Medical Child Support: Background and Current Policy

Carmen Solomon-Fears
Specialist in Social Policy

Medical child support is defined as the legal provision of payment of medical, dental, prescription, and other health care expenses for children living apart from one of their parents. It can include provisions for health care coverage (including payment of costs of premiums, copayments, and deductibles) as well as cash payments for a child’s medical expenses. The establishment and enforcement of medical support is intended to promote fairness in allocating childrearing costs between custodial and noncustodial parents and, when employer-sponsored health care is obtained, it saves federal and state dollars.

Medical child support has evolved over time. In the early days of the establishment and enforcement of medical child support, the primary goal was to make noncustodial parents responsible for their children and thereby lessen taxpayer burden by shifting costs to noncustodial parents. With the enactment of P.L. 109-171 (the Deficit Reduction Act of 2005), the emphasis on solely looking to the noncustodial parent for obtaining private health care coverage for children was replaced with the view that provision of medical child support is the goal regardless of which parent can provide it.

A study was commissioned by the Department of Health and Human Services (HHS), and conducted by the Urban Institute, to shed light on health care coverage of child support-eligible children. Based on an analysis using 2008 data, the Urban Institute found that out of an estimated 26 million U.S. children age 18 or under who had at least one parent living outside the home, approximately 51% of such child support-eligible children were enrolled in the Medicaid or the State Children’s Health Insurance Program (CHIP). An additional 31% of the child supporteligible population had private coverage from someone in their household and 6% obtained insurance coverage from someone outside the household (generally the noncustodial parent but sometimes a stepparent). A small proportion of children (1%) obtained coverage from other federal sources. The remaining 11% of child support-eligible children were classified as uninsured.

Health care coverage of children and medical child support are not synonymous. A child could be covered by a custodial parent’s health insurance plan and the child support order may not contain any provision for medical support. Conversely, a child may be receiving cash medical support but not be insured.

Although there is agreement that many children still lack health care coverage, full implementation of the Patient Protection and Affordable Care Act (P.L. 111-148; ACA, as amended) should further reduce the problem of uninsured children, but the issue of successful establishment and enforcement of medical child support may become even more complex. Although states submit medical support data to the federal government, the information is not subject to an audit to determine if it is complete and reliable. Also, medical support establishment allows states to initiate legal medical support orders before determining whether or not health insurance is affordable. However, state Child Support Enforcement (CSE) agencies are severely hampered, if not totally stymied, in enforcing medical child support orders in cases in which a medical support order is established but the health insurance is not considered affordable by federal/state standards.

Even though it is not likely that medical child support will receive congressional attention this year, with the continued implementation of the ACA in 2014, Congress may examine the impact of the ACA on the CSE program and address unresolved issues. This report describes current federal policy with respect to medical child support. It also examines the potential impact of the ACA on the CSE program. It provides a legislative history of medical support provisions in the CSE program (see Appendix A) and state data on the medical support coverage of children in the CSE program (see Appendix B).

Date of Report: March 21, 2013
Number of Pages: 49
Order Number: R43020
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Overview of Health Care Changes in the FY2014 Budget Proposal Offered by House Budget Committee Chairman Ryan

Patricia A. Davis
Specialist in Health Care Financing

Alison Mitchell
Analyst in Health Care Financing

Bernadette Fernandez
Specialist in Health Care Financing

On March 12, 2013, House Budget Committee Chairman Paul Ryan released the chairman’s mark of the FY2014 House budget resolution together with his report entitled The Path to Prosperity: A Responsible Balanced Budget, which outlines his budgetary objectives. The House Budget Committee considered and amended the chairman’s mark on March 13, 2013, and voted to report the budget resolution to the full House. H.Con.Res. 25 was introduced in the House March 15, 2013, and was accompanied by the committee report (H.Rept. 113-17). H.Con.Res. 25 was agreed to by the House on March 21, 2013.

