Wisconsin Administrative Code › Department of Children and Families › DCF 101-199 - Family and Economic Security › Chapter DCF 150 - Child Support Standard › Section DCF 150.05 - Medical support

Current through June 24, 2024
(1) RESPONSIBILITY FOR HEALTH EXPENSES. In
				addition to ordering child support for a child under this chapter, the court
				shall specifically assign responsibility for and direct the manner of payment
				for the child's health expenses under s.
				767.513,
				Stats.
(a) In this section, " private health
				insurance" does not include a medical program under subch. IV or V of ch. 49,
				Stats.
Note:
The BadgerCare Plus program under s.
				  49.471, Stats.,
				  is in subch. IV of ch. 49, Stats.
(b) Except as provided in pars. (d) and (e),
				the court may order either or both parents to enroll a child in a private
				health insurance plan that is accessible to the child and available at a
				reasonable cost, as follows:
1. The court may
				consider a private health insurance plan to be accessible to the child if the
				plan's service providers are located within a reasonable distance from the
				child's home. In general, service providers may be considered within a
				reasonable distance if they are located within 30 minutes or 30 miles of the
				child's residence, with a greater distance allowed in some rural
				areas.
2. The court may consider a
				private health insurance plan to be available at a reasonable cost if the cost
				of the policy does not exceed 10% of the insuring parent's monthly income
				available for child support and would cover hospitalization and other medical
				costs without large out-of-pocket deductibles or copayments. The 10% standard
				applies to the full cost of the health insurance, including the cost of
				self-only coverage and the cost to that parent after adding the child or
				children.
3. The court may order
				the non-insuring parent to contribute to the cost to enroll the children in a
				private health insurance plan in an amount that does not exceed 10% of the
				non-insuring parent's monthly income available for child support. A
				contribution to the cost to enroll the children may not exceed the cost to add
				the child or children to existing coverage. If the parent ordered to enroll the
				children does not have single coverage, a contribution to the cost to enroll
				the child or children may not exceed the difference between the cost of single
				coverage and the cost to the insuring parent to add the child or
				children.
4. The court may
				incorporate responsibility for a contribution to the cost of private health
				insurance as an upward or downward adjustment to a payer's child support
				obligation.
Note:
The cost to enroll a child in a private
				  health insurance plan and a contribution to the cost are in addition to a
				  parent's responsibility for child support. The court would order an upward
				  adjustment to a payer's child support order if the payee is the insuring parent
				  and the payer is contributing to the cost. The court would order a downward
				  adjustment to the payer's child support obligation if the payer is the insuring
				  parent, the payee is contributing to the cost, and the payee's contribution is
				  less than the payer's child support amount.
(c) The court may not order a parent whose
				income is below 150% of the federal poverty level to enroll a child in a
				private health insurance plan or contribute to the cost of a private health
				insurance plan unless there is no cost to the parent.
(d) If there is no private health insurance
				plan available that meets the requirements of par. (b), the court may order any
				of the following:
1. Enrollment in a private
				health insurance plan as a deviation under s.
				767.511(1m),
				Stats.
2. Responsibility for a
				contribution to the cost of the other parent's premium for the BadgerCare Plus
				program under s.
				49.471, Stats.,
				unless the parent's income is below 150% of the federal poverty level. The
				court may incorporate responsibility for a contribution to the cost of the
				premium as an upward or downward adjustment to a payer's child support
				obligation.
3. Enrollment in a
				private health insurance plan if a plan that meets the requirements of par. (b)
				becomes available to the parent in the future.
(e) If a person other than a parent has
				enrolled a child in an accessible private health insurance plan that covers
				hospitalization and other medical costs without large out-of-pocket deductibles
				or copayments, the court may determine whether to order a parent to enroll the
				child in a private health insurance plan.
(f) The court shall also establish an order
				for medical expenses that are not covered by insurance. The court shall
				consider each parent's ability to pay these medical expenses.
(g) The court shall consider the impact of
				the dependency exemption on the availability of insurance in the marketplace
				and the imposition of penalties under applicable federal law.
Note:
The following example shows how to apply
				  the reasonable cost standard.
Parent A: $4,500 monthly income available for child support
				  10% = $450
Parent B: $2,500 monthly income available for child support
				  10% = $250
Parent A's employer-sponsored insurance:
$230/month out-of-pocket cost for self-only coverage
$210/month out-of-pocket cost to add the child or
				  children
$440 total monthly out-of-pocket cost for the policy. ($440
				  < $450. Therefore, the total out-of-pocket cost of the policy does not
				  exceed 10% of the insuring parent's income. This is considered
				  reasonable.)
--Parent A may be ordered to enroll the child or children and
				  contribute up to $440.00/month for the policy.
--Parent B may be ordered to contribute up to $210/month
				  toward the cost. ($210 = lesser of 10% of Parent B's income or cost to add the
				  children)
--The court may incorporate responsibility for a contribution
				  from Parent B to the cost of health insurance as a downward deviation to Parent
				  A's child support obligation.
--The court shall consider the out-of-pocket cost for
				  self-only coverage for Parent B when determining a reasonable contribution from
				  Parent B to the cost of health insurance provided by Parent A.