This topic contains information on the following subjects:
Federal regulation 45 CFR 303.31 requires CSS to seek medical support as a part of all child support orders and, when appropriate, to exchange this medical insurance coverage information with the Division of Medical Assistance (DMA). The regulation requires CSS to pursue health insurance for a child in any case where the custodial parent (CP) and child have no satisfactory coverage available other than Medicaid. Satisfactory coverage includes situations where the CP has insured the child under North Carolina's Health Choice plan. The availability of medical insurance coverage services must be explained to Non-Public Assistance (NPA) CPs at the time of application.
Federal regulation 45 CFR 303.32 requires CSS agencies to use the National Medical Support Notice (NMSN) to enforce medical support when the court orders noncustodial parents (NCPs) to provide employment-related health care coverage for their dependent child(ren). The NMSN is used to notify employers of NCPs' medical obligations.
NCPs who are active duty or retired military personnel OR reservists who have been called to active duty can enroll their legal dependent child(ren) in the Defense Enrollment Eligibility Reporting System (DEERS). Enrollment in DEERS automatically makes the child(ren) eligible for TRICARE/CHAMPUS health care benefits. Caseworkers can verify whether or not a child is enrolled in DEERS by contacting the military member/NCP or CP or by reviewing the Defense Manpower Data Center (DMDC) medical insurance reports that are available in X/PTR.
CSS agencies must seek health insurance coverage for child support orders that are established for a TANF client. The client is required to cooperate with the CSS agency in establishing, modifying, or enforcing a medical support obligation. This service must be explained to a custodial parent (CP) in a TANF case and thoroughly documented in the case record.
Medical support services are also provided for any MAO client unless the CP and child have satisfactory coverage available other than Medicaid. Medicaid CPs can elect to have CSS establish and/or enforce medical support services, or they can choose the full range of CSS services.
Medical support coverage services are provided for any CP in an NPA case, unless the CP and child have satisfactory coverage available other than Medicaid. All NPA CPs must be advised that medical support services are provided, and the services must be explained to them.
NPA CPs cannot choose to receive only medical support services. CPs must be provided the full range of child support services to be eligible for services from the CSS program. This includes the redirection and enforcement of an existing child support order. CSS must advise NPA CPs who refuse to cooperate with the establishment and enforcement of medical insurance that this can be grounds to terminate services if neither party in the CSS case has adequate coverage for the child other than Medicaid. CSS must provide new applicants, as well as existing CPs, with this information when establishing a new support order or during the review and adjustment process.
Local CSS caseworkers must discuss the availability of dependent health insurance coverage with the noncustodial parent (NCP) and fully document the results of this discussion on the Application Checklist. Employers and insurance providers are required to provide medical, hospital, and dental insurance information concerning a minor child's coverage upon written request. When requesting information from an employer, caseworkers should cite NCGS 50-13.11, which requires the release of this information to the agency.
Following the entry or modification of any order to require the NCP to obtain health insurance, caseworkers must verify that the coverage was actually obtained. The necessary dependent health insurance information must be obtained from either the NCP, employer, or health insurance carrier and forwarded to the appropriate parties.
Caseworkers must send the National Medical Support Notice (DSS-4733) to the employer within five (5) business days of the entry of an initial order that includes a provision for employment-based medical insurance coverage, within two (2) business days of an NCP being added to the New Hire directory, or as soon as the caseworker becomes aware that the NCP has changed employment.
If no response is received from the employer and/or plan administrator Within forty (40) days, CSS should contact the employer and/or plan administrator to resolve the problem. Civil legal action can be taken against the employer or health plan administrator if dependent coverage is available but the NCP's child is not enrolled.
If an NCP claims to be paying support in more than one county, CSS must verify whether credit was given for the insurance cost. Credit is not to be given in more than one case, unless there is an additional cost to add a child to the health plan.
Local CSS agencies can disclose the Social Security numbers (SSNs) of the children to an NCP or an NCP's insurance company for dependent medical insurance enrollment purposes. In order to remain in compliance with the Privacy Act (PL 93-579), when CSS workers request SSN information from applicants or recipients of CSS services, they must advise applicants/ recipients that providing SSNs is necessary in order to receive full CSS services. CSS must also inform applicants/recipients about how the SSNs will be used.
