What is the National Medical Support Notice?

What is the National Medical Support Notice?
If you have been ordered by the court to provide medical insurance for your dependent child(ren) but
have failed to provide the required verification of coverage, CSED will send out a National Medical
Support Notice on the case. The National Medical Support Notice (NMSN) is a federal form that is used
to notify employers and insurance plan administrators of a court order for dependents’ medical support.
It instructs the employer, insurance plan administrator, and/or union representative, to provide
insurance enrollment for the child(ren) listed on the form. It solicits information from these parties as to
whether insurance is available to the responsible party/employee, dates coverage will be available, or
the reasons why it is not available, dates when coverage will be available, etc.
In addition, the NMSN notifies the employer and plan administrator that they must enroll the child even
1) The child was born out of wedlock, or the parent’s name does not appear on the birth
2) The child does not reside with the employee;
3) The child was not claimed as a dependent on the employee’s federal taxes;
4) The child lives outside the service provider’s area;
5) It is not an “open enrollment period”; or
6) The employee is not enrolled in available coverage.
What kind of medical support do you try to get for my child(ren)?
In the court orders that CSED obtains, the medical support provision states that the responsible parent
must obtain health insurance if it is available at a reasonable cost. Costs are considered reasonable if the
insurance is available through an employment-related or group health insurance plan, regardless of the
service delivery mechanism. This means that it covers “fee for service”, health maintenance
organizations (HMOs), preferred provider organizations and/or any other types of coverage under which
medical services could be provided to the dependent child(ren) of a non-custodial parent. Health
insurance will be considered adequate if it meets the minimum healthcare protection standards
contained in the State of New Mexico Insurance Code 59A-23B NMSA 1978, which include well baby and
well child care, basic primary and preventive care, and immunizations.
How does the court decide which parent should carry the insurance?
Usually, the CSLA (Child Support Legal Assistant) handling your case will obtain the information from
both parties for the court to consider such as who wants to carry (or already covers) the insurance for
the children and who has the best coverage/most affordable health insurance plan available, etc. The
hearing officer or judge will then make a ruling based on this information.
What if the child(ren) are on Medicaid, do I still have to supply health insurance?
Yes, if you are ordered to do so. Medicaid is considered the payer of last resort for insurance claims,
which means they will pay only if no other insurance is available.
Can’t the custodial parent choose to just stay on Medicaid if they don’t want my insurance?
It is each parent’s responsibility to support their child(ren) whenever possible. This means that if private
insurance is available for your child(ren), it is the insurance of first resort and must be used first. Federal
regulations state that “Unless the custodial parent and child(ren) have satisfactory health insurance
other than Medicaid, [CSED must] petition the court or administrative authority to include health
insurance that is available to the non-custodial parent at a reasonable cost in new or modified…orders
for support,” (45 CFR 303.31 (b) (1)).
Why do I have to cooperate with CSED if my ex is on Medicaid? We have an arrangement that I don’t
have to pay child support.
For most public assistance support or services from the government, the recipient is required to meet
eligibility conditions that include cooperation with CSED. When your “ex” applied for Medicaid, he/she
assigned rights to the State of New Mexico to seek and enforce medical support for your child(ren). That
“Assignment of Support Rights” requires CSED to act on the state’s behalf and enforce medical support
for your child(ren). So, even if no other help is being sought from you, the applicant cannot “opt out” (or
choose not to pursue) of the medical support requirement as long as they are receiving benefits.
The process may include establishing paternity for your child(ren) in order to get a court order for
support of any kind. When an order for medical support is obtained, it may not require child support
payment, only that you are required to obtain and keep medical support current for your child(ren).
Any private agreement made between you and your “ex” does not deny the State the right to pursue
appropriate support for child(ren) receiving benefits from the State.
I told my employer that the kids are on New Mexikids, (or the custodial parent’s health plan) so I’m
off the hook, right?
