National Medical Support Notice

The CSEA must enforce support orders with health insurance coverage or collection of court ordered medical support or birth costs to reimburse Medicaid. A medical support order is binding on the MI Obligor (person required to provide health insurance under a medical insurance order), their employers and any insurer that provides health insurance coverage for either parent or their children.

The National Medical Support Notice (NMSN) is a federally required tool used to enforce medical support orders for minor children. It is to be used throughout the United States to enroll children in employment related health insurance coverage. The NMSN is only required for employment based insurance coverage and is sent to the employer of the person who is ordered to provide medical insurance coverage.

The NMSN is a 14 page document with instructions for the employer and the health plan administrator. A description of the NMSN and the employer and Plan Administrator duties are described on the ODJFS/OCS Internet site at:


Health Plan Administrator is the person at the health insurance agency responsible for processing the National Medical Support Notice (NMSN)

Medical Insurance (MI) Obligee is the party that is not responsible for providing health insurance.

Medical Insurance (MI) Obligor is the person that is required to provide health insurance under a medical insurance order.

Medical Insurance (MI) Order is the requirement within a child support order for one or both of the parties to provide health insurance.

How is the NMSN Used?

The Child Support Enforcement Agency (CSEA) in the county with your child support/medical insurance order sends the NMSN to the health plan administrator in 20 business days, unless the employer does not provide insurance. The health plan administrator will enroll the child/children 20 days after receiving the NMSN, unless there is a waiting period or there is more than one health insurance plan option. In those cases, enrollment takes place when the waiting period ends or the plan option is selected.

MI Obligor Questions and Answers

I Received a “Notice of Medical Support Activity.” What does this mean?

The Notice of Medical Support Enforcement Activity was sent to tell you that the CSEA has sent a copy of the National Medical Support Notice (NMSN) to your employer. This NMSN is required by federal law and the Ohio Revised Code. It was sent to your employer because the CSEA believes that you are under a court or administrative order to provide medical insurance for your child(ren) and the CSEA just discovered that you are employed or changed employment.

What will my employer do with the NMSN?

The NMSN requires your employer to enroll your child(ren) in any medical insurance it has available for them and withhold the premiums from your paychecks.

What if I don’t agree with the information in the Notice of Medical Support Enforcement Activity?

You have a right to request an administrative mistake of fact hearing if you believe you are not the person named by the Notice, or if you have not been ordered to provide medical insurance for your child(ren). Complete and send in the last page of the Notice to the CSEA within 7 business days of the date of the Notice.

I can’t afford to pay for medical insurance for my child(ren). What can I do?

When your employer gets the NMSN, they will have to determine whether the amount of your child support order and the amount of the medical insurance premium, added together, will be more than the percent they are allowed to withhold from your paycheck under the federal Consumer Credit Protection Act. If the insurance and child support together equal more than this amount, you employer will not enroll your child(ren) in medical insurance.

You also have the right to request a review and adjustment of your child support order from the CSEA if you believe that your financial situation has changed. You should ask your CSEA about the specific requirements for this review.

What is the Consumer Credit Protection Act?

The Consumer Credit Protection Act (CCPA) is a federal law that protects people from having too much money withheld from their paychecks in order to pay child support. The amount withheld cannot exceed a set percentage (Between 50% and 65% of your earnings after mandatory deductions for taxes). The percentage depends on whether or not you have dependents, and whether or not you owe an arrearage on your child support order. Check with your employer for more details on this law.

My current spouse has my child(ren) covered on her insurance. Can I ignore this Notice?

No. Ohio law requires the NMSN to be sent to the employer of the person who is ordered to provide the medical insurance. You may, however, request a court hearing to change the medical insurance order to include your current spouse.

MI Obligee Questions and Answers

How will I receive plan information?

If only one health plan option is or becomes available, you will be notified by the health plan administrator for coverage availability. They will furnish you with a description and effective date of the plan’s coverage, and any forms or information necessary to put that coverage into effect. They will also provide you with the information on submitting claims for benefits.

What should I do when the CSEA tells me I have more than one health plan options?

The plan administrator will provide the CSEA with descriptions of all plan options including any additional conditions for coverage and any service area limits. The CSEA will provide this information to you. It is very important that you notify the CSEA of your choice promptly. Otherwise your child(ren) could be automatically enrolled in a default option, which may not be your first choice. If there is no default option available, the CSEA may make the plan option selection.

Is information released to the MI obligor if the MI obligee/child(ren) are subject to family violence?

No. There will be no information about the MI obligee and child(ren) shared with the MI obligor. The National Medical Support Notice will only be sent to the MI obligor’s employer.

For additional information, you may contact your local child support enforcement agency or visit: