
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC1396g-1]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
    SUBCHAPTER XIX--GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS
 
Sec. 1396g-1. Required laws relating to medical child support


(a) In general

    The laws relating to medical child support, which a State is 
required to have in effect under section 1396a(a)(60) of this title, are 
as follows:
        (1) A law that prohibits an insurer from denying enrollment of a 
    child under the health coverage of the child's parent on the ground 
    that--
            (A) the child was born out of wedlock,
            (B) the child is not claimed as a dependent on the parent's 
        Federal income tax return, or
            (C) the child does not reside with the parent or in the 
        insurer's service area.

        (2) In any case in which a parent is required by a court or 
    administrative order to provide health coverage for a child and the 
    parent is eligible for family health coverage through an insurer, a 
    law that requires such insurer--
            (A) to permit such parent to enroll under such family 
        coverage any such child who is otherwise eligible for such 
        coverage (without regard to any enrollment season restrictions);
            (B) if such a parent is enrolled but fails to make 
        application to obtain coverage of such child, to enroll such 
        child under such family coverage upon application by the child's 
        other parent or by the State agency administering the program 
        under this subchapter or part D of subchapter IV of this 
        chapter; and
            (C) not to disenroll (or eliminate coverage of) such a child 
        unless the insurer is provided satisfactory written evidence 
        that--
                (i) such court or administrative order is no longer in 
            effect, or
                (ii) the child is or will be enrolled in comparable 
            health coverage through another insurer which will take 
            effect not later than the effective date of such 
            disenrollment.

        (3) In any case in which a parent is required by a court or 
    administrative order to provide health coverage for a child and the 
    parent is eligible for family health coverage through an employer 
    doing business in the State, a law that requires such employer--
            (A) to permit such parent to enroll under such family 
        coverage any such child who is otherwise eligible for such 
        coverage (without regard to any enrollment season restrictions);
            (B) if such a parent is enrolled but fails to make 
        application to obtain coverage of such child, to enroll such 
        child under such family coverage upon application by the child's 
        other parent or by the State agency administering the program 
        under this subchapter or part D of subchapter IV of this 
        chapter; and
            (C) not to disenroll (or eliminate coverage of) any such 
        child unless--
                (i) the employer is provided satisfactory written 
            evidence that--
                    (I) such court or administrative order is no longer 
                in effect, or
                    (II) the child is or will be enrolled in comparable 
                health coverage which will take effect not later than 
                the effective date of such disenrollment, or

                (ii) the employer has eliminated family health coverage 
            for all of its employees; and

            (D) to withhold from such employee's compensation the 
        employee's share (if any) of premiums for health coverage 
        (except that the amount so withheld may not exceed the maximum 
        amount permitted to be withheld under section 1673(b) of title 
        15), and to pay such share of premiums to the insurer, except 
        that the Secretary may provide by regulation for appropriate 
        circumstances under which an employer may withhold less than 
        such employee's share of such premiums.

        (4) A law that prohibits an insurer from imposing requirements 
    on a State agency, which has been assigned the rights of an 
    individual eligible for medical assistance under this subchapter and 
    covered for health benefits from the insurer, that are different 
    from requirements applicable to an agent or assignee of any other 
    individual so covered.
        (5) A law that requires an insurer, in any case in which a child 
    has health coverage through the insurer of a noncustodial parent--
            (A) to provide such information to the custodial parent as 
        may be necessary for the child to obtain benefits through such 
        coverage;
            (B) to permit the custodial parent (or provider, with the 
        custodial parent's approval) to submit claims for covered 
        services without the approval of the noncustodial parent; and
            (C) to make payment on claims submitted in accordance with 
        subparagraph (B) directly to such custodial parent, the 
        provider, or the State agency.

        (6) A law that permits the State agency under this subchapter to 
    garnish the wages, salary, or other employment income of, and 
    requires withholding amounts from State tax refunds to, any person 
    who--
            (A) is required by court or administrative order to provide 
        coverage of the costs of health services to a child who is 
        eligible for medical assistance under this subchapter,
            (B) has received payment from a third party for the costs of 
        such services to such child, but
            (C) has not used such payments to reimburse, as appropriate, 
        either the other parent or guardian of such child or the 
        provider of such services,

    to the extent necessary to reimburse the State agency for 
    expenditures for such costs under its plan under this subchapter, 
    but any claims for current or past-due child support shall take 
    priority over any such claims for the costs of such services.

(b) ``Insurer'' defined

    For purposes of this section, the term ``insurer'' includes a group 
health plan, as defined in section 1167(1) of title 29, a health 
maintenance organization, and an entity offering a service benefit plan.

(Aug. 14, 1935, ch. 531, title XIX, Sec. 1908A, formerly Sec. 1908, as 
added Pub. L. 103-66, title XIII, Sec. 13623(b), Aug. 10, 1993, 107 
Stat. 633, renumbered Sec. 1908A, Pub. L. 106-113, div. B, 
Sec. 1000(a)(6) [title VI, Sec. 608(y)(1)], Nov. 29, 1999, 113 Stat. 
1536, 1501A-398.)

                       References in Text

    Part D of subchapter IV of this chapter, referred to in subsec. 
(a)(2)(B), (3)(B), is classified to section 651 et seq. of this title.


                             Effective Date

    Section 13623(c) of Pub. L. 103-66 provided that:
    ``(1) Except as provided in paragraph (2), the amendments made by 
this section [enacting this section and amending section 1396a of this 
title] apply to calendar quarters beginning on or after April 1, 1994, 
without regard to whether or not final regulations to carry out such 
amendments have been promulgated by such date.
    ``(2) In the case of a State plan under title XIX of the Social 
Security Act [this subchapter] which the Secretary of Health and Human 
Services determines requires State legislation in order for the plan to 
meet the additional requirements imposed by the amendments made by this 
section, the State plan shall not be regarded as failing to comply with 
the requirements of such title solely on the basis of its failure to 
meet these additional requirements before the first day of the first 
calendar quarter beginning after the close of the first regular session 
of the State legislature that begins after the date of enactment of this 
Act [Aug. 10, 1993]. For purposes of the preceding sentence, in the case 
of a State that has a 2-year legislative session, each year of such 
session shall be deemed to be a separate regular session of the State 
legislature.''

                  Section Referred to in Other Sections

    This section is referred to in section 1396a of this title.