No. The employer’s responsibilities under the NMSN are not affected by the child’s enrollment by the
custodial parent in another health insurance plan, Medicaid or New Mexikids. The employer is to
continue the child(ren)’s enrollment until CSED notifies them otherwise. If the court order has ordered
you to carry the insurance, you are still obligated to provide it. Even though the custodial parent has
gotten alternate or supplemental coverage, until the court modifies the order, you are still the party
responsible for carrying the insurance. The only time CSED will ask the employer to stop the enrollment
process is when we have verified that the order is no longer in effect, or that the case is suspended or
closed or all of the child(ren) have emancipated.
What if I don’t provide the health insurance as ordered?
The child support office can send a notice to your employer requiring enrollment of your child(ren) in
their plan. If you are not in a plan, they would be required to enroll the child(ren) in the plan anyway.
When the employer offers multiple plans, the employer will be required to enroll the child(ren) in the
plan that the custodial parent chooses. In addition, you can be taken back to court on an Order to Show
Cause to explain to the court why you have not complied with the court’s orders.
What if the custodial parent can get insurance or get it through his/her spouse instead?
As long as the current court order calls for you to provide insurance, CSED is mandated to enforce the
What if I can get my own insurance or get it through my current spouse instead?
If this is possible, you can pursue this. You must provide written verification of the child(ren)’s insurance
coverage to CSED to stop the NMSN process. When the insurance is verified, CSED will officially notify
your employer that they do not need to complete the child(ren)’s enrollment in the employment-related
insurance plan. However, you will not get credit on the child support guidelines if your spouse provides
medical insurance.
What if I cannot get the insurance because my employer does not offer it?
You may be able to get health insurance through your current spouse’s employment plan. If you belong
to a union, insurance coverage may be available through the union.
What if my employer doesn’t offer any insurance to me (I’m not eligible because I’m
probationary/part-time, etc.)? What am I supposed to do so that I don’t get into trouble with the
As in the previous question, insurance may be available through another source, like your union or your
current spouse. If neither one of these are options you can use, but you can pay a monetary payment to
help with the medical expenses, you may want to ask the court to modify your order to specify a
monetary payment instead of coverage. Remember, the court order usually says that you’re required to
carry the insurance if it is available through your employer at a reasonable cost. If you have checked but
aren’t eligible for your employer’s insurance, make sure that your employer verifies that fact for CSED in
written form.
I won’t be eligible for insurance until after my probationary period is over. What do I do?
You or your employer need to notify CSED of this fact, along with the date that you will be eligible for
health insurance coverage. Then, on the date that you have finished your probation, your employer will
need to enroll you and your child(ren).
What if I’m laid off or get hurt?
If you are unable to pay the insurance premium and the period of your lay-off or injury will be long
enough to cause a lapse in insurance coverage (where the child(ren) will be disenrolled), you and your
employer should notify CSED right away. The NMSN has a section for the employer to fill out if this
happens. If a re-employment date is known, you will need to include that in your notification to CSED.
I’m not on the insurance at work, so my kids can’t be enrolled either. What then?
According to the laws of the State of New Mexico, if group coverage is available through an employer,
your employer still is required to enroll your child(ren) even if you (the employee) are not enrolled. If
there is only one insurance plan available, the employer has two choices: if the insurance plan requires
you to be enrolled in order for your child(ren) to be enrolled, they will enroll you and the child(ren); or,
they can enroll the child only at the cost that you would pay for “Employee Only” coverage.
I’m on the insurance at work but I didn’t get around to putting my kids on the plan yet. What do I
need to do?
You will need to go to your employer and fill out the request to add your child(ren) to your plan, even if
it is not an “Open Enrollment” period. Then, you will need to provide written verification of the coverage
to CSED. If you do not do this, the National Medical Support Notice will be sent by CSED and will notify
your employer of your medical support order requiring them to enroll your child(ren). They will then
instruct their insurance plan administrator to enroll your child, and the employer will begin withholding
the premium amount from your wages.
There are a couple of insurance options. Which one will they enroll my child(ren) in?
