9% and 1.5% Caps: What Texas Parents Must Provide for Medical Support

Medical and dental support are required parts of every Texas child support order. Courts will order private insurance when it is available at a “reasonable cost,” defined by statute as no more than 9% of the paying parent’s annual resources for medical coverage and 1.5% for dental coverage. When coverage costs more than that, the court orders cash medical support instead, or requires the parent to apply for Medicaid or CHIP.

TL;DR:

• Private insurance costs exceeding 9% of a parent’s annual resources for medical or 1.5% for dental support trigger courts to order cash support or public programs instead.
• Employers are legally required to enroll children in coverage whenever a court orders or a National Medical Support Notice is issued, with premiums withheld from wages.
• Courts set and recalculate support caps based on income changes, with Medicaid and CHIP available when private coverage exceeds reasonable limits.
• Accurate documentation of coverage, premiums, and income is essential for effective enforcement or modification requests.
• Most support issues stem from verbal agreements that courts do not recognize, making organized paperwork critical for legal resolution.

Table of Contents

• What medical and dental support means under Texas law
• How the 9% and 1.5% reasonable cost rules work
• Who provides coverage and in what order
• Where Medicaid and CHIP fit into a medical support order
• Enforcement, employer duties, and the National Medical Support Notice
• Modifying medical support and what to expect along the way
• A practical checklist for Texas parents
• Practitioner perspective: when hiring a lawyer helps
• How the Law Office of Anna Din can help with medical support cases
• Sources
• FAQ

What medical and dental support means under Texas law

Texas courts do not treat medical and dental coverage as optional extras. The Texas Family Code requires every child support order to address how a child’s health care will be paid for, and judges must make specific findings about who has access to coverage and at what cost.

A court can order a parent to carry the child on an employer plan, order cash medical support in place of insurance, or require a parent to apply for a government program like Medicaid or CHIP. Temporary orders issued while a case is pending typically continue whatever coverage already exists, unless that coverage stops being reasonable in cost.

Judges rely on financial disclosures from both parents before deciding which option applies, so accurate paperwork matters from the first hearing forward.

How the 9% and 1.5% reasonable cost rules work

The math behind “reasonable cost” is straightforward once you see it applied. Texas law caps the premium a parent can be required to pay for a child’s coverage at [9% of that parent’s annual resources for medical insurance and 1.5% for dental insurance].(https://statutes.capitol.texas.gov/GetStatute.aspx?Code=FA&Value=154.001). “Annual resources” includes wages, overtime, bonuses, and most other income sources used in the child support calculation.

Reasonable cost thresholds: medical premiums cannot exceed 9% of the paying parent’s annual resources, and dental premiums cannot exceed 1.5%. Above those caps, the court moves to cash medical support or a government program instead of ordering private coverage.

• A parent earning modest wages with a high employer premium may fall outside the 9% cap, triggering cash support.
• A parent with several children on one family plan divides the premium cost proportionally among the children covered by the order.
• Courts recalculate the caps whenever a parent’s income changes enough to affect the reasonable cost figure.

Who provides coverage and in what order

Texas courts follow a set sequence when deciding who insures the child. Employment-based coverage comes first, then other private insurance sources, then cash medical support, and finally an application to a public program if nothing else fits within the reasonable cost limits.

1. The court checks whether either parent has access to reasonably priced coverage through an employer.
2. If employer coverage is reasonable, the court orders that parent to enroll the child and often orders the other parent to reimburse a share of the premium.
3. If no reasonable private coverage exists, the court orders cash medical support instead of insurance.
4. If neither parent can provide reasonable coverage, the court orders the custodial parent to apply for Medicaid or CHIP.

Before issuing any of these orders, the court requires both parents to disclose current coverage, premium amounts, and who is paying them.

Where Medicaid and CHIP fit into a medical support order

When private insurance is not available at a reasonable cost, Texas courts turn to public coverage rather than leaving a child uninsured. Children’s Medicaid and CHIP are the two programs judges rely on, and eligibility depends on household income.

• Children’s Medicaid generally serves families with the lowest incomes and carries no cost for eligible enrollees.
• CHIP covers children in families with income above Medicaid limits, up to about 201% of the federal poverty level, with small enrollment fees for households above 151% of that level.
• Courts can order a parent to apply for either program while also ordering cash medical support to cover costs the program does not.

Families who think they may qualify should apply directly through HHSC rather than wait for a hearing date, since enrollment can often move faster than the court process itself.

Enforcement, employer duties, and the National Medical Support Notice

Once a court orders medical support, enforcement runs through the same channels used for regular child support, and in some enforcement cases you may need to consider if you can get a bail bond for child support if arrested for nonpayment. Medical and dental support “may be enforced by any means available for the enforcement of child support,” according to the Texas Attorney General’s guidance for employers.

The main enforcement tool is the National Medical Support Notice, sent to a parent’s employer when the court orders coverage.

