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Services in MEO Cases

This article is about establishment and enforcement definitions and how each case should be treated for Medical Enforcement Only.


When a Child Support Services (CSS) case does not have a child support order for all of 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 a review and adjustment (aka modification), the case must be a full service case. A modification of the child support order is necessary when the order does not include a medical support provision, no insurance is available for the child(ren) or a parent (or custodial person) claims the available health insurance is not accessible or is not reasonable in cost.


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 medical enforcement only services, CSS enforces only the health insurance portion of the child support order through the use of the National Medical Support Notice. CSS does not enforce the payment of child support or fixed medical support through the Order/Notice to Withhold Income for Child Support or any other enforcement remedy in a medical enforcement only case.

However, if cash medical 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 custodial person does not have the option to only have the cash medical support enforced. Furthermore, cash medical support orders must provide for termination of cash medical if insurance becomes available.