MEDICAL SUPPORT

CS 495 Collecting Court Ordered Medical Support

01/90 Revised 03/15/2022 Training Completed 03/29/2022 Last Reviewed 07/10/25

45 CFR 302.50 and 302.51; R527-201-12

 

 

Introduction

 

Federal regulations found at 45 CFR 302.50 and 302.51 require the Office of Recovery Services/Child Support Services (ORS/CSS) to collect medical support obligations from the noncustodial parent (NCP) when the court or administrative agency has:

 

1.                   Designated a specific dollar amount for ongoing or arrears in the support order; and/or,

2.                   Reduced uninsured medical expenses to a sum-certain judgment.

 

NOTE:  ORS/CSS does not establish medical support orders with dollar amounts as described in (1) and (2) as a service.  However, after a custodial parent (CP) has obtained a specific dollar amount in the order, the service provided by the office is to collect medical support obligations.

 

 

Statutory Authority

 

45 CFR 302.50 Assignment of rights to support:

“The State plan shall provide as follows:

(a) An assignment of support rights, as defined in § 301.1 of this chapter, constitutes an obligation owed to the State by the individual responsible for providing such support. Such obligation shall be established by:

(1) Order of a court of competent jurisdiction or of an administrative process; or

(2) Except for obligations assigned under 42 CFR 433.146, other legal process as established by State laws, such as a legally enforceable and binding agreement.

(b) The amount of the obligation described in paragraph (a) of this section shall be:

(1) The amount specified in the order of a court of competent jurisdiction or administrative process which covers the assigned support rights.

(2) If there is no court or administrative order, an amount determined in a record by the IV-D agency as part of the legal process referred to in paragraph (a)(2) of this section in accordance with the requirements of § 302.56.

(c) The obligation described in paragraph (a) of this section shall be deemed for collection purposes to be collectible under all applicable State and local processes.

(d) Any amounts which represent support payments collected from an individual responsible for providing support under the State plan shall reduce, dollar for dollar, the amount of his obligation under this section.

(e) No portion of any amounts collected which represent an assigned support obligation defined under § 301.1 of this chapter may be used to satisfy a medical support obligation unless the court or administrative order designates a specific dollar amount for medical purposes.”

 
45 CFR 302.51 Distribution of support collections:

“The State plan shall provide as follows:

(a)(1) For purposes of distribution in a IV–D case, amounts collected, except as provided under paragraphs (a)(3) and (5) of this section, shall be treated first as payment on the required support obligation for the month in which the support was collected and if any amounts are collected which are in excess of such amount, these excess amounts shall be treated as amounts which represent payment on the required support obligation for previous months.

(2) In title IV-A and title IV-E foster care cases in which conversion to a monthly amount is necessary because support is ordered to be paid other than monthly, the IV-D agency may round off the converted amount to whole dollar amount for the purpose of distribution under this section and § 302.52 of this part.

(3)(i) Except as provided in paragraph (a)(3)(ii), amounts collected through Federal tax refund offset must be distributed as arrearages in accordance with § 303.72 of this chapter, and section 457 of the Act;

(ii) Effective October 1, 2009, or up to a year earlier at State option, amounts collected through Federal tax refund offset shall be distributed in accordance with § 303.72 of this chapter and the option selected under section 454(34) of the Act.

(4)(i) Effective October 1, 1998 (or October 1, 1999 if applicable) except with respect to those collections addressed under paragraph (a)(3) of this section and except as specified under paragraph (a)(4)(ii) of this section, with respect to amounts collected and distributed under title IV-D of the Act, the date of collection for distribution purposes in all IV-D cases is the date of receipt in the State disbursement unit

established under section 454B of the Act.

(ii) If current support is withheld by an employer in the month when due, and received by the State in a month other than the month when due, the date of withholding may be deemed to be the date of collection.

(iii) When the date of collection pursuant to this subparagraph is deemed to be the date the wage or other income was withheld, and the employer fails to report the date of withholding, the IV-D agency must reconstruct that date by contacting the employer or comparing actual amounts collected with the pay schedule specified in the court or administrative order.

(5)(i) Except as provided in paragraph (a)(5)(ii), a State must pay to a family that has never received assistance under a program funded or approved under title IV–A or foster care under title IV–E of the Act and to an individual who is not required to cooperate with the IV–D program as a condition of Food Stamp eligibility as defined at § 273.11(o) and (p) of title 7 the portion of the amount collected that remains after withholding any annual $25 fee that the State imposes under § 302.33(e) of this part.

(ii) If a State charges the noncustodial parent the annual $25 fee under § 302.33(e) of this part, the State may retain the $25 fee from the support collected after current support and any payment on arrearages for the month under a court or administrative order have been disbursed to the family provided the noncustodial parent is not required to cooperate with the IV–D program as a condition of Food Stamp eligibility as defined at § 273.11(o) and (p) of title 7.

(b) If an amount collected as support represents payment on the required support obligation for future months, the amount shall be applied to such future months. However, no such amounts shall be applied to future months unless amounts have been collected which fully satisfy the support obligation assigned under section 403(a)(8) of the Act for the current month and all past months.

(c)(1) The amounts collected by the IV-D agency which represent specific dollar amounts designated in the support order for medical purposes that have been assigned to the State under 42 CFR 433.146 shall be forwarded to the Medicaid agency for distribution under 42 CFR 433.154.

(2) When a family ceases receiving assistance under the State’s title XIX plan, the assignment of medical support rights under section 1912 of the Act terminates, except for the amount of any unpaid medical support obligation that has accrued under such assignment. The IV-D agency shall attempt to collect any unpaid specific dollar amounts designated in the support order for medical purposes. Under this requirement, any medical support collection made by the IV-D agency under this paragraph shall be forwarded to the Medicaid agency for distribution under 42 CFR 433.154.”

 

NOTE:  CSS does not reduce uninsured medical expenses to a sum-certain judgment when establishing an administrative or judicial child support order. 

 

 

Procedures – Collecting Medical Support Debts

 

When collecting a medical support debt, CSS is able to use the same procedures and methods available for collecting and enforcing child support debts.  

 

 

Procedures – Settling in Full a Medical Support Debt

 

When reviewing a medical support debt(s) for settlement, determine if the debt is a Medicaid debt or a Non-IV-A medical debt owed to the CP.  If the debt is:

 

1.                   IV-A Medicaid:  The debt may be settled by payment in full or at a discounted lump sum figure; or,

 

2.                   Non-IV-A:   The CP must agree to the settlement amount and sign the Non-IV-A Arrearage Settlement to Obligee form.

 

NOTE:  If the medical debt is owed to another state (incoming interstate case) contact the state and obtain their consent before making arrangements which the NCP to settle the medical debt.