurance, a party may request a review of the termination of cash medical support within ten days from the date of mailing of the notice. • 7
(2) When a party requests a review to contest the Notice of Proposed Termination of Cash Medical Support, OCSS reviews the case within ten days of receipt of the request and determines if termination of cash medical support is proper based on information provided by the contesting party. OCSS notifies the parties of the review decision. • 7
(3) When the parties disagree with the review decision, the parties have 15 days from the date of mailing the review decision to request a hearing on the termination of cash medical support.
(4) OCSS files a Notice of Termination of Cash Medical Support with the proper court when:
- (A) no party requests a review within the ten-day time period; or
- (B) no party requests a hearing after OCSS notifies them of the review decision.
(5) OCSS does not proceed with a separate termination of cash medical support when the child support and medical support order is modified within 30 days of notification that the child(ren) is enrolled in health insurance.
(6) When a cash medical support order is terminated within a modification action, OCSS requests the termination become effective the date of filing of the Motion to Modify or the date if later, when the child was actually enrolled in the insurance.

(k) Fixed medical costs. When the parties agree or the court orders, OCSS includes the total monthly fixed medical costs in the child support guidelines computation. If the obligor's share of fixed medical costs exceeds five percent of the obligor's gross income and the parties do not agree to exceed the five percent standard, OCSS requests the court determine the monthly amount of fixed medical costs included in the current child support order.

(l) Indian Health Services (IHS).

(1) A child support order that provides for the enrollment of a child(ren) in IHS may comply with the standards in subsection (d) of this Section. OCSS seeks an order for either or both parents to secure health insurance for the minor child(ren) when:
- (A) IHS does not meet the standards in subsection (d) of this Section; or
- (B) health insurance is available through an employer or other group plan and the custodial person requests it.
(2) OCSS does not request cash medical support when IHS is the chosen provider.

(m) Notification requirements. The noncustodial parent and the custodial person must notify OCSS in writing within 30 days after:

(1) health insurance becomes available;
(2) the cost of existing health insurance changes; or
(3) other provisions of existing health insurance change.

(n) Modification request. When a child support order exists, OCSS considers a request to establish a medical support order as a request for modification of the order per Section 118.1 of Title 43 of the Oklahoma Statutes. OCSS seeks a medical support order in a tribunal that has jurisdiction to modify the child support order.

INSTRUCTIONS TO STAFF 340:25-5-168

Revised 7-1-11

1. In cases referred to Oklahoma Child Support Services (OCSS) by a Family Support Services (FSS) worker, OCSS provides all appropriate IV-D services unless the person requests medical enforcement only. OCSS opens a full-service case when the FSS worker enters "Y" in the D8 block on the ED screen on the PS2 automated system.

2. If the parties state that health coverage is available, but there is no proof that it is in effect at the time the order is entered, OCSS seeks a temporary medical support order until proof of coverage is received. A final order may then be obtained.

3. Child support staff determine the out-of-pocket cost for health insurance by subtracting any amount paid by the employer through a benefit allowance from the premium amount paid by the insured.

4. (a) If the cost of the insurance premium for other adults in the household is included with the cost for the child(ren) and information is not available to determine a separate amount for the other adults, child support staff use this premium cost to determine the amount per child.

(b) For example, the total health insurance premium is $275. The portion of the premium for the parent carrying the insurance is $75. The portion of the premium for the other adults in the home is unknown and cannot be determined. The number of children covered is four. The number of children in the child support case is three. The cost of the insurance premium for each child in the child support case is $50 ($275 - $75 = $200 ¸ 4 = $50 x 3 = $150).

5. (a) Examples of when health insurance does not meet the standards for health coverage include when the noncustodial parent has:

(1) gross income of $1,733 a month and has an employer-sponsored plan that would cost the parent $225 a month in out-of-pocket premium costs for three children in the case under consideration. OCSS does not consider the contribution to the premium that might be made by another person or other entity. Since $225 is more than ten percent of the $1,733, the cost of the insurance is not considered reasonable;

(2) available health coverage, but the nearest network provider is 60 miles one-way from the primary residence of the child(ren); and

(3) available health coverage that only meets the definition of:

(A) a Limited Benefit Health Insurance Coverage; or

(B) a policy with an excessive deductible and co-payment amount.

(b) Child support staff follow the Child Support Manual, Medical Support chapter for information on deductible and co-payment amounts. Child support staff access the Child Support Manual on the OCSS InfoNet Home page.

6. When applying the reasonable cost standard, child support staff use the gross income of the parent at the time the order is established to determine whether the actual premium cost of available coverage for the child(ren)'s portion only exceeds five percent of the parent's gross income.

7. (a) When a request for review is received, OCSS staff use the first day of the second month following the date the Notice of Proposed Termination of Cash Medical Support as the termination date for the cash medical support. Example: A request for review is received on September 14. The termination date for the cash medical support would be November 1.

(b) When OCSS staff deny a request for review of termination of cash medical support and no party requests an administrative review within 15 days:

(1) staff update the child support case information on the automated Oklahoma Support Information System (OSIS) to remove the cash medical support amount in the current monthly child support obligation; and

(2) staff generate an amended Notice of Income Assignment to the employer that does not include the cash medical support amount.

(c) Examples of cases when termination of cash medical support is appropriate include when OCSS staff receive notice that:

(1) a parent's employer has enrolled the child in health insurance;

(2) the child is enrolled in health insurance through a private insurance policy or group health insurance through another source, such as a third party custodian or spouse of a parent; and

(3) the child is enrolled in alternative coverage such as Indian Health Services (IHS) or Defense Eligibility Enrollment Reporting System (DEERS).

(d) Examples of cases in which termination of cash medical support is not appropriate include:

(1) OCSS staff have information that a parent's employer has health insurance available but staff have not received notice that the employer has enrolled the child in health insurance; or

(2) OCSS staff have information that the child may be eligible for Indian Health Services (IHS) services or Defense Eligibility Enrollment Reporting System (DEERS), but have not received notice that the child is enrolled in this alternative coverage.

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