Legal Authorities:
- OAC 340:25-5-168(l)
- OAC 340:25-5-198.1 and OAC 340:25-5-198.2
- 42 USC § 666
- 45 CFR 302.33, 302.56, 303.7, 303.30, and 303.31
- 36 O.S. § 6058A
- 43 O.S. § 112, 118 through 118I, 118.2, and 119
- 56 O.S. § 237
What is Cash Medical (CM) support?
It is an amount ordered by the court to be paid toward the cost of health care coverage when employer-sponsored or private insurance is not available. The amount ordered is based on the income of the obligor.
CM support in lieu of health care coverage is ordered when health care coverage or alternative health care coverage is not available at the time the medical support order is entered by the court or if the court finds good cause exists for ordering CM instead of available insurance enrollment. See the Cash Medical Income Guidelines below for the CM support amounts. The amount can be amended by the court based upon evidence presented from the parties.
Cash Medical Income Guidelines Table – Effective March 1, 2023
The following table reflects 185% of the Federal Poverty Guidelines as of January 2023. If the obligor’s income as shown on the Child Support Computation and the total number of children in the case is at or below the amounts on the table, CM support will be established at $0. If the obligor’s income exceeds the amount listed on the table for the number of children not covered by health care coverage, the CM support obligation will be $115 per child for the children not covered by health care coverage, pro-rated by the income of the parents. The obligor’s share of the cash medical order may not exceed 5% of the gross income of the obligor.
| Number of children | One | Two | Three | Four | Five | Six | Seven | Eight or more |
|---|---|---|---|---|---|---|---|---|
| Obligor income | $3,040 | $3,833 | $4,625 | $5,417 | $6,210 | $7,002 | $7,795 | For each child over 7, add $792 per child |
When a family is receiving SoonerCare, the CM support is assigned (owed) to the Oklahoma Health Care Authority (OHCA). CSS collects the amount specified in the court order and forwards those collections to OHCA.
CM support is ordered temporarily until health care coverage is provided unless the court has ordered the CM support to be permanent. Permanent CM does not terminate when health care coverage becomes available and may be used in situations such as family violence (FV) or inconsistent availability of health care coverage. The court may have a concern that if the noncustodial parent is ordered to provide the health care coverage, the parent may be able to obtain either identifying information or location of the child through the insurance provider or claims process. In this event, the court may order permanent CM support.
Income Withholding Orders and CM Support
The Income Withholding Order (IWO) has a line specifying the amount of CM support to be withheld from the parent’s income. It is specifically identified as CM Support; however, CSS adds both the CM support and fixed medical support together for this line. They are added together to comply with federal requirements on the IWO form. If the CM support amount is terminated, the fixed medical amount remains on the IWO.
Distribution of CM Support
When a family is receiving Medicaid, any CM support is assigned to the Medicaid agency. In Oklahoma, this is the Oklahoma Health Care Authority (OHCA). Per AT-91-01, this CM support has the same priority as current cash child support. Therefore, when current support is collected, it is prorated between the cash child support and the CM support and does not follow PRWORA distribution rules. For example, if cash child support is $200 and CM support is $50, and CSS receives $100 in a non-TANF Medicaid case, that $100 is prorated between both the cash child support and the CM support. The impact of this is that CSS would send the CM support to OHCA prior to the custodian receiving all of the cash child support for the current month.
Termination of CM Support
When CSS receives notice that the parent ordered to pay CM support has enrolled the child(ren) in health care coverage or alternative health care coverage (e.g., IHS or TRICARE), CSS sends a Notice of Proposed Termination of Cash Medical Support (CM01 and CM02) to all parties in the case by regular mail. The CM01 and CM02 will automatically generate and mail out via the host printer when the health care coverage policy information screens are updated. The office should receive a message from ESC if they update the system showing that the child(ren) is covered by health care coverage. The caseworker should follow up on those messages and complete the process of terminating CM.
