In Montana, a child support order is never only about the monthly payment. Each temporary or final order that sets child support, and each modification, "must include a medical support order" (MCA § 40-4-204(4)). That order decides which parent insures the child and how premiums and uncovered bills are divided. The rules are in the Medical Support Order Enforcement part of the code, MCA §§ 40-5-801 through 40-5-825. This page is part of our Montana Divorce Guide.
What a Medical Support Order Is
A medical support order is a judgment, decree, or order, including approval of a settlement agreement, "that provides for the medical care of a child" and complies with the medical support statutes (MCA § 40-5-804(8)). Medical care is defined broadly as diagnosis, cure, mitigation, treatment, or prevention of disease, illness, or injury, including well baby checkups and periodic examinations (MCA § 40-5-804(7)).
In setting the order, the court or the Child Support Services Division considers the child's best interests, the child's present and anticipated medical needs, the parents' financial ability to pay for coverage, and how far an available plan is subsidized by an employer or a group (MCA § 40-5-805(1)). With limited exceptions, the child's eligibility for a public assistance program is not to be counted in deciding whether a parent can afford coverage (MCA § 40-5-805(2)).
Which Parent Must Provide Coverage
The statute uses the term "primary parent," meaning "the parent with whom the child resides for the most 24-hour periods in a plan year" (MCA § 40-5-804(13)). The parent required to provide for the child's medical care is the "obligated parent," who "is not necessarily the same as an obligor for child support" (MCA § 40-5-804(9)).
| Situation | What the order must do | MCA |
|---|---|---|
| The child is already covered, or coverage is available through the primary parent's plan, or it is available through the other parent's plan | The order must require participation in that plan, unless the cost is not reasonable or cost-beneficial or another plan would better serve the parties. | § 40-5-806(2) |
| Plans are available to both parents at a reasonable combined cost, with compatible primary and secondary benefits | The order must require both parents to provide coverage. | § 40-5-806(3) |
| No plan is available to either parent when the order is made | The parent other than the primary parent must obtain individual insurance, or obtain coverage later when it becomes available at reasonable cost, with two listed exceptions. | § 40-5-806(4) |
| Insurance is found not to be available at a reasonable cost | The tribunal notifies the primary parent of state group plans the child may qualify for and may order an application. | § 40-5-806(5) |
The duty in the third row is not enforceable if the primary parent has obtained coverage and both parents have agreed in writing to share its cost, or if the other parent persuades the tribunal that the cost of available plans is not reasonable or cost-beneficial (MCA § 40-5-806(4)).
Unless the tribunal expressly says otherwise, the order must address all of these possibilities even if only one applies today, so that "if circumstances later change, the health needs of the child will continue to be met" without a new order (MCA § 40-5-807(1)). A job change that ends one parent's plan does not leave the child without a rule.
What Reasonable Cost Means
The statute directs the Department of Public Health and Human Services to adopt a rule on when coverage is presumed available at a reasonable cost (MCA § 40-5-806(9)). Under that rule, ARM 37.62.1909, coverage is presumed reasonable in cost if:
- the premium for individual insurance or a health benefit plan does not exceed 5% of that parent's gross income; or
- a plan is available through an employer or other group that pays part or all of the premium.
The presumption may be rebutted by clear and convincing evidence. The tribunal has discretion to order coverage when the premium is above the presumptive amount and to decline to order it when the premium is below.
Sharing Premiums and Uncovered Costs
The order must provide that the cost of coverage, "any copayments and deductibles required under the coverage, and all medical expenses for the child that are not covered" are "shared between parents in accordance with the child support guidelines. If the order fails to designate each parent's share, each parent is liable for 50% of the costs and expenses" (MCA § 40-5-806(7)).
Inside the guidelines calculation, the actual cost of adding the children to a policy, and unreimbursed health care expenses over $250 per year per child that are recurring and predictable, are supplements divided by the parents' income shares (ARM 37.62.123). The statute adds a limit: the cost of coverage "may not be used as a direct offset to the child support obligation" (MCA § 40-5-806(8)). See how child support is calculated.
Duties of the Insuring Parent
The obligated parent must promptly sign and deliver the forms needed to enroll the child and keep the child enrolled, submit claims on time, and give the other parent insurance cards or other means of access to the coverage (MCA § 40-5-822(1), (2)). A parent who receives an insurance reimbursement for a bill the other parent paid must promptly pay it over (MCA § 40-5-822(3)).
Every support order also requires each parent to keep the court informed of the insurer, the policy number, and who is covered, or of whether coverage is available through an employer (MCA § 40-4-204(6)(a)(iii)).
When a Parent Does Not Follow the Order
An obligated parent who fails to obtain coverage, or who lets it lapse without a comparable replacement, "is liable for all of the child's medical expenses" and must indemnify the other parent for the cost of obtaining coverage (MCA § 40-5-822(4)). The parent can be relieved by proving, for example, that no reasonable-cost coverage was available and that the other parent was notified. Amounts owed may be entered as a judgment for unpaid support (MCA § 40-5-822(6)). A tribunal may also impose a civil penalty of up to $25 per day for a knowing violation (MCA § 40-5-821(1)).
A violation of a medical support order, or the absence of one, justifies an immediate modification of child support (MCA § 40-4-208(2)(c)). The medical duty lasts as long as the support duty: it "ceases only when the parental obligation to support a child terminates under law" (MCA § 40-5-808(1)). See modifying child support and when child support ends.
A spouse's own coverage after the decree is a different subject, covered in health insurance after divorce. For children with significant medical needs, see divorce with a special needs child.
This page explains Montana law in general as of the 2025 Montana Code Annotated and the current administrative rules. It is not legal advice about your specific case.