Recommendation 6 (Federal
Legislation)
(See page 3-7)
If the child is presently enrolled in either parent's private health care
coverage and the coverage is accessible to the child, that coverage should
be maintained. If, however, one of the parents has more appropriate coverage
(as determined in accord with Recommendation 8 through Recommendation 11)
and either parent requests that the child be enrolled in this plan, the decision
maker shall determine whether or not to maintain the existing coverage based
upon the best interests of the child.
Recommendation 13 (Federal
Legislation)
(See page 3-20)
After determining that a child is not enrolled in private health care coverage,
and that at least one parent could enroll the child in private coverage,
the decision maker should determine which plan is most appropriate for the
child (as defined in Recommendation 8) by evaluating the plan(s) in the following
manner:
Step 1. Determine whether the child has access to the services provided under
the coverage.
Step 2. Determine whether the cost of the coverage is reasonable.
Step 3. Determine whether the coverage is comprehensive.
Step 4. If, after following steps 1-3, the decision maker finds that only
the custodial parent has accessible, affordable, and comprehensive coverage,
that coverage should be ordered, with appropriate allocation of cost, as
determined by the State child support guidelines. (See Recommendation 2)
If, after following steps 1-3, the decision maker finds that only the
noncustodial parent has accessible, affordable, and comprehensive coverage,
that coverage should be ordered, with appropriate allocation of cost, as
determined by the State child support guidelines. (See Recommendation 2)
Step 5. If, after following steps 1-3, it is determined that accessible,
affordable, comprehensive coverage is available to both parents, then coverage
available to the custodial parent should be ordered unless (1) either parent
expresses a preference for coverage available through the noncustodial parent;
or (2) the noncustodial parent is already carrying dependent's coverage for
other children, either under a child support order for those children or
because the children reside in his current household, and the cost of
contributing toward the premiums associated with the custodial parent's coverage
is significant. If either of the exceptions applies, the decision maker should
make an assessment of what is in the best interests of the child and order
coverage accordingly.
If neither parent has family health coverage, see Recommendation 14 and Recommendation 15.
Recommendation 16 (Federal
Legislation)
(See page 3-25)
To facilitate enrollment of eligible children in public coverage, Federal
law should require State IV-D agencies to: (1) provide parents with information
about the Medicaid and SCHIP programs, as well as any other subsidized coverage
that may be available to the child; and (2) refer the family to the appropriate
program for possible enrollment.
Recommendation 17 (Federal
Legislation)
(See page 3-26)
Congress should amend §1920A of the Social Security Act to include IV-D
agencies among the "qualified entities" that may enroll children in Medicaid
for a presumptive eligibility period, based on preliminary information that
indicates that the child is income-eligible for Medicaid.
Recommendation 19 (Best
Practice, Federal Legislation)
(See page 3-28)
Part A (Best Practice): States should grant authority to the decision maker
to order the noncustodial parent to contribute toward the State cost of providing
coverage under Medicaid and SCHIP. Provided, however, no contribution should
be ordered from any noncustodial parent whose net income (as defined by the
State to determine Medicaid eligibility) is less than 133 percent of poverty.
Part B (Federal Legislation): Congress should amend §467 of the Social Security Act to provide that the amount the noncustodial parent may be ordered to contribute toward the monthly cost of coverage under Medicaid or SCHIP shall be the lesser of: (1) the estimated cost of enrolling the child in Medicaid or SCHIP; (2) five percent of the noncustodial parent's gross income; or (3) the amount indicated by a sliding fee schedule, developed by the State, which takes into account ability to pay and average Medicaid/SCHIP costs for dependent children.
Recommendation 20 (Federal
Legislation)
(See page 3-31)
Congress should amend Title IV-D of the Social Security Act to preclude State
IV-D agencies from attempting to recover Medicaid-covered prenatal, birthing,
and perinatal expenses from the noncustodial parent.
Recommendation 35 (Federal
Legislation)
(See page 4-11)
Congress should enact legislation requiring health care plans to send a copy
of any COBRA notice related to a child's loss of health coverage to the State
IV-D agency if the health care plan received any QMCSO, including the National
Medical Support Notice for that child, from the IV-D agency.
Recommendation 42 (Federal
Legislation)
(See page 4-14)
Congress should enact legislation that would allow Federal agencies to enroll
Federal employees and their dependents in the Federal Employees Health Benefits
Program without the employee's consent if the employee is ordered to provide
such coverage for his or her dependent(s).