When a party believes the child(ren) is not actually covered by health care coverage, a party may request a review of the termination of CM support within ten days from the date of mailing of the notice.
When a party requests a review to contest the Notice of Proposed Termination of Cash Medical Support (CM01 and CM02), CSS reviews the case within ten days of receipt of the request and determines if termination of CM support is proper based on information provided by the contesting party. CSS notifies the parties of the review decision.
When the request for review is denied, parties have 15 days from the date of mailing of the review decision to request a hearing on the termination of CM support.
CSS files a Notice of Termination of Cash Medical Support with the proper court when:
- No party requests a review within the ten-day time period; or
- No party requests a hearing after CSS notifies them of the review decision.
When CM is terminated because health care coverage is being provided through an employer, and then the employment terminates, CM is not automatically reinstated.
Reinstatement of CM Support
The Reinstatement of Cash Medical Support as an expedited process should only be used when:
- CM Support was included in the order for support and there is an Address of Record for the obligor and oblige,
- The obligor provided appropriate health care coverage for the child(ren) after the order was entered,
- The CM Support was then terminated pursuant to the order,
- The health care coverage has lapsed for the child(ren), and
- The order was not modified after the termination of CM to consider the payment of an health care coverage premium.
If it has been more than one year since the order has been established or reviewed, CSS may use the standard Review and Adjust process if other changes have occurred.
Additionally, if a modification of the child support order has occurred that provides for credit for health care coverage premium costs, the standard Review and Adjust process must be used to reinstate CM support instead of the expedited process.
Reinstatement Process
The reinstatement of CM support does not occur automatically. The following is the process to reinstate CM support.
Child No Longer Enrolled in Health Care Coverage and CM Support Previously in Court Order
OKESC updates OSIS with termination of health care coverage information and notifies the district office when the termination is by the person ordered to provide the coverage. Additionally, one of the parties may notify the district office of the enrollment termination (with sufficient documentation). Prior to moving to the next step, district office staff should review the court order to determine if the case is eligible for the expedited reinstatement of CM support process.
Notice of Proposed Reinstatement of CM Support
After the district office has received the information, the children are no longer enrolled in health care coverage, the Notice of Proposed Reinstatement of Cash Medical Support (CM10 and CM11) is prepared and sent to the non-custodial parent (NCP) and the custodial person (CP) by regular mail. This document does not require a signature.
The NCP and CP have ten days to submit a written request for a review based on a claim that health care coverage is still being provided for the child(ren). No other reasons for review are appropriate. Issues concerning reasonable cost and accessible coverage are outside the scope of this process. A Review and Adjustment process would be more appropriate for those issues.
Objection to Reinstatement of CM Support
If one of the parties objects (by completing the response form or providing the objection in writing), a desk review is conducted by the district office within ten days of the receipt of the request. The district office may either conduct the desk review with the parties or may request documentation be submitted for the review. The documentation provided should verify whether the child(ren) are or are not enrolled in health care coverage. The review decision is provided/sent to both the NCP and CP. They have 15 days from the review decision date to request a hearing to object to the reinstatement of the CM support. See OAC 365:10-5-5 for Oklahoma Insurance Department (OID) rules concerning minimum coverage.
If the parties bring in evidence concerning a significant change in circumstances (i.e., change in income, placement of child(ren), cost of health care coverage, etc.) the expedited process may be terminated and a full review and adjustment may be pursued.
Filing the Notice of Reinstatement of CM Support
If neither party requests a hearing within the specified time limit, the Notice of Reinstatement of Cash Medical Support (CM13) is filed with the proper court. At that point, the obligation and balance screens on OSIS are updated to add the cash medical support back, starting from the date file stamped on the Notice.
An amended IWO will be generated to the NCPs employer when the CM Support has been reinstated.
Reinstatement of CM Support Hearing
If one of the parties does request a hearing, the case is set for hearing at the earliest opportunity with notice sent to all parties with the location, date, and time of the hearing. At the conclusion of the hearing, the order is filed, docketed in district court, and provided to the parties.
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