REVIEW AND ADJUSTMENT OF A SUPPORT ORDER
CS 451P
Review and Adjustment of a Support Order to Include MEDICAL Support Only
01/92
Revised 09/09/24 Training Completed 09/23/24 Last Reviewed 07/10/25
45
CFR 303.31; Utah Code 26B-9-224,
81-6-101,
102,
202,
208; R527-201
Statutory
Authority
45 CFR 303.31 states:
“(b) The State IV–D agency must:
(1) Petition the court or
administrative authority to -
(i) Include
health care coverage that is accessible to the child(ren), as defined by
the State, and is available to the parent responsible for providing
medical support and can be obtained for the child at reasonable cost, as
defined under paragraph (a)(3) of this section, in new or modified
court or administrative orders for support; and
(ii) Allocate the cost of
coverage between the parents.
(2) If health care coverage
described in paragraph (b)(1) of this section is not available at the
time the order is entered or modified, petition to include cash medical support
in new or modified orders until such time as health care coverage, that is
accessible and reasonable in cost as defined under paragraph
(a)(3) of this section, becomes available. In appropriate cases, as
defined by the State, cash medical support may be sought in addition to
health care coverage.
(3) Establish criteria, which
are reflected in a record, to identify orders that do not address the
health care needs of children based on -
(i) Evidence
that health care coverage may be available to either parent at reasonable cost,
as defined under paragraph (a)(3) of this section; and
(ii) Facts, as defined
by State law, regulation, procedure, or other directive, and review
and adjustment requirements under § 303.8(d) of this part, which are
sufficient to warrant modification of the existing support order to address the
health care needs of children in accordance with paragraph (b)(1) of this
section.”
(4)
Petition the court or administrative authority to modify support orders, in
accordance with State child support guidelines for cases identified in
paragraph (b)(3) of this section to include health care coverage and/or cash
medical support . . . .”
Utah
Code 26B-9-224 states:
“In any action under this part, the office and
the department in their orders shall:
(1) include a provision assigning
responsibility for cash medical support;
(2) include a provision requiring
the purchase and maintenance of appropriate medical, hospital, and dental care
insurance for those children, if:
(a) insurance coverage is or becomes
available at a reasonable cost; and
(b) the insurance coverage is
accessible to the children; and
(3) include a designation of which
health, dental or hospital insurance plan, is primary and which is secondary in
accordance with the provisions of Section 30-3-5.4 which will take effect if at any time the dependent
children are covered by both parents' health, hospital, or dental insurance
plans.”
Utah Code 81-6-202 states:
“(10)
The court shall include the following provisions in a child support order: . .
.
(b)
a provision assigning responsibility for the payment of reasonable and
necessary medical expenses for the child as described in Section 81-6-208;
(c)
a provision requiring the purchase and maintenance of appropriate health care
insurance for the medical expenses of the child as described in Section
81-6-208 if health care insurance is or becomes available at a reasonable cost. . . .”
Utah Code 81-6-208 states:
“(1) As used
in this section, “health insurance” means the same as the term that is defined
in Section 31A-1-301.
(2) Except as
provided in Subsection (4), a child support order issued or modified in this
state on or after May 3, 2023, shall require compliance with the requirements
described in Subsection (3) as of the effective date of the child support
order.
(3) A child
support order shall:
(a) require
the parents provide health care coverage for the medical expenses of a child;
(b) require
the parents provide health insurance for the medical expenses of a child if
health insurance is available to the parents at a reasonable cost;
(c) designate
which health insurance plan is primary and which health insurance plan is
secondary if, at any time, a child is covered by both parents' health insurance
plans as described in Subsection (7);
(d) require
each parent to share equally the out-of-pocket costs of the premium actually
paid by a parent for the child's portion of health insurance; and
(e) include a
provision that requires each parent to equally share all reasonable and
necessary uninsured and unreimbursed medical and dental expenses incurred for a
child, including co-payments, co-insurance, and deductibles.
(4) The court
may deviate from the requirements described in Subsection (3) if:
(a) the court
makes specific findings establishing good cause for the deviation; or
(b) subject
to the court's approval, the parents agree which parent shall provide health
insurance for the child.
(5) In
determining whether to take the action described in Subsection (4), the court
may consider:
(a) the reasonableness
of the cost;
(b) the
availability of a group insurance policy;
(c) the
coverage of the policy; or
(d) the
preference of the custodial parent.
(6) Subject to Subsection (4), if a child support order does not
contain the requirements described in Subsection (3):
(a) the parents are nonetheless subject to the requirements
described in Subsection (3), as applicable;
and
(b)
for purposes of Subsection (3)(c), the health insurance plan of the parent
whose birthday falls first in the calendar year is primary, and the health
insurance plan of the parent whose birthday falls second in the calendar year
is secondary.” (Emphasis added).
