Medical Support

If private health insurance is not available to either parent when the child support order is issued or modified, both parents will be required to notify the Child Support Enforcement Agency (CSEA) when private health insurance becomes available.

When the CSEA is aware of changes that affect a parent’s obligation to pay cash medical support or provide health insurance, the CSEA will notify both parents.  Cash medical support may be assigned (paid) to the state of Ohio when the child is receiving Medicaid benefits.  When the child is not receiving Medicaid benefits, cash medical support is paid to the family. 

If an order was established between July 21, 2008 and March 27, 2019, and private health insurance is not available, cash medical support will charge and must be paid until private health insurance becomes available.

Once it is determined that an order for medical support exists, the Child Support Enforcement Agency (CSEA) will notify the health insurance obligor (the person ordered to pay child support) and their employer by issuing the National Medical Support Notice (NMSN).  This order requires the employer to enroll the child in the company’s health insurance program, when it is available and if it is a reasonable cost.  If insurance is available, the CSEA will assist in obtaining insurance cards if they have not been provided by the employer, the insurance company, or the health insurance obligor.

The CSEA will not issue the NMSN when it is determined that the health insurance obligor is an active member of the military. If an eligible child is not enrolled in the military health plan, the CSEA will notify the custodial parent of the steps that need to be taken to ensure enrollment.

It is important to know that for orders issued on or after October 17, 2019, Medicaid does satisfy the requirement of the health insurance obligor to provide medical support.

Health insurance is considered "reasonable in cost" for an order when it does not exceed 5% of the annual gross income of the parent.  In considering  5% of the cost, the cost is the total insurance premium.

Employers must provide medical insurance coverage to an employee's child when both of the following apply:

• The employer offers family care coverage as part of its benefit plan
• The employee is eligible for the family care coverage

If an employer does not offer family care coverage, it is not required to obtain coverage simply to comply with a medical support order. 

The employee may object through the Child Support Enforcement Agency (CSEA) to the National Medical Support Notice  (NMSN) based on a mistake of fact.  The employee may present testimony and evidence at an administrative hearing only regarding whether a mistake of fact has been made in the NMSN.  If the employee disagrees with the results of the administrative hearing, they may file a written motion with the court to determine if a mistake of fact still exists in the NMSN.  However, the hearing rights do not stop the withholding for premiums unless/until the employee wins their appeal.

CASH MEDICAL ORDERS

Effective July 21, 2008, federal and state laws require all new or modified child support orders to provide some form of medical support for the child.  The new laws were created to ensure that cash is available to assist with the child’s medical needs any time the child is not covered by private health insurance. 

All child support orders issued between July 21, 2008 and March 27, 2019 will include two ordered amounts:

• An amount for child support when health insurance is provided; and
• An amount for child support & cash medical support when health insurance is not provided.

All child support orders issued on or after March 28, 2019 will include one flat child support amount and a cash medical support amount that will always charge, regardless of whether or not health insurance is being provided.

The mother, the father, or both parents can be ordered to provide private health insurance – but only if it is reasonable in cost and accessible.  Private health insurance is reasonable if the annual cost does not exceed 5% of that parent’s annual gross income.  Private health insurance is accessible if primary care services are available within 30 miles of the child’s home.  Fully subsidized coverage through Ohio Medicaid (including Healthy Start) does not meet the requirement to provide private health insurance, for orders issued prior to October 17, 2019.  Medicaid does satisfy the requirement to provide health insurance for orders issued on or after October 17, 2019.

For orders established between July 21, 2008 and March 27, 2019, cash medical support is only paid when private health insurance is not provided, as ordered.  At that time, the non-custodial parent will be ordered to pay cash medical support.

If this parent’s annual gross income is less than 150% of the federal poverty level for an individual, they will not be required to pay cash medical support.

Cash medical support will always charge on orders established March 28, 2019 and forward, regardless of private health insurance coverage being provided.

If private health insurance is not available to either parent when the child support order is issued or modified, both parents will be required to notify the Child Support Enforcement Agency (CSEA) when private health insurance becomes available.

• When the CSEA is aware of changes that effect a parent’s obligation to either pay cash medical support or provide health insurance, the CSEA will notify both parents.
• Cash medical support may be assigned (paid) to the state of Ohio when the child is receiving Medicaid benefits. When the child is not receiving Medicaid benefits, cash medical support is paid to the family.

REMINDER:

If you experience a change in your child’s health insurance coverage immediately contact your CSEA.

Medical Insurance Facts to Remember . . .

The Stark County Child Support Enforcement Agency (CSEA) is required under Federal Law to obtain medical insurance coverage for the child (ren) on a child support order. This includes establishment of a medical insurance order and verification of enrollment by the party ordered to provide medical coverage.

• Medical Insurance is ordered to be obtained by the party who has access to the best available policy, making them the Medical Obligor.
• The order may give the Medical Obligor the option of alternative insurance, such as coverage through a union or current spouse rather than through their employer.
• Medicaid and Healthy Start are NOT valid substitutions for Court or Administrative Orders for private medical insurance for orders issued prior to 10/17/2019.
• CSEA may arrange to have Summary Plan Descriptions, medical cards, booklets, and pamphlets sent to the Obligee.
• Shared Liability for medical expenses is not a medical insurance order. Rather it divides medical expenses between the parties, as stated in the order
• When expenses are shared, the Obligee may or may not be required to pay the out-of-pocket expenses.

Child support orders address uncovered medical costs by dividing the costs between the parents, on a percentage basis.  The Child Support Enforcement Agency (CSEA) is unable to assist in the collection of out-of-pocket expenses that are incurred, unless a court action for non-payment of child support is completed at the same time.  The Custodial Parent must provide the CSEA with the required information upon making his/her request.