TPL

1
TPL Medical Support Enforcement

• Are You Working Together?

2
Child Support Background

• 24B in total child support collections
• National cost effectiveness ratio is 4.73
• 17M total cases
• 12.3M cases with orders
• 7.2M cases with medical support ordered
• 22.4 Cases with CS ordered and provided

3
Child Support Emerging Issues

• CSPIA
• Performance Measures Incentive
• Data Reliability Audits
• DRA
• Reduced IVD funding
• Repeal authority to use incentives as match for
  FFP
• Imposed 25 annual collection fee
• Reduction of federal match for genetic testing
  from 90 to 66
• New Medical Support Requirements
• Require all orders to include provision for
  medical support provided by either or both
  parents
• Allowed option to enforce medical support order
  against custodial parents
• Expands definition of medical support to include
  cash contributions

4
Child Support Emerging Issues

• Final Medical Support Regulations July 2008
• Defines cash medical and health insurance
• Defines reasonable cost
• Requires states to consider health care coverage
  from either parent
• CP enforcement optional
• Requires guidelines to address how parents will
  provide for health care needs
• All orders include provision for medical support
• Accessible and available
• Requires order for cash medical until private
  health insurance becomes available
• Requires all orders to include provision for
  medical support
• backlog
• Gives current support priority over medical
  support in withholding

5
Need for Collaboration

• CS cases typically require CP cooperation
• Some Medicaid programs do not require cooperation
• Unworkable Medicaid cases may cause loss of
  financial incentives available to IVD agency
• CS cases built around family relationships
• Medicaid eligibility built around household
  relationships
• Determining the existence of an assignment must
  often be determined on a case-by case-basis

6
Need for Collaboration

• Cases do not stay synchronized
• CS cases typically include court/adm orders which
  are intended to last a long time
• Medicaid eligibility may change frequently as
  household compositions change
• Cash medical collections will increase
• How to handle fee-for-service
• Over payments may be likely
• Cases may require management with manual
  intervention

7
Need for Collaboration

• Agency Administration
• Differing agency structures
• Case Management Systems
• MMIS vs. Child Support System
• Financing

8
Benefits to Collaboration

• Increase cost avoidance
• 63m in Massachusetts
• 740m in Texas
• Lewin Group conducting Cost avoidance study
• Increase cost recovery
• 51m in Texas
• Improved SCHIP coordination
• Decrease duplication of efforts by sharing
  insurance information
• KY NMSN collaboration
• Carrier match non-custodial parent link
• Child Support Insurance Solution

9
Questions

• Barbara Saunders
• HMS
• [phone]
• bsaunders_at_hms.com