Definition of National Medical Support Notice (NMSN)


The National Medical Support Notice form is used by all child support enforcement agencies to notify employers that one of their employees has been ordered to provide insurance coverage for a dependent. The NMSN has the same authority as a court order related to a dependent’s health insurance coverage.

What is the National Medical Support Notice (NMSN)?

The NMSN is a 2-part form that must be completed by an employer when they receive notice from a child support enforcement agency that an individual must cover an eligible minor under their health insurance.

In cases where the employee doesn’t have access to health insurance, the employer must complete a portion of form Part A of the notice will have been completed by the issuing child support enforcement agency and the court ruling on the judgment.

When health insurance is available, the form’s Part B will be completed by the issuing child support enforcement agency and the court ruling on the judgment. There is also a portion that must be completed by the employer’s health plan administrator.

Why is the National Medical Support Notice important to my business?

Because this process is associated with a court proceeding and judgment, it becomes a matter of legal record. Failure to comply with the court order will not only reflect poorly on the affected employee but also on your business.

Reputational risk isn’t your only concern in this instance. You may be subject to sanctions if your company does not respond to the NMSN within 40 days of its effective date. The employer or plan administrator can be penalized up to $200,000 per impacted child per month as a result of a filing from the State’s Attorney.

It is also the company or the plan administrator’s responsibility to notify the issuing agency of an employee’s termination or layoff within 7 days of the event.

What is the history of the NMSN?

This is not a new requirement. Its initial origins can be traced back to 1908 and the medical support provisions of the Omnibus Budget Reconciliation Act (OBRA). This legislation included a section related to Medicaid State plan requirements.

In more recent history, Section 382 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) added a new paragraph. This new language required a provision for health care coverage in all child support orders established or enforced by IV-D agencies.

Although the legislation went through several iterations and took a while to be finalized, it was effective as of January 26, 2001. It implements provisions of the initial Child Support Performance and Incentives Act of 1998 (CSPIA).

The Working Group for this legislation included thirty members representing:

  • Employers (including payroll professionals)
  • HHS and DOL
  • Organizations representing children potentially eligible for medical support
  • Organizations representing State child support programs
  • Sponsors and administrators of group health plans (as defined in section 607(1) of ERISA)
  • State child support directors
  • State Medicaid directors
  • State medical child support programs

This new legislation placed it under the oversight of the Department of Labor and Health and Human Services, specifically.

Other terms similar to the NMSN that can assist you

  • Affordable Care Act (ACA): A regulation managed through Health and Human Services (HHS). Applicable large employers (ALEs) must offer affordable health insurance options, as defined by this regulation, and comply with its stringent recordkeeping requirements.
  • Applicable Large Employers (ALEs): Employers with 50 or more full-time equivalent (FTE) employees.
  • Children’s Health Insurance Program (CHIPRA): A program aligned with Medicaid which must be communicated to all parents to ensure their children have access to affordable healthcare.

Summary of the National Medical Support Notice

The National Medical Support Notice is a process initiated by Health and Human Services agencies responsible for acts of Child Protection Services. This is specifically related to health insurance coverage for eligible children and may include wage garnishments.

There are contingencies in place to recognize times when the employee doesn’t have access to health insurance and what to do when health coverage is an option.

The NMSN is a means by which companies can participate in the protection and support of children. By completing and enforcing the actions required by these forms, your company not only serves as a concerned and responsible citizen but also ensures your employee is not taken advantage of by ensuring the limits and protections of the Consumer Credit Protection Act (CCPA) are upheld.

Similar glossary definitions you must know

  • ACA Reporting: Applicable large employers (ALEs) must provide their employees with their personal benefits-related reporting form 1095C. The IRS must receive both the individual 1094Cs and the consolidated 1095C. Self-insured companies, or those that do not meet the ALE definition, must provide the 1095B to all employees, and the IRS must receive both the 1094B and 1095B.
  • Consumer Credit Protection Act (CCPA): The law that governs wage and garnishment limits, which may vary by state — North Dakota is a prime example. The NMSN is subject to these provisions.

People also ask

From hiring to retiring, make managing your team a breeze with Zenefits