MEDICAL SUPPORT

CS 482P Securing a Medical Insurance Provision in the Support Order

01/90 Revised 09/01/25 Training Completed 09/15/25 Last Reviewed 10/01/25

45 CFR 303.31; 42 U.S. Code 652(f); Utah Code 26B-9-201, 206, 224, 63G-4-102, 31A-1-301, 81-4-406, 81-6-101, 202, 208; Utah Admin. Code R527-201

Statutory Authority

Legal authority found at 45 CFR 303.31(b)(1-4), 42 U.S. Code 652(f), Utah Code 81-4-406 and 81-6-101, 202, and 208, and Utah Admin. Code R527-201 require the Office of Recovery Services/Child Support Services (ORS/CSS) to:

1. Petition the court or administrative authority to include a medical support provision in the order if the custodial parent (CP) does not have satisfactory medical insurance for the child(ren).

1. 45 CFR 303.31:

“(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 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.”

2. 42 U.S. Code 652(f):

“The Secretary shall issue regulations to require that State agencies administering the child support enforcement program under this part enforce medical support included as part of a child support order whenever health care coverage is available to the noncustodial parent at a reasonable cost. A State agency administering the program under this part may enforce medical support against a custodial parent if health care coverage is available to the custodial parent at a reasonable cost, notwithstanding any other provision of this part. Such regulation shall also provide for improved information exchange between such State agencies and the State agencies administering the State medicaid programs under subchapter XIX of this chapter with respect to the availability of health insurance coverage. For purposes of this part, the term ‘medical support’ may include health care coverage, such as coverage under a health insurance plan (including payment of costs of premiums, co-payments, and deductibles) and payment for medical expenses incurred on behalf of a child. ”

3. Utah Code 81-4-406:

“(3) In a divorce decree, the court shall: . . .

(e) if the parties have a child as defined in Section 81-6-101, include:

(i) an order for child support and medical expenses as described in Chapter 6, Child Support;

(ii) a provision in the child support order that requires payment of an ongoing expense for child care subject to the procedures and requirements of Section 81-6-209.5; and

(iii) a statement providing notice that the Office of Recovery Services provides services to individuals who are seeking assistance in the collection or enforcement of child support orders.

(4) The court may include in the divorce decree any equitable orders relating to:

(a) the parties. . .;

(b) a child of the parties; and

4. Utah Code 31A-1-301:

“(84) (a) ‘Health care insurance’ or ‘health insurance’ means insurance providing:

(i) a health care benefit; or

(ii) payment of an incurred health care expense.”

5. Utah Code 81-6-208:

“(1) As used in this section, "health insurance" means the same as that term 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;

(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.

(7) (a) The provisions of an order under Subsection (3)(c) shall:

(i) take effect if at any time a child is covered by both parents' health insurance plans; and

(ii) include the following language: ‘If, at any point in time, a child is covered by the health insurance plans of both parents, the health insurance plan of (Parent’s Name) shall be primary coverage for the child and the health insurance plan of (Other Parent’s Name) shall be secondary coverage for the child. If a parent remarries and the child is not covered by that parent’s health insurance plan but is covered by a step-parent’s plan, the health insurance plan of the step-parent shall b e treated as if it is the plan of the remarried parent and shall retain the same designation as the primary or secondary plan of the child.’” (Emphasis added.)

For Utah orders issued or modified on or after May 3, 2023, a medical support provision is included in the order by operation of law. Refer to CS 451P Review and Adjustment of a Support Order to Include MEDICAL Support Only for more information.

f. Utah Admin. Code R527-201-5:

“(1) A notice to potentially obligated parents shall include a provision that an administrative or judicial proceeding will occur to:
(a) order either or both parents to purchase and maintain appropriate health care coverage; and
(b) order either or both parents to pay cash medical support.
(2) The notice shall be provided when the state either:
(a) initiates an action to establish a final support order or to adjust an existing child support order; or
(b) joins a divorce or modification action initiated by either the custodial or the noncustodial parent.”; and,

2. Develop criteria to pursue modification of a support order and include a medical insurance provision in child support cases with existing orders which:

a. Do not include health insurance coverage for the dependent child(ren); and,

b. Have a high potential for obtaining medical support.

45 CFR 303.31(b) states:

“(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 in accordance with paragraphs (b)(1) and (2) of this section.”

Definitions

1. Health Care Coverage – As defined by Utah Code 81-6-101:

“(14) ‘Health care coverage’ means coverage under which medical services are provided to a child through:

(a) fee for service;

(b) a health maintenance organization;

(d) any other type of private health insurance; or

(e) public health care coverage.”

2. Accessibility – As defined by Utah Admin. Code R527-201-2:

“(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.”

3. Both Ordered to Provide Insurance – Both the father and the mother are ordered to provide medical support.

4. Cash Medical Support – As defined by Utah Code 26B-9-201:

“(5) . . . means an obligation to equally share all reasonable and necessary medical and dental expenses of children.”