The uses of SSNs include:
CSS must give an applicant or recipient for CSS services this information regarding disclosure of SSNs as a part of the application and information dissemination process. Workers must document that this information has been provided. If an NCP requests an SSN for dependent medical insurance enrollment and the CP has not been informed of this disclosure procedure, CSS must contact the CP before releasing the SSN to the NCP.
If the NCP contacts the CSS agency either by telephone or by mail to request the child(ren)'s SSN(s), the number can be provided if the agency ascertains that the request is indeed for the purpose of obtaining health insurance for the child(ren). The same is true if the agency is contacted by an employer that requests the SSN for an employee's child for the same purpose.
Caseworkers must verify that coverage was actually obtained after it was ordered. The necessary dependent health insurance information must be obtained from either the NCP, employer, or health insurance carrier and then entered in ACTS. When medical coverage is obtained, the Division of Medical Assistance (DMA) is notified through the EIS interface.
Dependent medical insurance coverage information that is obtained for Non-Public Assistance (NPA) cases is not transmitted to DMA, but medical insurance information for Public Assistance (PA) cases is transmitted to DMA. This dependent insurance information must be send to all clients regardless of case type. Local CSS provides the CP with information concerning the medical insurance policy.
However, CSS is not involved with interpreting the policy or filing claims. Caseworkers must advise all NPA CPs that medical support are provided and explain the services to them. In order to provide the most effective service, the full range of CSS services must be provided to the NPA CP, including medical support services and including the redirection and enforcement of an existing child support order.
A family can receive Twelve Month Transitional Medicaid (TMA) when the earned income of a CP causes that family to be ineligible for TANF or some other Medicaid Assistance category. In order to receive TMA, the assistance unit must have an eligible child who is receiving Medicaid; eligibility can last up to twelve (12) consecutive months.
TMA begins in the first month that the family becomes ineligible for TANF or other Medicaid category. The case is coded in EIS as aid program/category "A-AF", payment type "5". The EIS/ACTS interface notifies local CSS when TMA is established, changed, or terminated. Medicaid regulations govern this type of assistance, and the case is considered to be a Medicaid case.
The CP can be the only individual in the case who receives TMA; the child(ren) can receive Medicaid under another aid category, such as MIC or SSI Medicaid. It is important to note that the CP is not required to cooperate with CSS while receiving TMA. If the CP is not cooperative, no individual exists to be sanctioned. These cases are not considered Child-Only Medicaid cases and, therefore, cannot be closed if the CP fails to cooperate.
Per federal regulations, county departments of social services must refer all Medical Assistance Only (MAO) cases when the reason for deprivation is based on the continued absence of either one or both parents, including children under eighteen (18) years of age living independently. County departments of social services are not required to refer Child-Only Medicaid cases when the custodial parent (CP) of the child does not receive any Medicaid or WFFA, unless the CP requests services. Cases should not be referred from Medicaid if the child has health insurance or has a court order for medical support already in place. Cases are also not to be referred if a finding or a pending action for Good Cause exists.
NOTE: If it is determined that an inappropriate referral has been made after the CSS case has been opened, the CSS agency must notify the CP that child support services are available but that the case will be terminated unless the CP does desire CSS services.
These referrals include any category of medical assistance as long as the above criteria are met. However, recipients of Medicaid for Pregnant Women (M-PW) are not required to cooperate with CSS either for the unborn child or for children receiving under other categories of medical assistance. Federal regulations do not require referral of these cases to CSS until the end of the CP’s 60-day post partum period. At that time the CP is no longer eligible for M-PW benefits and is required to cooperate with CSS in establishing and enforcing medical support. However, the case can be referred prior to this time if the CP desires CSS services.
A CP whose child is eligible for autonewborn benefits under Medicaid for infants and Children (MIC) also is not required to cooperate with CSS for that child up to sixty (60) days after the child's birth. The referral is made to CSS at the end of this 60-day period unless the CP desires CSS services prior to this time.
However, this child can receive autonewborn benefits for one (1) year; if the CP is not also receiving medical benefits, it is important to note that no individual exists to sanction if the CP is not cooperative. All other MIC-recipient cases are appropriate for referral to CSS no later than the disposition date of an application for medical assistance.
Since no TANF money payment exists, the referral is completed by a Medicaid caseworker, who indicates that this is an MAO case. This caseworker must also indicate on the referral whether there is a high potential for obtaining medical support, such as the availability of employment-related insurance or extensive medical needs.