Recommendation 43 (Federal
Legislation)
(See page 4-14)
Congress should enact legislation to allow the U.S. military to enroll its
employees and their dependents in Tri-Care without the employee's consent
if the employee is ordered to provide such coverage for his or her dependents.
Recommendation 44 (Federal
Legislation)
(See page 5-5)
When the decision maker requires the custodial parent to provide coverage
for the children, the parent should verify that the children have been enrolled
within a reasonable time, to be determined by the State. When the child support
enforcement agency provides enforcement services, and the children are not
enrolled as ordered, the child support enforcement agency should take appropriate
steps to enforce the order against the custodial parent. However, any notice
that is sent to the parent should ask the custodial parent to contact the
child support enforcement agency if she did not provide health care coverage
because of some financial difficulty, a change in employment, other change
in circumstances, and/or the noncustodial parent's failure to comply with
an order that required him/her to pay a portion of the premium.
Recommendation 58 (Federal
Legislation)
(See page 6-16)
Congress should repeal §1902(a)(25)(F) of the Social Security Act to
allow State Medicaid agencies to cost-avoid claims where the third party
coverage is derived through a noncustodial parent's obligation to provide
medical coverage.
Recommendation 62 (Federal
Legislation)
(See page 6-21)
Congress should amend ERISA §701(f)(2)(A)(iii) to include children enrolled
pursuant to a QMCSO among the categories of dependents who, if certain other
requirements are met, must be given special enrollment rights.
Recommendation 63 (Federal
Legislation)
(See page 6-23)
Provided that Congress makes the following changes to §1908 of the Social
Security Act (42 U.S.C. §1396g-1), Congress should also amend §1908
to state explicitly that the laws it requires States to pass as a condition
of participation in the Medicaid program apply to all children (regardless
of whether they are eligible for assistance under the State Medicaid plan),
and should amend §609 of ERISA to incorporate the requirements of the
amended §1908. The necessary changes are:
Recommendation 65 (Federal
Legislation)
(See page 7-6)
Congress should amend Federal law to provide for 90 percent enhanced Federal
Financial Participation to State IV-D agencies for a five-year period to
facilitate the implementation of the Title IV-D medical support requirements,
contained in §401 of CSPIA 1998, and additional Federal requirements
that result from the Working Group's recommendations. This funding may be
capped.
Recommendation 66 (Federal
Legislation)
(See page 7-8)
Congress should amend Federal law to require that the medical support incentive
measure is developed in conjunction with the implementation of CSPIA 1998
§401 requirements and additional requirements that may be imposed by
law or regulation, based on the recommendations of the Working Group. The
measure should also take into account the findings of the research and
demonstration grants undertaken by States and funded by HHS.
Recommendation 67 (Federal
Legislation)
(See page 7-10)
Congress should amend Federal law to require HHS to publish the medical support
performance incentive measure in final form within three years of the date
the 90 percent FFP goes into effect. Implementation of the medical support
performance incentive measure shall begin upon publication, including the
collection and submission by the States to OCSE of all data necessary to
calculate the measure. The medical support performance incentive measure
shall be included in the calculation of incentive payments due States beginning
2 years after publication. This five-year time period shall run concurrent
with that set forth in Recommendation 65 (Federal Legislation).
Recommendation 72 (Federal
Legislation)
(See page 8-11)
The Administration should convene a national policy and coordination group
that will act through the Federal agencies to provide oversight on health
care programs that affect children. The policy group should establish a mechanism
or process to encourage dialogue and ensure coordination on health care program
issues, especially those impacting children. This process will ensure that
interested groups, such as Child Support Enforcement, providers, and payers,
help in developing and implementing national objectives concerning health
care coverage for children. The group will help ensure that policies, objectives,
guidelines, and regulations are consistent, and that these initiatives are
designed with consideration for their impacts on all affected parties.
Recommendation 75
(Legislative Action)
(See page 8-15)
Amend Tax Code to Extend Exclusion: The exclusion from income for health
care costs under §105 and §106 should be extended to step-parents,
grandparents, and other individuals who accept responsibility for obtaining
or providing health care coverage for children, regardless of whether the
child qualifies as a dependent of that individual under other provisions
of the tax code.
