This White Paper reviews the changes in the health insurance market that sharply limit the availability and affordability of family coverage in the employer market. These changes make it difficult for non-custodial parents to obtain affordable health insurance for their children through their employer or union, if such coverage is available at all. However public coverage for children has become broadly available for single-parent households through Medicaid, Children’s Health Insurance Programs (CHIP), or – in fewer cases – premium subsidies through the Affordable Care Act. In 2016, the federal Office of Child Support Enforcement recognized public coverage as a valid source of medical support. These changes suggest new strategies for administering medical support enforcement by states, which are detailed in this White Paper. 

This White Paper analyzes the impact of the Affordable Care Act (ACA) on the medical support function of Title IV-D child support services. The IRS enforcement role for the ACA requirement to carry health insurance can conflict with the traditional medical support role of the IV-D program. The paper recommends re-structuring the medical support function to improve coverage for kids and their parents, reduce the burden on employers, and streamline services under the IV-D program. Click here to read. 

When the Title IV-D child support program was started more than 40 years ago, it was intended to function primarily as a recovery program for the Aid to Families with Dependent Children (AFDC) program. As the Temporary Assistance to Needy Families (TANF) program has replaced AFDC and significantly shrunk cash payments to single-parent household, recovery of TANF payments by the child support program have diminished to 4.4 percent of total IV-D collections. Accordingly, this discussion paper proposes support for current recipients and would end recovery altogether for former TANF recipients. Such a modernization of distribution policy would streamline administration of the program, enhance the IV-D program’s relationships with custodial and non-custodial parents alike, increase the self-sufficiency of former TANF recipients, and remove the inherent contradiction that clouds the IV-D program’s mission. Click here to read.