How Is Medical & Dental Support Calculated In Texas?

Health and Dental Insurance for Children in Texas: What You Need to Know

When it comes to healthcare and dental coverage for children, Texas law has specific requirements for parents to ensure that the child’s medical needs are met. Whether you’re navigating a divorce, child custody, or child support case, understanding your responsibilities regarding insurance coverage for your child is essential. In this blog, we’ll break down Texas law concerning health and dental insurance for children, including what’s required, any cost limitations, and options like CHIP and state-funded programs.

Questions About Medical & Dental Support in Texas?

Our Dallas-Fort Worth child support lawyers help answer questions about medical and dental support to clients throughout the Dallas-Fort Worth metro area, including residents of Dallas County, Collin County, Tarrant County, Rockwall County, Denton County, Ellis County and Hunt County. Contact our Dallas family law attorneys for your initial consultation.

What Is Required in Texas Law?

Under Texas Family Code, parents are required to provide health insurance coverage for their child when it is available and affordable. The law generally holds that if either parent has access to employer-sponsored insurance, they are expected to provide that coverage to the child. The parent who is designated as the primary custodial parent is typically the one responsible for obtaining health insurance if the child is not already covered by one of the parents’ plans.

• Court Orders: When a court issues a custody order, it often includes a health insurance provision requiring one or both parents to provide coverage for the child. If a parent is ordered to provide insurance, they are also generally responsible for covering the costs associated with the child’s medical care.
• Medical Expenses: Beyond just coverage, parents are often required to split the costs of uninsured medical expenses for the child, such as copays, prescriptions, and out-of-pocket healthcare costs. These expenses should be clearly defined in a parenting plan or child support agreement.

Are There Any Caps on How Expensive Health Insurance Should Be?

Texas law does not impose a strict cap on how much health insurance should cost, but it does recognize the affordability of the insurance plan. If the cost of providing health insurance for a child is deemed unreasonable based on the paying parent’s income, the court may choose not to require that parent to provide the insurance.

The Texas Family Code has an affordability safe harbor clause, meaning that if the cost of providing health insurance for a child is more than 9% of the parent’s gross income, it may be considered unaffordable, and the parent may not be required to provide that insurance.

However, the court will still require that the child be covered, and if one parent cannot provide affordable insurance, the other parent may be required to cover the child’s medical expenses or find another way to meet the child’s healthcare needs.

What Is CHIP (Children’s Health Insurance Program)?

CHIP is a state and federally funded program in Texas that provides health insurance coverage to children from families that earn too much to qualify for Medicaid but cannot afford private insurance. It’s an affordable option for low-income families and provides comprehensive medical and dental care to children under the age of 19.

Here’s how CHIP works:

• Eligibility: CHIP covers children in families that earn up to 200% of the federal poverty level. For instance, a family of four with an income of up to $55,500 annually may be eligible for CHIP. Eligibility is based on income, family size, and other factors.
• Coverage: CHIP covers a wide range of healthcare services, including routine checkups, immunizations, doctor visits, hospital stays, prescriptions, and even dental care.
• Cost: CHIP is designed to be affordable, with low monthly premiums and co-payments based on the family’s income.

Is There Free State Coverage? How Does a Parent Do This?

While CHIP is not entirely free, it is low-cost and provides an excellent option for children who need health insurance. There is also the Medicaid program in Texas, which does provide free or low-cost coverage to children in low-income families.

Here’s how parents can access free or low-cost coverage for their children:

1. Medicaid for Children

Medicaid is a state-funded program that offers free or low-cost health insurance to children from low-income families. Medicaid covers all necessary medical care for children, including hospital visits, doctor’s appointments, prescriptions, and dental care.

• Eligibility: Children under 19 are eligible if their family’s income falls below a certain threshold. The specific income guidelines vary by family size.
• How to Apply: Parents can apply for Medicaid through the Your Texas Benefits website or by calling the Texas Health and Human Services Commission. The process involves submitting income information and other documentation to determine eligibility.

2. How to Apply for CHIP or Medicaid

To apply for either CHIP or Medicaid, parents can:

• Online: Visit the Your Texas Benefits website and complete an online application.
• Phone: Call 211 or the Texas Health and Human Services Commission to apply.
• In Person: Visit a local office for the Texas Health and Human Services Commission to apply for benefits in person.

Both programs require documentation of family income, household size, and sometimes medical needs to determine eligibility. Applications are typically processed fairly quickly, and once approved, children will be eligible to receive healthcare coverage under either CHIP or Medicaid.

3. Free or Reduced-Cost Dental Coverage

In addition to medical coverage, both CHIP and Medicaid also offer dental coverage. This includes routine checkups, fillings, and other necessary dental procedures. If a child qualifies for CHIP, they will automatically receive dental insurance.

What Happens if a Parent Doesn’t Provide Health Insurance for Their Child?

If a parent fails to comply with a court order requiring health insurance coverage for the child, they could face legal consequences, including being held in contempt of court. The other parent may seek enforcement of the order through the Office of the Attorney General (OAG) or by filing a motion with the court.

Even if there is no formal order for health insurance, both parents are typically still expected to ensure that the child’s medical needs are met. If the child is uninsured, the court may require one parent to pay for uninsured medical expenses or reimburse the other parent for out-of-pocket medical costs.

Final Thoughts on Medical & Dental Support in TX

Ensuring that your child has the necessary health and dental coverage is one of the most important responsibilities of being a parent, especially after a divorce or separation. Texas law makes it clear that both parents are responsible for providing this coverage to the best of their ability, with specific guidelines in place to ensure children’s needs are met.

Programs like CHIP and Medicaid provide essential coverage for children in families with limited financial resources, and they can be a lifeline for parents who cannot afford private insurance. Whether you are navigating a child support case, custody arrangement, or simply seeking affordable healthcare options for your children, understanding the ins and outs of Texas healthcare programs can help ensure that your child’s needs are met.

If you need assistance with child support or health insurance issues, the Shemesh Family Law team is here to help. We can guide you through the legal process and help you find the best options for your child’s well-being.