In Washington State, both parents share a legal obligation to provide health insurance for their children as part of any child support order under RCW 26.09.105. Courts must address medical support in every child support case, requiring parents to either maintain employer-sponsored coverage or contribute cash medical support capped at 25% of their basic support obligation. With the January 1, 2026 implementation of Engrossed House Bill 1014, Washington has updated its child support economic table to cover combined monthly incomes up to $50,000 and increased the self-support reserve to 180% of federal poverty guidelines, directly affecting how health insurance costs are calculated and allocated between parents.
| Key Facts | Details |
|---|---|
| Filing Fee | $314-$364 depending on county (as of January 2026) |
| Waiting Period | 90 days mandatory cooling-off period |
| Residency Requirement | No minimum duration; must be a Washington resident at filing |
| Grounds | No-fault only (irretrievable breakdown of marriage) |
| Property Division | Community property state (50/50 presumption) |
| Health Insurance Cap | 25% of obligated parent's basic support obligation |
| Governing Statute | RCW 26.09.105 (Medical Support Conditions) |
Washington's Mandatory Health Insurance Requirement in Child Support Orders
Washington courts must include a medical support provision in every child support order requiring both parents to provide health insurance coverage for their children under RCW 26.09.105. This requirement applies to all dissolution cases involving minor children, and neither parent can be excused from this obligation simply because the children receive public health coverage such as Apple Health (Medicaid). The statute mandates that if accessible employer-sponsored coverage is available at no additional cost, the parent must enroll the children regardless of other coverage sources.
The medical support obligation in Washington consists of three distinct components that courts must address. First, parents must provide or maintain health insurance coverage through their employer, union, or private policy. Second, parents may be required to pay cash medical support toward premiums paid by the other parent or a public entity. Third, both parents must share responsibility for uninsured medical expenses in proportion to their respective incomes.
Under RCW 26.09.105, a parent ordered to provide health care coverage must submit proof of coverage or proof that coverage is unavailable within 20 days of the order's entry. This deadline applies when payments are directed through the Washington State Support Registry. Failure to provide timely proof can trigger direct enforcement mechanisms, including the National Medical Support Notice to the parent's employer.
The Division of Child Support (DCS) plays a critical enforcement role in medical support cases. When DCS establishes or modifies a child support order, they automatically include medical support provisions requiring both parents to provide health care coverage when available through employment or union membership. The agency monitors compliance and can initiate enforcement actions against non-compliant parents.
The 25% Affordability Cap on Health Insurance Costs
Washington law caps health insurance costs at 25% of the obligated parent's basic child support obligation to ensure affordability while maintaining coverage requirements. Under RCW 26.09.105, a parent satisfies their health care coverage obligation by providing employer or union-based coverage that costs no more than one-quarter of their basic support amount. For example, if a parent's basic monthly support obligation is $800, their health insurance cost for the children cannot exceed $200 per month under the standard calculation.
The 25% threshold applies specifically to the obligated parent's basic support obligation, not their total income or the combined parental income. This distinction matters significantly when calculating medical support responsibilities. The basic support obligation is determined using Washington's economic table under RCW 26.19.020, which factors combined parental income and number of children.
Courts retain discretion to order coverage exceeding the 25% cap when doing so serves the child's best interests. Situations warranting this exception include children with special medical needs requiring comprehensive coverage, significant disparities in coverage quality between parents' available plans, or circumstances where the only available coverage exceeds the cap but remains the most appropriate option.
How the 25% Cap Calculation Works
| Monthly Basic Support Obligation | Maximum Health Insurance Cost |
|---|---|
| $400 | $100 |
| $600 | $150 |
| $800 | $200 |
| $1,000 | $250 |
| $1,500 | $375 |
| $2,000 | $500 |
When health insurance costs exceed 25% of the basic support obligation, the obligated parent may instead be required to contribute cash medical support. This payment goes toward coverage provided by the other parent or a public health program, ensuring children maintain continuous coverage regardless of cost constraints.
Cash Medical Support Obligations Explained
Cash medical support in Washington consists of two components under RCW 26.09.105: monthly premium contributions capped at 25% of basic support and a proportionate share of uninsured medical expenses. When a parent cannot provide direct coverage through their employer, they must instead pay cash medical support to offset costs incurred by the other parent or the state for providing coverage.
The monthly premium payment represents the obligated parent's proportionate share of the premium actually paid for coverage. If the custodial parent pays $300 monthly for family health coverage and the non-custodial parent has 40% income responsibility, the cash medical support for premium would be $120 per month—provided this amount does not exceed 25% of the obligated parent's basic support.
