Health Insurance / Medical Support Orders

Ohio law requires that all child support orders include both a child support payment amount when private health insurance is being provided, and another amount for when health insurance is not provided. Each order must also include a cash medical support obligation.

Cash medical is an amount of money ordered to be paid in addition to child support by a person ordered to pay child support when no private health insurance is provided. Cash medical support is only ordered if the non-custodial parent's gross income is more than 150% of the federal poverty level. View the Poverty Guidelines.

Each support order must also include medical support orders that addresses the heath insurance needs of each child. These include:

  • An order for one or both parents to provide private health insurance coverage for the child
  • An order for both parents to share the cost of the child's medical expenses that are not covered under the insurance plan

If neither parent has health insurance available, both parents are ordered to report coverage that becomes available to the Child Support Enforcement Agency (CSEA) as soon as it is available.

Reasonable Cost

When a parent has access to health insurance, the administrative officer or judge has to make sure the coverage is of reasonable cost. The cost is considered reasonable if the cost of family coverage minus cost of single coverage is not greater than 5% of the parent's gross income.

  • A parent can agree to provide coverage even if it is not of reasonable cost
  • If the judge believes it is in the child's best interest, a parent can be ordered to provide coverage despite the cost

National Medical Support Notice

The CSEA will send a National Medical Support Notice (NMSN) to the employer of the person ordered to provide medical insurance, spelling out the medical support needs and what the employer must do to comply. If the person required to provide insurance loses coverage, they will receive a Notice Regarding Cash Medical Support (JFS 04031), advising both parties that the obligor will begin to pay cash medical support the first day of the month following the date private coverage was lost. This Notice provides the obligor an opportunity to request a Medical Support Mistake of Fact hearing within 7 business days.

Enforcement of Medical Support Order

A medical support order is binding on both parents, their employers, and any insurer that provides health insurance coverage for either parent or their children. Enforcement activities can include contempt of court, if the person ordered to provide medical insurance has failed to obtain available health insurance or has allowed coverage to lapse. The CSEA must enforce medical support orders, especially when Medicaid is entitled to reimbursement.

Helpful Resources

View these links for more about Medical Support: