A Colorado child support order is not finished until it says who carries the children's health insurance, how the premium is shared, and how the bills the insurance does not cover get split. The statute does not treat medical support as optional. Under C.R.S. § 14-10-115(10), the court must provide for the children's current and future medical needs in every order, and an order that leaves it out can be modified for that reason alone.
The short version: the parent with coverage available at reasonable cost usually carries the children, the children's share of the premium goes into the child support worksheet and is divided in proportion to income, and uninsured costs are divided the same way. Since May 31, 2025, that division starts with the first dollar. The old $250-per-child threshold is gone.
The Court Must Order Medical Support in Every Case
Section 14-10-115(10)(a) directs the court to order either or both parents to enroll the children on an existing policy, buy coverage for them, or provide for their medical needs "in some other manner," a phrase that covers public coverage. The same order must say who pays deductibles and copayments.
Which parent carries the plan is mostly a question of availability and cost. The statute uses two markers for a premium that is too expensive to require: when adding it would drive the support order down to $50 or less, or when it is five percent or more of that parent's gross income. In either case the court may decline to order coverage, but the parent must provide it once it becomes available at reasonable cost. If a plan excludes the children because they live outside its service area, the court orders separate coverage if it can be had at reasonable cost.
Two overlooked provisions. If the carrying parent's new spouse provides the coverage, the worksheet credit is given as if the parent paid the premium. And the policyholder must give the other parent the insurer's name, group and policy numbers, and claims address on request; the court can fine a parent who refuses.
How the Premium Enters the Worksheet
Only the children's share of the premium counts. Under § 14-10-115(10)(c), the amount added to the basic child support obligation is the actual premium attributable to the children. When the employer cannot break that out, the statute supplies the math: divide the total premium by the number of people covered, then multiply by the number of children on the order.
A round-number example. A father's family plan costs $900 a month and covers him, his new wife, and the two children. The children's share is $900 divided by four, times two, or $450. That $450 is added to the basic obligation and divided by income. If he earns 60 percent of the combined income, his share is $270 and the mother's is $180.
What happens next depends on who pays the carrier. If the parent paying support carries the plan, the $450 he actually pays is subtracted from his monthly support figure, so the other parent's share comes back to him through a lower payment. If the parent receiving support carries the plan, the paying parent's share is already built into the monthly number. The court requires proof of enrollment and premium cost before allowing the adjustment.
Two income wrinkles. Premiums deducted through a pre-tax cafeteria plan still count as gross income, under In re Marriage of Cardona (2014), while the employer's own contribution is not income to the employee where it cannot be taken as cash, under In re Marriage of Davis (2011). And because a premium is predictable and recurring, In re Marriage of Alvis (2019) puts it on the worksheet: neither parent can later bill the other for it a second time.
Uninsured and Extraordinary Medical Expenses After HB25-1159
House Bill 25-1159 rewrote § 14-10-115(10)(h). The new definition took effect when the bill was signed on May 31, 2025, unlike the new support schedule and parenting-time table, which waited until March 1, 2026. Extraordinary medical expenses now include copayments, deductibles, and uninsured out-of-pocket costs for professional medical care, prescriptions, medical equipment, orthodontia, dental treatment, asthma treatment, physical therapy, vision care, counseling or psychiatric therapy for behavioral or mental health disorders, and any uninsured chronic health problem. For a child with a disability who qualifies for long-term services and supports, the list extends to home and vehicle modifications, therapeutic activities, and respite care.
Not covered: minor items already priced into the basic obligation, such as over-the-counter medicine and bandages, unless a provider recommends them to manage a chronic condition.
The statute sorts these expenses into two channels. Expenses that are consistent and expected to continue, such as a monthly orthodontia payment or weekly therapy, may be added as a line on the worksheet. Everything else runs through reimbursement, with rules that have teeth:
- The parent who paid must provide proof of the expense within a reasonable time.
- Absent extraordinary circumstances, proof delivered after July 1 of the following calendar year waives the reimbursement.
- The other parent has 49 days after receiving the request to pay or work out a payment arrangement.
- After that, the paying parent may move for a judgment for that year's expenses. The motion must state the amount, the share sought, and when and how the request was made.
Orders entered before the change usually carry the old $250-per-child language. Those orders mean what they say until someone modifies them; the first-dollar rule applies to orders entered or modified since.
When a Parent Loses Employer Coverage
A parent ordered to provide coverage must notify the other parent, and the child support enforcement unit if it is involved, of any change or discontinuation no later than 14 days after it happens. Losing coverage opens a limited special-enrollment window on the other parent's employer plan and on the state marketplace, and a parent who sits on the news can leave the children uninsured.
A well-drafted order anticipates the loss. It names a fallback: the other parent's plan, marketplace coverage, or public coverage if the children qualify. It says who pays the new premium. And it recognizes that when a $450 premium moves from one parent's paycheck to the other's, the worksheet result often moves by more than ten percent, the threshold for a modification under C.R.S. § 14-10-122. A modification is effective from the date the motion is filed, so the parent who picks up the premium should file promptly rather than absorb it.
One connected change: since May 31, 2025, the court allocating the dependency exemption must consider how the allocation affects either parent's ability to claim a marketplace premium tax credit. A parent who ends up buying marketplace coverage for the children has a real interest in who claims them.
Writing the Order So It Does Not Come Back to Court
Most post-decree medical-expense fights come from vague orders. The provisions that prevent them:
- Name the carrying parent, the plan, and the premium figure used in the worksheet, and require an annual exchange of updated premium information.
- Define the shared expense categories by tracking the statutory list, and say whether recurring items are on the worksheet or reimbursed.
- Set the documentation method and deadlines; the statutory July 1 and 49-day rules are the default.
- Say who pays the provider first and how the other parent reimburses.
- Tie elective care such as orthodontia to the decision-making allocation, so one parent cannot commit the other to a large bill unilaterally.
- Address emancipation. Support ends at 19 in most cases, and the court cannot compel coverage past that point without a written agreement or a finding that the child is disabled, but parents can agree to keep a child on a plan through college.
Talk to a Denver Divorce Attorney About Children's Health Coverage
Aaron Herzberg is a divorce attorney in Greenwood Village, Colorado, serving Denver and the Front Range, with more than 30 years of trial experience and a practice focused on divorce, custody, and financially complex family law. Medical support is decided once and lived with for years, so the premium math and the reimbursement rules deserve attention before the order is signed, not after the first orthodontist bill. A first meeting is a paid consultation, not a free call and not a sales pitch.
Read the full guide on DenverDivorce.com: Child Support in Colorado.
Educational information only, not legal advice. Reading this article does not create an attorney-client relationship.
