Legal Authorities:
- 29 USC § 1169
- 42 USC § 666(a)(19)– Health Care Coverage
- 29 CFR § 2590– Rules and Regulations for Group Health Plans, Qualified Medical Child Support Order
- 45 CFR § 160.103
- 45 CFR § 164.501
- 45 CFR § 164.512(a) and (d)(1)(iii)
- 45 CFR §§ 56, 303.30, 303.31, and 303.32 – Guidelines and Enforcing Medical Support for Children
- 36 OS § 6058A
- 43 OS § 118.2(B)
- 21 OS § 566.1
- 43 OS § 139.1
- OAC 340:25-5-67
- OAC 340:25-5-114
- OAC 340: 25-5-123
- OAC 340:25-5-168 – Establishment of Medical Support
- OAC 340:25-5-171 – Enforcement of Medical Support
- OAC 340:25-5-198.2
- Executive Order No. 13181
- 65 FR 81321
Overview
When a parent has been ordered to provide health care coverage for the child(ren) and the other parent or custodial person has failed or refused to provide information necessary to enroll the child(ren) in the health insurance plan, CSS:
- Releases the information to employers and plan administrators as appropriate when family violence (FV) is not an issue;
- Determines noncooperation and begins the case closure process when the parent refusing to provide the information is the applicant for services;
- Obtains the necessary information from the parent by a license revocation action (NOIR), or by an indirect contempt of court action; OR
- Seeks a modification (Mod) of the order.
Release of Information
CSS is required to provide sufficient information to parties to a child support case, their attorneys, interpreters, and authorized representatives for the children’s enrollment and coverage. This information includes the child’s name, date of birth, and social security number.
Additionally, CSS may indicate to the plan administrator whether the child resides within their service area upon request. CSS is not prohibited from requesting or receiving health care coverage and employment information due to HIPAA.
The information requested in the National Medical Support Notice (NMSN or MED5/MED5C) is not protected health information as defined in 45 C.F.R. § 164.501. The information requested in the NMSN (MED5/MED5C) does not relate to a condition of the individual, providing health care coverage to that individual, or payment for health care coverage to that individual. Even if this information were to be construed as protected health information, a covered entity may disclose protected health information to the extent that disclosure is required by law or to an agency performing a government regulatory program. The employer is required by numerous federal and state laws to comply with the NMSN (MED5/MED5C) by providing information to CSS so that child(ren) might receive appropriate medical care.
Enrollment FAQs
Is it reasonable and necessary for an employer to enroll and disenroll again and again when the employee works seasonally or is temporary?
No, the employer is not obligated to seasonally enroll and disenroll the employee or his/her children. Employers must notify ESC/CSS that the situation would exceed the Consumer Credit Protection Act (CCPA) or reasonable cost limits (whichever applies on the case). When Child Support Services (CSS) is notified of this by the employer, the case may need to be reviewed to establish permanent cash medical (CM) support or to obtain private coverage.
What options does the employee have if he/she must take out health care coverage, but the company coverage is too costly?
CSS needs to review the response from the employer. There are multiple reasons for this response.
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- If the provision in the order is for a reasonable cost limitation and the cost of the health care coverage for the children exceeds that amount, CSS specialists may need to perform a review of the order. CSS needs to ensure the employer is calculating the cost of the health care coverage appropriately. The cost of coverage for the employee or other adults is not included in the amount to be reviewed for the reasonable cost limit. Additionally, the reasonable cost limit is a numeric amount set by the court and is not calculated by the employer at the time of considering enrollment. If the order does not have a reasonable cost limit listed in it, the CCPA limits apply.
- Without a reasonable cost limit listed in the order, CSS staff needs to review the cost of the health care coverage in comparison to the CCPA limits. If those limits are exceeded, CSS may need to review the case for a modification (Mod) of the child support order.
How should CSS respond to an employer who indicates an employee tells them they have private health care coverage?
Employers are required to honor the National Medical Support Notice (NMSN or MED5/MED5C) regardless of whether the employee states he/she has private coverage. CSS staff must modify (Mod) the court order for private health care coverage before employer coverage can be terminated.
The employee says that the cost of health care coverage is not supposed to be more than 5% of his/her income. Is the employer supposed to calculate this amount?
No, this calculation is done by the court when the order is entered. The employer may not have access to all the information about an individual’s income. He/she could have multiple sources of income the court must consider.
How does CSS know if the health care coverage is accessible to a child?
The NMSN (MED5/MED5C) provides the address of the custodian and/or child. If the child is within 60 miles (one way) of the provider, the health care coverage is considered accessible in most cases. When an employer offers coverage only for an area where the child does not reside, the order may need to be modified (modded) for a different health care coverage option (e.g., private coverage, cash medical support, etc.).
