Current through Vol. 42, No. 1, September 16, 2024
(a)
Scope and applicability.
Oklahoma Human Services (OKDHS) Child Support Services (CSS) refers to federal
and state law for establishment of a medical support order, per:
(1) Section 666 of Title 42 of the United
States Code (42 U.S.C.
§
666) and
25 U.S.C. §
1603(12);
(2) Sections 302.33, 302.56, 303.7, 303.30,
and 303.31 of Title 45 of the Code of Federal Regulations (45 C.F.R. §§
302.33,
302.56,
303.7,
303.30 amp; 303.31); and
42 C.F.R. §
433.152; and
(3) Section
6058A of Title 36 of the Oklahoma
Statutes (36 O.S. § 6058A), and 43 O.S. §§ 112, 118-118I, 118.2
and 119, and 56 O.S. § 237.
(b)
Medical support provision of child
support order. A child support order CSS requests the court to establish
must contain a medical support provision.
(c)
Calculating the cost of medical
support. To calculate the actual premium cost of health insurance, CSS:
(1) deducts from the total insurance premium,
the cost of coverage for the parent;
(2) deducts from the total insurance premium,
the cost of coverage for any other adults in the household, when that cost
information is available;
(3)
divides the remainder by the number of dependent children covered;
and
(4) multiplies the amount per
child by the number of children in the child support case under
consideration.
(d)
Standards for medical support provision. When choosing a medical
support provision, CSS requests the court to apply the standards in (1) through
(3) of this subsection.
(1) Health insurance
must be reasonable in cost, meaning that the pro rata share of the actual
out-of-pocket premium cost paid for the child(ren) by the insured does not
exceed five percent of the gross income of the parent ordered to provide health
insurance.
(2) Health insurance
must be accessible, meaning the health care providers must be available to meet
the child(ren)'s individual health care needs, and must be located no more than
60 miles one-way from the primary residence of the child(ren).
(3) Health insurance must provide coverage
for both routine and major medical expenses including, but not limited to:
preventive care, office visits, hospitalization, and medication coverage in
compliance with the Oklahoma Insurance Department, per Oklahoma Administrative
Code (OAC)
365:10-5-3(14)
and OAC 365:10-5-5(f).
Limited Insurance Coverage , per OAC
365:10-5-5(k)
does not satisfy this requirement. Annual deductibles must be reasonable and
relate to the medical circumstances of the child(ren).
(e)
Exceptions to standards for medical
support provision. When the parents agree or it is otherwise
appropriate, CSS requests the court make an exception to the standards for
health coverage when the:
(1) reasonable cost
of health insurance exceeds five percent of the gross income of the parent
ordered to provide health insurance; or
(2) closest insurance provider exceeds 60
miles one-way from the primary residence of the child(ren).
(f)
Selection of health care
coverage. CSS requests the court consider the cost, quality, and
accessibility of health care coverage available to the parties when entering a
medical support order.
(g)
Health coverage preference. When health coverage meeting standards
in (d) of this Section is available to both parents, CSS requests the court
give priority to the preference of the custodial person (CP).
(h)
Applicability of cash medical
support. CSS requests a cash medical order by the obligor, when:
(1) the court determines an order for health
insurance is inappropriate due to family violence concerns;
(2) the only health care plan available for
the child is a governmental medical assistance program or health plan, such as
SoonerCare (Medicaid); or
(3) there
is no health care plan available for the child(ren).
(i)
Cash medical support.
(1) When cash medical support is applicable,
CSS requests the court order the obligor to pay cash medical support, until the
obligor enrolls the child(ren) in accessible insurance coverage and provides
proof of enrollment to CSS and the CP.
(2) CSS refers to the Cash Medical Income
Guidelines Table as found in the child support computation form prescribed by
CSS and published by the Administrative Office of the Courts on the Oklahoma
State Courts Network site, per 43 O.S. § 120 to determine the cash medical
support amount.
(3) CSS computes a
cash medical order by applying the Cash Medical Income Guidelines Table, using
the gross income for the noncustodial (NCP) of the child in the case under
consideration and the number of children in the instant case.
(A) When the NCP's gross income is at or
below the income amount for the number of children in the case, CSS requests
the court order a cash medical order at $0 per month.
(B) When the NCP's gross income exceeds the
income amount for the number of children in the case, CSS computes the
requested cash medical order by:
(i)
multiplying the amount of $115, representing the average monthly cost of health
care for an uninsured child(ren), by the number of children in the case not
covered by insurance; and
(ii)
prorating the result by the percentage of income for each
parent.
(C) The NCP's
share of the cash medical amount is added to the child support
obligation.
(D) CSS does not
request the court set cash medical support against a parent who has at least
182 overnights.
(4)
Unless the parties agree or the court orders a greater amount, the prorated
cash medical support amount must not exceed five percent of the gross income of
the parent who is ordered to pay cash medical support.
(5) CSS seeks cash medical support only as
part of a prospective order for child support. CSS does not include a cash
medical support amount in a judgment for support for a prior period, per OAC
340:25-5-179.1.
(6) In a child support modification action,
CSS requests a cash medical support order be effective the first day of the
month following the entry of the order.
(7) In a multiple case action, when the
monthly child support amount in the combination child support computation form
exceeds 20 percent of the NCP's gross income, CSS may request a deviation to
set cash medical support at $0 per month in the individual computation forms as
applicable.
