As an experienced family law attorney here in Texas, I know the details of child support arrangements can get confusing—especially when life changes. That’s why I got a call from Edward after his ex-wife made a career change and lost her employer-paid health insurance.
“Chris, things were moving along smoothly. Greta—my ex—and I were getting along just fine, the kids seem to be okay, and we’re not really fighting over money. But now she’s going out on her own, and she lost her employer’s health insurance,” Edward explained.
“That could be a major change for you guys,” I said.
“Well, thankfully, she did it smart. She’s going to make similar money—maybe more—within a few months, and I’m willing to pitch in and support her. In the long run it should be good for the kids, and maybe me too. But what about the kids’ health insurance?”
“What was the prior arrangement?”
“She just paid it. Had the kids on the plan from her old job.”
“Well, if that’s gone, you might have to pick up the slack.”
“How much will it cost me? I can probably get them on my plan from work.”
“Judges deal with this all the time and have standards to help you figure it out. The good news is, while you might need to pay for their insurance, it doesn’t mean your overall monthly support obligation will go up. Let me go over some information with you first, then we’ll talk about how this might impact you.”
“Great. Thanks, Chris. I’m ready to learn more about it.”
Key Takeaways for This Article
- Health insurance premiums can reduce your child support payment dollar-for-dollar when the non-custodial parent provides coverage – the premium is deducted before calculating support percentages
- The “reasonable cost” limit is 9% of annual income – premiums exceeding this threshold won’t qualify for child support reduction under Texas law
- Both parents share legal responsibility for health insurance – courts must order coverage through employer plans, private insurance, or government programs like Medicaid/CHIP
- Job changes or premium increases can modify support orders – document changes and notify within 30 days to request court review and avoid penalties
In Texas, every child support order has two moving parts: money for day‑to‑day needs and a separate medical support requirement that makes sure the child has health‑insurance coverage. So parents like Edward often ask, “If I’m already paying for the child’s health insurance, will my monthly child support go down?”
Below I walk through how Texas courts take health insurance premiums into account, how those costs can lower the basic child support obligation, and what steps you can take to protect your child’s best interest while staying on the right side of state law.
Remember, ensuring the child’s well-being is a central goal of child support and health insurance arrangements.
Child Support & Medical Support Basics Under Texas Law
Texas law treats financial support and medical support as twin duties that work together. It is each parent’s legal responsibility to provide health insurance for their child as part of their support obligations. Providing health insurance is considered a form of child support under Texas law.
What Is a Child Support Order?
A child support order is a court order that tells each parent exactly what they must do to cover the cost of the child’s care, including cash support and medical coverage. The court can modify an existing child support order if medical expenses or health insurance coverage change.
Texas Family Code Chapter 154 sets child support guidelines, defines medical support orders, and allows judges to adjust payments when needed. Judges may update child support orders to reflect changes in circumstances.
Health Insurance Coverage Requirements in Texas
Texas courts must order a health insurance plan for minor children. The court ensures the child’s health insurance is in place to provide coverage for the child. Coverage can come through:
- an employer‑sponsored plan
- a private health insurance policy
- Medicaid or CHIP when private insurance is not “accessible” or affordable
Parents may need to obtain health insurance plans through their employer, the private market, or government programs to meet court requirements for coverage for the child.
If neither parent can find private insurance at a reasonable cost, the court may order cash medical support instead.
“Reasonable Cost” Standard for Health Insurance Premiums
“Reasonable cost” means the premium amount cannot top 9 % of the paying parent’s annual resources—roughly equivalent to gross income or the parent’s income—for health insurance (and 1.5 % for dental coverage).
The court evaluates the premium amount based on the parent’s income to ensure affordability. The Affordable Care Act marketplace and the federal poverty level can also guide a judge when deciding what is affordable. The court may also consider whether the health insurance plan offers comprehensive coverage to meet the child’s needs.
How Health Insurance Premiums Affect Child Support Calculations
Texas uses a modified income shares model. The court starts with each parent’s resources and considers both parents’ incomes, then applies guideline percentages to set the basic child support obligation.
The amount of overall child support may be adjusted based on the cost of medical care and medical costs not covered by insurance, such as surgeries or ongoing treatments.
The Income Shares Model & Basic Child Support Obligation
Combined parental income sets the floor; guideline percentages (20 % for one child, 25 % for two, and so on) are then applied to the non‑custodial parent’s net resources.
The court allocates support obligations based on the respective incomes of both parents, ensuring that each parent’s financial contribution is considered. Child support calculations are parents based, taking into account each parent’s financial situation according to state guidelines. The amount of support may also depend on which parent the child lives with, as this can affect both health insurance and financial responsibilities.
Crediting the Parent Who Pays the Child’s Health Insurance
When the parent who pays support also pays the child’s premium, the court subtracts the monthly premium from that parent’s net resources before applying the guideline percentage.
When a parent pays for the child’s health insurance, the court credits that payment in the support calculation. The court determines which parent provides health insurance and is the parent responsible for coverage, considering legal and financial obligations. Health insurance premiums can significantly impact the final child support amount as they are added to the base support obligation.
For example: Net resources $4,000; one child → guideline 20 % = $800. If you pay a $250 premium, the court first deducts that $250, then applies 20 % to $3,750, dropping support to $750.
Likewise, if the custodial parent provides health insurance coverage, the non‑custodial parent must usually reimburse the premium as additional child support—again capped by the reasonable‑cost rule. If the custodial parent has access to a better plan at a lower cost, the court may decide they should maintain the coverage.
Handling Additional & Extraordinary Medical Expenses
Unreimbursed costs—co‑pays, prescriptions, or therapy—are often split 50/50. Additional medical costs not covered by insurance must be paid by the parents according to the court’s allocation.
When a child has extraordinary medical expenses (for example, ongoing oncology care), courts can set a different percentage tied to each parent’s income. Parents should keep records of all medical expenses paid for reimbursement purposes. The parent incurring additional medical expenses must file a motion with the court to seek a modification.
Sample Calculations & Case Scenarios
Texas Child Support Health Insurance Calculator
Try it out! We’ve pre-filled example values from the article. Replace them with your actual numbers to see your potential savings.
Below is a quick look at how a $250 premium can change child support payments, depending on which parent’s plan covers the child:Assumes $4,000 net resources and one child. Health insurance premiums are factored into the calculation of total child support payments, and who covers the child can impact the final amount owed.
Here’s an anecdote that might help clarify how it works: I once represented a Dallas father whose employer plan covered his child at a cost of $260 a month. By documenting that premium, we convinced the court to reduce his guideline child support payments by roughly $52 each month—enough to fund his child’s after‑school tutoring instead. The judge praised the father for “keeping receipts and staying ahead of medical support.”
Families above CCPA withholding limits (50–65 % of disposable earnings) may see smaller credits because federal law caps income withholding.
Parental Responsibilities & Enforcement Mechanisms
Assigning the Medical Support Obligation
Judges weigh access to insurance, cost, and the child’s needs. If benefits are job‑based, the court issues a National Medical Support Notice that orders the employer to enroll the child.
When parents cannot decide on health insurance coverage, a judge can order one parent to provide coverage. The court may also require the child to be enrolled in a specific parent’s plan to ensure the child receives adequate health coverage.
Consequences for Failing to Provide Court‑Ordered Insurance
Ignoring a court order can trigger:
- contempt findings
- income withholding
- suspension of driver’s or professional licenses
- collection actions by the child support enforcement agency
Splitting Uninsured Medical Bills
Texas default is 50/50, but courts may shift costs to match each parent’s financial resources. Best practice: pay providers directly or reimburse within 30 business days of receiving the bill.
Modifying a Child Support Order When Health‑Insurance Circumstances Change
What Counts as a “Substantial Change in Circumstances”?
- Losing coverage
- switching jobs
- a sharp premium hike
- a diagnosis raising health‑care costs
How to Request a Review or Court Hearing
You may:
- Ask the state agency (free administrative review)
- File a motion to modify in family court
Bring premium invoices, proof of new coverage, and updated pay stubs.
Importance of Timely Action & Legal Counsel
Delays create arrears. Here at Warren & Migliaccio, we guide clients through the paperwork and attend hearings so they stay compliant and avoid garnishments.
