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What is Cash Medical?

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What is cash medical support?

It is an amount ordered by the court to be paid toward the cost of health coverage when employer-sponsored or private insurance is not available. The amount ordered is based on the income of the obligor.

Cash medical support in lieu of insurance is ordered when insurance or alternative 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 cash medical instead of available insurance enrollment. See the Cash Medical Income Guidelines below for the cash medical support amounts. The amount can be amended by the court based upon evidence presented from the parties.

Cash Medical Income Guidelines Table – Effective September 15, 2015

The following table reflects 185% of the Federal Poverty Guidelines as of April 1, 2014. 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, cash medical 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 insurance, the cash medical support obligation will be $115 per child for the children not covered by health insurance, 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 $2,425 $3,051 $3,677 $4,303 $4,929 $5,555 $6,181 For each child over 7, add $626 per month

When a family is receiving SoonerCare, the cash medical 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.

Cash medical support is ordered temporarily until insurance is provided unless the court has ordered the cash medical support to be permanent. Permanent cash medical does not terminate when insurance becomes available and may be used in situations such as family violence or inconsistent availability of insurance coverage. The court may have a concern that if the noncustodial parent is ordered to provide the insurance, 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 cash medical support.

Income Withholding Orders and Cash Medical Support

The Income Withholding Order (IWO) has a line specifying the amount of cash medical support to be withheld from the parent’s income. It is specifically identified as Cash Medical Support; however, OCSS adds both the cash medical support and fixed medical support together for this line. They are added together to comply with federal requirements on the IWO form. If the cash medical support amount is terminated, the fixed medical amount remains on the Income Withholding Order.

Distribution of Cash Medical Support

When a family is receiving Medicaid, any cash medical support is assigned to the Medicaid agency. In Oklahoma, this is the Oklahoma Health Care Authority (OHCA). Per AT-91-01, this cash medical 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 cash medical support and does not follow PRWORA distribution rules. For example, if cash child support is $200 and cash medical support is $50, and OCSS receives $100 in a non-TANF Medicaid case, that $100 is prorated between both the cash child support and the cash medical support. The impact of this is that OCSS would send the cash medical support to OHCA prior to the custodian receiving all of the cash child support for the current month.

Termination of Cash Medical Support

When OCSS receives notice that the parent ordered to pay cash medical support has enrolled the child(ren) in health insurance or alternative coverage (e.g., IHS or TRICARE), OCSS sends a Notice of Proposed Termination of Cash Medical Support to all parties in the case by regular mail. The Notice of Proposed Termination will automatically generate and mail out via the host printer when the insurance 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 insurance. The caseworker should follow up on those messages and complete the process of terminating cash medical.

When a party believes the child(ren) is not actually covered by health insurance, a party may request a review of the termination of cash medical 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, OCSS reviews the case within ten days of receipt of the request and determines if termination of cash medical support is proper based on information provided by the contesting party. OCSS 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 cash medical 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 OCSS notifies them of the review decision.</li

When cash medical is terminated because insurance is being provided through an employer, and then the employment terminates, cash medical is not automatically reinstated.

Reinstatement of Cash Medical Support

The Reinstatement of Cash Medical Support as an expedited process should only be used when:

  1. Cash Medical Support was included in the order for support and there is an Address of Record for the obligor and obligee,
  2. The obligor provided appropriate health coverage for the child(ren) after the order was entered,
  3. The Cash Medical Support was then terminated pursuant to the order,
  4. The healthcare coverage has lapsed for the child(ren), and
  5. The order was not modified after the termination of cash medical to consider the payment of an insurance 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 insurance premium costs, the standard Review and Adjust process must be used to reinstate cash medical support instead of the expedited process.

Reinstatement Process

The reinstatement of cash medical support does not occur automatically. The following is the process to reinstate cash medical support.

Child No Longer Enrolled in Insurance and Cash Medical Support Previously in Court Order

OKESC updates OSIS with termination of insurance 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 cash medical support process.

Notice of Proposed Reinstatement of Cash Medical Support

After the district office has received the information the children are no longer enrolled in insurance, the Proposed Notice of Reinstatement of Cash Medical Support 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 insurance 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 Cash Medical 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 insurance. 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 cash medical 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 insurance, etc.) the expedited process may be terminated and a full review and adjustment may be pursued.

Filing the Notice of Reinstatement of Cash Medical Support

If neither party requests a hearing within the specified time limit, the Notice of Reinstatement of Cash Medical Support 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 Income Withholding Order will be generated to the NCPs employer when the Cash Medical Support has been reinstated.

Reinstatement of Cash Medical 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.