Recommendation 1 (Federal
Regulation)
(See page 3-3)
The HHS should require each State to maximize the enrollment of children
in appropriate health care coverage; the first recourse should be appropriate
private coverage of either parent. ("Appropriate coverage" is defined in
Recommendation 8.)
Recommendation 2 (Federal
Regulation)
(See page 3-4)
Each State's child support guidelines should show how the cost of health
care coverage will be allocated between the parents.
Recommendation 3 (Federal
Regulation)
(See page 3-5)
Each State should develop mechanisms that require both parents to disclose
information about actual and potential private health care coverage in order
to help the decision maker determine whether private coverage is available
to either parent.
Recommendation 4 (Federal
Regulation)
(See page 3-5)
States should use existing automated databases providing information about
private health care coverage available through employers or use insurers'
databases. Such databases need not contain information about the types of
benefits offered, only whether dependent coverage is offered by an employer.
For further details about the development of or modification to such databases,
see Recommendation 64.
Recommendation 8 (Federal
Regulation)
(See page 3-10)
If a child is not enrolled in private coverage, the decision maker shall
determine whether one or both parents are able to obtain appropriate coverage
for the child based on three factors: (1) comprehensiveness of the plan,
(2) access to services, and (3) affordability. Each factor should be assessed
individually and then considered together in accord with Recommendation 13.
If a child has special needs, the decision maker should consider this circumstance in conjunction with the needs of the primary plan member and other dependents (see Recommendation 12).
Coverage is comprehensive if it includes at least medical and hospital coverage; provides for preventive, emergency, acute, and chronic care; and imposes reasonable deductibles and co-payments. In determining which coverage is more comprehensive when both parents have such coverage, the decision maker should consider the following: basic dental coverage, orthodontics, eyeglasses, mental health services, and substance abuse treatment.
Coverage is accessible if the covered children can obtain services from a plan provider with reasonable effort by the custodial parent. When the only health care option available through the noncustodial parent is a plan that limits service coverage to providers within a defined geographic area, the decision maker should determine whether the child lives within the plan's service area. If the child does not live within the plan's service area, the decision maker should determine whether the plan has a reciprocal agreement that permits the child to receive coverage at no greater cost than if the child resided in the plan's service area. The decision maker should also determine if primary care is available within the lesser of 30 minutes or 30 miles of the child's residence. If primary care services are not available within these constraints, the coverage should be deemed inaccessible. In lieu of the 30 miles/30 minutes standard, States may adopt an alternative standard for time and distance, such as the standard that the State uses to administer programs such as Medicaid managed care services or to regulate managed care provider networks.
In determining accessibility, the decision maker should also assess whether one can reasonably expect the coverage to remain effective for at least one year, based on the employment history of the parent who is to provide the coverage.
Reasonable cost should be assessed based on Recommendation 9 through Recommendation 11.
Recommendation 9 (Federal
Regulation)
(See page 3-14)
The Federal regulation that deems all employment-related or group-based coverage
to be reasonable in cost should be replaced with a standard based on the
cost of coverage relative to the income of the parent who provides the coverage.
Except as noted in Recommendation 10 and Recommendation 11, if the cost of
providing private coverage does not exceed five percent of the gross income
of the parent who provides coverage, then the cost should be deemed reasonable.
Recommendation 21 (Federal
Regulation)
(See page 3-32)
The States should give the decision maker authority to order either or both
parents to contribute toward: (1) the cost of any co-payments, deductibles,
or costs associated with the ordered health care coverage; and (2) any uncovered
medical expenses incurred by the child.
Recommendation 22 (Federal
Regulation)
(See page 3-33)
To the extent that unreimbursed costs are not included in the State's basic
child support guideline formula, those costs should be apportioned pro rata
between the parties.
Recommendation 29 (Federal
Regulation)
(See page 4-8)
HHS and DOL should publish the National Medical Support Notice in final form
no later than September 1, 2000 to allow States sufficient time to implement
automated processes by October 1, 2001.
Recommendation 36 (Federal
Regulation)
(See page 4-12)
If some or all of the options under a health care plan are limited to specified
geographic service areas, such as those covered by specific zip codes, then:
Recommendation 37 (Federal
Regulation)
(See page 4-12)
If the plan administrator cannot determine a child's zip code or location
from the Notice because a Substitute Official's address is used, the plan
administrator should be instructed to contact the IV-D agency and provide
sufficient information to permit the agency to decide whether or not the
coverage is accessible as defined in Recommendation 8.
