9.8 Medical Support

Overview

Federal statutes and regulations require the enforcement of medical support orders relating to cash medical, reasonable cost, and accessibility.  

Policy

Whether the Wyoming Child Support Program is enforcing a health insurance provision or a cash medical obligation as described below, the amount that can be withheld from an obligor's income is limited by the Consumer Credit Protection Act (CCPA), and the withholding is prioritized as described in 9.9 Income Withholding.  If the medical support order contains language requiring a non-custodial parent to provide medical insurance for a minor child if the insurance is available through employer or at a reasonable cost, or otherwise available at a reasonable cost, the CSP will enforce the medical support order even if the child is receiving Medicaid or Kid Care (Wyoming’s State Children’s Health Insurance Program (SCHIP)).  If the medical support order requires the parent who claims the child as a dependent for income tax purposes to ensure that medical coverages are provided for the child, enrolling the child in Medicaid and KidCare will constitute compliance with the order.  

 Health Insurance

Reasonable Cost Threshold

The CSP defines reasonable cost as the cost to provide health care coverage or to provide cash medical support for children at no more than 5% of the providing party’s gross income.

If healthcare is is not available to a non-custodial parent’s at reasonable cost, the case worker will not proceed with health insurance enforcement.  However, if there is a cash medical obligation for the non-custodial parent pending health insurance, the case worker will enforce the cash medical obligation as discussed below in “Cash Medical”.

If a non-custodial parent’s income meets or exceeds the reasonable threshold as defined by Wyoming statute, the case worker will ensure the health insurance is accessible by the child(ren).

Accessible

In Wyoming, a health care plan is accessible if it is available and provides coverage for the child residing within the geographic area covered by the insurance plan.

If the health insurance is accessible and available at reasonable cost, the case worker will ensure the child(ren) are added to the non-custodial parent’s health insurance policy.  If the health insurance policy is not accessible, the case worker will not proceed with health insurance enforcement.  If there is a cash medical obligation for the non-custodial parent pending health insurance, the case worker will enforce the cash medical obligation as discussed below in “Cash Medical”.

Employer Related Coverage

When a non-custodial parent is ordered to provide health insurance for a minor child if it is available at a reasonable cost and accessible, the CSP will utilize the federally mandated National Medical Support Notice (NMSN).  Within 2 days of the date an employer is verified on POSSE, POSSE will generate and the CSP will send a NMSN to the employer unless:

• POSSE indicates the employer does not provide health care coverage for its employees; or

• The parent’s income precludes health insurance coverage based upon the definition of “reasonable;” or

• The parent lives in another state and the health insurance is not “accessible."

Employer Responsibilities

When an employer receives a NMSN sent by the CSP or any other state, the employer will respond to Part A of the NMSN within 20 business days with one of the following:

• Employee never employed by employer;

• Employer does not provide health care coverage;

• Employee is amongst a class of employees that are not eligible;

• Employee no longer works for employer; or

• State or federal withholding limits and/or prioritization prevent withholding from employee’s income.

If the employer does provide healthcare coverage, the employer will respond to Part B of the NMSN (or forward to the plan administrator to respond within 20 business days) with one of the following:

• 1 – Qualified Medical Child Support Order (QMCSO);

• 2 – Employee and child(ren) are to be enrolled in the following:

  • A - Children currently enrolled;

  • B – Only one type of coverage and child(ren) enrolled;

  • C – Employee is enrolled in an option and already providing dependent coverage – child(ren) will be enrolled;

  • D – Employee is enrolled in an option that permits dependent coverage – child will be enrolled; and

  • Also provides coverage effective dates and options;

• 3 – More than one option and employee not enrolled – then the CSP will choose – if no response in 20 days, the child(ren) will be enrolled in default option, if any;

• 4 – Employee subject to waiting period that expires X/X/XX;

• 5 – NMSN does not constitute a QMCSO because:

  • Names of children/employee unavailable;

  • Mailing address of children/employee unavailable; or

  • Children no longer eligible;

• Allow the child(ren) to be enrolled outside of enrollment periods; or

• Withhold from the non-custodial parent the cost of the premium.

Special Circumstances

Missing or Incomplete Information.  Some employers or plan administrators may return Part B responses with missing or incomplete information.  In order to ensure children are properly covered by an insurance policy, a case worker will contact the employer/plan administrator for the missing data.  Once the data is received, the case worker will update POSSE with the policy information.  The following are common examples of missing or incomplete information.