Uninsured medical expenses include co-pays, deductibles, prescription costs, dental care, orthodontia, vision care, mental health treatment, and any other healthcare costs not covered by insurance. Under RCW 26.19.080 (effective January 1, 2026), health care costs are shared by parents in the same proportion as the basic child support obligation. These costs encompass medical, dental, orthodontia, vision, chiropractic, mental health treatment, and prescription medications.
A practical example illustrates how cash medical support works: Parent A earns 65% of combined income and pays $400 monthly for family coverage through their employer. Parent B earns 35% of combined income. Parent B's cash medical support would be 35% of $400, equaling $140 monthly toward premiums. Additionally, if the child incurs $500 in uninsured orthodontia costs, Parent B would owe $175 (35% of $500) as their proportionate share.
2026 Changes to Washington Child Support Law Under HB 1014
Engrossed House Bill 1014, effective January 1, 2026, represents the most significant overhaul to Washington's child support laws in decades, directly affecting how health insurance costs factor into support calculations. The economic table now covers combined monthly net incomes from $2,200 to $50,000, quadrupling the previous $12,000 ceiling. This expansion affects the 25% health insurance cap calculation for higher-income families.
The self-support reserve increased from 125% to 180% of the federal poverty guideline for a one-person household. In 2026, this means a paying parent's net income cannot be reduced below approximately $2,015 monthly after child support deductions (180% of the 2026 federal poverty guideline of $1,120 for one person). This protection ensures parents can afford basic necessities while meeting support obligations.
New allowable deductions under HB 1014 include Washington Paid Family and Medical Leave (PFML) contributions and Washington Cares long-term care trust contributions. These mandatory state insurance premiums can now be deducted from gross income before calculating child support, potentially reducing basic support obligations and the associated 25% health insurance cap.
The minimum support order remains $50 per child per month, applying when a parent's income falls below the self-support reserve threshold. Even parents receiving this minimum order must still address medical support obligations, though courts may adjust cash medical support expectations based on demonstrated financial hardship.
2026 Child Support Changes Summary
| Component | Before 2026 | After January 1, 2026 |
|---|---|---|
| Economic Table Maximum | $12,000/month combined | $50,000/month combined |
| Economic Table Minimum | $1,000/month combined | $2,200/month combined |
| Self-Support Reserve | 125% FPL (~$1,400/month) | 180% FPL (~$2,015/month) |
| PFML Deduction | Not allowed | Allowed |
| WA Cares Deduction | Not allowed | Allowed |
| Minimum Monthly Support | $50/child | $50/child (unchanged) |
Employer Obligations and the National Medical Support Notice
Employers in Washington must respond to National Medical Support Notices within prescribed timeframes when ordered to enroll a child in a parent-employee's health plan. Under federal law (42 U.S.C. Section 666(a)(19)) and RCW 26.18.170, employers receiving an NMSN must provide information about available coverage options, enroll qualifying children when directed, and withhold premium contributions from the employee's wages.
The NMSN process begins when a child support order contains specific language warning that failure to provide coverage may trigger direct enforcement. The Division of Child Support can then send the NMSN to the parent's employer without additional notice to the parent. Employers must respond to Part A (Notice to Withhold for Health Care Coverage) and, if serving as their own plan administrator, also complete Part B (Medical Support Notice to Plan Administrator).
Employers who fail to comply with NMSN requirements face potential penalties under both federal ERISA regulations and Washington state law. The Department of Labor oversees NMSN compliance, while the Division of Child Support monitors enforcement within Washington. Employees cannot be penalized or terminated for having an NMSN filed against them.
Allocation of Coverage When Both Parents Have Insurance
When both parents have employer-sponsored health insurance accessible to the children, Washington courts exercise discretion in determining which parent must provide coverage under RCW 26.09.105. The statute directs courts to consider the needs of the child, the cost and extent of each parent's coverage, and the accessibility of coverage when making this determination.
The parent with superior coverage typically receives the coverage order, while the other parent pays a monthly premium contribution. Factors determining superior coverage include lower deductibles and co-pays, broader provider networks, better prescription drug coverage, inclusion of dental and vision benefits, and coverage for pre-existing conditions or ongoing treatments the child requires.
Accessibility means the child can actually use the coverage without unreasonable burden. Coverage may be deemed inaccessible if the plan's provider network does not include physicians or facilities within reasonable distance of the child's residence, if the plan excludes the child's state of residence from coverage, or if plan terms otherwise prevent practical utilization.