Per New Mexico law, if you are enrolled in a plan, your child(ren) will be enrolled in the same insurance
plan that you are enrolled in. However, if there are several options for insurance coverage, and you are
not enrolled in any of them, the custodial parent of the child(ren) will be allowed to select the plan for
the child(ren). They will be enrolled in the plan selected. If the custodial parent does not notify CSED of
his/her selection within 20 days, your child(ren) will be enrolled in the “Default Option”, that is, the
insurance option that is the least costly choice.
But the child(ren) live out of state (or out of the insurer’s service area)!
The employer’s responsibilities under the NMSN are the same regardless of the child’s residence. In
most cases, an insurance provider usually has collateral agreements with insurance providers in other
areas so that care can be coordinated in the other location.
My employer never gave me a copy of the NMSN. Wasn’t I supposed to get one?
The employee will receive a notice when the NMSN is sent to the employer. This notice advises the
employee of his/her obligation to provide health coverage and allows the employee the right to contest
it by administrative review.
I think you’re wrong about my order. So, if I request an Administrative Review, the enrollment process
will be stopped, right?
No. Employees may contest the insurance withholding on the basis of a mistake of fact. The employer
must continue to withhold premiums during the administrative review until the employer receives
notice from CSED that the issue has been resolved.
Isn’t my signature required before you can enroll the child(ren) on my insurance?
No. Federal law allows the enrollment by the employer. The employer is required to complete the
applicable sections and forward the NMSN to the health care Plan Administrator within 20 days,
pursuant to New Mexico State Rule 8.50.109 NMAC.
How long after an employer receives the NMSN must the employer begin withholding the insurance
Withholding for health insurance premiums is to begin no later than the first pay period that occurs 14
days after the mailing date of the NMSN. The premiums are to be paid directly to the insurance carrier.
I’m not made of money, you know. Just how much can you take out of my check?
Total withholding cannot exceed the amounts set by state and Federal law, as specified in the
“Limitations on Withholding” section in the “Instructions to Employer” portion of the NMSN. The
deduction for the premium is made after deducting taxes, but before disposable income is determined.
New Mexico allows for a maximum of support and health premiums to be withheld up to 50 percent of
the employee’s income after mandatory tax deductions.
What if I don’t earn enough in wages to pay both the child support and the insurance premiums
without exceeding the 50% withholding limitation?
New Mexico law gives first priority to the collection of current support, and then health insurance
premiums. If enrolling the child(ren) in the health insurance plan exceeds the limitation, then the
employer must return the “Employer Response” portion of the NMSN with number “4” selected. In New
Mexico, health care enrollment will not occur in this situation. (Employers must follow the laws of the
employee’s principal place of employment state in prioritizing cash versus medical support limitations).
I have more than one case, so what does this 50% thing mean to me?
It means that the total on-going support obligated on all of your cases will be the first debt to be
withheld. Then, if the 50% limitation has not been reached, medical support will be pursued. If there are
still attachable wages left after that, withholding for past child support will be collected. If your wages
do not cover the total of all of your obligations, you may become delinquent. You may consider
requesting a “Review and Adjustment” on your cases to ensure that you are paying enough on your
obligations to avoid becoming delinquent.
Whose responsibility is it to notify CSED when the insurance premiums go up?
It is the employee’s responsibility. (It is, however, the employer’s responsibility to notify CSED when the
coverage terminates).
Can my employer charge me to process this National Medical Support Notice?
No. However, if the employer is also processing the on-going child support withholding along with the
medical support enforcement provision, the employer may charge $1.00 for each income withholding.
What if my employer doesn’t comply with the NMSN? Does anything happen to me?
Any employer who fails to comply with the NMSN requirements is in violation of New Mexico law. The
employer will face possible penalties and sanctions, including fines and the award of damages.
When will my employer know to cease withholding premiums for my child(ren)?
The Child Support Enforcement Division will notify the employer when the employer is no longer
obligated to withhold premiums for a child. Once a termination notice is received, the employer should
consult with the employee to determine whether he or she wants to voluntarily continue health care for
the child(ren).