Cash Medical Support in Oklahoma: Why DHS Adds to Your Child Support When Your Child Is on SoonerCare

​One of the most common complaints I hear from parents paying child support through Oklahoma DHS goes like this: "Why am I paying extra to the State? The child support should go to my kid, not the government."

Usually, the "extra" is something called cash medical support, and it shows up when the child is covered by SoonerCare, Oklahoma's Medicaid program. Here is what it is, how it works, and why, in many cases, it is actually the cheapest way your child will ever be insured.

EVERY CHILD SUPPORT ORDER MUST ADDRESS HEALTH CARE

Under 43 O.S. § 118F, every Oklahoma child support order must include a medical support order. That means the court has to decide how the child's health care will be covered. The options generally are:

- One parent carries private health insurance (often through an employer) at a reasonable cost; or
- Cash medical support is ordered in place of insurance, including when the only coverage available is a government program like SoonerCare.

Private insurance is considered "reasonable in cost" when the paying parent's share of the premium for the children does not exceed 5% of that parent's gross income.

WHAT IS CASH MEDICAL SUPPORT?

Cash medical support is a monthly amount added to your regular child support to help cover your child's health care when you are not providing insurance.

Under the Oklahoma child support computation form and DHS rules (OAC 340:25-5-168):

- The amount is $115 per child per month, split between the parents according to their share of combined income.
- It only applies if the paying parent's gross income is above the amount listed on the Cash Medical Income Guidelines Table for the number of children. If your income is at or below that amount, cash medical is set at $0.
- Your share generally cannot exceed 5% of your gross monthly income.
- If the children are on SoonerCare, the cash medical payment goes to the Oklahoma Health Care Authority to help reimburse the State for the cost of that coverage.

EXAMPLE

Say Dad earns 70% of the parents' combined income and Mom earns 30%. They have two children on SoonerCare.

$115 x 2 children = $230 per month
Dad's 70% share = $161 per month in cash medical, added to his regular child support

So yes, it can easily add $100 or more to the monthly payment. That's real money, and it is understandable that it stings.

WHY THE STATE IS INVOLVED

When a child receives SoonerCare, the State has a financial interest in the case. Medicaid is public assistance, and Oklahoma law allows the State to seek reimbursement from parents who are able to contribute. That is one reason DHS Child Support Services often becomes involved in these cases even when the parents never asked for it, and why the child support (and cash medical) is processed through the State.

It can feel like the State is simply collecting money from you. But look at what you are getting for it.

THE PART MOST PARENTS MISS: IT'S USUALLY A BARGAIN

Ask yourself: if the child were not on SoonerCare, how would the child be insured?

Somebody has to cover that child. If it isn't SoonerCare, it is going to be private insurance, and either you or the other parent will be paying a share of the premium through the child support worksheet. Health insurance costs in this country have gone up dramatically, and adding children to an employer plan is often far more expensive than people expect. Family coverage on many plans can run several hundred dollars a month or more just for the dependents.

Compare that to $115 per child, split between both parents by income. In most cases, you are not going to beat that price on the private market. A few jobs offer very cheap or free dependent coverage, but they are the exception.

The child also gets real coverage through SoonerCare: doctor visits, prescriptions, dental, and more.

CAN I GET RID OF CASH MEDICAL?

Generally, cash medical is meant to be a substitute for insurance. If you enroll your child in private health insurance that is accessible and reasonable in cost, and give proper notice, cash medical can be ended going forward. But before you do that, compare the cost. Your share of the private premium will be added to the child support calculation, and it may end up costing you more than the cash medical did.

If your income has dropped, or your cash medical was calculated incorrectly, you may be able to modify the order. And if the child is covered through Indian Health Service, different rules apply, and cash medical is typically not ordered just because of IHS coverage.

QUESTIONS ABOUT CHILD SUPPORT IN OKLAHOMA?

Child support worksheets, DHS cases, and medical support orders can be confusing, and mistakes in the calculation can cost you for years. Attorney Joel K. Mitchell has handled Oklahoma child support, custody, and divorce cases for more than 25 years. Call or text (918) 230-5844 to talk about your case.

This article is for general information only and is not legal advice. Every case is different. Reading this article does not create an attorney-client relationship.