Health insurance, dental and child care in Texas child support (2026)

Is health insurance included in Texas child support?

It is ordered on top of it. Texas Family Code § 154.064 says the guidelines assume the court will also order medical and dental support. Section 154.181 requires a medical support order whenever child support is ordered or modified, including in interstate cases under chapter 159, and § 154.1815 does the same for dental support. Amounts ordered as medical or dental support are child support obligations, enforceable by wage withholding (§ 154.183(a)).

Who has to provide the children’s health insurance in Texas?

Section 154.182(b) sets an order of priority, unless a party shows good cause for a different order:

1. If insurance is available through a parent’s job or union at reasonable cost, the court orders that parent to cover the child.
2. If not, but a parent can get insurance at reasonable cost from another source, the court may order that parent to provide it.
3. If neither applies, the court orders the paying parent to pay cash medical support, up to 9 percent of that parent’s annual resources, in addition to guideline support.

If neither parent has access to private insurance at reasonable cost, the court orders a parent to apply for a government medical assistance program or health plan for the child, and orders cash medical support if the child takes part (§ 154.182(b-2)).

“Reasonable cost” for health insurance means a cost for all the children under the order of not more than 9 percent of the paying parent’s annual resources, as resources are defined in § 154.062(b), that is, before deductions (§ 154.181(e)).

What happens when the parent the children live with provides the insurance?

The other parent pays for it. When the parent ordered to provide insurance is the parent receiving support, the court orders the paying parent to pay, as additional child support, the actual cost of the children’s coverage, but not more than the reasonable cost limit (§ 154.182(b-1)). If the plan also covers other minor dependents of that parent, the total cost is divided by the number of minor dependents covered, including the child.

What happens when the paying parent provides the insurance?

The cost is deducted from that parent’s net resources before the percentage is applied (§ 154.062(d)(5)), and divided per covered dependent when the plan covers other minor dependents too (§ 154.062(e)). For two children and wages of $6,000 a month, a children’s premium of $300 a month gives:

Two children, insurance paid by the paying parent

In Texas: 2 children; the other parent earns $6,000 a month before tax; health insurance for the children of $300 a month, paid by the other parent.

1. Take off taxes§§ 154.061 and 154.062, net resources

   $6,000 gross − $372.00 Social Security − $87.00 Medicare − $584.17 federal income tax − $300.00 the children's health insurance = $4,656.83 of net resources a month.

   $4,656.83

2. Apply the guideline for 2 children§ 154.125, guideline percentages and cap

   $4,656.83 × 25% = $1,164.21.

   $1,164.21 a month

Without the premium, the guideline for the same family is $1,239.21 a month. The paying parent pays the premium directly as well, so the two figures do not compare total costs.

How does dental support work in Texas?

The same way, with a lower limit. “Reasonable cost” for dental insurance is a premium of not more than 1.5 percent of the paying parent’s annual resources (§ 154.1815(a)). The court gives priority to dental insurance through a parent’s job or union, then to other dental insurance a parent can get at reasonable cost (§ 154.1825(c)). If the parent receiving support provides it, the paying parent pays its actual cost as additional support, up to that limit (§ 154.1825(d)).

Who pays uninsured medical bills, copays and deductibles?

Both parents, in shares the court sets. As additional child support, the court allocates between the parties “according to their circumstances” the reasonable and necessary health care expenses, including vision and dental, that insurance or cash medical support does not cover, and the deductibles and copayments for covered care (§ 154.183(c)). The statute does not fix the split.

Is child care added to Texas child support?

No. Unlike states that add child care to the guideline amount, Texas sets support only as a percentage of the paying parent’s net resources (§ 154.125). Child care expenses either parent pays in order to keep working are one of the factors a court must consider when deciding whether applying the guideline would be unjust or inappropriate (§ 154.123(b)(6)). Possession time is another (§ 154.123(b)(4)); see the shared custody guide.

Can medical support be changed after the order?

Yes. A health or dental coverage order can be modified on the same grounds as the rest of a support order (§ 156.401(a)), and in a Title IV-D case an order that lacks the required coverage can be modified at any time to add it (§ 156.401(a-2)). The Attorney General’s Child Support Division describes how a change in coverage can lead to a review of the order.

Open this family in the Texas calculator

What this guide does not cover

This guide does not cover the Title IV-D health care program in § 154.1826, employer enrollment under a medical support notice, or how courts set the shares of uninsured costs. The engine also leaves out these parts of the Texas guideline:

• For children in one household. Children in more than one household are computed with a credit for the other children (154.128), or with the alternative table in 154.129; not modeled.
• Dental support (up to 1.5% of the paying parent's resources, 154.1825), cash medical support when no health insurance is available (154.182(b)(3)) and uninsured medical costs (154.183(c)) are ordered on top of this, not modeled.
• Self-employment income is not modeled. The engine deducts an employee's Social Security and Medicare; for self-employment income the Attorney General's self-employed chart deducts self-employment tax instead, which gives lower net resources.
• Net resources here only count wages. Other income and some deductions (154.062) are not modeled.

The figures are estimates of the guideline amount. A court can order a different amount, and an existing order only changes when it is modified.