Legal Authority
Overview
After a medical support order has been entered, Child Support Services (CSS) may update a case to Medical Enforcement Only (MEO) based upon a request from the custodial person (CP) unless:
- Assigned court-ordered child support and/or medical support is owed under OAC 340:25-5-117; or
- The child(ren) is in a deprived or delinquent juvenile court action;
If the child support order contains an order for medical insurance that is in effect, or it provides for cash medical (CM) support in the amount of $0.00 the case may be updated to MEO on request of the CP. However, if the order provides for CM support in an amount greater than $0.00 and non-TANF Medicaid services are being provided, the case must remain full-service.
If there are multiple custodians on the case, a case could be both MEO and full service. For example, if there are two children on the case and each one resides with a different custodian who has applied for non-TANF Medicaid only, each custodian has the option to request MEO or full-service. If the first custodian requests full-service and the second custodian requests MEO, any child support balances related to the second custodian would not be enforced. Full-service would be provided to the first custodian.
Appropriate Application of MEO
There seems to be widespread misunderstanding about the appropriate application of medical enforcement only (MEO) status. It is the intention of this article to clear up some of this misunderstanding and provide accurate information about when MEO is and is not appropriate.
The purpose behind MEO status is to provide a way for custodians to cooperate with CSS for the purposes of Medicaid eligibility, as is required by statute, but to allow them to do so without having to pursue a full child support case in situations where the parties have reached agreeable arrangements between themselves. As such, MEO is designed to be used only in situations where the only state benefit being expended is Medicaid (SoonerCare).
Additionally, MEO may be used in situations where a customer requests case closure, but we are unable to close the case because of SoonerCare benefits. If the conditions for MEO are met in those situations, it might be a good option for the case. See also “MEO Criteria” and “Levels of Service” articles for more information.
Also, please remember that child-only SoonerCare cases on which an order has been established cannot be closed at the CP’s request but should only be closed with either closure code 16 (Non-TANF, CP Unreachable for 60 Days) or closure code 17 (Non-TANF, Customer Uncooperative). These closure codes will only work if the CP is not active on SoonerCare. If the CP is active on SoonerCare, the only way to close the case is for the CP to be removed from SoonerCare through the non-cooperation process and then close the case using closure code 17. See “Closing Child Only Medical Cases Overview Legal Authority” for more information.
The point of greatest confusion appears to be that many are under the impression that a case cannot be placed into MEO status if the custodial person (CP) is receiving SoonerCare as well. This is not correct.
Services in MEO Cases
This article is about establishment and enforcement definitions and how each case should be treated for Medical Enforcement Only.
Establishment
When a CSS case does not have a child support order for all the children on a case, it is classified as an establishment case. CSS must establish paternity, if necessary, and a child support order. That order must include a provision for current child support, medical support, and may include support for a prior period.
In essence the case is treated as a full-service case until after the child support order is established. At that point, CSS can make the determination of whether the case is eligible for Medical Enforcement Only (MEO).
Additionally, if the case requires review and adjustment (R&A), the case must be a full-service case. A modification (Mod) of the child support order is necessary when the order does not include a medical support provision, no health care coverage is available for the child(ren) or a parent (or custodian) claims the available health care coverage is not accessible or is not reasonable in cost.
Enforcement
When CSS has a case with an order for support for at least one child in the family, it is classified as an enforcement case. There are some cases that are both establishment and enforcement cases when some children have established orders while others do not within the same family.
When a person receiving non-TANF Medicaid requests MEO, CSS enforces only the health care coverage portion of the child support order using the National Medical Support Notice (NMSN or MED5/MED5C). CSS does not enforce the payment of child support or fixed medical support through the Order/Notice to Withhold Income for Child Support (IWO) or any other enforcement remedy in an MEO.
However, if CM support has been ordered in a sum greater than $0.00 and the family is receiving SoonerCare (Medicaid), those amounts are assigned to the State of Oklahoma. The case must be a full-service case and all provisions of the order are enforced. The CP does not have the option to only have the CM support enforced. Furthermore, CM support orders must provide for termination of CM if health care coverage becomes available.
For related articles, try clicking one of the tags at the bottom of this page.