When CSS is notified health care coverage is NOT accessible, what should happen?
At the time of establishing an order, CSS should pursue a different option in the health care coverage hierarchy. These options include private coverage, alternative coverage from another policy holder, and cash medical support. At the time of enforcing an order, CSS should consider modifying (modding) the child support order to pursue a different option in the health care coverage hierarchy listed above.
What happens if Family Violence (FV) has been indicated on the case? Does the NMSN (MED5/MED5C) still go out?
Yes, the NMSN (MED5/MED5C) is issued but CSS’ address is on the document instead of the custodial person’s (CP’s). The employer should contact the Employer Services Center (ESC) to provide the information about the service area of the provider. Then ESC will indicate whether the child is within that service area. CSS should not release the address of the children when family violence (FV) has been indicated.
Does CSS send out NMSN (MED5/MED5C) on custodians (CPs)? Does the employer really need to enroll the child?
Yes, there are some court orders that require the CP to provide health care coverage for the child. A CP version of the NMSN, MED5C or MED5CA, is sent to CP’s employer when the court order requires CP to provide the health care coverage. OSIS must have an obligation where the MED ORD field is either C or D, the CHMU must be completed and a current, verified employer must exist on the CPEU.
What if the child is on SoonerCare? Should the child be enrolled in health care coverage?
Yes, the employer must comply with the NMSN (MED5/MED5C) and enroll the child. The fact the child is on SoonerCare does not require CSS to pursue cash medical (CM) support. CM support is ordered when health care coverage is not available, not reasonable in cost, or the court determines it would be in the best interest of the child (e.g., family violence (FV) has been indicated and there is a concern of disclosing the location of the children to the non-custodial parent (NCP) or health care coverage availability is inconsistent). See the CS Quest Article What is Cash Medical (CM)?.
When does cash medical (CM) support stop after a child has been enrolled in health care coverage? Should the employer stop withholding the CM support from the employee’s paycheck when they enroll the child?
Since the termination of CM support must be confirmed by a court, the CM support cannot be stopped automatically by the employer. The employer should notify CSS and the health care coverage recipient that enrollment has occurred. The CM termination process must be completed prior to an amended Income Withholding Order (IWO) being issued. The CM termination must be completed and filed with the court prior to the obligation (OBL) being updated and an amended IWO being issued to the employer. If you update the OBL prior to filing the documents in court, your documents will NOT print. See the CS Quest Article Cash Medical (CM) Termination Process.
What if the noncustodial parent (NCP) is now eligible for health care coverage but wants to continue paying cash medical (CM) support instead. Can we do that?
No, if the court order specifies the employee must enroll the child when health care coverage is available, he/she cannot choose to not enroll the child.
Is it possible to have an Income Withholding Order (IWO) with cash medical (CM) support and fixed medical support simultaneously?
It is possible for the court order to have both a fixed medical support amount and a child to be enrolled in health care coverage. The fixed medical support would be for a fixed recurring payment for items such as orthodontia or asthma treatments. The fixed medical support and cash medical (CM) support are added together on the IWO. CSS staff may need to review the obligation (OBL) and the CSPAYI screen to ensure the amounts are listed correctly.
Should CSS send out the National Medical Support Notice (NMSN or MED%/MED5C) to the employer of a stepparent?
No, the NMSN (MED5/MED5C) is sent out to the employer of a non-custodial parent (NCP) or a custodian (CP). It is not sent out to the employer of a stepparent. The stepparent is not legally obligated to enroll the child in health care coverage. The court may recognize the stepparent is currently providing coverage in the child support order but if that coverage lapses, the non-custodial parent (NCP) or biological parent (BP) would have the legal obligation to replace that health care coverage instead of the stepparent having the obligation. These cases would be coded with a MED ORD field of “K” on the obligation to indicate alternative coverage to prevent the NMSN (MED5/MED5C) from issuing on the case. However, if the health care coverage lapses, the order may need to be reviewed to determine if another type of coverage should be ordered for the child or if the premium costs should be adjusted in the child support guidelines (GLS).
Can a non-custodial parent (NCP) or custodian (CP) provide health care coverage for his/her child even if the other parent was ordered to provide health care coverage?
Yes, NCP or CP may want to voluntarily provide health care coverage for a child without being legally obligated to do so. This is an issue in which CSS does not become involved.
If the children are enrolled in health care coverage, does that mean the SoonerCare case with OHCA should close?
No. The children could maintain their SoonerCare enrollment if they are eligible. The Oklahoma Health Care Authority (OHCA) would seek payments from the health care coverage company prior to paying for medical care from Medicaid funds. This is the Third-Party Liability (TPL) program. CSS shares health care coverage information with OHCA to facilitate this occurring.