Effective January 1, 1995, children who are eligible for SSI benefits are automatically eligible for Medicaid. SSI/Medicaid determinations and redeterminations are administered by Social Security. For these cases, there is no longer an application process with the Department of Social Services (DSS) and a referral to CSS when child support services are needed. In these situations, the CP has been advised to contact the local CSS office to apply for services.
Medicaid can make a referral to CSS when the CP makes a request for CSS services to the Medicaid worker and agrees to cooperate with CSS.
A referral must be made to CSS when a child receives SSI and the CP also receives Medicaid in any aid program/category except MPW. The CP’s cooperation with CSS is required to establish medical support.
When applying directly with CSS, the CP is responsible for providing verification regarding SSI/Medicaid eligibility. Verification can include the letter from DMA and/or the current Medicaid card. The CP should present the usual identification to complete the CSS application process. These cases are to be treated in the same manner as any other MAO case, and no application fee is charged.
If the child in an existing CSS case becomes an SSI/MAO recipient, the CP can elect to receive medical assistance only services. No continuation of services notice is sent to the CP in this situation.
If other children in the household are included in a TANF check, a separate case must be established for the SSI recipient child. Often support for an SSI recipient child and non-recipient child are included in one court order. In this circumstance, each child’s share of the support must be included in the appropriate case. Depending on whether the order was CSS-initiated and if it is a unity order or a prorated order, additional steps could be required.
In order for Medicaid eligibility to be established, the CP is required to cooperate with the local CSS agency in the following ways:
1. Identifying and locating the parent of any child for whom assistance is requested;
2. Establishing the paternity of any child born out of wedlock for whom assistance is requested;
3. Obtaining medical support coverage information from the NCP for any child for whom assistance is requested; and
4. Assigning to the Division of Medical Assistance (DMA) any medical support payments due the parent who remains in the home and/or any child for whom assistance is requested.
A Work First CP who does not cooperate with CSS without good cause is ineligible for Medicaid for one (1) month or until compliance, whichever is later (unless the CP is pregnant). If an MAO CP refuses to cooperate with CSS, the local caseworker must notify the Medicaid unit of the CP's noncooperation. The procedures for processing a noncooperation claim in a Medicaid case is the same as those applied in a TANF case.
When the CP is declared ineligible for Medicaid, the Medicaid case (regardless of the aid category) is considered a Child-Only Medicaid case. Child-Only Medicaid cases can be closed when the caretaker of the child fails to cooperate with CSS; however, some exceptions exist. See “Child-Only Medicaid Cases” in the PA Cases Chapter.
If the local CSS agency discovers that an MAO recipient has received and retained medical support payments assigned to the State, this information must be reported to the local Medicaid worker.
CSS caseworkers and supervisors must generate the Case Closure Intent Notice (DSS-4617) with the closure reason code indicating that the CP is not cooperating, as notification of case closure to the caretaker that child support services will terminate in sixty (60) days.
The CSS agency must provide medical support services to an MAO CP. At the CP’s request, the CSS agency must also provide any appropriate child support services (such as establishment and enforcement of a child support order). These services are provided at no cost to the MAO CP. Child support amounts collected in these cases are routed in the same manner as Non-TANF cases. However, if an MAO CP does not desire the establishment or enforcement of a support order, these services are not provided.
Through the EIS/ACTS interface, local DSS notifies local CSS when Medicaid coverage terminates. When notification of this termination is received, the Medicaid CP is notified automatically that services will continue to be provided without the application fee, unless instructed otherwise by the CP. However, if any AFDC/TANF arrearages, medical arrearages, or overpayments due to the State exist, the responsibility for enforcement must remain with CSS until these amounts are paid in full.
If the CP does not want continued CSS services, no arrearages are owed to the State, and an order has been established, the case is redirected to the Clerk of Court. If the noncustodial parent (NCP) is no longer under order to provide medical insurance for the child(ren), the CSS agency that is enforcing the medical obligation must send a Medical Termination Notice To Employer (DSS-4734) within ten (10) business days.
Local CSS agencies must seek health insurance coverage for children in TANF, MAO, and NPA cases. For MAO cases, local CSS can secure an order just for health insurance if the custodial parent (CP) does not wish to accept child support services.
