1. + IV-D & the ACA It’s time to collaborate

2. + The Affordable Care Act Most significant change in social policy in a very long time Affects every American in some way Remains controversial – but it is the law

3. + Medical Support 101 All child support orders enforced pursuant to Title IV-D of the Social Security Act “shall include a provision for medical support for the child to be provided by either or both parents.” State agencies administering IV-D programs will “enforce medical support included as part of a child support order whenever health care coverage is available to the noncustodial parent at a reasonable cost.” At State option, the State IV-D agency may enforce medical support against a custodial parent when it’s available at a reasonable cost. “Medical support may include health care coverage such as coverage under a health insurance plan (including payment of costs of premiums, co-payments, and deductibles) and payment for medical expenses incurred on behalf of a child.”

4. + And then came the ACA…. AT-10-02: State IV-D agencies not penalized if the State IV-D agency is not in compliance with the 2008 federal medical support regulations. IV-D agencies must continue to provide medical support enforcement services. AT-10-10: Provide States with the flexibility to improve interoperability between IV-D and Medicaid and CHIP. OK to define medical support to include private health care insurance as well as Medicaid, CHIP, and other state coverage plans, and cash medical support, and/or Update medical support guidelines, including modifying the definition of “reasonable cost”; and/or Continue current and planned medical support policies and practices.

5. + Who’s Who in the ACA Internal Revenue Service (IRS) Center for Medicare & Medicaid Services (CMS) Center for Medicaid and CHIP Services (CMCS) Center for Consumer Information and Insurance Oversight (CCIIO)

6. + Common Goal To ensure all Americans have access to quality, affordable health care coverage. Given the ACA, what should the role of child support be, in establishing and enforcing medical support?

7. + Who needs to be at the table? Medicaid (MediCal) Medicaid no longer “the coverage of last resort” Medicaid referrals & cooperation requirements – and sanctions

8. + Who needs to be at the table? What about the NMSN? Employers Cash medical

9. + Who needs to be at the table? Automation No data sharing from the Federal Marketplace, but State Marketplaces have more discretion

10. + Who needs to be at the table? Support orders Guidelines Tax deduction for dependents Cash medical

11. + How you can reach me Kathy Sokolik, Sr. Strategist SRA, International Inc. On contract to ACF/OCSE – Central Office Kathy.sokolik@acf.hhs.gov 707-373-2975 (CA)