5. Either/Or Ordered to Provide Insurance – Either the mother or the father is ordered to provide medical support.

6. Father Ordered to Provide Insurance – The father of the child(ren) is ordered to provide medical support.

7. Medical Insurance Not an Issue – Medical insurance is not applicable; e.g., the only debt CSS is enforcing is based on a sum certain judgment, which typically does not address medical support.

8. Mother Ordered to Provide Insurance – The mother of the child(ren) is ordered to provide medical support.

9. None Ordered to Provide Insurance – The order does not have a medical support provision.

10. Other Ordered to Provide Insurance – Someone other than the mother or father is ordered to provide medical support, e.g., legal guardian.

11. Temporary Order – The order is temporary in nature and will be replaced with a final order; e.g., an order establishing parentage only should be replaced with a final order, which will include both child and medical support.

12. Public Insurance Ordered – The order includes language indicating public health insurance may be considered as health care coverage for purposes of medical support enforcement.

13. Public Insurance Allowed – The order includes language indicating the person or persons allowed to use public health care coverage, where applicable.

NOTE 1: Per changes in Federal rule and State statute, effective July 1, 2018, all new or modified child support orders issued in Utah will recognize public health care coverage (e.g., Medicaid) as included in the definition of “health care coverage” for purposes of medical support enforcement.

NOTE 2: If an order requires either parent to provide health care coverage, ORSIS will send National Medical Support Notice to an NCP’s employer even if the CP is providing public health care coverage (i.e., Medicaid) for the child(ren), if all other criteria are met.

Medical Support Orders

Utah law found at Utah Code 26B-9-224, 81-6-202, and 81-6-208 require all administrative and judicial child support orders which order current support to include the following:

1. A provision requiring a parent to purchase and maintain health insurance for the child(ren), if it is available at a reasonable cost.

a. Utah Code 31A-1-301:

“(84) (a) ‘Health care insurance’ or ‘health insurance’ means insurance providing:

(i) a health care benefit; or

(ii) payment of an incurred health care expense.”

b. Utah Code 26B-9-224:

“(1) As used in this section, ‘health insurance’ means the same as that term is defined in Section 31A-1-301.

(2) In any action under this part, the office and the department in their orders shall include: . . .

(b) a provision requiring the purchase and maintenance of appropriate health insurance for the child, if:

(i) insurance coverage is or becomes available at a reasonable cost; and

(ii) the insurance coverage is accessible to the child. . . .”

c. Utah Code 81-6-202:

“(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. . . .”

d. Utah Code 81-6-208:

“(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. . . .”

NOTE: Pursuant to Utah Code 81-6-208, Utah orders issued or modified on or after May 3, 2023 include a medical support provision in the order by operation of law, even if language constituting a medical support provision is absent from the order. Refer to CS 451P Review and Adjustment of a Support Order to Include MEDICAL Support for more information.

2. That there is uniform language related to the coordination of health insurance benefits when a dependent child of the marriage is covered by both parent’s health insurance policies. Per Utah Code 81-6-208 provides:

“(3) A child support order shall:. . .

(6). . .(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.

(7)(a) The provisions of an order under Subsection (3)(c) shall:

(i) take effect if at any time a child is covered by both parents' health insurance plans; and

ii) include the following language: ‘If, at any point in time, a child is covered by the health insurance plans of both parents, the health insurance plan of (Parent's Name) shall be primary coverage for the child and the health insurance plan of (Other Parent's Name) shall be secondary coverage for the child. If a parent remarries and the child is not covered by that parent's health insurance plan but is covered by a step-parent's plan, the health insurance plan of the step-parent shall be treated as if it is the plan of the remarried parent and shall retain the same designation as the primary or secondary plan of the child.’

(b) A court or administrative agency may not modify the language required by Subsection (7)(a)(ii).

(c) Notwithstanding Subsection (7)(b), the court may allocate the payment of medical expenses including co-payments, deductibles, and co-insurance not covered by health insurance between the parents.

(d) In designating primary coverage pursuant to Subsection (3)(c), the court may take into account:

(i) the birth dates of the parents;

(ii) a requirement in a court order, if any, for one of the parents to maintain health insurance coverage for a child;

(iii) the parent with physical custody of the child; or

(iv) any other factor the court considers relevant.”

NOTE 1: Please be aware that the court has discretion to allocate the payment of medical expenses based upon certain factors detailed in the statute above. If you have questions about which parent should cover health insurance expenses, consult with the assigned Assistant Attorney General (AAG) before proceeding.

NOTE 2: If, at any point in time, a child is covered by the health insurance plans of both parents, the health insurance plan of the parent whose birthday occurs first in the calendar year, shall be designated as primary coverage for the child. The health insurance plan of the other parent shall be designated as secondary coverage for the child. If this primary/secondary designation is specifically contested during an administrative establishment process, refer the case for judicial establishment.

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 day in the same year, then the parent whose health insurance plan was in effect first is designated as primary coverage for the child.

3. That both parents are to share equally all reasonable and necessary uninsured medical and dental expenses, including deductibles and co-payments, incurred for the dependent children.

1. Utah Code 81-4-406:

“(4) The court may include in the divorce decree any equitable orders relating to: . . .