Recommendation 39 (Federal
Regulation)
(See page 4-13)
If an employee is in a waiting period that will expire within 90 days after
the receipt date of the Notice, then the plan administrator should: (1) determine
whether the Notice is a qualified order, and (2) notify the IV-D agency and
the parents of the date on which coverage will begin.
If the waiting period expires more than 90 days after the receipt of the
Notice, or if the duration of the waiting period is determined by some measure
other than the passage of time (for example, the completion of a certain
number of hours worked), then once the plan administrator has determined
that the Notice is a qualified order, the plan administrator would describe
the waiting period on the portion of the Notice returned to the IV-D agency
(Part B), and the employer would notify the plan administrator when the employee
is eligible to enroll in the plan and when a NMSN is in effect with respect
to one or more children of the employee. The plan administrator then notifies
both parents.
Recommendation 45 (Federal
Regulation)
(See page 5-6)
The Secretaries of HHS and DOL should request the Department of Commerce
to review the current provisions of the Consumer Credit Protection Act, which
specifies limits on wage garnishment for family support payments, 15 U.S.C.
§167(b)(2)(A) and (B). The Department should clarify whether the lower
wage garnishment applies only to individuals who have an order to support
a spouse or one or more children outside of their households and are also
supporting a spouse and/or child within their household.
Recommendation 49 (Federal
Regulation)
(See page 5-11)
A Federal policy on the priority of allocation by employers of funds collected
through wage withholding should be promulgated. Employers should first attribute
withheld funds to current cash support (alimony and child support), then
to health care premiums and other current medical support, then to arrears
(cash or medical) and then to other obligations. Decision makers should have
the flexibility under State law to deviate on a case-by-case basis and provide
that health care premiums will be paid first when that is in the best interest
of the child.
Recommendation 52 (Federal
Regulation)
(See page 6-7)
HCFA should issue SCHIP regulations that allow a child to be eligible for
SCHIP if the child is enrolled in a group health plan but does not have
reasonable access to care under that plan.
Recommendation 61 (Federal
Regulation)
(See page 6-21)
The DOL should issue regulation(s) that make it clear that ERISA
§701(f)(1)(C)(ii) (special enrollment for individuals losing other coverage)
permits a child to be specially enrolled in a new plan, after prior coverage
obtained through a Qualified Medical Child Support Order (QMCSO) is terminated,
if the coverage ends during the period covered by the order or at the end
of the period covered by the order. This would permit a child to enroll in
other available coverage provided by either parent, if coverage is terminated
for some reason related to the medical support order.
Recommendation 64 (Federal
Regulation)
(See page 6-24)
The term "family health coverage" should be defined in regulations and guidelines
to include health coverage that provides benefits to dependents, including
a dependent-only policy.
Recommendation 5 (Federal
Guidance)
(See page 3-6)
To further expand the ability of IV-D agencies to obtain information about
actual and potential health care coverage available to both parents, OCSE
should inform these agencies that §466(c)(1)(C) gives the agencies the
authority to request health care benefits information from employers before
they establish a medical support order. In conjunction with this, the DOL
should inform plan administrators subject to ERISA that they must respond
to such IV-D requests when they are made for the purpose of drafting a Qualified
Medical Child Support Order (QMCSO). (See Recommendation 29.)
Recommendation 12 (Federal
Guidance)
(See page 3-16)
The decision maker must consider a child's special medical needs when deciding
which form of private or public coverage is appropriate under Recommendation
8 through Recommendation 11. HHS should identify governmental agencies that
are currently studying issues involving children with special needs and should
coordinate with these agencies in the development of a common definition
of "special needs" children. HHS should provide guidance to State IV-D agencies
on how best to use the decisionmaking matrix set out in Recommendation 13
when a special needs child is involved.
HCFA should require Medicaid agencies to identify whether there is a special needs child in any case they refer to the IV-D program pursuant to the child support cooperation requirement of the Medicaid program.
Recommendation 18 (Federal
Guidance)
(See page 3-26)
Provided that Congress amends the Social Security Act to allow State IV-D
agencies to presumptively enroll children in Medicaid, OCSE and HCFA should
strongly encourage all States to exercise this option or to take other steps
to facilitate Medicaid enrollment, including placing Medicaid or SCHIP staff
in IV-D offices, providing application forms to potentially eligible families,
and arranging eligibility appointments.