(j)
Medical support for OKDHS adopted children. CSS does not request
health insurance or cash medical support for children who are adopted through
OKDHS Adoption Services. CSS requests a medical support order reflecting that
the child(ren) receive SoonerCare (Medicaid) through the adoption plan. The
parties may agree to cover the child(ren) on health insurance.
(k)
Termination of cash medical
support.
(1) When CSS receives notice
the parent ordered to pay cash medical support enrolled the child(ren) in
health insurance, CSS sends a Notice of Proposed Termination of Cash Medical
Support to all parties in the case by regular mail. When a party believes the
child(ren) is not covered by accessible health insurance, a party may request a
review of the termination of cash medical support within 10-calendar days from
the date of mailing of the notice.
(2) When a party requests a review to contest
the Notice of Proposed Termination of Cash Medical Support, CSS reviews the
case within 10-calendar days of receipt of the request and determines if
termination of cash medical support is proper based on information the
contesting party provides. CSS notifies the parties of the review
decision.
(3) When the parties
disagree with the review decision, the parties have 15-calendar days from the
date of mailing the review decision to request a hearing on the termination of
cash medical support.
(4) CSS files
a Notice of Termination of Cash Medical Support with the proper court when no
party requests a:
(A) review within the
10-calendar day time period; or
(B)
hearing after CSS notifies them of the review decision.
(5) CSS does not proceed with a separate
termination of cash medical support when the child support and medical support
order is modified within 30-calendar days of notification that the child(ren)
is enrolled in health insurance.
(6) When a cash medical support order is
terminated within a modification action, CSS requests the termination become
effective the date of filing of the Motion to Modify or the date, if later when
the child was actually enrolled in the insurance.
(l)
Reinstatement of cash medical
support.
(1) CSS seeks reinstatement of
the cash medical order when:
(A) a child
support court order previously ordered the NCP to pay cash medical support
until insurance was available;
(B)
insurance became available;
(C) the
cash medical support was terminated; and
(D) the insurance subsequently
lapsed.
(2) CSS uses one
of the processes listed in (A) or (B) of this paragraph to seek reinstatement
of the cash medical order.
(A)
Modification. CSS seeks modification of the child support order
and reinstatement of cash medical support, per OAC
340:25-5-198.1 and OAC
340:25-5-198.2 when:
(i) the child support order that provided for
cash medical support was modified to include credit for insurance premium
costs; or
(ii) there is another
material change of circumstance in addition to the lapse of health
coverage.
(B)
Expedited Process. When (A) of this paragraph does not apply, CSS
uses an expedited process to reinstate the cash medical support. CSS uses the
expedited process when there is an address of record for the obligor.
(3) CSS initiates a reinstatement
of cash medical support when it receives notice the parent whose cash medical
support was terminated due to the enrollment of the child(ren) in health
insurance has allowed the coverage to lapse. CSS sends a Notice of Proposed
Reinstatement of Cash Medical Support to all parties in the case by regular
mail. When a party believes the child(ren) is covered by health insurance, a
party may request a review of the reinstatement within 10-calendar days of the
date the notice was mailed.
(4) A
party may file a written objection to the reinstatement of cash medical support
and submit it to CSS with supporting health care coverage documentation. CSS
reviews the case within 10-calendar days of receipt of the objection and
determines if reinstatement of cash medical support is proper based on the
information the contesting party provides. CSS provides the CP and the NCP with
written notice of the review decision.
(5) When the parties disagree with the review
decision, they have 15-calendar days from the date of the review decision to
request a hearing.
(6) CSS files a
Notice of Reinstatement of Cash Medical Support with the proper court when no
party requests a:
(A) review within the
10-calendar day time period; or
(B)
hearing after CSS notifies them of the review decision.
(m)
Fixed medical
costs. When the parties agree or the court orders, CSS includes the
total monthly fixed medical costs in the child support guidelines computation.
When the obligor's share of fixed medical costs exceeds five percent of the
obligor's gross income and the parties do not agree to exceed the five percent
standard, CSS requests the court determine the monthly amount of fixed medical
costs included in the current child support order.
(n)
Indian Health Services
(IHS).
(1) When a child support order
that provides for the enrollment of a child(ren) in IHS does not meet the
standards in (d) of this Section, CSS seeks an order for either or both parents
to secure another type of health care coverage besides IHS for the minor
child(ren)
(2) CSS does not request
cash medical support when a child(ren) is receiving IHS.
(o)
Notification requirements.
The NCP and the CP must notify CSS in writing within 30-calendar days after:
(1) health insurance becomes
available;
(2) the cost of existing
health insurance changes; or
(3)
other provisions of existing health insurance change.
(p)
Modification request. When a
child support order exists, CSS considers a request to establish a medical
support order as a request for modification of the order, per 43 O.S. §
118.1. CSS seeks a medical support order in a tribunal that has jurisdiction to
modify the child support order.
Reserved at 21 Ok Reg
242, eff 11-7-03 (emergency); Amended and renumbered from 340:25-5-183 at 21 Ok
Reg 1344, eff 7-1-04; Amended at 23 Ok Reg 1842, eff 7-1-06; Amended at 24 Ok
Reg 1301, eff 7-1-07; Amended at 25 Ok Reg 1307, eff 7-1-08; Amended at 26 Ok
Reg 1245, eff 7-1-09; Amended at 26 Ok Reg 3036, eff 7-21-09 (emergency);
Amended at 27 Ok Reg 1201, eff 7-1-10; Amended at 28 Ok Reg 812, eff 7-1-11;
Amended at 29 Ok Reg 765, eff 7-1-12
