Child Support and Healthcare Expenses

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 How Do Courts Deal with Healthcare Expenses and Child Support?

Paying for healthcare is a major issue for the majority of Americans and planning in a divorce how the parents are going to provide and pay for health care for their children is of critical importance. In fact, getting divorced can enhance a child’s need for medical care, especially mental health treatment. This makes the issue even more worthy of attention.

Of course, parents have a legal obligation to provide their child with health care. Failure to do so can amount to child neglect.

Different states have different laws regarding child support, e.g. whether one parent must pay child support to the other and how much they must pay. Child support can be temporary support that is paid while the divorce action is pending in court. After a divorce is final, it is permanent in most cases until the child reaches the age of 18 or there is a change in circumstances that justifies ending child support.

State courts must address the issue of health care expenses as part of any order regarding the payment of child support. This may involve a number of questions. The major issues would be who will pay for a child’s health care and who will provide care when a child needs it.

Federal law requires that every child support order made in the U.S. include support for medical care. That support can take the following forms:

  • Private health insurance that a parent has through their employment;
  • Health insurance that a person purchases in the marketplace,
  • Health care coverage from government-sponsored Medicaid or the Children’s Health Insurance Program (CHIP),
  • Private payment by the parents themselves of health care costs.

In most child support orders, two or more forms of support might be addressed.

How Do I Navigate Medical Care During a Custody Dispute?

First of all, it is important to recognize that there are 2 kinds of child custody, physical and legal. Physical custody is where a child lives, whether full-time with one parent in a sole or primary custody situation or for periods of time with each in a shared or joint-custody arrangement.

Legal custody is the authority to make decisions regarding the care of the child, e.g. where they go to school, the religion, if any, in which they are to be raised and how their need for medical care is addressed. Legal custody can also be sole, where one parent has full authority, or shared or joint, in which both parents have input and they collaborate on decisions.

It might help parents to remember that providing their child with medical care is an issue they deal with every day. When a couple gets divorced, their arrangement simply needs to adapt to the new living arrangements the parents and child may have. It might help to treat it as a simple practical matter. Courts regard it in this manner. A child needs medical care; their parents have to provide it, and an arrangement has to be made using the available options.

Of course, both parents share the obligation to provide medical care to their children and to help pay for it to the extent that they can.

Paying for the care may be the most critical part of the issue. The way it works for most Americans today is that a child is covered by health insurance. The manner in which the premiums for health insurance are to be paid is included in every child support calculation.

The obligation to provide health insurance is either covered by an agreement that the parents make themselves or by a decision of the court. Either way, the plan for health insurance must be in the final court order on the subject per federal law.

Of course, there may be costs and co-pays that insurance does not cover and a court must address this issue as well in an order regarding child support.

If either parent has the ability to provide health insurance through his or her employment at a reasonable cost, the court will most likely order that parent to enroll the child in their health insurance or keep them enrolled if they already are. If the parent required to provide health insurance does not have primary custody of the child, then the court can order arrangements that are necessary to ensure coverage for the child.

If a parent pays out-of-pocket for an insurance policy, the court may give them an allowance for this as part of an award of child support. The cost of health insurance factors into the amount of a final child support award.

Who Pays the Cost of Medical Care That Is Not Covered by Insurance?

Parents must pay for the cost of medical care that is not covered by insurance. These would include copays, and deductibles. If neither parent can supply prescription insurance, dental insurance or vision insurance, then the costs of those types of care would also have to be paid by the parents themselves.

Most child support orders would include direction as to which parent must pay what percentage of uninsured and unreimbursed medical expenses.

If a person’s child support order does not address these issues fully, they may want to seek a change in their existing order.

Do I Have to Communicate with My Ex about Our Child’s Medical Care?

It is important for both parents to communicate with each other and with health care providers when necessary. If parents do have effective communication regarding these issues, they may want to seek some professional guidance for improving their communication. That is because effective communication is necessary for ensuring quality care for their child.

While one parent may have sole legal custody of the child and full authority to make decisions regarding health care, the other parent probably has visitation. In any event, clearly both parents need to be up-to-speed on the health status of the child, who their primary care physician is and their medical needs, e.g. whether they take medication regularly and if so how much and on what schedule.