Recommendation 25 (Federal
Guidance)
(See page 3-34)
To facilitate implementation of Recommendation 24, the DOL and HHS should
develop model language regarding health care coverage for inclusion in child
support orders. The model language, which would not be mandatory, would alert
attorneys, child support workers, and court personnel to common issues that
should be addressed in such orders.
Recommendation 27 (Federal
Guidance)
(See page 4-4)
DOL and HHS should: (1) make it clear that the Notice is deemed to be a Qualified
Medical Support Order only if issued by IV-D agencies, and (2) explain how
the QMCSO process works for private parties. (See Recommendation 25)
Recommendation 33 (Federal
Guidance)
(See page 4-9)
The DOL should inform employers, insurers, and plan administrators that when
a noncustodial parent carries health care coverage for a child, and the provider
of services or the custodial parent of such child submits the claim, 42 USC
§1396g(a)(5) requires the insurer to pay the person or entity that submits
the claim to the same extent the employee is entitled to be paid.
Recommendation 40 (Best
Practice/Guidance/Technical Assistance/Notice Comments)
(See page 4-14)
Where the court determines that a pattern of misappropriation of insurance
payments exists, the court may, at its discretion, order the insurer to pay
all claims for reimbursement directly to the provider of services. This provision
should be binding on all parties.
Recommendation 26 (Technical
Assistance)
(See page 3-34)
Following adoption of the recommendations of the Medical Child Support Working
group, DOL and HHS should provide training and technical assistance to courts
to facilitate implementation of the recommendations, particularly those relating
to the decision-making matrix and enrolling children in Medicaid and SCHIP.
Recommendation 28 (Technical
Assistance)
(See page 4-5)
The DOL and HHS should collaborate with State IV-D agencies and organizations
representing employers, plan administrators, and payroll agents to develop
automated State IV-D systems that can produce the National Medical Support
Notices and distribute these Notices and their responses to affected parties.
Recommendation 30
(Education/Technical Assistance)
(See page 4-9)
The DOL and HHS should develop strategies to educate and reach out to all
categories of constituents who have a need for, or interest in, the National
Medical Support Notice, including the following categories of constituents:
Recommendation 31 (Education
and Technical Assistance)
(See page 4-9)
DOL and HHS should reach out to courts and administrative authorities to
educate them regarding the Notice and the health coverage data required for
completion.
Recommendation 32
(Education/Technical Assistance)
(See page 4-9)
The DOL and HHS should draft an easy-to-understand booklet similar to HHS's
The Employer's Desk Guide to Child Support and DOL's booklet on Qualified
Domestic Relations Orders (QDRO) under ERISA. The booklet should explain
the National Medical Support Notice and the DOL's views and interpretations
of ERISA's Qualified Medical Child Support Order (QMCSO) provisions.
Recommendation 34 (Technical
Assistance)
(See page 4-10)
The DOL and HHS should develop and make available to States a suggested model
"Notice of Release" that State IV-D agencies may issue to employers when
a noncustodial parent's obligation to provide health care coverage terminates.
Recommendation 40 (Best
Practice/Guidance/Technical Assistance/Notice Comments)
(See page 4-14)
Where the court determines that a pattern of misappropriation of insurance
payments exists, the court may, at its discretion, order the insurer to pay
all claims for reimbursement directly to the provider of services. This provision
should be binding on all parties.
Recommendation 7 (Best
Practice)
(See page 3-9)
DOL and HHS should request the NAIC to encourage insurance providers with
limited coverage areas to enter coordination agreements under which children
who are covered under a geographically inaccessible plan can obtain services
from a plan that is geographically accessible to them. Child support enforcement
should publicize the availability of such plans and encourage States to take
into account the possibility that out-of-area coverage may be available when
assessing whether a particular plan is accessible to the child.
Recommendation 10 (Best
Practice)
(See page 3-15)
No parent whose net income is at or below 133 percent of the Federal poverty
level should be ordered to provide private coverage, unless that parent has
access to private coverage that does not require an employee contribution
to obtain coverage.
Recommendation 11 (Best
Practice)
(See page 3-15)
No parent whose resident child is covered by Medicaid, based on that parent's
income, should be ordered to provide private coverage, unless the parent
has access to private coverage that does not require an employee contribution
to obtain coverage.