A budget resolution provides general budgetary parameters; however, it is not a law. Changes to programs that are assumed or suggested by the budget resolution would still need to be enacted in separate legislation. Chairman Ryan’s budget proposal, as outlined in his report and in the committee report, suggests short-term and long-term changes to federal health care programs including to Medicare, Medicaid, and the health insurance exchanges established by the Patient Protection and Affordable Care Act as amended (ACA, P.L. 111-148, P.L. 111-152).

Within the 10-year budget window (FY2014-FY2023), the budget proposal assumes that certain ACA provisions would be repealed, including those that expand Medicaid coverage to the nonelderly with incomes up to 133% of the federal poverty level, and those provisions that establish health insurance exchanges. The proposal also suggests restructuring Medicaid from an individual entitlement program to a block grant program. Beyond the 10-year budget window, beginning in 2024, the budget proposal assumes an increase in the age of eligibility for Medicare and the conversion of Medicare to a fixed federal contribution program.

This report summarizes the proposed changes to Medicare, Medicaid, and private health insurance as described in H.Con.Res. 25, the accompanying committee report, and Chairman Ryan’s Path to Prosperity report. Additionally, it briefly examines the potential impact of the proposed changes on health care spending and coverage.


Date of Report: March 22, 2013
Number of Pages: 15
Order Number: R43017
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A Public Health Action Plan to Prevent Heart Disease and Stroke

Purpose of the plan: To chart a course for the Centers for Disease Control and Prevention (CDC) and collaborating public health agencies, with all interested partners and the public at large, to help in promoting achievement of national goals for preventing heart disease and stroke over the next two decades—through 2020 and beyond.

Heart disease and stroke are among the nation’s leading causes of death and major causes of disability, projected to cost more than $351 billion in 2003. In the next two decades, these conditions can be expected to increase sharply as this country’s “baby boom” generation ages. The current disease burden, recent trends, and growing disparities among certain populations reinforce this projection.

Yet these conditions are largely preventable. As expressed in the Steps to a HealthierUS initiative from Secretary of Health and Human Services Tommy G. Thompson, the long-term solution for our nation's health care crisis requires embracing prevention as the first step. To reverse the epidemic of heart disease and stroke through increasingly effective prevention, action is needed now.

A Public Health Action Plan to Prevent Heart Disease and Stroke addresses this urgent need for action. Key partners, public health experts, and heart disease and stroke prevention specialists came together to develop targeted recommendations and specific action steps toward achievement of this goal, through a process convened by CDC and its parent agency, the U.S. Department of Health and Human Services (HHS).

CDC and public health partners will provide national leadership to assure meaningful progress in implementing the plan. This includes bringing the public health community together with new and existing partners representing every interested segment of society. An important aspect of this process is continuing coordination between CDC and the National Institutes of Health (NIH), HHS, which is the co-lead agency with CDC for the heart disease and stroke focus area of Healthy People 2010.

Today, support for public health programs to prevent heart disease and stroke remains low, constituting less than 3% of the aggregate budget of our state public health agencies. Despite substantial public health gains in recent years, the failure to halt and reverse the epidemic has been extremely costly. Numbers of victims and health care expenses will only escalate unless the epidemic is reversed.

Fortunately, a new promise of success exists today. We have knowledge from decades of research and experience, especially because of the contributions of NIH and the American Heart Association. We also have a growing commitment to prevention, exemplified by the Secretary's Steps to a HealthierUS initiative. And we have the potential collaboration of many major national partners.

The Action Plan represents a comprehensive public health strategy to assist in addressing the Healthy People 2010 goal of improving cardiovascular health through the prevention, detection, and treatment of risk factors; early identification and treatment of heart attacks and strokes; and prevention of recurrent cardiovascular events. This strategy depends on a balanced investment in all available intervention approaches, from policy and environmental changes designed to prevent risk factors to assurance of quality care for the victims of heart disease and stroke, and it includes education to support individual efforts to prevent or control risk factors.