Federal regulation 45 CFR 303.31(b)(2) and NCGS 50-13.11 (a1) require CSS agencies to petition the court to include a provision for health insurance for the child(ren), whether or not the coverage is available at the time an order is either entered or modified. NC Child Support Guidelines require that the court must order either parent to obtain and maintain medical health insurance for a child if it is currently available at a reasonable cost. If it is not currently available, the court must issue an order that insurance be obtained if and when reasonably priced coverage becomes available to a parent.
PER NCGS 50-13.11 (a), HEALTH INSURANCE IS DEFINED AS REASONABLE IN COST IF IT IS EMPLOYMENT-RELATED OR IS GROUP HEALTH INSURANCE, REGARDLESS OF SERVICE DELIVERY. Dependent medical insurance that is available to the noncustodial parent (NCP) as a result of current membership in unions or fraternal organizations or dependent coverage that is currently provided to the NCP due to retirement or disability meets this definition of being reasonable in cost. This definition does not include separate dental insurance policies that are available through an employer, although the court can require one or both parents to provide dental insurance.
When obtaining new or modified support orders, CSS must petition the court to include a provision for employment-related health insurance if it is or becomes available for dependents at a reasonable cost to the NCP.
When the court enters an order that contains a provision for health insurance coverage when it becomes available from an employer at a later date, the CSS agency is then in a position to transfer the notice of the obligation to provide dependent insurance to subsequent employers.
Any time the court does not grant the petition that the NCP provide medical insurance for the child(ren), caseworkers document in the case record that the coverage was not ordered and include this finding in the court order. When coverage subsequently becomes available to the NCP, an order to provide medical insurance must be sought.
The provision of medical insurance coverage must be addressed in support orders even if the NCP already has insurance coverage for the child(ren) at the time the order is negotiated. All efforts to obtain medical support and any information that is received MUST be thoroughly documented in ACTS.
Military member/NCPs can voluntarily enroll their child(ren) in TRICARE/ CHAMPUS. The NCP must take a copy of the child(ren)’s birth certificate or Affidavit Of Parentage and a copy of the support order (if one is established) to the customer service unit of the personnel center on the base and complete a DOD Form 1172 (Application for Uniformed Services Identification Card/DEERS Enrollment).
When the court orders military NCPs to provide health insurance for a dependent child or children, dependent child or children, CSS caseworkers can determine the child(ren)'s enrollment status through the quarterly DMDC (Defense Manpower Data Center) reports or by contacting the CP or NCP for verification of enrollment. Caseworkers DO NOT send the National Medical Support Notice to the DMDC Support Office. DMDC cannot enroll the child(ren) in TRICARE/CHAMPUS.
Local CSS agencies must identify cases and petition the court for modification of existing orders that do not contain a provision for medical insurance coverage. Every attempt should be made to obtain modified voluntary support agreements whenever possible. If unsuccessful, local CSS must petition the court for modification under NCGS 50-13.7 when the facts are sufficient to warrant the modification.
The current amount of any insurance premiums that are paid by a parent or stepparent should be used in the computation of any modification of a support obligation. (Health insurance must be sought even if potential exists for a reduction in the NCP's ability to pay support.)
Seeking health insurance is not required if the CP and child(ren) have adequate medical insurance other than Medicaid. In those situations where the CP has adequate dependent medical insurance, this must be stated in the order and the CP is required to continue to provide the coverage.
The CP must be instructed to notify the agency if coverage is no longer available. The CSS agency must then petition the court to address medical coverage for the child and, if ordered, modify the existing order to require the NCP to cover the child. If the existing order already contains a provision that the NCP secure medical insurance when it is available, it is appropriate to enforce this requirement.
NOTE: All complaints and orders addressing medical insurance must contain findings as to the availability of insurance coverage for the child(ren) to either the CP or NCP and state who is providing the insurance at the time the order is entered.
Once a court order has been established for medical insurance, the signature of either the CP or NCP is valid authorization for the insurer to process the insurance claim on behalf of the child(ren) who are covered by the order.
NCGS 58-51-120 requires that when a court order requires a parent to provide health insurance for a child and that parent is eligible for family health benefit plan coverage, the insured parent, the child's other parent, or the Department of Health and Human Services (DHHS) must be allowed to enroll that child in the family coverage plan. A child cannot be disenrolled without evidence that the court order is no longer in effect, that the child has other comparable coverage, or that the employer has eliminated the benefit plan.
