I am writing in my role of President of the National Council of Child Support Directors to request that your office review the position that OCSE is taking in regard to the establishment of a performance indicator for medical support. We all are in agreement that obtaining medical coverage for children is good public policy. However, obtaining this coverage is not solely a function of the IV-D Agency. Since the inception of the S-Chip program, many children are covered under that program, or under the traditional Medicaid Programs.

While I understand that the federal statutes mandate a performance measurement for child support in the medical area, I strongly recommend that we step back and determine the following: "What is the purpose of the medical indicator?" Is the reason that we have an indicator to ensure that as many children as possible have access to health coverage? If the answer to that question is yes, then a performance measurement for child support will not get us where we need to go. Child support plays a role in that mission, but other agencies play a much larger role.

A number of IV-D Directors and IV-D staff participate on the medical group that is looking at this issue. While the preponderance of states expressed strong reservations about establishing any indicator at this time, it is my understanding that OCSE has determined that a measurement will be established.

The representatives, with whom, I have been in contact, have stated that they are not in favor of any indicator at this time, but if they had no choice an "establishment" indicator would be preferable.

As you are aware, the medical working group issued their report of the 76 recommendations that the group believed were necessary to improve the delivery of medical support to children. These recommendations are being reviewed by the IV-D Directors and will be discussed at the meeting in Williamsburg. Some of the recommendations may be problematic in some states, but many others will assist in the establishment of medical support. However, these recommendations have not been promulgated in statute, regulations, or technical assistance. One of the major recommendations strongly endorses an enhanced FFP in order to improve the area of medical support.

Creating a medical indicator for establishment, even if the implementation is postponed, will not accomplish the goal that we have jointly undertaken. It will only measure what most of us are already doing, establishing medical support as part of the court order. This does not make medical coverage available; it merely gives a legal basis to pursue the coverage.

The establishment of an indicator will only serve to highlight the flaws in the automated systems in tracking the data, even though many states are obtaining orders. It will distort the payment of incentives, merely redistributing the amount that is already being disbursed. But, because of the cap on the incentive pool, this will not be an incentive to do better, as no additional money will be paid to the states.

I urge you, instead, to postpone even considering a measurement. Advise Congress that the IV-D community and OCSE is meeting with HCFA, the employers, and the other players in the medical community to find a way to actually obtain the medical support for children that we all support. The postponement of an indicator, or perhaps the establishment of a "high performance bonus" for getting kids health care coverage, no matter what the method, would encourage the various players in the state to work together to accomplish this common goal.

We hope that you will consider the postponement of any decision until after our meeting in Williamsburg. I look forward to your response.