To successfully implement the plan, two fundamental requirements must be met. First, we must communicate to the public at large and to policy makers the urgent need and unprecedented opportunity to prevent heart disease and stroke. Second, we must transform the nation’s public health infrastructure to provide leadership and to develop and maintain effective partnerships and collaborations to support the needed actions.

Date of Report: March 27, 2013
Number of Pages: 120
Order Number: G1314
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National Synthetic Drugs Action Plan: The Federal Government Response to the Production, Trafficking, and Abuse of Synthetic Drugs and Diverted Pharmaceutical Products

It is urgent that parents of teenagers become fully informed on the risks associated with synthetic drugs, also known as “designer drugs.” The United States – especially parents and their teenage children -- face an array of drugs of abuse. Many, such as cocaine, heroin, and marijuana have confronted us for decades. The federal government has developed programs and initiatives to combat these drugs—to prevent use, treat the addicted, and disrupt production and the marketplace for drugs. But the significant threat to the nation posed by synthetic drugs, especially methamphetamine and MDMA, or “Ecstasy,” is a more recent phenomenon. A related threat is the growth in nonmedical use of pharmaceutical controlled substances. Diversion of these legitimate drugs is fueled in part by easy access over the Internet. The most recent NSDUH and other data indicate that we continue to confront increased use of such drugs, notably pain relievers and tranquilizers. This document recommends some new approaches to address this challenge.

The United States and its parents face an array of drugs of abuse by teenagers and students. Many, such as cocaine, heroin, and marijuana have confronted us for decades. We have developed programs and initiatives to combat these drugs—to prevent use, treat the addicted, and disrupt production and the marketplace for drugs. The significant threat to the nation posed by synthetic drugs, especially methamphetamine and MDMA, or “Ecstasy,” is a more recent phenomenon. Initial efforts to confront synthetic drugs are already showing results. As demonstrated by the findings of the most recent National Survey on Drug Use and Health (formerly known as the National Household Survey on Drug Abuse) and the 2003 Monitoring the Future study, when we collectively push back, the synthetic drugs threat also will decline.

A related threat is the growth in nonmedical use of pharmaceutical controlled substances. Diversion of these legitimate drugs is fueled in part by easy access over the Internet. The most recent NSDUH and other data indicate that we continue to confront increased use of such drugs, notably pain relievers and tranquilizers. This document recommends some new approaches to address this challenge.

This document is a product of the hard work of the Department of Justice Criminal Division’s Narcotic and Dangerous Drug Section, in cooperation with the Drug Enforcement Administration and several other agencies, and in consultation with various components of the Department of Health and Human Services. We are grateful for their efforts. The Action Plan represents an important step forward in our nation’s effort to control dangerous synthetic drugs and pharmaceutical products and, moreover, in the continued achievement of the objectives set forth in the President’s National Drug Control Strategy.

Date of Report: March 20, 2013
Number of Pages: 74
Order Number: G1312
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Railroad Retirement Board: Retirement, Survivor, Disability, Unemployment, and Sickness Benefits

Scott Szymendera
Analyst in Disability Policy

The Railroad Retirement Board (RRB) administers retirement, survivor, disability, unemployment, and sickness insurance for railroad workers and their families. This report describes Railroad Retirement Act (RRA) and Railroad Unemployment Insurance Act (RUIA) eligibility requirements, benefit types and compensation amounts, and program financing. This report also covers temporary extended railroad unemployment benefits enacted since 2009.

During FY2012, the RRB paid $11.3 billion in retirement and survivor benefits to about 573,000 beneficiaries. Unemployment and sickness benefits totaling $89 million, including over $7 million in temporary extended unemployment benefits, were paid to approximately 26,000 claimants.

Because of sequestration, railroad unemployment and sickness benefits will be reduced by 9.2% effective March 1, 2013. Sequestration does not affect railroad retirement, survivor, or disability benefits.


Date of Report: March 14, 2013
Number of Pages: 13
Order Number: RS22350
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