Make no mistake; the Court will assign as medical child support who pays for and who obtains health insurance for the children included in a custody lawsuit. The Judge will consider what health insurance plans are available, which parent or conservator should enroll the children and on what plan, and who is to pay how much.
In any suit affecting the parent-child relationship in Texas, whether it is part of a divorce with children or simply a stand-alone cause of action, the Court must specify the manner in which healthcare coverage is to be provided. First, the Court will consider what options are available. Could this be through a parent or conservator’s work? Could it be through the “Obamacare Marketplace” now available online? Could it be through services for indigent care through the State of Texas? The Court will elicit responses to these questions and require the parties to obtain information to allow a reasonable determination as to what is available.
Second, the Court will determine what money is available to pay for the costs of obtaining the selected coverage. As you can see right away, if the parties have no funds to pay for healthcare insurance, the Court will likely order a party to seek enrollment in a State-funded program, such as Medicaid, that will cover the children adequately. Likewise, if sufficient funds are available, then the Court will direct funds to go for the “reasonable cost” of covering the children on the selected private plan.
So what is a “reasonable cost” under the Texas Family Code? Anything at or under 9% of a party’s annual resources is the answer found in Section 154.181(e) of the Code. As an example, that means a party making $100,000 per year could be held accountable for up to $9,000 of health insurance coverage. In other words, so long as premiums to include children on the coverage would be $750 or less per month, then the Judge would order that party to either pay the premiums directly or reimburse the other party if the other party paid the premiums directly.
Third, the Court will likely order this obligation to continue so long as the children are considered under the continuing exclusive jurisdiction of the Court (i.e., under 18 and not yet graduated high school, not otherwise emancipated, not under special needs, or a continuing disability, etc.).
Finally, that leaves the Court to its discretion to allocate between the parties the percentage each will be responsible to pay for those expenses that the insurance plan fails to cover, such as deductibles, co-pays, and services/products not covered under the plan. The Court will usually take a 50/50 approach, but it can assign the costs as it sees fit after considering the available resources of each party.