(1) Whenever a child support order is entered or modified under this chapter, the court shall require both parents to provide medical support for any child named in the order as provided in this section.

     (a) Medical support consists of:

     (i) Health insurance coverage; and

     (ii) Cash medical support.

     (b) Cash medical support consists of:

     (i) A parent's monthly payment toward the premium paid for coverage by either the other parent or the state, which represents the obligated parent's proportionate share of the premium paid, but no more than twenty-five percent of the obligated parent's basic support obligation; and

     (ii) A parent's proportionate share of uninsured medical expenses.

     (c) Under appropriate circumstances, the court may excuse one parent from the responsibility to provide health insurance coverage or the monthly payment toward the premium.

     (d) The court shall always require both parents to contribute their proportionate share of uninsured medical expenses.

     (2) Both parents share the obligation to provide medical support for the child or children specified in the order, by providing health insurance coverage or contributing a cash medical support obligation when appropriate, and paying a proportionate share of any uninsured medical expenses.

     (3)(a) The court may specify how medical support must be provided by each parent under subsection (4) of this section.

     (b) If the court does not specify how medical support will be provided or if neither parent provides proof that he or she is providing health insurance coverage for the child at the time the support order is entered, the division of child support or either parent may enforce a parent's obligation to provide medical support under RCW 26.18.170.

     (4)(a) If there is sufficient evidence provided at the time the order is entered, the court may make a determination of which parent must provide coverage and which parent must contribute a sum certain amount as his or her monthly payment toward the premium.

     (b) If both parents have available health insurance coverage that is accessible to the child at the time the support order is entered, the court has discretion to order the parent with better coverage to provide the health insurance coverage for the child and the other parent to pay a monthly payment toward the premium. In making the determination of which coverage is better, the court shall consider the needs of the child, the cost and extent of each parent's coverage, and the accessibility of the coverage.

     (c) Each parent shall remain responsible for his or her proportionate share of uninsured medical expenses.

     (5) The order must provide that if the parties' circumstances change, the parties' medical support obligations will be enforced as provided in RCW 26.18.170.

     (6) A parent who is ordered to maintain or provide health insurance coverage may comply with that requirement by:

     (a) Providing proof of accessible private insurance coverage for any child named in the order; or

     (b) Providing coverage that can be extended to cover the child that is available to that parent through employment or that is union-related, if the cost of such coverage does not exceed twenty-five percent of that parent's basic child support obligation.

     (7) The court may order a parent to provide health insurance coverage that exceeds twenty-five percent of that parent's basic support obligation if it is in the best interests of the child to provide coverage.

     (8) If the child receives state-financed medical coverage through the department under chapter 74.09 RCW for which there is an assignment, the obligated parent shall pay a monthly payment toward the premium.

     (9) Each parent is responsible for his or her proportionate share of uninsured medical expenses for the child or children covered by the support order.

     (10) The parents must maintain health insurance coverage as required under this section until:

     (a) Further order of the court;

     (b) The child is emancipated, if there is no express language to the contrary in the order; or

     (c) Health insurance is no longer available through the parents' employer or union and no conversion privileges exist to continue coverage following termination of employment.

     (11) A parent who is required to extend health insurance coverage to a child under this section is liable for any covered health care costs for which the parent receives direct payment from an insurer.

     (12) This section shall not be construed to limit the authority of the court to enter or modify support orders containing provisions for payment of uninsured health expenses, health care costs, or insurance premiums which are in addition to and not inconsistent with this section.

     (13) A parent ordered to provide health insurance coverage must provide proof of such coverage or proof that such coverage is unavailable within twenty days of the entry of the order to:

     (a) The other parent; or

     (b) The department of social and health services if the parent has been notified or ordered to make support payments to the Washington state support registry.

     (14) Every order requiring a parent to provide health care or insurance coverage must be entered in compliance with *RCW 26.23.050 and be subject to direct enforcement as provided under chapter 26.18 RCW.

     (15) When a parent is providing health insurance coverage at the time the order is entered, the premium shall be included in the worksheets for the calculation of child support under chapter 26.19 RCW.

     (16) As used in this section:

     (a) "Accessible" means health insurance coverage which provides primary care services to the child or children with reasonable effort by the custodian.

     (b) "Cash medical support" means a combination of: (i) A parent's monthly payment toward the premium paid for coverage by either the other parent or the state, which represents the obligated parent's proportionate share of the premium paid, but no more than twenty-five percent of the obligated parent's basic support obligation; and (ii) a parent's proportionate share of uninsured medical expenses.

     (c) "Health insurance coverage" does not include medical assistance

provided under chapter 74.09 RCW.

     (d) "Uninsured medical expenses" includes premiums, copays, deductibles, along with other health care costs not covered by insurance.

     (e) "Obligated parent" means a parent ordered to provide health insurance coverage for the children.

     (f) "Proportionate share" means an amount equal to a parent's percentage share of the combined monthly net income of both parents as computed when determining a parent's child support obligation under chapter 26.19 RCW.

     (g) "Monthly payment toward the premium" means a parent's contribution toward premiums paid by the other parent or the state for insurance coverage for the child, which is based on the obligated parent's proportionate share of the premium paid, but no more than twenty-five percent of the obligated parent's basic support obligation.

     (17) The department of social and health services has rule-making authority to enact rules in compliance with 45 C.F.R. Parts 302, 303, 304, 305, and 308.

[2009 c 476 § 1; 1994 c 230 § 1; 1989 c 416 § 1; 1985 c 108 § 1; 1984 c 201 § 1.]

NOTES:

     *Reviser's note: The reference to RCW 26.23.050 appears to refer to the amendments made by 1989 c 416 § 8, which was vetoed by the governor.

     Effective date -- 2009 c 476: "This act takes effect October 1, 2009." [2009 c 476 § 10]