Child support includes health care

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Massachusetts Law Reform Institute

A child support order must include health care coverage. Parents can:

  • Provide health care coverage through their employer.
  • Buy health care coverage on their own.
  • Get health care coverage for their children through MassHealth.
  • Give the court a written agreement that says their child will get health care coverage some other way. For example, a grandparent might provide health care coverage.

The judge can order either parent to provide health care coverage.

When the judge orders you to provide health care coverage for your child, the order is not only about getting coverage. You must also keep the coverage.

The Massachusetts Child Support Guidelines discusses health and dental coverage and medical expenses in sections H, I and J.

When can a judge order keeping a child on MassHealth?

The judge can order you to keep your child on MassHealth if:

  • Your child is on MassHealth or a health program like it in another state, or
  • You or the other parent is on MassHealth.
When can a judge order a parent to pay for private health insurance?

The judge can order you to pay for private health insurance if it is not a hardship for either parent and it is in your child's best interest.

The judge can only order you to pay for private health insurance if:

  1. The services are within 15 miles of your child’s main residence, so they are "accessible,"
  2. The coverage costs 5% or less of your income, so its cost is "reasonable,"
  3. Your income is more than 150% of the "Federal Poverty level." and
  4. You do not get MassHealth.
What if I want to change a child support order about health insurance?

If the court already ordered health care coverage, you can ask the court to change the order if:

  • The services are more than 15 miles from your child's main residence,
  • The cost is more than 5% of your income,
  • The coverage causes you a hardship. or
  • The order is no longer in the best interest of your child.
What if I cannot provide health care coverage?

If the judge decides:

  • Health care coverage is not "accessible" or available at a "reasonable" cost, or
  • Providing coverage creates a serious or unfair hardship for you,

they will not order you to provide health care coverage.

But the judge will order you to tell:

  • The Department of Revenue Child Support Enforcement (DOR/CSE), if they are providing child support collection services, or
  • The other parent, if the DOR/CSE is not providing child support collection services.

as soon you can get health care coverage.

What is "undue hardship"?

If the judge decides providing  health care coverage  is a serious or unfair hardship, they will not order you to provide it. When the judge is deciding if the cost would be a serious or unfair hardship, some of the things they look at are if:

  • Paying for health care coverage means you could not pay the child support order.
  • The health care coverage is not enough to meet your child's health care needs - and you would have to pay a lot more for medical expenses that the coverage does not cover.
  • Your gross income is less than 300% of the federal poverty guidelines.

If any of these reasons apply to you, be sure to tell the judge.

If a judge decides that providing health care coverage creates a serious or unfair hardship, you can read the judge's reasons on the Findings and Determinations for Child Support and Post-Secondary Education court form. See the HEALTH CARE COVERAGE section of the form.

Does the parent who gets child support have to pay something towards our child's health care expenses not covered by insurance?

Every year, the parent who gets child support must pay the first $250 of routine, uninsured, medical and dental expenses for your children. This $250 is for all the children in the order together, not $250 for each child.

For amounts over $250, the Court can order the parent who pays child support to pay all or part of routine, uninsured, medical and dental expenses.

Who pays for extraordinary and uninsured health care expenses?

"Extraordinary" health care expenses are those that not all children have. They include things like braces and counseling.

The judge decides case-by-case how parents should pay for extraordinary, uninsured, medical, dental, and vision expenses.

Sometimes parents have already agreed on how to pay for these expenses. The judge decides if the agreement is fair.


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