Health insurance, medical bills and child care in Virginia child support (2026)

Is health insurance added to child support in Virginia?

Yes. Code of Virginia § 20-108.2 E says the cost of health care coverage, vision care coverage and dental care coverage for the children in the order, paid by a parent or that parent’s spouse, is added to the basic obligation from the schedule. The total is split by income share.

The parent who pays the premium gets credit for it. Under § 20-108.2 G 1, when the other parent (or their spouse) pays the coverage directly, that parent’s share of support is reduced by the cost. One family with $300 a month of coverage for the child:

Who pays the $300 premium	Guideline a month
No coverage	$750.60
The parent the child lives with	$930.60
The other parent	$630.60

In each case the other parent pays the amount shown to the parent the child lives with.

How is the children’s share of a family premium worked out?

Only the cost for the children in the order counts (§ 20-108.2 E). If the insurer gives a per child cost, that is used. Otherwise, the cost of individual coverage for the policy holder is subtracted from the total premium, and the rest is divided by the number of other people covered, to get a cost per person; that is applied to each child in the order.

What counts as health insurance at a reasonable cost?

Coverage is available at a reasonable cost when it costs no more than five percent of the gross income of the parent responsible for providing it, unless the court decides otherwise in the children’s best interests or the parents agree (§ 63.2-1900). Every Virginia support order must include an order for health care coverage, or a statement that coverage is not available at a reasonable cost, and a statement on whether either parent pays a share of uncovered medical costs (§ 20-60.3).

Who pays medical and dental bills that insurance does not cover?

Both parents. Unless there is good cause or the parents agree otherwise, § 20-108.2 D says every support order must require the parents to pay any reasonable and necessary unreimbursed medical or dental expenses in proportion to their gross incomes, as the expenses are incurred. The order must say how payment is made.

• These costs are not added to the monthly amount; each parent pays their share as the bills come.
• The statute lists eyeglasses, prescription medication, prosthetics, orthodontics, and mental health or developmental disability services, including counselors and therapists, as examples.
• The current statute does not set a minimum amount that one parent covers before sharing starts.

For a first support case started within six months of a child’s birth, the unpaid expenses of the pregnancy and delivery are also shared in proportion to income, unless there is good cause or an agreement otherwise (§ 20-108.2 D1).

Which child care costs are added?

Section 20-108.2 F adds child care costs incurred because the parent the children live with is employed. The statute also says:

• the cost may not exceed what is needed for quality care from a licensed source;
• on request of the other parent, the court may require proof of the costs;
• the court considers the other parent’s willingness and availability to provide child care personally when deciding whether costs are necessary or excessive;
• on request of either parent, with a showing of the tax savings from child care deductions or credits, the court factors in the actual tax consequences.

The effect for one family, with $800 a month of work related child care paid by the parent the child lives with:

One child, sole custody, with child care

In Virginia: 1 child; the parent the children live with earns $4,000 a month and the other parent $6,000, before tax; 0 days a year with the other parent; child care of $800 a month, paid by the parent the children live with.

1. Add the two incomesCode of Virginia § 20-108.2

   $4,000 + $6,000 = $10,000 a month. The other parent's share is $6,000 ÷ $10,000 = 60%.

   60%

2. Look up the schedule§ 20-108.2 B, schedule of support

   The schedule's amount for $10,000 of combined income and 1 child.

   $1,251.00

3. Work out the sole-custody figure§ 20-108.2 G, sole and shared custody

   ($1,251.00 + child care $800) × 60% = $1,230.60.

   $1,230.60

4. Check for shared custody§ 20-108.2 G, sole and shared custody

   0 days with the other parent is not more than 90, so the sole-custody figure applies.

   $1,230.60 a month

Child care while the parent the children live with attends an education or training program is not added automatically. It is one of the factors a court may use to deviate from the guideline (§ 20-108.1 B 4).

How do these costs work in shared custody?

In shared custody, each parent’s share of the shared need is increased by their income share of the coverage and work related child care that the other parent pays, and the two amounts are netted (§ 20-108.2 G 3 (b)). So it matters which parent pays the child care. The same family with 146 days a year with the other parent and $800 of child care:

Who pays the child care	Guideline a month	Paid by
The parent the child lives with most	$830.28	the other parent
The other parent	$30.28	the other parent

See shared custody in Virginia for the whole formula.

Are extracurricular activities and school costs included?

They are not among the costs § 20-108.2 adds to the schedule. Court ordered direct payments for a child, such as education expenses, the special needs of a child, and a written agreement of the parents are factors a court may use to order a different amount (§ 20-108.1 B 6, 8 and 14).

What this guide does not cover

When the other parent pays child care directly and there is no shared custody, the calculator credits that payment against their share, the way § 20-108.2 G 1 credits health coverage; the statute names only health coverage for that credit, and a court may treat a direct child care payment as a reason to vary (§ 20-108.1 B 6). This guide does not cover how courts decide which parent provides coverage; or cash medical support orders in detail. The engine also leaves out these parts of Virginia’s guideline:

• Half of any self-employment tax paid is also deducted from income (not modeled).
• Reasonable and necessary unreimbursed medical and dental costs are shared in proportion to gross income as they are incurred, outside the monthly amount (§ 20-108.2 D, not modeled).
• Deductions for other children are not modeled: support paid for other children under an order or written agreement, and the schedule amount for a parent's own children living with that parent (§ 20-108.2 C).
• Disability benefits paid to the children from a parent's entitlement count as that parent's income and are credited against support (§ 20-108.2 C); not modeled.
• Low income is not modeled beyond the minimum: when the paying parent's gross income is at or below 150% of the federal poverty level, a court may set less than the statutory minimum, and the minimum does not apply to some parents (for example those imprisoned for life or totally and permanently disabled) (§ 20-108.2 B). Shared custody support is not presumed correct when either parent's income is that low (G 3 (d)).
• Days are counted as whole days; the half-day rule for an overnight of less than 24 hours (§ 20-108.2 G 3 (c)) is not modeled.
• Split custody, different schedules for different children, and mixes of sole, split and shared custody (§ 20-108.2 G 2, 4 to 6) are not modeled.

The figures are estimates of the guideline amount, not legal advice. A court can order a different amount, and an existing order only changes when it is modified.