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Medical Support Hot Topics

This is an overview of medical support topics presented to Child Support Services (CSS) attorneys at the January 27, 2017 Legal Leadership Institute training.

Child on SoonerCare

Q: If the child(ren) is (are) on SoonerCare and neither parent currently has health insurance in place, do we request an order for both parents to carry insurance or just the noncustodial parent (NCP)?
A: You may request that the Court order the NCP, custodial parent (CP), biological parent (BP), or all to carry the health coverage in the future, if it is accessible and cost does not exceed $xx.xx (where the pro rata cost of the insurance does not exceed 5% of gross income). Cash medical should also be ordered, even if the amount is $0.00.


Title 42 USC Section 666(a)(19)(A) (Section 466 of the Social Security Act)

AT-08-08 and DCL-17-01 (newest regulation): Under both these federal policy memos, you need to read the Comments to understand that the intent of the Federal Office of Child Support Services (OCSS) was to allow for the possibility that either the NCP or the CP may be the person ordered to provide medical support. While 45 CFR 303.31(a)(2) was changed in 2016 to define “health care coverage” instead of defining “health insurance,” the requirement that either parent may be ordered to provide health coverage has not changed.

Title 43 OS 118F (this section does not specifically mandate who is to provide coverage when cash medical terminates).

How to update MED5

Q: If the Court enters a cash medical order and orders that either parent be required to get employer-sponsored insurance in the future if it becomes available at a cost of no more than $xx.xx per month, how should the Oklahoma Support Information System (OSIS) be updated to assure a MED5 goes out to the proper parent’s employer?
A: If the order provided for medical support only by NCP, MED ORD on OBLU would be updated to “A,” and CHMU screen would be updated with the reasonable cost limit, percentage share and required coverage types as to the NCP. That would result in a MED5A to the NCP’s employer that fills in the reasonable cost amount and the coverage types to be provided. Likewise, if the order provided that CP provide the insurance, MED ORD field would be updated to C, the CHMU screen would be updated with information as to the CP, and a MED5C would be generated if CP employer information is updated on OSIS. The correct MED ORD code if either parent is ordered to provide the insurance is “D.” However, if you generate a MED5 or MED5C with MED ORD updated as “D,” the reasonable cost amount and coverage types you have updated in CHMU will not print on the document. The CHMU can produce only one MED5 at a time. If you want to generate a MED5A, you would have to change MED ORD to “A,” update CHMU with the NCP’s information, and generate the MED5 or MED5A.

Note: Best Practice – allow the automated medical support enforcement to work:

You may be wondering “what should I leave the code as by default when I’m not manually printing MED5s?”

If one parent is employed when you are updating CHMU and the other is not, it is probably best to update CHMU to allow automated medical enforcement to work on the employed parent. For example: The CP is usually (and/or currently) employed, but the NCP is not. Leave the CHMU screen updated to “C” to allow a MED5 to print when needed.

If neither parent has employment information, it may be most effective to leave the code as “A.” APEU is checked and updated more frequently than CPEU and automated medical enforcement would, therefore, be more effective with CHMU showing “A.”

Termination of Cash Medical and TRICARE

Q: What are DEERS and TRICARE?
A: Military members are provided a health benefit through TRICARE. This benefit is made through the Defense Enrollment Eligibility Reporting System (DEERS). Active-duty and retired service members are automatically registered in DEERS, but additional action is required to enroll eligible dependents.
See OAC 340:25-5-168 and 340:25-5-171.
Q: Should cash medical be terminated when the child is enrolled in TRICARE?
A: Yes, termination of cash medical can be appropriate when CSS has received verification that the child is enrolled in alternative coverage such as TRICARE. Send a Notice of Proposed Termination of Cash Medical Support (CM01 for the NCP version, and CM02 for the CP version) to all parties in the case by regular mail. Parties have 10 days from the date of mailing to request a review.
Q: I looked at POLA, but the TRICARE policy holder is someone other than the obligor (see example below). Should we still terminate cash medical? (insert Image #1-CPOL screen)
A: Yes. When a child is enrolled in TRICARE, the CM01 and CM02 should be sent, regardless of who is listed as the service member associated with the coverage.Screen print of the CPOL screen.
Q: Doesn’t the CM01 and CM02 generate automatically once a policy is added to OSIS?
A: Not necessarily. If the policy holder is someone other than the NCP, the CM01 and CM02 will have to be manually generated:

  • CSCD (sp) CM01U
  • CSCD (sp) CM02
Q: How can I find out if a child is enrolled in TRICARE, so I can see if I need to manually generate the CM01 and CM02?
A: When a TRICARE policy is added by the Employer Services Center (ESC) to a case with cash medical, ESC will send a high-priority message to the caseworker. In addition, CMOD report CY909R01 lists children currently enrolled in medical coverage.
Q: What if there are premiums being paid?
A: For active-duty service members, there is no cost for DEERS coverage. However, there are some reserve members of the armed services who report that they do pay some premiums for TRICARE. We should still send out the CM01 and CM02, and if a party objects to termination of cash medical because cash medical is being used to pay TRICARE premiums, then we may opt to continue the cash medical while seeking a modification.
Q: If SoonerCare is no longer active, and the child is enrolled in TRICARE, do any cash medical payments issue to the CP?
A: Until the Notice of Termination of Cash Medical has been filed, this is a possibility. This is why we need to make sure that we send out the CM01 and CM02 as soon as we receive verification of enrollment.

Authority: OAC 340:25-5-168

Q: What if a parent has been ordered to provide TRICARE for a child but is unable to do so because the other parent will not provide required information or take necessary action? It has been reported that DEERS now requires a birth certificate for the child (not just a copy of the medical support order) and the Social Security Number (SSN) for the military sponsor. Uncooperative parents may not voluntarily exchange this information.
A: Cash medical can only be terminated upon proof of “enrollment” in coverage, not merely eligibility for enrollment. Title 43 OS 118F. Cash medical would continue until enrollment is effective and either a new medical support order is entered or the cash medical is terminated per OAH 340:25-5-168(k). CSS may release a SSN to a party if it is needed in order to enroll a child in health coverage. See OAC 340:25-5-67(b)(2). CSS does not usually have certified copies of birth certificates for children. Check the language in your child support order for a requirement for parents to exchange information necessary to allow dependent health coverage to be accessed. Consider possible enforcement through a Motion for Production of Document or other means. If you are working a case in which a child may be newly eligible for TRICARE or other health coverage, consider setting a future hearing date to review the compliance of the parents with orders to exchange information necessary to secure insurance enrollment.