Texas law mandates that every child support order includes provisions for health insurance coverage under Texas Family Code Sections 154.181 through 154.187. The obligor (paying parent) must provide health insurance if available through employment at a reasonable cost, defined as no more than 9% of annual gross resources for medical coverage and 1.5% for dental coverage. When neither parent has access to affordable employer-sponsored insurance, courts order cash medical support as an alternative. As of September 2025, the Texas child support income cap increased to $11,700 per month, affecting maximum medical support calculations for high-income parents.
Key Facts: Health Insurance and Child Support in Texas
| Requirement | Details |
|---|---|
| Filing Fee | $300-$400 (varies by county) |
| Waiting Period | 60 days minimum |
| Residency Requirement | 6 months in Texas, 90 days in filing county |
| Medical Support Cap | 9% of obligor's annual gross resources |
| Dental Support Cap | 1.5% of obligor's annual gross resources |
| Unreimbursed Expenses | Typically split 50/50 between parents |
| Property Division | Community property (50/50) |
| Governing Statutes | Tex. Fam. Code §§ 154.181-154.187 |
Who Pays for Health Insurance in Texas Child Support Orders
The non-custodial parent (obligor) typically must provide health insurance for children if coverage is available through their employer at a reasonable cost under Texas Family Code § 154.182. Texas courts prioritize employer-sponsored insurance because it generally offers the most comprehensive coverage at the lowest per-person cost. If the obligor lacks access to affordable employer coverage, the court may order the custodial parent (obligee) to obtain insurance, with the obligor reimbursing the premium cost. When neither parent has access to reasonable employer-sponsored coverage, courts turn to alternative arrangements including CHIP, Medicaid, or cash medical support payments.
The determination of who provides coverage follows a specific priority order established by statute. Courts first examine whether the obligor has employer-sponsored insurance available at reasonable cost. If not, they consider whether the obligee has such access. Only after exhausting these options do courts order cash medical support or public program enrollment.
What Qualifies as Reasonable Cost for Health Insurance
Reasonable cost for health insurance child support in Texas means the premium cannot exceed 9% of the obligor's annual gross resources under Texas Family Code § 154.181(e). For a parent earning $60,000 annually, the maximum reasonable cost for medical coverage equals $5,400 per year or $450 per month. Dental insurance has a separate cap of 1.5% of annual resources under Texas Family Code § 154.1815, translating to $900 annually or $75 monthly for the same earner. These percentage caps apply regardless of how many children require coverage under the same order.
The reasonable cost calculation uses gross resources, which includes wages, salary, commissions, bonuses, self-employment income, and most other forms of regular income. Courts do not reduce this figure for voluntary retirement contributions, car payments, or other personal expenses when determining whether insurance qualifies as reasonably priced.
| Annual Income | Max Medical Support (9%) | Max Dental Support (1.5%) | Combined Maximum |
|---|---|---|---|
| $30,000 | $225/month | $37.50/month | $262.50/month |
| $60,000 | $450/month | $75/month | $525/month |
| $90,000 | $675/month | $112.50/month | $787.50/month |
| $140,400 (cap) | $1,053/month | $175.50/month | $1,228.50/month |
Cash Medical Support When Insurance Is Unavailable
Texas courts order cash medical support when neither parent has access to health insurance at reasonable cost, with payments capped at 9% of the obligor's annual gross resources under Texas Family Code § 154.182. This cash amount is paid in addition to regular child support and helps the custodial parent purchase coverage independently or covers out-of-pocket medical expenses. For an obligor earning $50,000 annually, the maximum cash medical support equals $4,500 per year or $375 per month. Starting September 1, 2023, all cash medical and dental support payments must be processed through the Texas Child Support Disbursement Unit rather than paid directly between parents.
Cash medical support serves as a bridge when private insurance remains inaccessible. Courts may also direct families toward public programs like the Children's Health Insurance Program (CHIP) or Medicaid when children qualify based on household income. The cash support can then offset any premiums or out-of-pocket costs associated with these programs.
How Texas Courts Divide Unreimbursed Medical Expenses
Texas courts typically order parents to split unreimbursed medical expenses 50/50 under Texas Family Code § 154.183, though judges may assign different percentages based on each parent's financial resources. Unreimbursed expenses include deductibles, copayments, prescription costs, orthodontics, vision care, mental health services, and any medical treatment not covered by insurance. The parent who incurs the expense must submit all receipts, bills, and explanation of benefits documents to the other parent within 30 days of receiving them. The reimbursing parent then has 30 days to pay their share.
This expense-sharing obligation exists independently of health insurance premiums. Even when one parent pays 100% of the insurance premium, both parents typically share out-of-pocket costs equally. Courts recognize that insurance never covers all medical needs, making this division essential for ensuring children receive comprehensive healthcare without placing undue burden on either parent.
