Legal Questions About Child Support Medical Expenses, Answered

anaging costs is one of the most important health issues co-parents face after divorce. Expenses related to a child’s health care, like ER trips, procedures, and medication should of course be split between the parents. And while it may seem straightforward, figuring out who’s responsible for paying to keep your kids healthy is complicated in practice.

It’s not always as simple as a 50/50 split. Often, one parent is paying child support to the custodial parent. For the parent writing the checks, shelling out additional money for unexpected doctor’s office visits and emergency dental work can be an unpleasant surprise. They might expect that the child support they pay covers all aspects of childcare costs, including medical expenses.

However, divorced parents would be wrong to assume that child support is all encompassing. Those regular payments are not appropriate for all medical expenses. For example, what if one child needs braces? Most of the time, specific payments for orthodontic care are not spelled out in a child support court order. Still, their exclusion doesn’t mean that no one is responsible for the payments. Both parents still have an obligation to kick in money — and an obligation to figure out how much each will pay.

This article will focus on your children’s medical and dental expenses above and beyond the amounts courts set down for the payment of child support. We’ll look at the payment and sharing of child support medical expenses between custodial and non-custodial parents. This will include:

• Providing medical insurance
• Each parent’s responsibility for medical expenses not covered by insurance, like copays and other out-of-pocket items
• Expensive non-emergency medical and dental care (e.g., plastic surgery and orthodontics)
• Strategies for effectively and fairly splitting child support medical expenses

Basics: Insurance and Uninsured Expenses

As you’re probably aware, after a divorce your obligations to your ex and your children are set out in a court order. These obligations include spousal support (alimony) and child support.

In its most basic form, child support equalizes child care expenses between the custodial parent and the non-custodial parent. In plain language: If a child spends more time with one parent, that parent typically spends more money on that child because they are present for day-to-day needs. Child support is a way for the other parent to share in those costs and make things more equal.

Health insurance coverage is one of the most important costs of raising a child. Keeping your kids healthy is a high priority for every parent. Nonetheless, basic child support payments don’t usually cover most of the medical costs that the custodial parent will face.

It may make sense to include costs for scheduled checkups and wellness visits in a child support order. But those routine medical appointments are not the biggest driver of health care costs. The most expensive items will instead be health insurance and medical expenses that aren’t covered by insurance. As a rule, these medical expenses won’t be covered by child support. They must be paid on top of agreed-upon support arrangements.

Depending on the state and situation between co-parents, the child support order may require the non-custodial parent to provide health insurance (as well as dental/vision insurance) for the child, along with any health insurance premiums.

Most of the time, health insurance policy premiums will comprise the majority of children's health care expenses. But because medical needs are impossible to predict, other child support medical expenses inevitably arise. And that is when things can get tricky.

Uninsured Child Support Medical Expenses

Many health care costs aren’t covered by health insurance. They include deductibles, copays, and out-of-network costs charged by medical and dental providers. These expenses are collectively referred to as uninsured medical expenses.

As anyone who has visited an emergency room knows, medical bills can be as enormous as they are unexpected. Their inherent unpredictability makes it difficult to quantify those expenses in advance and include them in child support payments. As a result, they usually aren’t included in a court’s child support order.

Child support guidelines for uninsured medical expenses (also known as medical support) differ from state to state. Most of the time, however, these expenses will need to be split 50/50 between co-parents. This will often take the form of the custodial parent paying up front and then asking the other parent for reimbursement.

If the parties are unable to fairly split the costs between themselves, a court may get involved and either enforce or amend the court order to make the arrangement about child support medical expenses clear.

Going to court for child support medical expenses is an expensive and time-consuming process. That’s not to say that conversations with your ex about money are any picnic either, but those conversations can help you avoid a more difficult and expensive conversation with a family court judge.

So, even though talking with your ex about paying for medical expenses matters can be unpleasant, getting over the discomfort is worth it. A little communication can go a long way toward saving you both a lot of money and trouble, particularly with regard to hospital bills or other unexpected emergency care.

Expensive Non-Emergency Care

Emergency medical treatment is the most dramatic and easiest to grasp example of uninsured medical expenses not covered by child support. But it’s not the only one. Non-emergent care, for occasional non-life-threatening issues or for ongoing conditions that your child might have, is also often outside of the scope of child support payments.

For example, your child might need weekly speech therapy. An even more common example is orthodontic care: braces, bionators, and other treatment for dental and jaw conditions in children.

Child support arrangements may or may not include non-emergent medical expenses. It differs from case to case and whether parents recognize the need for including them in support payments. For instance, if you and your spouse divorce as your child is being evaluated by an orthodontist, it would be wise to make sure that those child support medical expenses are included in the court’s order. The same could be true for therapy or corrective plastic surgery.

Assuming that the need for non-emergent medical treatment didn’t become apparent until after the divorce, the treatment will likely be considered an uninsured medical expense that needs to be split in the way that emergency care would. You’ll want to lean on tools and resources that were built to handle this exact situation.

Tools for Handling Child Support Medical Expenses

Efficient communication and planning tools are your best friend when it comes to child support medical expenses. One of the easiest ways to do this is to create a shared calendar relating to all the medical treatments coming up for all your kids. That way, both co-parents can see what needs to be done and the likely costs.

Talks involving family finances can be especially delicate after divorce. Having an expense sharing app can be a lifesaver. All parents need to talk about needs and expectations surrounding health care coverage and costs.

The Onward app is a convenient, flexible way to keep track of all expenses regarding your children and propose fair splits of those expenses with your spouse. Being able to have those conversations without the emotional baggage and context that might be present in an email or phone call greatly reduces stress and the potential for misunderstanding.

Onward is particularly helpful for adding unexpected expenses as they come up, as uninsured medical expenses often will. After you add the child support/medical expenses you need reimbursed into the Onward system, your co-parent will get a notification saying they need to pay you back.

Or, you can propose a future cost after receiving an estimate for a treatment so your co-parent can prepare for the bill. No nagging or awkward text exchanges needed!

Staying on Good Terms (and Out of Court)

Having children is wonderful. The stress that can come from trying to keep them alive and healthy? Not always so wonderful. As with other aspects of your divorce, try and plan what you can in advance. When you can’t do that, good communication and mutual cooperation is key to making it work.

The last thing anybody wants is to go back to court. The Onward app and other communication can help you get problems resolved quickly and without involving lawyers. Instead of stewing in court or mediation, you and your family have more time to enjoy your health and your life together.

Matthew Carter has been a licensed attorney since 2004. He has successfully handled a variety of trials, appeals, and evidentiary hearings throughout state and federal courts. Matthew has done pro bono work in the Las Vegas community representing foster children and helping reunite families separated in the Las Vegas family court system.