Practical Tips for Texas Parents
Track Premium Amounts & Medical Bills Meticulously
- Save explanation of benefits forms
- Use a spreadsheet or app to log medical bills, dates, and direct payment receipts
Communicate Early & in Writing
Notify the other parent—and, if required, the court—of any insurance change within 30 business days.
Leverage Free or Low‑Cost Legal Resources
Family‑services offices, OAG hotlines, and many firms (ours included) offer a free consultation for child‑support questions.
Frequently Asked Questions (FAQs)
How much does health insurance reduce child support in Texas?
Health insurance premiums reduce child support dollar-for-dollar when the non-custodial parent provides coverage. The court deducts the monthly premium from the parent’s net resources before calculating the child support obligation.
Example calculation:
Net monthly resources: $5,000
Health insurance premium: $300
Adjusted resources: $4,700
Child support (20% for one child): $940 instead of $1,000
Total monthly savings: $60
Under Texas Family Code, this reduction applies only when premiums don’t exceed 9% of the parent’s annual resources.
Does paying health insurance reduce child support in Texas?
Yes. When the parent who pays support also pays the child’s premium, the court deducts that premium from net resources before applying guideline percentages. This creates a direct reduction in the monthly child support obligation.
The reduction only applies when the non-custodial parent provides the healthcare coverage and the premium costs remain within the “reasonable cost” limits defined by Texas law.
Does employer health insurance count toward child support?
Yes, employer-sponsored health insurance premiums count toward child support reductions in Texas. The court treats employer health insurance the same as private coverage when calculating child support obligations.
Key requirements:
Premium must be specifically for the child’s coverage
Cost cannot exceed 9% of the parent’s annual resources
Parent must provide documentation of actual premium amounts
Coverage must meet the court’s medical support requirements
Employer plans often provide the most cost-effective healthcare coverage option for meeting medical support obligations.
What if both parents have health insurance for the child?
When both parents carry health insurance for the same child, Texas courts typically designate one parent as the primary coverage provider. The primary provider receives the child support credit, while the secondary coverage may help with unreimbursed medical expenses.
Court considerations for primary designation:
Lower premium cost
Better coverage benefits
Accessibility of providers
Parent’s employment stability
The non-primary parent may still receive partial credit if their coverage provides essential benefits not covered by the primary plan.
Source: Child Support In Texas: Your Guide To Health Insurance And Medical Expenses
Can the non-custodial parent opt out of providing health insurance coverage?
Only if insurance is truly unavailable at a reasonable cost. Otherwise, the court must order coverage or cash medical support. The reasonable cost standard is 9% of annual resources for health insurance premiums.
How do courts determine the “reasonable cost” of health insurance premiums?
By statute, premiums over 9% of annual resources exceed reasonable cost for health insurance coverage (1.5% for dental coverage). Judges may also look at ACA marketplace rates for comparison and consider the parent’s employer-sponsored options.
Factors courts examine:
Percentage of parent’s gross income
Available employer benefits
Marketplace plan alternatives
Coverage quality and provider networks
How can you prove health insurance costs for child support modification?
Document all healthcare costs with official records when requesting a child support modification. Courts require specific evidence to adjust child support arrangements based on medical insurance changes.
Required documentation:
Premium statements from insurance provider
Employer benefits summary showing costs
Proof of coverage effective dates
Child’s enrollment verification
Comparison of available coverage options
Submit documents within 30 days of requesting the modification to avoid delays in processing your case.
What happens if a parent fails to maintain court-ordered health insurance?
The court can hold that parent in contempt, issue an income withholding order, and assess fines until coverage is reinstated. Additional consequences include license suspension and collection actions by child support services.
Who pays uninsured or extraordinary medical expenses for the child?
Courts usually split unreimbursed medical expenses 50/50 between parents, but they may adjust percentages based on each parent’s income or the child’s special medical needs. The child support agreement should specify how these out-of-pocket expenses are handled.
What happens if health insurance premium increases after a child support order?
Premium increases can justify modifying the child support order if they create a substantial change in circumstances. The parent should immediately notify the other parent and request a review through child support services or family court.
Action steps:
Document the premium increase with official notices
Calculate the impact on net resources
File for modification within 30 days when possible
Provide new premium statements to the court
Significant increases may affect whether coverage remains at “reasonable cost” under Texas guidelines.