• The notice legally requires the employer to enroll the child in available coverage, even outside the normal open enrollment window.

• Premiums are withheld from the parent’s paycheck before other support deductions and sent along with the income withholding.

• Cash medical support payments, when ordered instead of insurance, are processed through the State Disbursement Unit.

Pro Tip: Tell your employer immediately about any premium change ordered by the court, since withholding calculations depend on current figures and delays can create payment shortfalls.

The Office of the Attorney General handles most enforcement, but it does not resolve custody disputes. When enforcement overlaps with a custody disagreement, a private attorney can often move faster than the OAG’s standard process.

Modifying medical support and what to expect along the way

Medical support orders are not permanent fixtures. A parent can request a change when circumstances shift enough to meet the legal standard.

1. Texas generally requires a “material and substantial change” in circumstances, and orders are automatically eligible for review roughly every three years without needing to prove that standard.
2. Common triggers include losing a job with health benefits, a new employer plan with a different premium, or a significant income change that pushes costs above or below the reasonable cost caps.
3. Before filing, gather a current benefits statement, itemized premium invoices, and recent pay stubs showing net resources.
4. If your case is handled through the Title IV-D program, contact the OAG first; otherwise, file a motion to modify with the court and consider speaking with a family law attorney if the case involves more than a simple premium change.

Verbal agreements between parents do not change a court order, no matter how well the arrangement seems to be working.

A practical checklist for Texas parents

Start with documentation, since most disputes over medical support come down to who can prove what.

• Confirm what your current order actually requires, and pull a copy if you do not have one on hand.
• Save every insurance premium receipt, enrollment confirmation, and email exchange about coverage changes.
• If you are the parent required to provide insurance, notify your employer promptly and keep proof of enrollment.
• If you cannot obtain reasonable coverage, document the actual premium quotes before requesting a modification.

Pro Tip: Bring your court order, insurance documents, and payment history to any consultation. Attorneys and the OAG both move faster when the paperwork is already organized.

Once your documentation is in order, contact the OAG for enforcement help or schedule time with a family law attorney to discuss next steps.

Practitioner perspective: when hiring a lawyer helps

Most medical support problems that reach an attorney’s office started as small, unrecorded agreements between parents. A verbal understanding to “split the extra cost” or switch insurance plans carries no weight in court once a disagreement starts.

The OAG handles straightforward enforcement well, but when a medical support dispute is tangled up with a custody disagreement or a pattern of missed payments, a private modification or enforcement petition usually resolves things faster. A local attorney typically reviews the existing order, calculates whether current costs still fall within the statutory caps, and files whichever motion fits the facts.

— Giri

How the Law Office of Anna Din can help with medical support cases

Sorting out who owes what for a child’s health coverage gets complicated fast, especially when income, insurance plans, or custody arrangements have changed since the original order was signed. Legal professionals work with parents on medical support orders, from establishing initial orders to enforcing ignored ones.

Our child custody and support practice covers modifications, enforcement, and paternity matters connected to medical support disputes. Before your consultation, bring:

• Your current court order and any prior modifications.
• Recent pay stubs or income documentation for both parents.
• Insurance premium statements or CHIP and Medicaid correspondence.

Contact a legal office to schedule a consultation and review your specific order with an attorney who can explain your options plainly.

This article is general information, not a substitute for advice from a qualified lawyer. Consult a qualified legal professional about your own circumstances before acting on anything here.

Sources

• Texas Family Code — Subchapter D (Medical and Dental support provisions)
• Medical Support General Information (Texas Attorney General employer portal)
• HHSC — Children’s Health Insurance Program (CHIP) information
• National Medical Support Notices - For Employers (Texas Attorney General)

FAQ

What is a medical support order in Texas?

A medical support order is the part of a child support order that determines who provides health and dental coverage for the child and at what cost. It can require a parent to carry insurance, pay cash medical support, or apply for Medicaid or CHIP when private coverage is not reasonably priced.

Why did I get a national medical support notice?

Employers receive a National Medical Support Notice when a court has ordered a parent to provide health coverage through that employer’s plan. The notice legally obligates the employer to enroll the child and begin withholding premiums, even outside normal open enrollment.

What are the medical assistance programs available in Texas?

Texas offers Children’s Medicaid for the lowest-income families at no cost, and CHIP for families with income up to about 201% of the federal poverty level, sometimes with small enrollment fees. Courts can order a parent to apply for either program when private insurance is not affordable.

What income is considered for support in Texas?

Texas calculates support using a parent’s “annual resources,” which includes wages, overtime, bonuses, and most other income. The same figure determines whether insurance premiums fall within the 9% medical and 1.5% dental reasonable cost caps set by the Family Code.

Recommended

• Child Support in Texas: What Every Parent Needs to Know
• Fathers’ Rights in Texas: What Every Dad Needs to Know
• What Texas Courts Actually Consider When Deciding Child Custody
• Common Child Support Myths Every Parent Should Know in Texas