Virginia’s juvenile and domestic relations district court (JDR) handles all cases that concern the welfare of a child, including child custody, visitation and support. The JDR looks at all aspects of both parents’ ability to provide support for the child, such as income, social security benefits, medical insurance, daycare expenses and living arrangements before it makes a determination about child support, which includes the division of unreimbursed medical costs.
Virginia Child Support Guidelines
The state of Virginia has a set of guidelines in place for determining child support in both shared and split custody cases. In addition to basic child care expenses, parents have a duty to pay unreimbursed medical costs for children. Unreimbursed medical costs include services such as co-pays and deductibles, which are not covered by insurance. These child support guidelines break down what each parent is expected to pay when there are unreimbursed medical costs over $250 per child per year.
In 2013, Virginia updated the state child support guidelines to reflect a change in the threshold amount for out-of-pocket medical costs split between parents from $100 to $250 per child per year. The new $250 regulation is the most common amount of all state guidelines, and is the average out-of-pocket medical expense amount for children nationwide. This guideline means that after the $250 threshold is reached, the non-custodial parent is responsible for a portion of the medical bill, as determined by the court.
This updated guideline frees up time and resources for all parties. For example, a $150 eyeglasses prescription, paid out of pocket, no longer requires that a receipt be submitted for payment to the Virginia Division of Child Support Enforcement (DCSE).
Splitting Unreimbursed Medical Expenses
However, if glasses, prescription medications, orthodontics, prosthetics or mental health services, such as therapy and counseling, incur a bill of over $250, then both parents split the cost in proportion to their gross income. This means that if you make $60,000 in gross income a year, and your ex-wife makes $30,000 a year, you will be responsible for two thirds of the medical bill.
Medicaid and FAMIS
Some families qualify for Medicaid or Family Access to Medical Insurance Security (FAMIS), both of which have low to no out-of-pocket costs for medical care, including vision and dental. Families that qualify for these programs may never reach the $250 yearly threshold. FAMIS insures children from families whose income is 200% or less of the federal poverty level. Medicaid has the lower income eligibility of 133% and comes at no cost to the family. 55% of Virginian children are enrolled in Medicaid.
For families that do not qualify for Medicare or FAMIS, the amount of yearly unreimbursed medical costs is impossible to predetermine, because it varies widely from child to child. Healthy children typically only incur the costs of a well-child visit, which is considered an essential health benefit, and is not subject to cost sharing. However, other children may need eyeglasses, expensive prescription medications, or developmental services. Cost sharing for these families depends on gross incomes, insurance plan structure and out-of-pocket capped amount.
Challenging Support Amounts
The payment amounts detailed in the child support guidelines are presumed correct, but can be challenged by either parent if the payment amount is thought to be unfair to parent or child. However, only a court can decide to grant an amount different from those in the child support guidelines. Many factors are considered when determining the amended support amount, including a child’s special needs, additional family members, and debt and tax consequences, among others.
If your income changes by 25%, typically due to loss of a job, you can ask the court to change the child support order, including the amount of unreimbursed medical expenses you are accountable for. You may also request a review if a child needs to be added or taken off of your support order, if your health insurance costs have changed, or if there are substantial unpaid medical or dental bills. Regardless of whether you request a review, DCSE reviews all child support orders every 36 months.
Payment of Support to DCSE
Payment for medical costs over the threshold are paid directly to DCSE, as are all other child support payments. But what if you don’t think non-essential medical care is needed? Unreimbursed medical costs can become a source of contention for some parents if both parties don’t agree about the use of medical services. For example, if you think that your child needs braces, but your ex-wife disagrees, the court can make a determination of whether orthodontic work is needed or not.
Contact the Child Support Attorneys for Dads!
Child support laws in Virginia can be complicated and confusing, so it’s a good idea to contact a child support lawyer who will keep your best interests in mind. If you have questions about your specific case, contact the experienced attorneys at The Firm for Men to schedule a consultation by calling 757-383-9184. We’re located in the heart of Virginia Beach and are proud to serve all of Hampton Roads.