The 2026 Child Support Income Cap and Medical Support
The Texas child support income cap increased from $9,200 to $11,700 per month effective September 1, 2025, marking a 27% increase and the first adjustment since 2019 under Texas Family Code § 154.125. This cap directly affects medical support calculations for high-income obligors. For one child, the maximum guideline child support payment now equals $2,340 monthly (20% of $11,700). The 9% medical support cap on $11,700 monthly income equals $1,053 per month or $12,636 annually. Combined maximum monthly obligations for one child can reach $3,393 before adding dental support and unreimbursed expense obligations.
The income cap applies to guideline calculations only. Courts retain discretion to order above-guideline support when children demonstrate proven needs exceeding standard amounts. Medical support calculations use the same net resources figure as child support, meaning the cap equally limits both obligations for high earners.
Texas Child Support Percentage Guidelines
Texas uses a percentage-of-income model for child support calculations, applying fixed percentages to the obligor's net monthly resources under Texas Family Code § 154.125. This approach differs from the income-shares model used by 41 other states, which considers both parents' earnings. The Texas model focuses solely on the paying parent's income, making calculations more straightforward but less reflective of total household resources.
| Number of Children | Percentage of Net Resources | Maximum Monthly Payment (2026) |
|---|---|---|
| 1 child | 20% | $2,340 |
| 2 children | 25% | $2,925 |
| 3 children | 30% | $3,510 |
| 4 children | 35% | $4,095 |
| 5+ children | 40% | $4,680 |
Medical and dental support add to these base amounts. A parent ordered to pay 20% child support plus 9% medical support plus 1.5% dental support has a total obligation equaling 30.5% of net resources before unreimbursed expense sharing.
Modifying Medical Support Orders in Texas
Texas allows modification of medical support orders when material and substantial changes occur under Texas Family Code § 156.401. Common grounds for modification include job loss affecting access to employer insurance, significant income changes altering what qualifies as reasonable cost, changes in the child's medical needs, and availability of new insurance options through either parent's employment. Courts require demonstrating that circumstances have changed since the original order and that modification serves the child's best interests.
To request modification, a parent files a motion with the court that issued the original order. The process typically involves mediation before a hearing. Courts will not modify orders retroactively—changes take effect from the modification date forward. Parents should act promptly when circumstances change rather than simply stopping compliance with existing orders, which risks enforcement actions.
Enforcement of Medical Support Obligations
Texas courts enforce medical support orders through wage withholding, license suspension, bank account liens, and contempt proceedings under Texas Family Code § 157.001. The Texas Attorney General's Office Child Support Division actively pursues non-compliant parents and can intercept tax refunds, report delinquencies to credit bureaus, and in extreme cases seek jail time for willful non-payment. Insurance enrollment orders carry particular enforcement weight because gaps in coverage directly harm children's access to healthcare.
Employers play a crucial role in enforcement. When courts issue a National Medical Support Notice, employers must enroll children in available insurance plans and withhold premium costs from the obligor's wages. Employers face penalties for failing to comply with these notices. Parents who lose employer coverage must notify the court and opposing party within 30 days to avoid enforcement actions for lapses they could not control.
CHIP and Medicaid as Coverage Alternatives
The Children's Health Insurance Program (CHIP) and Medicaid provide coverage alternatives when neither parent has access to affordable private insurance under Texas guidelines. CHIP covers children in families earning up to 200% of the federal poverty level ($62,400 for a family of four in 2026), with monthly premiums ranging from $0 to $50 depending on income. Medicaid covers children in lower-income families at no premium cost. Courts may order enrollment in these programs and require the obligor to pay cash medical support covering any associated costs.
Public program enrollment does not eliminate private insurance obligations when circumstances change. If an obligor later gains access to employer coverage at reasonable cost, courts may modify orders to require private insurance enrollment. The Texas Attorney General's Office coordinates with health agencies to ensure children maintain continuous coverage regardless of which parent provides it.
Health Insurance Requirements During Divorce Proceedings
Texas requires health insurance coverage to remain in effect for children during divorce proceedings unless the court orders otherwise under Texas Family Code § 154.181(b). Temporary orders at the case's outset typically mandate that existing coverage continue unchanged until final orders issue. Removing children from insurance during pending litigation without court approval constitutes contempt and may negatively affect the offending parent's position in custody and support determinations.
The temporary orders phase also requires both parties to disclose current insurance information including the carrier name, policy number, premium cost, and whether coverage comes through employment. This disclosure enables courts to make informed decisions about continuing existing coverage versus ordering new arrangements. Failure to provide required disclosures can result in sanctions and adverse inferences.
Impact of Remarriage on Medical Support Obligations
Remarriage does not automatically change medical support obligations in Texas because child support orders remain binding until formally modified. A new spouse's income is not considered when calculating child support or medical support under Texas guidelines. However, if a new spouse's employer offers family coverage, this may create access to reasonable-cost insurance that didn't previously exist. The obligor parent should seek modification to reflect new coverage options rather than unilaterally changing arrangements.