Recommendation 14 (Best
Practice)
(See page 3-22)
When neither parent has access to private health care coverage at reasonable
cost but a step-parent does, enrolling the children in the step-parent's
coverage should be considered under certain conditions. These conditions
are: (a) the coverage is accessible to the children; (b) the step-parent
is willing to provide such coverage; and (c) there are no employer/insurer
constraints for enrollment of the child.
When these conditions are met, the parent who is married to the step-parent should be ordered to provide health care coverage for the children. The order should specify that this obligation may be met by enrolling the children in the step-parent's health care coverage. Moreover, the order must make it clear that if the obligated parent and the step-parent later commence proceedings for a separation or divorce, the obligated parent has responsibility for obtaining information about the cost and availability of COBRA coverage for the children and enrolling the children in this coverage. The order should also specify that if COBRA (or other) coverage is not available or affordable, the obligated parent must immediately seek modification of the medical provisions of the child support order. As an alternative, the custodial parent should seek publicly-funded coverage in order to minimize any lapse in coverage for the children.
Recommendation 15 (Best
Practice)
(See page 3-24)
When neither parent can provide comprehensive, accessible, affordable private
health care coverage, the decision maker should explore the possibility of
providing coverage to the child through Medicaid or the SCHIP. If the child
is ineligible for Medicaid or SCHIP, the decision maker should explore whether
there is any available lower-cost, child-only plan, such as Sacramento IV-D
Kids.
Recommendation 19 (Best
Practice, Federal Legislation)
(See page 3-28)
Part A (Best Practice): States should grant authority to the decision maker
to order the noncustodial parent to contribute toward the State cost of providing
coverage under Medicaid and SCHIP. Provided, however, no contribution should
be ordered from any noncustodial parent whose net income (as defined by the
State to determine Medicaid eligibility) is less than 133 percent of poverty.
Part B (Federal Legislation): Congress should amend §467 of the Social Security Act to provide that the amount the noncustodial parent may be ordered to contribute toward the monthly cost of coverage under Medicaid or SCHIP shall be the lesser of: (1) the estimated cost of enrolling the child in Medicaid or SCHIP; (2) five percent of the noncustodial parent's gross income; or (3) the amount indicated by a sliding fee schedule, developed by the State, which takes into account ability to pay and average Medicaid/SCHIP costs for dependent children.
Recommendation 23 (Best
Practice)
(See page 3-33)
Since the extent of unreimbursed costs is unknown at the time an order is
established, each State should develop protocols that permit the court or
administrative agency to reduce such expenses to a judgment based on the
language of the order. These protocols should include time limits for the
parent who has paid the expenses to claim reimbursement and time limits for
the obligated parent to pay these expenses, as well as simple pro se procedures
for making or contesting such claims. The protocols should also include
procedures to enforce collection from the noncustodial parent.
Recommendation 24 (Best
Practice)
(See page 3-34)
State child support guidelines should require that the medical support provisions
of a child support order for private or public health care coverage clearly
explain the obligation of each parent in meeting the child's health care
needs. Although not necessary to be qualified under §609(a) of ERISA,
orders should address, as fully as possible, each of the following issues:
Recommendation 38 (Best
Practice)
(See page 4-12)
In situations in which the IV-D agency is advised that a choice is required
with regard to plan options, the agency should do the following:
Recommendation 40 (Best
Practice/Guidance/Technical Assistance/Notice Comments)
(See page 4-14)
Where the court determines that a pattern of misappropriation of insurance
payments exists, the court may, at its discretion, order the insurer to pay
all claims for reimbursement directly to the provider of services. This provision
should be binding on all parties.
Recommendation 46 (Best
Practice)
(See page 5-7)
The current Federal wage-withholding limits should be maintained, but the
Federal OCSE should advise the States that they can set lower limits, as
long as they are not so low that they make it impossible to order the parent
to provide health care coverage, in addition to child support, when it is
available at reasonable cost.
Recommendation 47 (Best
Practice)
(See page 5-8)
In any case where the amount of the parent's current child support payments
exceeds Federal wage withholding limits, the decision maker should examine
the calculation of the noncustodial parent's disposable income to determine
whether the parent is reducing their disposable income through excessive
withholding or other reductions in gross income that are not contemplated
by the Consumer Credit Protection Act (CCPA).
Recommendation 48 (Best
Practice)
(See page 5-9)
If the cost of providing private health care coverage increases a parent's
child support obligation so that the amount exceeds Federal wage-withholding
limits, the decision maker should have the authority to direct the custodial
parent to apply for the Medicaid or SCHIP. If the child is found eligible,
the decision maker may require the noncustodial parent to contribute toward
the cost of coverage consistent with Recommendation 19.
