First Things First
Enter all information into the program before you go to the "Medical" screen. Number of kids. Income.
Handy Guides
Health Insurance Case Examples
Handy Health Insurance Questions and 252E.1A
Unreasonable Cost Health Insurance - What to Do.
How to Determine what is "Reasonable Cost".
Hawki Guide
No Health Insurance
If the parties have no health insurance coverage on the kids, call around. If the parties are low income, the premiums are subsidized and can get into the $100 - $125 per month range per child. If there is no coverage, cash medical support kicks in. It is discussed below. for HealthCare.gov.
The Kids are Covered
Iowa Total Care is considered Title XIX. If the kids are covered by Iowa Total Care, click the "Title XIX" box. Iowa privatized its Medicaid system in 2016. Iowa Total Care is one of three private health insurance companies who have managed care contracts with the State. Someone who has a health plan through Iowa Total Care would be considered to be on Title XIX Medicaid.Yes by a private plan such as Wellmark Iowa Support Master tells you what the yearly reasonable cost is. Look at the image below which is taken from the "Medical" screen. The number is based off of the income of the party. If in the example below the NCP has the kids covered at a cost of $3,000 per year, that cost is not reasonable. The question everybody has is .... what do we do?
What to do... Enter $3,000 as the cost. Iowa Support Master will push the number on through to the Form 1 and apportion it (unless the NCP falls in "Area A" under Rule 9.12(4) of the Guidelines). In our example, the cost is $250 more per year than the amount that would be reasonable. The parties either agree to it or you must negotiate a resolution. The CP may object to it and if you cannot agree, the court will decide. The insurance is going to be approved, the question becomes what to do about the excess cost. Perhaps you could agree on $2,750 being reasonable, enter that amount into the program and then let NCP pay the excess $250 for the year. Then give the NCP extra credit of $250 per year toward the non-covered health expenses on the kids.
Yes, by a private plan and by Title 19/Iowa Total Care or Hawki We have heard of people having a private plan AND Title 19. If this is the case, we believe you should enter the cost of the private plan per the rules. Next, provide full disclosure to the court. If you have to add a comment on your Form 1 that the kids are also covered by Title 19.
Yes, by Title 19, Iowa Total Care or Hawki These are not private plan health insurance programs, they are publicly (government) funded. Cash medical is triggered. If your case is "Shared Care - Equal Custody", there is no non-custodial parent so no cash med. If you read 252E.1A, the non-custodial parent must contribute cash medical support. The CSRU should not be seeking payment of cash medical support in shared custody cases where the children are on Title 19.
Check the Title 19 box for Title XIX or Iowa Total Care. Check the Hawki box if Hawki applies. Next, you need to know whether the NCP falls within an exception to the rule on being required to pay cash medical support or if it is a Shared Care case, no cash medical applies.
Exceptions to the Cash Med Rule
1. The NCP falls within the low-income, Area A of the guidelines. See Rule 9.12(4) of the Guidelines, Area A. No cash medical ordered. You need do nothing, Iowa Support Master will calculate this.
For the next three exceptions, if they apply, you would need to check the box displayed in this image.
2. The payor is himself/herself on Title 19 or Hawki. No cash medical support ordered. 252E.1A(4)
3. The payor has a child he/she is responsible for, who is on Title 19 or Hawki. No cash medical is ordered. 252E.1A(4)
4. The payor is self-employed (their only source of income is non-paycheck). No cash medical support. 252E.1A(4)
If the NCP falls within the exceptions found in rules 2 - 4 above, check the box as 252E.1A applies! That will remove cash medical and add those funds back into NCP's income for purposes of calculating child support.
Basic Title 19 and Hawki Rules
Who can apply? There is no requirement that only a "custodial parent" can apply for Title 19 benefits for a child. It is believed that the child(ren) would need to spend substantial time with that parent but we know of no rule that the amount of time must be more than 50% of the time.
Must we notify CSRU if the kids are on or going on Title 19? It is mandatory that CSRU open a case if the child receives FIP. It is not required if the children are on Title 19. A parent who has the children on Title 19 may request that CSRU open a case.
Shared Care - Title 19 Cases
If the parents will have shared care, 50/50, neither parent is considered "non-custodial". According to 252E.1(A), the NCP is required to contribute cash medical support. Both parents are custodial in shared care cases.CSRU rules provide that they will only pursue cash medical against a non-custodial parent. Under section 252E.1A(7)(c) (being amended by HF 2414 effective October 1, 2018. [252E.1B(3)], in CSRU-initiated actions for new or modified support orders involving shared care, CSRU only requests an order for a parent to provide health care coverage under limited circumstances when a health benefit plan is actually available to a parent. If a health benefit plan is not available for the children in a shared care case, CSRU will not request a cash medical support order against either parent, even if the children are on Title 19.
When the children are on Title 19 or Hawki and the parties in a privately initiated shared care action want to voluntarily follow the CSRU policy and request that a cash medical support order not be entered, CSRU will not object. When Title 19 is involved, the parents may have less of an interest in the cash medical support as it could be assigned to the State and they may be more likely to voluntarily agree to ask for a variance from the statute and Rule and ask to follow CSRU's policy. or Hawki.
for Title XIX Information.