Courts may enter orders requiring both parents to maintain their respective coverage when doing so benefits the children. For example, if one parent has excellent medical coverage but no dental, while the other has comprehensive dental coverage, courts can order each parent to maintain their specific coverage type.
Enforcement of Medical Support Orders in Washington
The Division of Child Support enforces medical support obligations through multiple mechanisms under RCW 26.18.170. Enforcement actions include sending National Medical Support Notices to employers, intercepting tax refunds, suspending driver's and professional licenses, reporting to credit bureaus, and initiating contempt proceedings through the courts.
When a parent fails to provide ordered health insurance coverage, the other parent or DCS can petition the court for enforcement. Remedies include makeup payments for medical expenses that would have been covered, reimbursement for premiums paid by the other parent to maintain coverage, and contempt findings that can result in fines or incarceration for willful non-compliance.
Parents must provide proof of coverage within 20 days of the support order's entry when payments flow through the Washington State Support Registry. Acceptable proof includes insurance cards, coverage verification letters from the insurer, or employer certification of enrollment. DCS maintains records of coverage status and monitors compliance.
Modification of medical support orders follows the same process as modifying basic child support. Parents can seek modification when circumstances substantially change, such as loss of employer-sponsored coverage, significant changes in coverage costs, changes in children's medical needs, or changes in parental income affecting the 25% cap calculation.
Health Insurance Considerations During Divorce Proceedings
Health insurance coverage for children must be addressed in the parenting plan and child support order during Washington divorce proceedings. The superior court cannot finalize a dissolution involving minor children without determining medical support responsibilities. This requirement applies to both contested and uncontested divorces.
During the 90-day mandatory waiting period between filing and finalization under RCW 26.09.030, existing coverage should remain in place. Courts can enter temporary orders addressing health insurance to ensure continuous coverage throughout proceedings. Allowing coverage to lapse during divorce can expose both parents to liability for medical expenses.
COBRA coverage provides a 36-month continuation option for children losing coverage due to a parent's divorce. While expensive (typically 102% of the full premium), COBRA ensures no gap in coverage while parents establish new arrangements. The divorce decree should specify responsibility for COBRA premiums if utilized.
Spouses covered under a partner's employer plan lose eligibility upon divorce finalization. This creates a critical planning issue separate from children's coverage. Washington's health insurance marketplace (Washington Healthplanfinder) offers special enrollment periods following divorce, allowing newly-single individuals to obtain individual coverage outside open enrollment.
Children's Health Coverage Options in Washington
Washington offers multiple health coverage options for children in child support cases, and courts consider all available sources when crafting medical support orders. Employer-sponsored insurance typically provides the most comprehensive coverage and represents the preferred option under RCW 26.09.105.
Apple Health (Washington's Medicaid program) covers children in families earning up to 312% of federal poverty guidelines, which in 2026 equals approximately $80,000 annually for a family of four. Children receiving Apple Health may still require a parent to provide employer coverage if available at no additional cost, as public coverage alone does not excuse the medical support obligation.
The Children's Health Insurance Program (CHIP) in Washington operates through Apple Health and covers children who do not qualify for Medicaid but whose families cannot afford private coverage. Eligibility extends to higher income levels than standard Medicaid, providing a safety net for children whose parents lack employer-sponsored options.
Private marketplace plans through Washington Healthplanfinder offer another avenue for children's coverage. When neither parent has employer-sponsored coverage, courts may order one or both parents to obtain marketplace coverage, with costs allocated according to the income-proportionate standard. Subsidies may reduce premium costs for qualifying families.
Uninsured Medical Expenses and Cost Sharing
Washington mandates proportionate sharing of uninsured medical expenses between parents under RCW 26.19.080. These expenses include deductibles, co-payments, coinsurance, and any healthcare costs not covered by the children's health plan. The sharing percentage mirrors each parent's share of the basic support obligation.
Uninsured medical expenses specifically enumerated in Washington law include medical treatment, dental care, orthodontia, vision care, chiropractic treatment, mental health services, and prescription medications. Courts can address additional categories such as medical equipment, physical therapy, and emergency care in the support order.
The parent incurring an uninsured medical expense typically pays upfront and seeks reimbursement from the other parent. Standard practice requires providing documentation (receipts, explanation of benefits statements) within 30 days of incurring the expense. The owing parent must reimburse within 30 days of receiving proper documentation.
Disputes over uninsured medical expenses—such as whether a procedure was medically necessary or whether less expensive alternatives existed—can be addressed through motion practice in family court. Courts generally favor coverage of reasonable medical expenses actually incurred, with the burden on the objecting parent to demonstrate unreasonableness.