Effective October 1, 2019, Maryland's law on "extraordinary medical expenses" changed. The law (and these updates) is found in Maryland Annotated Code, Family Law Article §§12-201 and 12-204.

"Extraordinary medical expenses" are part of Maryland's child support law. They can be incorporated into the child support guidelines and, therefore, be contributed to via child support. Or, these can be paid outside of child support, in proportion to incomes, either directly to the provider or via reimbursement to the parent advancing the total cost.

Either way, this typically resulted in the child support recipient paying the first $100, with anything above that contributed to by both parents.

"Extraordinary medical expenses" include uninsured, reasonable, and necessary costs for orthodontia, dental treatment, (now) vision care, asthma treatment, physical therapy, treatment for any chronic health problem, and professional counseling or psychiatric therapy for diagnosed mental disorders.

Previously, "extraordinary medical expenses" were defined as "uninsured expenses over $100 for a single illness or condition. This was confusing because it's wasn't always clear what constituted a single illness or condition. A recurring ear infection? Also, did this apply to the total expenses over the lifetime of the condition? Or, implied to apply to the cost per year?

Now, "extraordinary medical expenses" are defined as "uninsured costs for medical treatment in excess of $250 in any calendar year" and add vision care. These changes apply to expenses incurred on or after October 1, 2019.

The new definition clears up uncertainty over single illness or condition and lifetime versus annual expenses. But, does is create other uncertainties?

Under the prior law, if a child had a known and ongoing medical condition, for which it was possible to calculate the average out of pocket/uninsured medical expenses beyond the first $100, then this specific could be included in the child support calculation. Now, the law aggregates all uninsured expenses falling within the definition of "extraordinary medical expenses".

This means that the child support recipient is likely to be responsible for paying the first $250 per year - every year - before the other parent is required to contribute.

Also, does the new definition unintentionally discourage factoring "extraordinary medical expenses" into the child support calculation and, instead, encourage parent-to-parent reimbursement outside the guidelines? How knowable, versus speculative, is it that a child will incur $250 per year in uninsured medical expenses? If speculative, the court is unlikely to include it in the guidelines. Which places the responsibility of seeking reimbursement on the parent advancing the costs (usually the child support recipient).

I assume that for existing court orders and agreements that only refer to "extraordinary medical expenses" (without further definition) that the new definition will apply. However, I do wonder about those agreements that define "extraordinary medical expenses" using the specific language of the prior law. Until we see a court case or guidance otherwise, I gather that the agreement will apply unless and until a party seeks to modify it to mirror the current law. Will such a request require a material change in circumstance? And, is the change in the law, itself, a material change? We shall see.

Other states approach "extraordinary medical expenses" this way. For now, out of state decisions may be our starting guidance until Maryland's appellate courts apply and interpret our new law.

Since 2002, Lindsay Parvis has represented clients in Maryland custody, divorce, and marital matters. She negotiates, litigates, and advocates for the best interests of her clients, whether in contested litigation, uncontested settlement, or premarital and other agreements. Her clients are not only spouses and parents, but also children whose interests she is appointed by the court to represent in contested custody litigation. She is a graduate of Mount Holyoke and University of Baltimore School of Law. Lindsay strives to improve Maryland law in the General Assembly, volunteering her time to monitor, advocate, and educate about legislative developments in family law.

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