MEDICAL SUPPORT

CS 484P Gather and Disseminate Medical Insurance Information

01/90 Revised 09/08/24 Training Completed 09/23/24 Last Reviewed 07/10/25

45 CFR 303.30, 303.31; R527-010 and R527-201-9; 42 U.S.C. 652(f)

 

 

Statutory Authority

 

Federal regulations found at 45 CFR 303.30 state:

“(a)  If the IV-A or IV-E agency does not provide the information specified in this paragraph to the Medicaid agency and if the information is available or can be obtained in a IV-D case for which an assignment as defined under Sec. 301.1 of this chapter is in effect, the IV-D agency shall obtain the following information on the case:

(1)  Title IV-A case number, Title IV-E foster care case number, Medicaid number or the individual's social security number;

(2) Name of noncustodial parent;
(3) Social security number of noncustodial parent;
(4) Name and social security number of child(ren);
(5) Home address of noncustodial parent;
(6) Name and address of noncustodial parent's place of employment;
(7) Whether the noncustodial parent has a health insurance policy and, if so, the policy name(s) and number(s) and name(s) of person(s) covered.
(b) The IV-D agency shall provide the information obtained under paragraph (a) of this section to the Medicaid agency in a timely manner by the most efficient and cost-effective means available, using manual or automated systems.”

 

In addition 45 CFR 303.31 requires CSS to:

 

1.                   Petition the court or administrative authority to include health care coverage that is accessible to the child(ren) and is available to the parent providing the medical support and is reasonable in cost.

“(b)(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. . . .”

 

2.                   Communicate with the Medicaid agency to determine lapses in medical insurance coverage on all Medicaid recipients.

“(b)(5) Periodically communicate with the Medicaid agency to determine whether there have been lapses in health insurance coverage for Medicaid applicants and recipients.”
 
 

Definitions and Procedures

 

1.                   Obligated Parent: As defined by the Office of Recovery Services/Child Support Services (ORS/CSS) – For purposes of adding insurance information to ORSIS, the parent providing the insurance that is used to search and add a policy on ORSIS. This person may or may not be specifically ordered to provide insurance in an order.

 

EXAMPLE:          

§     The noncustodial parent (NCP) and the custodial parent (CP) are both ordered to provide insurance for two minor children.

§     The CP’s spouse carries insurance for both children.

 

If both parents are providing insurance, each insurance policy is added to ORSIS separately.

 

2.                   Parent/Guardian: As defined by ORS/CSS for purposes of adding medical insurance information to ORSIS – The NCP or CP who is the mother, father or guardian of the child.

 

 

Forms Overview

 

1.                   Insurance Warning Letter. Manually request and send this letter to the parent(s) ordered to provide insurance coverage when:

a.                   CSS is enforcing this obligation;

b.                   All the insurance policies have been ended on ORSIS; and,

c.                   There is no known insurance available; e.g., no active employer records on ORSIS with insurance available for the obligated parents (i.e., an unemployed or self-employed parent or insurance through a union).

               

The letter notifies the parent(s) that s/he has been ordered to provide insurance coverage for the child(ren), that s/he should obtain the coverage, and contact ORS/CSS with the information within 15 days.

 

2.                   Insurance Notification to the Non-IV-A Obligee. This letter is automatically generated to the CP when a new insurance policy is added to ORSIS. The letter notifies the CP of the most recent insurance policy gathered or verified.

 

3.                   IVR Insurance Coverage Letter. This letter is generated by ORS ACCESS (Automated Case and Customer Service System) and notifies the requestor of the most recent insurance policy gathered or verified.

 

4.                   National Medical Support Notice. This notice is automatically generated for an NCP/CP who meets the criteria.

 

 

Sources for Insurance Information

 

You may use any of the sources listed below to obtain the necessary medical insurance information.