Practically, remarriage often affects insurance dynamics. A stepparent's employer plan might offer more affordable coverage than either biological parent's options. While courts cannot order stepparents to cover stepchildren, parents can voluntarily arrange coverage through new spouses' plans and seek appropriate adjustments to cash support obligations through modification proceedings.
Frequently Asked Questions About Health Insurance and Child Support in Texas
Does paying health insurance premiums reduce my child support payment in Texas?
Yes, health insurance premiums you pay for your children reduce your net resources before calculating child support under Texas Family Code § 154.062. If you pay $300 monthly for your children's health insurance, that amount is deducted from your gross income when determining net resources. However, you will also pay medical support (up to 9% of income) in addition to the base child support percentage, so the total obligation may still be substantial.
What happens if I cannot afford the health insurance my employer offers?
If employer-sponsored coverage exceeds 9% of your annual gross resources, Texas law considers it unreasonable and the court cannot order you to provide it under Texas Family Code § 154.181(e). The court will instead examine whether the other parent has access to affordable coverage or order cash medical support as an alternative. Document your income and the premium costs to demonstrate that coverage exceeds the reasonable cost threshold.
Can the custodial parent be ordered to provide health insurance?
Yes, courts may order the custodial parent (obligee) to provide health insurance if they have access to reasonable-cost coverage through employment and the non-custodial parent does not under Texas Family Code § 154.182. When this occurs, the non-custodial parent must reimburse the actual premium cost as additional child support, though the reimbursement cannot exceed what would constitute reasonable cost for the obligor.
How are orthodontic expenses handled under Texas child support?
Orthodontic expenses qualify as unreimbursed medical expenses subject to division between parents under Texas Family Code § 154.183. Courts typically split these costs 50/50 unless the order specifies different percentages based on parental income disparity. Parents should discuss major orthodontic treatment in advance and, ideally, obtain written agreement on cost-sharing before beginning treatment to avoid disputes.
What is the difference between medical support and dental support in Texas?
Medical support covers health insurance premiums and caps at 9% of the obligor's annual gross resources under Texas Family Code § 154.181. Dental support covers dental insurance premiums and caps at 1.5% of annual gross resources under Texas Family Code § 154.1815. Both are separate obligations added to base child support payments. Courts order both types of support in every child support case unless good cause exists for deviation.
Can I use CHIP instead of private insurance for my children?
Yes, CHIP can satisfy medical support obligations when children qualify based on household income (up to 200% of federal poverty level) and neither parent has access to affordable private coverage. Courts may order cash medical support to cover CHIP premiums, which range from $0 to $50 monthly depending on income. The Texas Attorney General's Office coordinates with CHIP enrollment to ensure children maintain continuous coverage.
What happens if my ex removes our children from health insurance?
Unilateral removal of children from health insurance violates court orders and constitutes contempt under Texas law. You should immediately file a motion for enforcement with the court and contact the Texas Attorney General's Child Support Division. Courts take insurance lapses seriously because they directly harm children's access to medical care. Penalties can include wage withholding, fines, and jail time for willful violations.
How do I get my medical support order modified after losing my job?
File a motion to modify with the court that issued your original order, demonstrating that job loss constitutes a material and substantial change in circumstances under Texas Family Code § 156.401. Continue making payments according to the existing order until modification is granted—modifications are not retroactive. The court may convert insurance obligations to cash medical support or reduce amounts based on your new financial situation.
Are mental health services covered under medical support in Texas?
Yes, mental health services including therapy, counseling, and psychiatric care fall under unreimbursed medical expenses shared between parents under Texas Family Code § 154.183. If covered by insurance, parents share copays and deductibles according to their order's percentage split. If not covered, the full cost is divided. Courts recognize mental health as essential healthcare for children and enforce these obligations accordingly.
What is the maximum amount I can be ordered to pay for health insurance in Texas?
The maximum health insurance obligation equals 9% of your annual gross resources under Texas Family Code § 154.181. With the 2026 income cap at $11,700 monthly ($140,400 annually), the absolute maximum medical support equals $12,636 per year or $1,053 monthly. Add 1.5% for dental support ($175.50 monthly maximum) and your combined insurance obligation caps at $1,228.50 monthly before adding base child support and unreimbursed expense sharing.
Filing for Divorce with Child Support in Texas: Key Requirements
Texas requires six months of state residency and 90 days of county residency before filing for divorce under Texas Family Code § 6.301. Filing fees range from $300 to $400 depending on the county, with Harris County charging $350-$365 and Dallas County charging $250-$350 as of March 2026. After filing, Texas mandates a 60-day waiting period under Texas Family Code § 6.702 before finalizing any divorce. Medical support orders become part of the final decree and remain enforceable until children age out or circumstances warrant modification.
Parents seeking fee waivers may file a Statement of Inability to Afford Payment of Court Costs under Texas Rule of Civil Procedure 145 if they receive government benefits, earn below 125% of the federal poverty level, or demonstrate genuine financial hardship. The court waives fees for qualifying individuals to ensure access to justice regardless of economic circumstances.