As you may be aware, Ohio child support law was recently updated for the first time in 25 years. These changes were overdue and necessary, but because they are significant, they are likely to be confusing to those who have to deal with them. One of the major changes has to do with ordinary and extraordinary health care expenses and medical support.
“Cash Medical Support” Before and After the Change in the Law
H.B. 366, the act that overhauled Ohio child support, has changed the nature of “cash medical support.” Prior to the changes in the law, “cash medical support” was one of two things: an alternative to private health insurance coverage, if insurance coverage was unavailable for the children; or a specified amount a parent was ordered to pay to defray the cost of either Medicaid or health insurance for the children. Cash medical support also encompassed funds to be paid for medical expenses that insurance did not cover.
Under the updated law, cash medical support is defined as the amount that is ordered to be paid toward ordinary medical expenses (which includes co-pays, deductibles, and uninsured medical expenses) in a child support order. The act also repeals the provisions in the law relating to administration of payments for cash medical support in cases where private health insurance was not provided.
The act requires every child support order to include a cash medical support amount. Previously, only obligors whose income was 150% of the federal poverty level for an individual were required to pay cash medical support. The new obligation for cash medical support includes an amount for every child who is subject to the child support order.
How is the amount of cash medical support determined? The amount is calculated by multiplying the total paid for health services for children by the portion of that expense that is out-of-pocket, and divided by the number of minor children who have private health insurance. The Ohio Department of Job and Family Services (ODJFS) is required to update cash medical support amounts periodically, taking into account the Medical Expenditure Panel Survey conducted by the United States Department of Health and Human Services (HHS).
In Ohio, cash medical support is paid by the child support obligor through ODJFS (CSEA in most counties) to the obligee parent, so long as the children subject to the order do not receive Medicaid. If the children are Medicaid recipients, payments are made through ODJFS to the Department of Medicaid. Prior to the update in the law, there was no express requirement that payments of cash medical support be made through ODJFS.
How the New Law Treats Ordinary and Extraordinary Health Care Expenses
What was previously known as a “separate order for extraordinary medical or dental expenses” is now referred to as a “separate medical support order.” A separate medical support order covers all healthcare needs, including dental, optical, and psychological services as well as orthodontia.
Significantly, the definition of what is considered an “extraordinary” medical expense has changed under the law. Previously, a medical expense crossed a threshold from “ordinary” to “extraordinary” when uninsured medical expenses for a child during a calendar year were greater than $100. Under the updated law, the threshold between “ordinary” and “extraordinary” expenses is crossed when a child’s medical expenses exceed the cash medical support owed for that child during that year.
The act also requires that all child support orders contain a requirement that either the child support obligor, obligee, or both, are responsible for paying extraordinary medical expenses for the children subject to the order. The amount of each person’s obligation for extraordinary medical expenses is determined by a formula established under the courts, if child support was ordered by a court. If child support was established by an administrative order, the child support enforcement agency (CSEA) establishes the formula.
The obligation towards a child’s extraordinary healthcare expenses is expressed in an order by percentages of responsibility for each parent to be paid or reimbursed after the total cash medical amount has been met. Before that threshold is met, the person receiving child support, the obligee, bears responsibility for payment of all the healthcare expenses because he/she is receiving cash medical along with child support.
To the extent that one party is ordered to reimburse the other for healthcare expenses, the new law has modified the guidelines for this as well. The child support order still requires contact information for the person to be reimbursed for the expenses, but this information no longer needs to contain a telephone number. The law also simplifies the language that must be included in the required statement in the order.
If you have questions about ordinary and extraordinary health care expenses as they relate to Ohio child support, or questions about the changes in Ohio child support law in general, we invite you to contact our law office to schedule a consultation.