On this 6th day of June 2001, the National Council of Child Support Directors resolves that:
* The work of the Medical Child Support Working Group (MCSWG), which was comprised of diverse stakeholders in the medical support enforcement process, should be commended for the breadth of topics covered in its report, synthesizing multiple perspectives and adopting a holistic approach for health care coverage for children.
* The federal Office of Child Support Enforcement, Administration for Children and Families, Department of Health and Human Services (OCSE) should immediately act on the MCSWG's non-legislative recommendations that call for:
* regulatory changes including redefining "reasonable cost" and the priority of withholding;
* coordination of actions between IV-D, Medicaid and State CHIP programs;
* research and demonstration grants to further define health care availability and the health care coverage landscape;
* technical assistance and guidance including the sharing of states' best practices; and
* a process for determining which plan provided by either custodial party or noncustodial parent is most appropriate for the child.
* OCSE and Congress should consult with state Child Support, state Medicaid and state CHIP programs, and national child support associations, such as the National Council of Child Support Directors, the Eastern Regional Interstate Child Support Association, and the National Child Support Enforcement Association to ensure consistent policies related to IV-D medical support enforcement, to refine respective roles and responsibilities, to identify MCSWG's legislative proposals for which there is consensus and specifically identify proposals that lack consensus.
* OCSE should consult with state Child Support, state Medicaid and state CHIP programs, employers and plan administrators about the content and design of the national medical support notice prior to its 10/01/01 implementation;
* OCSE should provide immediate technical assistance and outreach prior to the implementation of the notice to state Child Support, state Medicaid, and state CHIP agencies, the employers and plan administrators to ensure that all parties are engaged and fully understand the purpose of the notice.
* In its report to Congress regarding a medical support indicator, OCSE should:
* Emphasize that the IV-D community is committed to the role it plays in assuring health care coverage for children,
* Identify the cap on the incentive funds as a significant barrier to motivating and rewarding states,
* Recommend that the IV-D agency track the percentage of child support orders that are established which have an order for medical support,
* Recommend that the medical support measure not be incorporated into the performance measure system and tied to funding at this time,
* Recommend that the development and implementation of any medical support performance measure should be phased in to allow the states to implement the MCSWG's recommendations,
* Request enhanced 90 percent FFP targeted to IV-D implementation of medical support requirements for a limited 5-year period to ensure timely and consistent implementation of any of the MCSWG's recommendations that require state child support agencies to assume new responsibilities, and
* Recommend a plan for states and the federal government to work together to identify desired medical support outcomes and define the work of the IV-D program in achieving those goals; and to develop rules and provide for technical assistance to support that work.
Over 5 million children living in single parent families in America do not have health care coverage while most are eligible for either private health insurance or publicly funded coverage such as Medicaid or State CHIP. The availability of employer based health care coverage in America has been dramatically changing in terms of cost, access and comprehensiveness of coverage to families.
The Title IV-D program has had a historical responsibility to establish and enforce medical support since 1984, reinforced by Congressional amendments in 1987, 1988, 1993, 1996 and 1998.
The Child Support Performance and Incentive Act of 1998 (CSPIA) amended 42 USC Section 652(f) and Section 666(a)(19) to require that states' IV-D agencies ensure that health insurance is a part of every support order and to enforce the obligation through the issuance of a National Medical Support Notice. CSPIA also required the development of a medical support performance indicator and the formation of the Medical Child Support Working Group.
The Medical Child Support Working Group's deliberations culminated in the August 2000 issuance of the report "21 Million Children's Health: Our Shared Responsibility" presenting 76 recommendations to enhance health care coverage for our nation's children. The National Council of Child Support Directors (NCCSD) believes that obtaining medical coverage for children is good public policy, that establishment and enforcement of medical support is the responsibility of the child support program, and concurs that the recommendations contained in the report of the Medical Child Support Working Group "21 Million Children's Health: Our Shared Responsibility" would improve the access to medical coverage for this nation's children.
However, while a number of the recommendations receive the full endorsement of the IV-D community, including NCCSD, others warrant further discussion, due to differences in state structure or the need for enhanced funding.