When an NCP is no longer under order to provide medical insurance for the child(ren), the local CSS agency enforcing the medical obligation must send a Medical Termination Notice (DSS-4734) within ten (10) business days to the NCP's employer(s).
Employers must withhold any employee share of the premiums for coverage from the employee's wages. For a child enrolled under an NCP's health plan, the insurer must provide the CP with the information that is necessary to obtain benefits and must allow the CP or health care provider to submit claims for services. Payments on claims are to be made directly to the NCP, CP, provider, or DHHS (whichever is appropriate).
If dependent health insurance is not available through an employer, CSS must question the NCP about the availability of other group insurance. Group health insurance includes insurance that is available to the NCP as a result of current membership in unions or fraternal organizations or coverage currently provided to the NCP due to retirement or disability. If dependent coverage is available through the NCP’s group health insurance, the CSS agency must request that the NCP voluntarily agree to provide this coverage for the child(ren).
If the NCP voluntarily enrolls the child(ren) for the health insurance, a provision for the NCP to provide medical insurance for the child(ren) must be included in the child support order. If the NCP refuses to provide this coverage for the child(ren), the CSS agency must petition the court to determine whether the child(ren) should be added to the NCP's existing coverage. The CSS agency cannot require the NCP to seek and purchase a private insurance policy.
If insurance for the child(ren) is available through both an employer and through other group insurance and the child is not enrolled in either plan, the NCP must be asked to secure the employment-related insurance, even if other group insurance can be obtained for less cost.
If the NCP voluntarily enters into an order, that order must include a provision for the NCP to provide the employment-related insurance for the child(ren). If the NCP refuses, CSS petitions the court to resolve any issues regarding which insurance should be obtained.
However, if the NCP already covers the child under a non-employment related policy, it is appropriate to allow the NCP to continue this coverage. When the child support order is established, a provision for the NCP to provide medical insurance for the child(ren) must be included in the order.
Title XXI of the Social Security Act created a health insurance coverage plan for uninsured children with family incomes up to two hundred percent (200%) of the federal poverty level. In North Carolina, NCGS 108A-70 established this program, effective October 1, 1998, as “NC Health Choice”. It is administered by the Division of Medical Assistance (DMA).
To be eligible for Health Choice, children must not qualify for Medicaid and have no medical insurance coverage available. If a child's noncustodial parent (NCP) is required under a separation agreement or a court order to provide or maintain medical insurance but fails to comply, Health Choice considers the child to be uninsured for the purpose of determining eligibility for Health Choice coverage.
Families must re-enroll in Health Choice yearly. If the family's income at re-enrollment is greater than two hundred percent (200%) but equal to or less than two hundred twenty-five percent (225%) of the federal poverty level, the family has the option to pay the full monthly premium that is charged to remain on Health Choice, Optional Extended Coverage, for one (1) year.
When an individual applies for NC Health Choice, the Income Maintenance caseworker determines whether or not the applicant is required to seek assistance from CSS. If the Health Choice applicant informs the Income Maintenance caseworker at the time of the application that a CSS case already exists, the Income Maintenance caseworker verifies this information by reviewing the inquiry screens in ACTS.
When no medical support order exists OR the NCP is in compliance with an existing medical support order, DMA does not require the Health Choice applicant to apply for child support services. If the Health Choice applicant indicates that the NCP is not complying with an existing medical support order, DMA requires the applicant to apply for CSS services in order to receive the 12-month Health Choice coverage, which is renewable each year.
Health Choice cases are not considered Medicaid cases, and they are NOT automatically referred from EIS to ACTS.
When an individual applies for medical assistance at DSS, the Income Maintenance caseworker enters the application information into the EIS system. If the child is eligible for Medicaid, CSS receives an automated referral. However, if the child is not approved for Medicaid but is approved for Health Choice, CSS does NOT receive a referral.
After approval, the NC Health Choice status can be verified in the EIS system. After the Health Choice application is approved, no other requirements exist for the recipient. (DSS makes no sanctions against these CPs, and CSS does not refer these NPA CPs for noncooperation if the recipient terminates the case.)
The NC Health Choice applicant is required to seek CSS services if:
1. A parent is absent from the home;
2. A separation agreement or a court order exists, requiring that parent to provide medical insurance coverage; and
3. That parent is NOT in compliance with the separation agreement or court order.
CSS initiates the case when the Health Choice applicant applies for CSS services. The applicant is subject to the child support application fee, since these cases are Non-Public Assistance (NPA) cases.