Use the following criteria to determine whether it is
appropriate to modify an order to include a medical support provision.
NOTE
2: A determination of safeguarding or
nondisclosure, or the existence of a protective order is not grounds for not proceeding
to establish a medical support order.
1.
No medical provision in the judicial support order, but either the
noncustodial parent (NCP) or the custodial parent (CP) currently has insurance
coverage on the children.
a.
If the order is a Utah order that was issued or modified prior to May 3, 2023, you must proceed
to obtain a medical support provision in the order.
This means that for Utah child support orders issued or modified on or
after May 3, 2023 that do not include a medical support provision, a
modification of the order to include a medical support provision is NOT
necessary. The insurance plan of the
parent whose birthday falls first in the calendar year will be the primary plan
and the other parent’s plan will be the secondary plan, as appropriate.
If both parents were
born in the same month, then the parent, whose birthday occurs first in the
month, is designated as the primary coverage for the child. If both parents were born on the same day,
then the parent whose birth year is first is designated as primary coverage for
the child. If both parents were born in
the same year, then the parent whose insurance plan was in effect first is
designated as primary coverage for the child.
NOTE: It is important to be aware that there still may
be instances where it will be appropriate to modify Utah orders issued on or
after May 3, 2023. If you are unsure whether or not it is appropriate to modify
a Utah order issued or modified on or after May 3, 2023 to include a medical
support provision, consult with your assigned Assistant Attorney General (AAG)
for assistance.
2.
No medical support provision in the support order, the children are
currently NOT covered by insurance, and insurance MAY be available to the
NCP. Proceed as follows:
a.
Contact the NCP or his/her employer by phone or letter to determine if
insurance is available to the NCP through his/her employer.
b.
If insurance is unavailable to the NCP, but s/he informs you that insurance
is available to the CP, contact the CP or his/her employer to determine if
insurance is available.
3.
There is a medical support provision in an administrative order that was
issued prior to May 3, 2023, but it does not specifically include dental
coverage, and the NCP’s and/or CP’s employer is challenging a National Medical
Support Notice on the grounds that the order does not specify that dental
coverage should be provided. Only
enforce the medical provision and modify the order to include the current
medical provision. Any claims for dental
expenses prior to the effective date of the modified order must be addressed
judicially by the participants through private counsel. A new INEB may be sent to the employer after
the order has been modified. For more
information, refer to CS 490P Enforcement of Medical Insurance. Judicial orders issued by CSS are not
affected.
NOTE:
Utah orders issued or modified on or after May 3, 2023 will not need to
be modified to include the current medical support provision as these orders
include the current medical support provision by operation of law.
4.
There is a medical support provision in the Utah order issued prior to May
3, 2023, but the parent ordered to provide medical insurance is currently on
Medicaid with the child(ren). This criteria is in accordance with Federal regulations
found at 45 CFR 303.31(b), which states:
“(1) Petition
the court or administrative authority to -
(i) Include health care coverage that is accessible to
the child(ren), as defined by the State, and is available to the parent
responsible for providing medical support and can be obtained for the child at
reasonable cost, as defined under paragraph (a)(3) of this section,
in new or modified court or administrative orders for support . . . .”
R527-201-2 states:
“(1) “Accessible" is whether the health care
coverage provided by a parent is reasonably available for the child's use. Insurance is considered accessible to the
child if non-emergency services covered by the health insurance plan are
available to the child within 90 minutes or 90 miles of the child's primary
residence.”
Write a case narrative every time
you evaluate a case for possible adjustment to include a medical support
provision and record the results of the evaluation in the case narrative.
Criteria Exceptions
Do NOT proceed to modify a support order to include a
medical support provision if the case meets the criteria listed below.
1.
The Utah order was issued or modified on
or after May 3, 2023 and is silent regarding health care coverage. These orders
include the current medical support provision by operation of law.
2.
The Utah order was issued or modified
prior to May 3, 2023 and:
a.
The last child on the case will emancipate
within 12 months of the date the case would be referred to the AGO to pursue judicial action; or,
b.
No medical support provision in the
support order, the children are currently NOT covered by insurance and
employment related insurance is not available to the children. For cases to fall into this category you must
have verified, at a minimum, that insurance is unavailable to both the NCP and
the CP by contacting his/her employer.
i.
If the order is a Utah order that was issued or modified prior to May 3,
2023, you do not need to pursue obtaining a medical support provision until
coverage becomes available to the children.
ii.