• Insurance Information.  In response to Part B, plan administrators enclose insurance cards for the custodial parent to use. Upon receipt of the insurance cards, a case worker will enter the health insurance information into POSSE, file a copy of the insurance cards with the Clerk of District Court, and send the health insurance cards to the custodial parent.  If health insurance information is not received, the case worker will contact the employer or the plan administrator to gather the requisite information and enter the information on POSSE.  

• Insurance Cards.  In some instances, the employer/plan administrator may complete Part B, but may neglect to provide health insurance cards for the custodial parent to use for the enrolled dependent children. In such an event, the case worker will contact the employer and/or plan administrator for insurance cards on behalf of the custodial parent.  

• Plan Options.  Some employers offer health insurance options.  Upon receipt of Part B of the NMSN with an indication of multiple plan options, the case worker will contact the plan administrator for information on the health insurance options. Once information about the plan options is received, the case worker will contact the custodial parent to assist in choosing a plan that serves the needs of the child.  Once the custodial parent chooses a plan, the case worker will contact the plan administrator with the custodial parent’s health insurance option and ask the plan administrator to send the insurance card to the custodial parent.  If the custodial parent does not respond within 20 days, the employer/plan administrator may select the default insurance option. 

Additional dependents listed.  In some instances, an employer or plan administrator may return the NMSN listing additional dependents.  If this occurs, the case worker will review POSSE to determine if each child listed also has an order for insurance.  Any questions will be directed to the District CSE Office Manager. Otherwise, the following rules will govern this situation:

• If the additional dependents provided by the employer are listed on a case in POSSE where a NMSN has been sent, the case worker will update POSSE with the health insurance information to show the employer response for the appropriate case;

• If the additional dependents provided by the employer are not listed on a case in POSSE, the health insurance information will only be entered for the children on the NMSN for whom there is a health insurance order; or

• If the additional dependents provided by the employer are listed on a case in POSSE, but there is not an order for insurance, these children will not be entered on POSSE, and the case worker will review the order for possible modification as discussed in Chapter 10 Review and Adjustment.

Current spouse coverage.  In some instances, the employer may respond to the NMSN that another party is providing insurance (such as the non-custodial parent’s current spouse).  If the employer provides proof of insurance in the form of a signed document from the spouse’s insurance company, then the information will be entered into POSSE with a special comment that the health insurance is provided by another party.  If the employer does not provide proof, the case worker will contact the non-custodial parent for proof of coverage.

Outside of coverage area.  While it is not a response on Part A of the NMSN, some employers may respond that the child cannot be covered because the child lives outside of the coverage area.  In this instance, the case worker will call the employer to learn more about the employer’s health insurance.  If there are multiple options and one allows for coverage of the child, then the child should be enrolled in that option.  On the other hand, if there is only one plan available and the child cannot be covered, the case worker will process the response as Part A, “Employee not eligible for insurance.”  The case worker will update POSSE with a POSSE note indicating the child lives outside of the coverage area.  

Non-Compliant Employers

If the employer does not respond to the NMSN within 20 days the case worker will receive an alert from POSSE.  The case worker will review POSSE to ensure that:

• The non-custodial parent is still employed with the employer that received the NMSN;

• The case is still open; and

• The child(ren) have not all emancipated.

If, after reviewing POSSE, the case worker determines that pursuing health care coverage is still appropriate, the case worker will contact the employer to inquire about the receipt and return of the NMSN and explain the employer’s responsibilities.  If the employer still has Part A, the case worker will review the possible responses with the employer, gather the information, and update POSSE appropriately.  If health insurance is available, the case worker will determine if the employer forwarded Part B to the plan administrator and set an alert in POSSE to check for a response in 30 days.

If the employer refuses to respond to the NMSN, the case worker will discuss a possible contempt action with the District CSE Office Attorney.

NMSN Termination

When a IV-D case closes as described in Chapter 12 Closure or a current support order no longer exists, the case worker will contact the employer to terminate the health insurance coverage.

Cash Medical

The District Court Judge may order an amount to be paid by the non-custodial parent to offset the cost of health insurance provided by another person or a public entity, to pay for uncovered medical expenses, or to provide health care coverage until health insurance that is both accessible and reasonable is available.

If the child support order contains a cash medical provision, the case worker will enforce the cash medical provision through wage withholding as described in 9.9 Wage Withholding.

Medical Judgments

The Wyoming Child Support Program does not obtain medical support judgments.  A parent may seek a judgment for unpaid medical support from the other parent through the District Court.  If the custodial parent obtains a District Court judgment based upon uncovered medical expenses, medical bills or premium payments, the District CSE Office will enforce the judgment utilizing appropriate enforcement remedies as defined in this Chapter. 

Cross Reference

None