After the case is created, CSS is required to pursue enforcement of the court order.
Health Choice applicants who apply for CSS services are required to provide the Income Maintenance caseworker with a receipt from CSS as proof that they paid the application fee for CSS services before the end of the 45-day Health Choice processing period.
If the applicant cannot obtain an appointment with CSS within the 45-day period, CSS must give the applicant documentation of the scheduled appointment date to present to the Income Maintenance caseworker. A signed copy of the client's appointment letter is appropriate documentation, or some other written form of verification could be used.
When Health Choice recipients apply for CSS services, CSS must provide these individuals with the full range of child support services. These services include the enforcement of any medical support order and the redirection and enforcement of any existing child support order. CSS provides the full range of services for as long as the Health Choice recipient requests them.
CSS must determine if:
1. A separation agreement or court order exists that requires the NCP to provide medical insurance for the child(ren);
2. The NCP is in compliance with that separation agreement or court order;
3. Medical insurance is currently available.
If a Health Choice recipient closes his/her CSS case and plans to re-enroll in Health Choice after the 12-month coverage period, the recipient must re-apply for CSS services before DSS can approve the Health Choice re-enrollment.
Most private sector employer group health plans are self-insured and governed by federal law, known as ERISA (Employee Retirement Income Security Act of 1974), rather than state law. To compel compliance of an ERISA-covered employer to provide health insurance, the standardized federal National Medical Support Notice (DSS-4733) was developed for all states to use in enforcing medical support obligations. In order for this Notice to meet the ERISA requirements for a "qualified medical child support order," it must contain the names and addresses of the obligor and dependents, the type of coverage available to dependents, and the name and address of the plan administrator. The Notice must be approved by the plan administrator to be considered a qualified medical child support order.
If dependent insurance coverage is available and the noncustodial parent (NCP) fails to add the child(ren), local CSS must notify the new employer to add the child(ren) and to deduct the cost of the insurance premium from the NCP's wages. Civil legal action can be taken against the employer or health plan administrator if coverage is available but the NCP's child is not enrolled.
NOTE: Sometimes continued insurance benefits are available for up to eighteen (18) months after the termination of employment through COBRA for either an ERISA or Non-ERISA plan.
The CSS Attorney should be consulted before suspending any part of an insurance provision.
It is important to note that if CSS requests an employer to enroll a child(ren) and to deduct the cost of the premium from the NCP's wages, it is the NCP’s responsibility to make any request for review of the child support order to the local CSS agency. The local CSS agency must assess the case and determine whether a modification is appropriate.
While it is appropriate to review past paid medical expenses to determine a reasonable amount to allow for extraordinary medical expenses on the guidelines worksheet, CSS does not have the authority to recoup past paid medical assistance for the Division of Medical Assistance (DMA).
Medical support judgments designating a specific dollar amount for medical purposes are enforceable by CSS. However, the establishment of such obligations, or the establishment and enforcement of medical support of unspecified dollar amounts (such as orders providing for one half of the unreimbursed medical expenses) is not a required CSS function. Each case should be assessed to determine what provisions of the order can be monitored by the agency, and the assessment should be explained to the client and documented in the case record.
When the court order specifies a dollar amount for reimbursement of medical expenses (such as periodic monthly payments or lump-sum judgments), CSS is required to distribute this medical support. Caseworkers must ensure that court orders stipulate that such payments are directed to the Department of Health and Human Services (DHHS) for collection and distribution of the medical support to the proper party, either the Division of Medical Assistance (DMA) or the custodial parent (CP).
NOTE: This applies to dollar amounts for ongoing expenses or for a past due balance. It is not required if no dollar amounts are specified.
DMA retains any medical support for a specified dollar amount that is assigned to DMA for the duration of the CP’s eligibility for medical assistance. Any retained amount in excess of the amount of medical assistance that is expended is reimbursed to the CP upon termination of medical assistance eligibility.
CSS agencies must ensure that all current and new cases containing orders for medical support specifying a dollar amount be directed to DHHS for distribution. If an order requires the NCP to reimburse the CP for health insurance premiums or medical expenses paid by the CP but does not state a specific cash amount, CSS is not required to enforce such a provision in the order.
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.