If the order is a Utah order that was issued or modified on or after May 3,
2023, a medical support provision is already included in the order by operation
of law and you do not need to pursue the modification of the order to include a
medical support provision. Refer to CS 484P Gather and Disseminate Medical
Insurance Information.
c.
If the NCP has entered a court ordered
in-patient licensed mental health or substance abuse treatment program, do not
attempt to review or adjust the support order to include medical support;
however, if the NCP is participating in an out-patient treatment program, or
once s/he is released as an in-patient, you may proceed to review an order to
include medical. See CS 707P Special
Circumstances: Individuals Participating
in Mental Health or Substance Abuse Treatment Programs for more information; or
d.
A tribal support order does not mention
medical support and either the CP or the NCP reside on the reservation. See CS 210P
Native American Noncustodial Parents for additional information.
NOTE
2: If you are not sure if the child
support order contains an “acceptable” medical support provision, refer to CS
482P Securing a Medical Insurance Provision in the Support Order. If you are still unsure, contact the Attorney
General’s Office (AGO) for assistance.
Pre-request
Procedures
When you
receive a written request for a medical only review or when the criteria listed
above for a medical only review are met, follow the review and adjustment
procedures in CS 450P-1 Initiating a Review and Pre-request Procedures.
Review
Procedures
When you
receive the alert, you have 160 days to complete a review and adjustment, if
necessary. Follow the steps below to
complete the review.
1.
If the
non-requesting parent has failed to return the required documents, attempt to
obtain the best available information regarding the non-requesting parent’s insurance.
2.
Update ORSIS
with the results of the review.
After you update the review and code ORSIS appropriately for
judicial orders, follow the steps below to make a referral to the AGO.
3.
Check
resources for any judicial action that may be pending or has been completed and
has not been imaged into Content Manager.
Narrate the results of the search.
4.
Code ORSIS
appropriately.
NOTE: If either parent contacts you and
asks, “Do I need to respond to the Summons if I agree with the pleadings?” Since the case has been referred to the AGO,
inform the parent that any inquiries about the court action need to go to the
AGO.
5.
Prepare the
referral packet.
6.
Refer the
referral packet to the AGO.
7.
When the AGO
is done with the modification, they will document the results and return the
case to you.
8.
If the AGO
declines to proceed with the modification, verify that policy was followed. If
procedures in policy were followed, complete the steps listed below. If not,
consult with your management chain for further discussion.
a. If consensus is reached that the case will not be pursued, the agent sends the “Review and Adjust: Review Request/Modification Denied” letter denying the modification.
9.
If the order
was modified, complete the following steps:
a.
Verify the medical support order contains the following:
i.
A cash medical support provision pursuant to Utah Code 81-6-208,
which states:
“(3) A child support order shall:
. . .
(e) include a provision that requires
each parent to equally share all reasonable and necessary uninsured and
unreimbursed medical and dental expenses incurred for a child, including
co-payments, co-insurance, and deductibles.”; and,
i.
A designation of which health insurance plan
is primary and which health insurance plan is secondary pursuant to Utah Code
81-6-208, which states:
“(3)
A child support order shall: . . .
(c)
designate which health insurance plan is primary and which health insurance
plan is secondary if, at any time, a child is covered by both parents’ health
insurance plans as described in Subsection (7). . . .”
The insurance must be accessible to the child(ren) pursuant to
R527-201-2, which states:
“(1) “Accessible" is whether the health care coverage
provided by a parent is reasonably available for the child's use. Insurance is
considered accessible to the child if non-emergency services covered by the
health plan are available to the child within 90 minutes or 90 miles of the
child's primary residence.”
b.
Update ORSIS
appropriately.
10.
Write a case
narrative any time you take an action during the review process.
If the CP in
a IV-A case refuses to stipulate to a medical support
order, refer the case to the AGO to initiate legal action. If the applicant in a Non-IV-A case refuses
to cooperate, follow closure procedures.
If the NCP
refuses to cooperate in obtaining a medical support order, refer the case to
the AGO.
Intergovernmental Cases, Other State Orders
On incoming interstate cases, if insurance is available you must proceed to establish a medical support provision if one does not exist. Federal Regulations requires us to provide the same services to interstate and intrastate cases when establishing and/or enforcing a medical support provision.
International Cases
If the foreign country fails to recognize the
intergovernmental referral or provide enforcement services, and you have
something documented in writing from the country, you may close the case,
provided that the NCP does not work for the federal government or for a company
that has its headquarters in the United States, and you have determined that
the NCP has no reachable domestic income or assets. For more information on case closure, refer
to CS 061P Case Closure Overview.