Recommendation 55 (Best
Practice)
(See page 6-11)
State child support enforcement and SCHIP agencies should establish effective
ways of communicating with each other.
Recommendation 56 (Best
Practice)
(See page 6-12)
In IV-D cases, when coverage is provided through Medicaid or SCHIP and
information provided by the parties or obtained through New Hire Reporting
indicates that private dependent health care coverage may now be available,
it should be determined whether that coverage is appropriate for the child
(as defined in Recommendation 8). If private dependent health care coverage
is available and appropriate, the order should be modified as needed and
a National Medical Support Notice should be sent to the employer and the
child should be enrolled.
Recommendation 68 (Research
and Demonstration)
(See page 7-11)
HHS should study the savings and cost avoidance to the Medicaid program when
IV-D secures and enforces a medical child support order for private insurance
for Medicaid-eligible children. HHS should also study alternate methodologies
to supplement funding for the child support enforcement program based on
such Medicaid program savings and avoided costs. If HHS does not have sufficient
funds to meet the cost of such a study, it should seek an additional
appropriation from Congress.
Recommendation 69 (Research
and Demonstration)
(See page 8-4)
The Federal OCSE should conduct a study of the 11 States that ask employers
to submit health care coverage information as part of their New Hire Reporting
process. The study should analyze the costs and benefits of these efforts
from the point of view of employers and States, consider the privacy issues
raised by such an information exchange, and identify any precautions taken
to protect the privacy of case participants. The results shall be communicated
to the States and to the Congress.
If HHS does not have sufficient resources available to fund these studies and/or demonstration projects, the agency should seek an additional appropriation from Congress.
Recommendation 70 (Research
and Demonstration)
(See page 8-6)
HHS should undertake projects that will examine various aspects of the
intersections of child and medical support enforcement. These projects will
encourage States to implement the Working Group's recommendations and promote
further innovations to expand health care coverage for children. The projects
may be, but should not be limited to, §1115 demonstrations and Child
Support Enforcement State program improvement grants projects. These grants
might examine issues such as:
Recommendation 71 (Research
and Demonstration)
(See page 8-10)
The HHS should seek Congressional appropriation to fund demonstration projects
for a minimum of three to five years to encourage states to adopt public-private
partnership health care models for children who are eligible for IV-D services.
The HHS should provide information to the States regarding how to establish
a public-private model (such as Sacramento IV-D Kids) that is combined with
SCHIP/Medicaid program to make private insurance available for individual
children at a group rate. Model programs will have features such as the
following:
Recommendation 54
(Administrative Action)
(See page 6-10)
The Secretary of HHS should convene a Working Group to develop protocols
for implementing the recommendations concerning the enrollment of IV-D children
in public rather than private health care coverage, particularly in interstate
cases. This group should be comprised of staff from OCSE, HCFA, the Office
of the Secretary, State Child Support, Medicaid, and SCHIP agencies as well
representatives of other appropriate agencies and the courts.
Among the tasks of this Working Group should be: (1) determining the feasibility and advisability of developing and mandating the use of a standard notification system to transmit information between the State courts, child support enforcement agencies, and Medicaid and SCHIP agencies; (2) assessing the feasibility of each State creating a IV-D/Medicaid/SCHIP database to facilitate a standardized system for information exchange; and (3) exploring the possibility of administrative simplification between the IV-D, Medicaid, and SCHIP programs.
Recommendation 73
(Administrative Action)
(See page 8-12)
All Federal and State regulatory agencies should develop mechanisms for reviewing
proposed health care programs and mandates and incorporating programs and
mandates for subsequent periodic review.
Review mechanisms should focus on:
Recommendation 76
(Administrative Action)
(See page 8-16)
The Administration should establish an interagency group to evaluate the
impact of tax and health care policy on the provision of children's health
care coverage. This group, drawn from the Federal Departments of Treasury,
Health and Human Services, and Labor should recommend and help develop tax
laws that support the goal of securing health care coverage for all children.
[ Go to Contents ]
Top of Page
Contents of Report
Home Pages:
HHS Fatherhood Initiative
Assistant Secretary for Planning and Evaluation
(ASPE)
U.S. Department of Health and Human Services
(HHS)
Last updated: 11/21/00