Legislature(1999 - 2000)
02/24/2000 03:06 PM House HES
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
HB 300 - MEDICAL SUPPORT ORDERS FOR CHILDREN Number 1440 CHAIRMAN DYSON announced the next order of business as House Bill No. 300, "An Act relating to the establishment and enforcement of medical support orders for children; and providing for an effective date." Number 1467 BARBARA MIKLOS, Director, Central Office, Child Support Enforcement Agency (CSED), Department of Revenue, came forward to present HB 300. Her agency has requested that this legislation be introduced because it will better serve the public. The bill makes three changes to existing statute. First it allows the CSED to establish a medical support order only. Right now the courts and the CSED establish financial support orders that require a monthly support obligation, and in conjunction with that, there is a medical support order. There isn't the option under state law just to establish a medical support order. This becomes a problem for some people in Medicaid or Denali KidCare because the federal government requires CSED to have a medical support order. When the order is established, it comes along with a monthly support obligation which is not necessarily what the parents want. MS. MIKLOS explained that a medical support order would order either parent to provide health insurance for the child if it is available to the parent at reasonable cost. The federal definition of reasonable is health insurance available through the parent's employer. The state has further defined it by saying if it is available through work but may be expensive, it wouldn't necessarily be considered reasonable. As far as the federal government is concerned, if someone has health insurance available, he/she must provide it. If it's not available, it doesn't mean he/she can't provide it. There are still other ways to provide cost of medical care, and that is defined in some of the child support orders. The intent is the public will not pay for the child's health care if the parents can provide for the child. MS. MIKLOS said the way it is now, when the orders are done, the financial order comes along with it. Some people don't want to go on Medicaid or Denali KidCare because they don't want a child support order. The CSED prefers to give the parents that choice but cannot give them that choice right now under state law. Sometimes when people go on Medicaid, they'll have a financial support order, and the CSED will not enforce that order, and the obligation will continue to accumulate. The CSED would like to make it simpler by having the option of just doing a medical support order. MS. MIKLOS explained the second change in the law says that either parent may be required to provide health insurance, not just the obligor. Court Rule 90.3, Guidelines for Child Support, already says that; the CSED would like to have that in statute. MS. MIKLOS said the third change just clarifies that the order may be established before the order is in place, but the order is not in effect until the insurance is in place. MS. MIKLOS summarized that HB 300 helps the public, helps the CSED and is consistent with federal law. Number 1722 REPRESENTATIVE GREEN asked if a family couldn't afford insurance, would it be in contempt if insurance wasn't provided. MS. MIKLOS replied no, not at all. Insurance is only required if it is available at reasonable cost. The original intent when Congress passed this years ago was that if someone had a first family, and that first family didn't have insurance available and had public insurance, but then the person had a second family on insurance, then the children from the first family would be included on the insurance. REPRESENTATIVE GREEN asked who determines reasonable cost. MS. MIKLOS answered CSED would make that original determination. Someone may appeal that decision through a hearing within the Department of Revenue or further through the court. People have an opportunity to say it is not reasonable. She further explained there are circumstances when parents work things out and would choose not to be involved and choose not to get a financial support order, and the CSED would like to honor those requests. CHAIRMAN DYSON asked how someone would accumulate a debt from the support orders. MS. MIKLOS explained in order to do a medical support order now, the CSED also has to put on a financial obligation. The CSED is not enforcing the financial obligation, so the debt for the monthly support obligation still accumulates. There are rules that must be done consistently so the amount for the financial order could not be zero; the obligation is based on how much money is earned by the parent. The CSED doesn't want to be in the position of collecting a debt that no one wanted in the first place, and HB 300 will do that. If the bill doesn't pass, the CSED has to continue to put on debts. CHAIRMAN DYSON asked if the state starts supporting a custodial parent and children, and a debt starts accumulating to the non- custodial parent, and the children are covered under Denali KidCare, does the non-custodial parent owe a debt to reimburse the state and the federal government for the insurance costs obligated under Denali KidCare. MS. MIKLOS answered no. CHAIRMAN DYSON asked Ms. Miklos why does it say "insurance" instead of just saying the parents have to provide for the children's medical needs. Number 2175 MS. MIKLOS admitted it never occurred to them. In terms of child support, the CSED has gone as far as required by the federal government which is that the insurance be available. In terms of providing for medical care, there could be a lot of problems, but it wouldn't necessarily be a child support issue. The CSED is only trying to separate out the medical support order from the financial support order to make it easier for people. CHAIRMAN DYSON said it sounds like the bill is trying to remove the administrative barrier to get children signed up for Denali KidCare. MS. MIKLOS agreed that might be one of the things, but it is not the only thing. It is also that there are debts accumulating in existing cases in the Medicaid program; a debt goes on that no one really wanted in the first place. In response to a question by Representative Coghill, Ms. Miklos explained that if any family goes on Medicaid, CSED must go after medical support, and that is why the CSED is involved. Number 2284 REPRESENTATIVE KEMPLEN asked Ms. Miklos how the CSED will address the orders that have been accumulating but not enforced under HB 300. MS. MIKLOS said ways are being looked at to reestablish an order that would be medical support only if it can be done. MS. MIKLOS explained the intent of a financial support order originally was to reimburse the state and federal government for public assistance, and a medical support order was for medical assistance. The first choice is for the parents to support the children. TAPE 00-21, SIDE B Number 2364 REPRESENTATIVE WHITAKER asked Ms. Miklos for clarification on the connection of a parent providing health coverage if it is at a reasonable cost and Denali KidCare. MS. MIKLOS said she is not the expert on Denali KidCare so she can only go so far. The idea is if someone is on the Medicaid program, the state's obligation for that program would be reduced if there is other insurance available. She doesn't know if the obligation goes totally away; all she knows is the state's obligation is reduced. REPRESENTATIVE WHITAKER asked if he heard correctly that there was an inference that this was somehow tantamount to increasing the number of children on Denali KidCare. MS. MIKLOS stated that HB 300 would not make more people qualify for Denali KidCare. It's just that there may be people that wouldn't get involved at all because of the financial issue. Number 2215 CHAIRMAN DYSON informed the committee he does not intend to move HB 300 out today so there will be time to have other questions answered. REPRESENTATIVE KEMPLEN asked how the CSED will deal with the paper debts that have been accumulating. MS. MIKLOS answered as long as the custodial parent does not want CSED to enforce the paper debt, it won't. If the custodial parent asked CSED to enforce the paper debt, it would have to. REPRESENTATIVE KEMPLEN commented he would like CSED to commit to getting those paper debts off the books if HB 300 passes. CHAIRMAN DYSON asked Ms. Miklos for responses on the following: 1) Representative Kemplen's last question; 2) where and why in the law it says "medical insurance" and doesn't say "medical care"; 3) the portion of the bill that fixes the accumulating paper debt; 4) the definition of the criteria of "reasonable"; why isn't it a certain percentage of the income. REPRESENTATIVE COGHILL said he was interested to know if a debt on responsible health care delivery can be levied against the obligor. Number 2086 REPRESENTATIVE GREEN asked if the accumulated paper debts include some bad debts that shouldn't be eliminated. MS. MIKLOS said the bad debts will not be eradicated. That is why the bill would not be effective the day the Governor signs it. If possible, the old order would be vacated and a new order established separating those debts out. She cannot definitely answer that will be done, but that is what is being looked at. CHAIRMAN DYSON asked if the paper debts were accumulating with interest and penalties. Number 1919 MS. MIKLOS answered yes. CHAIRMAN DYSON suspended the hearing on HB 300. [HB 300 was heard and held.]
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