Everybody has to be on the same page and know how to contact the doctor, when to do so and what the child’s medical history is in the event that information is needed in an emergency. This requires planning and the effective sharing of information by the parents.

Do Both Parents Have a Right to Access a Child’s Medical Records?

Both parents have a right to access their child’s medical records unless a court finds good cause to deny a parent access. This would be unusual, and a court would probably do it only in a case of child abuse.

Of course, nowadays, most people do not keep their medical records at home. They are maintained by doctors’ offices, hospitals and insurance companies. The main obligation of the parents would be to recognize and allow each parent’s right to access the records, if they should want to do that.

The situation may be different with respect to medical care that is not covered by insurance but must be paid by the parties. Courts usually offer various procedures for payment:

  • The noncustodial parent pays their share directly to the custodial parent who then uses the funds to pay the expense;
  • The noncustodial parent can pay the health care provider directly;
  • The noncustodial parent pays a health care provider or child support agency directly.

In any event, a parent who is paid by the other parent for the other’s share of medical expenses would want to take certain measures with respect to records of treatment in case they have an issue collecting unreimbursed or uninsured medical expenses:

  • Keep all bills related to health care provided to their child;
  • Keep all explanations of benefits statements received from the insurance company and make a record of the date of the document and the identity of the doctor who provided services;
  • Keep records of payments made, including receipts, bank statements, checks, and any other document that relates to the payment for medical care;
  • Make copies of records for oneself and for the other parent;
  • If informal requests for payment are not successful, a parent wants to request payment in writing with copies of related documents. Be business-like and give the other parent a reasonable amount of time in which to pay;
  • Be sure to comply with procedures stated in the child support order.

How Do I Create a Health Care Plan for Shared Custody?

If a person is in the process of getting divorced and is represented by an experienced family law lawyer, their lawyer can offer guidance on how to prepare a plan.

If the parents plan to share custody, then hopefully they would be able to negotiate and collaborate on drafting a complete plan that a court could approve.

If this is not possible, then a plan might still be negotiated, although it might take longer and be more challenging. In the event that the parties cannot agree on a plan, the issue would be left with the court. The court would hold a hearing or hearings on the issue and then provide a plan in the final divorce decree.

What If My Child Support Order Does Not Address Some Kinds of Healthcare Expense?

Again, the options are for the parties, either themselves or through their respective lawyers, to negotiate an agreement of the issue. If that is not possible, then one spouse would return to court to seek modification of their child support order.

States do have guidelines reading medical expenses and child support. Some of the options for dealing with expenses not covered by some form of insurance are as follows:

  • Parents share the costs, splitting them on the basis of their monthly income;
  • Parents share the cost when the amount is greater than a certain percentage of the original child support payment;
  • The noncustodial parent pays after the custodial parent pays a specific dollar amount or percentage.

Some states treat non-recurring and recurring health care costs differently. These states require parents to share the cost of unpredictable, non-recurring costs only. They would share the cost based on their relative incomes.

One parent might argue that a certain medical service was not necessary and refuse to pay. A court might consider the reasonableness of the medical service to determine whether the parents should split the payment. However parents would want to question whether they should endure the expense, time and stress of going to court as opposed to just paying a share of a medical bill.

A parent might only go to court if there is an issue of an ex-spouse who incurs uninsured medical expenses repeatedly. Or, one parent might make use of unlicensed practitioners of alternative treatments that are not covered by insurance and seek payment from the other spouse. If the issue cannot be resolved between the spouses, again they might have to go to court.

Do I Need the Help of a Lawyer for My Child Support and Healthcare Expenses?

As can be seen from the above, figuring out childcare in the context of custody and child support situations might become complicated. Some people might feel competent to manage the issue themselves and collaborate with their spouse to come up with a plan they both agree on.

Other people may find the issue daunting or they may have a spouse who is not cooperative. In these cases, a family law lawyer can help. can connect you to a lawyer who understands both federal and state requirements and can guide you through the process of devising a plan for providing medical care for your child and paying for it that works for you, your child and your ex.

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