How long does a modification of child support take once health insurance changes?
Administrative reviews average 60-90 days through child support services. Court motions vary by county docket but often resolve within four months if paperwork is complete and both parties cooperate with the process.
Is private health insurance required if the child already has Medicaid or CHIP?
No. When a child is covered by Medicaid or CHIP, the court may substitute cash medical support instead of requiring private insurance. This allows the child support obligations to focus on other healthcare costs and basic support needs.
Can I get credit for dental insurance in child support calculations?
Yes, dental insurance premiums can reduce child support obligations using the same calculation method as health insurance. However, dental premiums cannot exceed 1.5% of the parent’s annual resources to qualify for reasonable cost under Texas Family Code.
The credit applies when the non-custodial parent provides dental coverage and documents the actual premium costs to the court.
What role does income withholding play in collecting health insurance premiums?
If the paying parent fails to reimburse healthcare coverage premiums, courts can add that amount to the income withholding order to ensure timely payment. This automatic deduction helps enforce both basic child support and medical support obligations. If a parent fails to provide required health insurance coverage, the court may order reimbursement for medical expenses incurred by the other parent.
Conclusion
Paying a child’s health‑insurance premium can reduce a parent’s child‑support obligation—but only when the premium is properly documented and credited. Keep clear records, inform the other parent of changes, and act fast if coverage or income shifts.
Next Steps:
Still unsure? We offer a free consultation to review your order, run fresh child support calculations, and build a plan that meets your child’s needs.
Source: Texas Has the Highest Rate of Uninsured Children, and It’s Getting Worse – Public Health Watch
How Will Edward Proceed?
“Chris, I was worried that this health insurance expense would be tacked onto what I’m already paying—but it seems that’s not the case, right?” Edward asked.
“The bottom line will stay the same. You’ll just have a little extra math and paperwork to deal with. I can help you with that. Do you think you and Greta can come to an agreement so we can avoid getting the courts involved?” I asked.
“She’s been reasonable with everything so far about the kids, so I think she will be about this too. I’d like to make a fair offer.”
“First, I need you to check if you can get the kids on your policy at work. And if so, find out what the monthly premiums will be. Maybe get a few options for different plans. Greta might appreciate having some choices.”
“Okay, I can talk to HR next week.”
“Once we have some numbers, I’ll show you how those premiums will effectively come out of the bottom-line number of what you send her each month.”
“It’s not a simple subtraction, right? I saw that it gets deducted from my gross income before they calculate the percentage I have to pay,” he said.
“That’s right. But let’s keep it simple for the moment. We can go there if we need to. First, let’s make Greta an offer you can afford and feel good about. Something like: ‘I can put both kids on my insurance at, say, $400 a month, and then I’ll pay you $400 less in child support.’ Just something simple to get the conversation started.”
“I might even want to be a little more generous—say I’ll do it temporarily, until she gets her new insurance plan settled. I want her new business to succeed. I just didn’t want to get clobbered by this change in her life.”
“That’s good long-term thinking,” I told him. “But if she doesn’t agree or this gets contentious, I can help you follow the Texas standards and make the calculations according to the law. The law is there first to benefit the children—but also to make sure this comes out fairly for both parents.”
“Thanks, Chris. Let me look into this, feel Greta out, and I’ll get back to you. I think it’s all going to work out, despite this health insurance thing being such a pain.”
Schedule a Consultation With Our Firm to Learn About How Paying for Health Insurance Can Reduce Child Support in Texas
Wondering about the impact of paying for your child’s health insurance in Texas can be stressful and challenging, but you do not have to face it alone. Our team of experienced Dallas family attorneys is ready to provide you with the guidance, support, and legal advocacy you need during these challenging times.
Whether you are concerned about the impact of health insurance payments on child support, or navigating other child custody related issues, we are here to help you every step of the way. We welcome you to schedule a consultation to discuss your situation and case objectives. We can answer your legal questions and discuss how we can help you move forward. Call our law office at (888) 584-9614 or contact us online to schedule your consultation.
Disclaimer
This article is for informational purposes only and does not create an attorney‑client relationship or constitute legal advice. Every case is unique; consult a qualified Texas family‑law attorney before acting on any information here.