 

1.                   Insurance information listed in the Application for Child Support Services Packet form;

 

2.                   The case file:  Check:

a.                   Content Manager for:

i.                     An old Financial Statement for Review/Adjustment, Medical Insurance section; and,

ii.                   Letters from the CP or NCP or others.

b.                   ORSIS narratives; etc.

 

3.                   The employer, union, and/or insurance company.  Call or send the Employer Request form.

 

4.                   The Bureau of Medical Collections (BMC). 

 

5.                   The CP:  Call or contact the CP for insurance information.

 

6.                   The NCP:  Call or contact the NCP for insurance information. 

 

 

State Child’s Health Insurance Program (CHIP)

 

The State Child’s Health Insurance Program (CHIP) is an alternative health insurance program administered by the Department of Health and Human Services. CHIP provides health insurance coverage to previously uninsured, low-income children who do not qualify for Medicaid, and have no other insurance available. CHIP is not a Medicaid program, and ends as soon as the child becomes Medicaid eligible or is covered by a commercial insurance policy.

 

 

Providing Insurance Information to the Custodial Parent

 

CSS disseminates the insurance information to the appropriate CP or other state on an incoming intergovernmental case.  After insurance information is added to the appropriate medical screens, ORSIS automatically generates one of the following letters to the appropriate CP per case, per day, per insurance company:

 

1.                   Insurance Notification to the Non-IV-A Obligee.

2.                   Insurance Notification on an Incoming Interstate Case.

 

ORSIS does not generate an insurance notification letter to a IV-A or Non-IV-A Medicaid CP.  Each month the IV-A or Non-IV-A Medicaid CP receives a new Medicaid Card. Once the insurance information is verified by BMC, it is sent to the Medicaid agency in accordance with 42 U.S.C. 652(f) which states,

“. . . 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 with respect to the availability of health insurance coverage.”

 

IV-A or Non-IV-A Medicaid CP’s receive a plastic Medicaid Member Card from the Medicaid agency.  In addition to the card, IV-A or Non-IV-A Medicaid CP’s will receive a Benefit Letter in the mail.  The letter has eligibility and plan information.  When there are changes, the Medicaid agency will send a new Benefit Letter.  

 

NOTE: Insurance cards that are received for CIC cases are not sent to the lead agency for the case. After adding the insurance information to ORSIS, the insurance cards must be shredded.

 

 

Insurance Lapse Notification

 

Federal regulations found at 45 CFR 303.30 and 303.31 require CSS to identify lapses in medical insurance coverage, periodically communicate all lapses in medical insurance coverage on IV-A and Non-IV-A Medicaid CPs to the Medicaid agency, and request employers and other groups offering medical insurance coverage to notify CSS of any lapses in coverage.

 

1.                   Noncustodial Parent Notification:  A NCP who owes past-due support and meets the notice criteria will receive the “Annual Notice of Past-Due Child Support” annually.  A NCP who does not owe past-due support will receive the “Initial Contact Notice” at the time the case is opened.  These forms instruct the NCP to notify CSS of any changes in the child(ren)s medical insurance coverage.

 

2.                   Custodial Parent Notification:  The CP receives the insurance notification letter each time CSS adds insurance information to the medical screens.  This letter also requests that the CP keep CSS advised of any lapses in insurance coverage.  This information is also included in the “Notice of Services” that all IV-A and Non-IV-A applicants receive at the time they apply for IV-A assistance or CSS services.

 

3.                   Medicaid Agency:  ORSIS electronically transfers insurance information to the Medicaid agency when BMC verifies insurance information and updates the medical screens on ORSIS.

 

4.                   Employer Notification:  The Employer Request letter and National Medical Support Notice notify employers and other groups offering medical insurance to advise CSS of any lapses in coverage.

 

In accordance with R527-201-9, employers are required to notify CSS when the obligated parents terminate employment:

“(9) In accordance with Subsection 26B-9-306(9), the employer shall:

(a) notify ORS within five days after the parent terminates employment;

(b)  provide ORS with the parent's last-known address; and

(c)  provide the name and address of a new employer, if known.”