(b) a child of the parties; and

2. Utah Code 81-6-208(3):

“(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. That both parents are to share equally the out-of-pocket cost of the premium actually paid for the child(ren)’s portion of insurance by the parent ordered to maintain the insurance. The child(ren)’s portion is a per capita share of the actual paid premium. To determine the child(ren)’s portion, divide the premium amount by the number of persons covered under the policy and multiply that number by the number of children in the case to be covered. See CS 407P Health Insurance and Medical Expenses. Per Utah Code 81-6-208:

“(3) A child support order shall: . . .

(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. . . .”

Insurance Language Examples

Sometimes, it may be difficult to determine if the child support order has an appropriate medical support provision. Below are examples of possible insurance language.

1. Acceptable medical support order:

a. “The father and the mother shall be responsible for maintaining insurance for the dependent child(ren) if it is available to either parent at a reasonable cost.”

b. “The respondent (NCP) shall provide insurance for the minor child if it is available at a reasonable cost.”

c. “The petitioner (CP) shall provide insurance for the minor child if it is available at a reasonable cost.”

NOTE: Regarding b and c: If the ordered party is not carrying insurance but the other party is, there is still a valid medical insurance provision and it does not need to be modified.

2. Unacceptable medical support order for orders issued or modified prior to May 3, 2023:

a. Neither party is ordered to carry insurance, but the order reads: “Petitioner (CP) and Respondent (NCP) are ordered to share the out of pocket expense of insurance.”

b. The order is silent regarding medical insurance.

If there is a Utah order issued or modified prior to May 3, 2023, and it falls within the examples given, ORS must establish an order for the appropriate medical language.For Utah orders issued or modified on or after May 3, 2023, a medical support provision is included in the order by operation of law, even if language constituting a medical support provision is absent from the order. If you are unsure of whether or not there is a valid order for insurance, consult with the assigned AAG.

Establishing a Medical Support Order

Establish Medical Support Order: State law found at Utah Code 26B-9-206 provides specific authority for CSS to use the administrative process, known as the Utah Administrative Procedures Act (UAPA). Utah Code 81-6-202 and 208 (see subsection Medical Support Orders above) also provide a basis to establish child support orders which include a medical support order.

Utah Code 26B-9-206 states:

“(1) Through an adjudicative proceeding the office may issue or modify an administrative order that:

(a) determines parentage;

(b) determines whether an obligor owes support;

(c) determines temporary orders of child support upon clear and convincing evidence of parentage in the form of genetic test results or other evidence;

(d) requires an obligor to pay a specific or determinable amount of present and future support;

(e) determines the amount of past-due support;

(f) orders an obligor who owes past-due support and is obligated to support a child receiving public assistance to participate in appropriate work activities if the obligor is unemployed and is not otherwise incapacitated;

(g) requires an obligor to pay an ongoing expense for child care in accordance with

Section 81-6-209.5;

(h) imposes a penalty authorized under this chapter;

(i) determines an issue that may be specifically contested under this chapter by a party who timely files a written request for an adjudicative proceeding with the office; and

(j) renews an administrative judgment.”

Utah Code 63G-4-102 Scope and applicability of chapter:

“(1) Except as set forth in Subsection (2), and except as otherwise provided by a statute superseding provisions of this chapter by explicit reference to this chapter, the provisions of this chapter apply to every agency of the state and govern:

(a) state agency action that determines the legal rights, duties, privileges, immunities, or other legal interests of an identifiable person, including agency action to grant, deny, revoke, suspend, modify, annul, withdraw, or amend an authority, right, or license; and

(b) judicial review of the action.”

For procedures on establishing a medical support order using UAPA, refer to CS 352P Administrative Process, and CS 153P Order and Parentage Establishment.

At the time you are establishing an administrative child support order, also establish an administrative medical support provision on all IV-A, Non-IV-A Medicaid, and Non-IV-A cases.

If there is a judicial order in the case and it is silent regarding medical insurance, do not administratively establish a medical support obligation. In accordance with Utah Admin. Code R527-201-5(3) which states:

“If a judicial support order does not include a medical support provision, ORS shall begin judicial action to include a medical support provision.”

Send the case to the Attorney General’s office to obtain a medical support provision in the order.

NOTE 1: For Utah judicial orders issued prior to May 3, 2023, which are silent on medical insurance, send a referral packet to the Attorney General’s Office to obtain a medical support provision in the order. (See CS 451P.)

NOTE 2: For Utah orders issued or modified on or after May 3, 2023, a medical support provision is included in the order by operation of law, even if language constituting a medical support provision is absent in the order. Do not send a referral packet to the Attorney General’s Office to obtain a medical support provision in the order. Refer to CS 451P Review and Adjustment of a Support Order to Include MEDICAL Support Only for more information.

NOTE 3: Once a case meets the criteria for medical support enforcement, ORSIS automatically generates a medical document to every open employer for the parent(s). To avoid sending multiple unnecessary medical documents, you must end all old employer records for the parent(s) before the case leaves pre-order.