Medicaid:

Ensuring that Noncustodial Parents Provide Health Insurance Can Save Costs

HRD-92-80: Published: Jun 17, 1992. Publicly Released: Jul 24, 1992.

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Pursuant to a congressional request, GAO evaluated state and federal efforts to ensure that noncustodial parents with available health insurance resources cover their Medicaid-eligible children.

GAO found that: (1) states are not ensuring that noncustodial parents provide health insurance to their children; (2) states and the federal government could save about $122 million annually if noncustodial parents provided insurance available through their employers; (3) federal requirements permit wide variability in state laws enforcing medical support; and (4) employer health plans covered by the Employee Retirement Security Act of 1974 (ERISA) can exclude noncustodial parents' children from coverage, and states cannot compel coverage with their medical support requirements.

Matters for Congressional Consideration

  1. Status: Closed - Implemented

    Comments: Section 13623 of the Omnibus Reconciliation Act of 1993 requires that, effective April 1, 1994, states are to enact specified laws to ensure the compliance of insurers and employers in carrying out a court or administrative order for medical child support.

    Matter: Congress should require, as a condition of federal participation in their child support programs, that states enact laws enabling the programs to enforce health insurance requirements on employers, such as is done with income withholding for cash support.

  2. Status: Closed - Implemented

    Comments: The Omnibus Budget Reconciliation Act of 1993 implemented this recommendation.

    Matter: Congress should amend ERISA to give states the authority needed to ensure that their medical support efforts can be effective.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: Because HHS has agreed to develop outcome-oriented performance standards for medical support activities and monitor compliance, this recommendation--which was made as an alternative to the action HHS has agreed to take--is no longer applicable.

    Recommendation: The Secretary of Health and Human Services should direct the Office of Child Support Enforcement to improve state efforts to establish noncustodial parents' medical support obligations by specifying in program guidance the minimum steps and time frames that states must meet to monitor and enforce medical support obligations.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Implemented

    Comments: While HHS amended its child support audit regulations (at "Federal Register" Volume 59, No. 256, December 23, 1994) to include audits of medical support requirements, it has not changed the requirements for medical support activities since February 1991. Without changing the actual medical support requirements--i.e., laying out specific enforcement steps or performance standards that ensure that enforcement is accomplished, the extent to which the audit requirements ensure that something gets done in medical support is still questionable. Currently, the requirement is still worded "take steps to enforce...".

    Recommendation: The Secretary of Health and Human Services should direct the Office of Child Support Enforcement to improve state efforts to establish noncustodial parents' medical support obligations by developing outcome-oriented performance standards for medical support activities and monitoring whether these standards are met.

    Agency Affected: Department of Health and Human Services

 

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