Stepparent Coverage
If a stepparent has coverage on the kids, you may still deduct a share of the cost in your case and the cost must still be reasonable. Use the calculation method at the top of this page to determine how much of the cost of the plan may be entered into the program.Rule 9.14(5)(e) provides that if a parent objects to allowing a deduction for coverage by a stepparent, the court must decide the issue based on a determination of whether it would be equitable to the parties and the children.
Rule 9.11 Variance/Discretion
You may ask the court to vary from the guidelines. Rule 9.11(2) provides that the court shall not vary from the guidelines without a written finding that the guidelines would be unjust or inappropriate as determined under certain criteria. Read Rule 9.11(2).
No Health Means Cash Med
If the parties cannot get the kids under a plan, the NCP must pay cash medical. Cash medical, in short, is the what the reasonable cost of health insurance would be.Keep in mind that if the children are on Title 19 or Hawki, the NCP may be required to pay cash medical support. There are exceptions set out in 252E.1A(4). They are set out below.
How do you know if the children are on Title 19 or Hawki? You will have to ask questions. Title 19 is provided at no charge. It is for no/low-income folks. Hawki is intended for those who have income just above the levels that qualify for Title 19. There may be a charge for Hawki. If your client does not know, perhaps they can call one of the medical providers of the children to inquire as to who is being billed for care.
If custody is "Shared", neither party should be required to pay cash medical as neither party is considered the "non-custodial parent". See 252E.1A
252E.1A ESTABLISHING AND MODIFYING ORDERS - AMENDED 10.01.2018
Click the link below.252E Amended - Click Here.
252E.1A Establishing and modifying orders for medical support.
1. This section shall apply to all initial or modified orders for support entered under chapter 234, 252A, 252C, 252F, 252H, 598, 600B, or any other applicable chapter. If an action to establish or modify an order for support is initiated by the child support recovery unit, section 252E.1B shall also apply.
2. An order or judgment that provides for temporary or permanent support for a child shall include a provision for medical support for the child as provided in this section.
3. The court shall order as medical support for the child health care coverage if a health benefit plan other than public coverage is available to either parent at the time the order is entered or modified. A health benefit plan is available if the plan is accessible and the cost of the plan is reasonable.
a. The cost of a health benefit plan is considered reasonable, and such amount shall be stated in the order, if one of the following applies:
(1) The premium cost for a child to the parent ordered to provide coverage does not exceed five percent of that parent’s gross income or the child support guidelines established pursuant to section 598.21B specifically provide an alternative income-based numeric standard for determining the reasonable cost of the premium, in which case the reasonable cost of the premium as determined by the standard specified by the child support guidelines shall apply.
(2) The premium cost for a child exceeds the amount specified in subparagraph (1) and that parent consents or does not object to entry of that order.
b. For purposes of this section, “family coverage” means coverage that covers multiple individuals and covers or could cover the child or children subject to the child support order.
c. For purposes of this section, “gross income” has the same meaning as gross income for calculation of support under the guidelines established under section 598.21B.
d. For purposes of this section, “the premium cost for a child to the parent” ordered to provide coverage means the amount of the premium cost for family coverage to the parent which is in excess of the premium cost for single coverage, regardless of the number of individuals covered under the plan.
4. If a health benefit plan other than public coverage is not available to either parent at the time of the entry of the order, and the custodial parent does not have public coverage for the child, the court shall order cash medical support in an amount which shall be stated in the order. This subsection shall not apply in any of the following circumstances:
a. If the parent’s monthly support obligation established pursuant to the child support guidelines prescribed by the supreme court pursuant to section 598.21B is the minimum obligation amount. If this paragraph applies, the court shall order the parent to provide health care coverage when a plan becomes available for which there is no premium cost for a child to the parent.
b. If the noncustodial parent does not have income which may be subject to income withholding for collection of cash medical support at the time of the entry of the order. If this paragraph applies, the court shall order the noncustodial parent to provide health care coverage when a health benefit plan becomes available at a reasonable cost, and the order shall specify the amount of the reasonable cost as specified in subsection 3, paragraph “a”, subparagraph (1).
c. If the noncustodial parent is receiving assistance or is residing with any child receiving assistance as provided in section 252E.2A, subsection 1, paragraph “c”, subparagraph (3) or
(4). If this paragraph applies, the court shall order the noncustodial parent to provide health care coverage when a health benefit plan becomes available for which there is no premium cost for a child to the parent.
5. If a health benefit plan other than public coverage is not available to either parent at the time of the entry of the order, and the custodial parent has public coverage for the child, the court shall order the custodial parent to provide health care coverage, and the court shall order the noncustodial parent to pay cash medical support, which amount shall be stated in the order, unless an exception under subsection 4 applies.
6. Notwithstanding the requirements of this section, the court may order provisions in the alternative to those provided in this section to address the health care needs of the child if the court determines that extreme circumstances so require and documents the court’s written findings in the order.
7. An order, decree, or judgment entered before October 1, 2018, that provides for the support of a child may be modified in accordance with this section.