Medical Costs, Childcare, and Extraordinary Expenses in Washington Child Support

Child Support Often Is More Than the Basic Calculation

Basic child support in Washington covers day-to-day living expenses, but many of a child’s most important needs fall outside of the basic support calculation. Medical bills, health insurance premiums, therapy, orthodontia, work-related childcare, and other extraordinary expenses are treated as additional support obligations. Washington’s child support laws, including RCW 26.19, require proportional sharing of certain expenses.

DCS orders often address basic support only and may not include childcare, uninsured medical costs, or special needs expenses. Court-issued orders can address more complicated situations such as children with ongoing medical needs, high therapy costs, rapidly changing daycare needs, or unusual transportation requirements. Parents must exchange bills, follow reimbursement timelines, and pay their share promptly. If a parent refuses to contribute, the other parent must bring the issue to court because judges will not act on their own.

Attorneys help families secure clear expense-sharing rules, enforce unpaid reimbursements, and protect parents from unfair demands. They can also help prevent disputes by ensuring the order includes the right medical and childcare provisions from the start.

➡ For more general information visit our page Child Support In Washington State

Myths and Misconceptions About Medical and Childcare Costs

Myth: “Child support covers everything.”

Basic support does not include uninsured medical bills, work related childcare, therapy, braces, or other extraordinary expenses unless the order specifically addresses them.

Myth: “If my insurance covers the child, I pay nothing else.”

Both parents usually share the cost of premiums and all uninsured medical expenses in proportion to their incomes.

Myth: “Daycare is optional if I do not approve it.”

Work-related childcare is generally required. Courts expect parents to contribute unless the cost is unreasonable or unsupported by evidence.

Myth: “I can claim childcare expenses even if a family member is providing care.”

Courts look for real, paid, licensed childcare. Alleged expenses involving unpaid family members are often rejected.

Myth: “Extracurricular activities must be divided 50/50.”

Sharing sports, clubs, and lessons is discretionary. The court may order sharing if the activities are reasonable and consistent with the child’s needs.

Myth: “If the other parent will not reimburse me, the court will fix it automatically.”

Parents must file a motion to enforce reimbursement. The court will not intervene unless asked.

Myth: “Refusing to pay medical expenses is a minor issue.”

Failing to pay for braces, therapy, or routine care can result in contempt and makes a parent appear unsupportive of their child’s needs.

Myth: “All expenses will be included in a DCS order.”

DCS focuses on basic support. Childcare, premiums, therapy, and special expenses may be left out unless addressed in a court-issued order.

Medical Expenses and Health Insurance

Who pays uninsured medical expenses in Washington?

Parents usually share uninsured medical expenses in proportion to their incomes. This includes copays, deductibles, dental care, orthodontia, and therapy.

What counts as a “medical expense” for child support?

Medical expenses include doctor visits, prescriptions, dental care, orthodontics, vision care, mental health treatment, and other necessary healthcare costs.

Do parents have to split the cost of braces?

Yes. Orthodontia is generally considered a necessary medical expense unless the treatment is purely cosmetic.

Do parents have to share therapy or counseling costs?

Yes. Therapy, counseling, and mental health treatment are typically considered necessary expenses.
➡ Learn more on our page Decision Making and 191 Restrictions

What if the other parent refuses to reimburse medical bills?

You may file a motion for enforcement or contempt. Courts expect parents to follow reimbursement timelines and pay their proportional share.

Who provides health insurance for the child?

Either parent may be ordered to provide insurance. Courts often order the parent with the most affordable plan to carry coverage.

How are insurance premiums divided?

Premiums can be shared proportionally if the order includes them. DCS does not always divide premiums unless specifically instructed to do so. But it is very common to include the premiums for the children as part of the child support calculation, requiring both parents to contribute to the medical insurance for a child. This can often reduce the amount of support the parent who is already providing medical insurance for the child must pay.

Does the parenting plan affect medical decisions?

Yes. The parenting plan determines who makes non-emergency medical decisions and how parents communicate about treatment. Medical decision-making is determined in the parenting plan, not the support order.
➡ Learn more on our page Decision Making and 191 Restrictions

Can a parent refuse to pay for braces or orthodontics?

Not typically. Orthodontia is usually considered a necessary medical expense unless clearly cosmetic, and parents are expected to share the cost proportionally.

Work related Childcare Costs

Who pays for daycare in Washington?

Work-related childcare is usually shared based on the parents’ proportional incomes. Childcare used for personal errands, social activities, or convenience is usually the responsibility of the parent who chooses it.

Is childcare included in child support?

It can be. Daycare is included when it is regular, documented, and necessary for a parent to work, study, or seek employment.

What counts as “work-related childcare”?

Daycare, preschool, after-school care, and summer programs used so a parent can work or attend training generally qualify.

Does childcare need to be licensed?

Courts strongly prefer licensed childcare. You should question claims involving payment of family members who are unlicensed and otherwise only watching your children. You should ask for a licensed care provider as part of a professional service (could be a family member) if you are asked to pay a fee.

What if a parent claims childcare expenses when a family member is providing care?

Courts typically reject these claims unless the family member is genuinely being paid and can show proof of payment.

What if childcare costs increase or change?

Parents must notify each other and may need to adjust contributions or modify the child support order if work related childcare is also included in the court order and costs change significantly. 

Should childcare also appear in the parenting plan?

Yes. Parenting plans can include childcare expectations and decision-making to reduce conflict.
➡ Learn more on our page Parenting Plan Rules, Communication, and Other Provisions

Extraordinary and Special Needs Costs

What is an extraordinary expense?

Extraordinary expenses include tutoring, specialized education, transportation for long-distance exchanges, therapy, and other unusual costs.

How are costs handled for a child with special needs?

Courts may order additional support for children with medical, developmental, or therapeutic needs. These expenses can be substantial and require documentation.

Do parents split transportation or travel expenses?

Yes. Reasonable travel costs related to the child’s schedule or exchanges can be divided proportionally.

Who pays for tutoring, testing fees, or specialized education?

Courts may order sharing if the expenses are necessary and well documented.

Do parents have to share travel or transportation expenses for long-distance parenting time?

Usually yes. Travel costs for residential time may justify proportional sharing or even a deviation from basic support when the expenses are significant and necessary for the child’s relationship with both parents.

How do courts handle expenses for children with special needs?

Courts may order additional support when a child has medical, developmental, or therapeutic needs that create substantial expenses. Documentation is essential.

Reimbursement and Enforcement

How do I request reimbursement for medical or childcare costs?

Follow the timelines in your order. Provide receipts, proof of payment, and a written request to the other parent. If your order does not include timelines, communicate the information as soon as reasonable.

Is there a deadline for asking the other parent to reimburse?

Yes. Most orders require reimbursement requests within a specific number of days. Late claims may be denied. If reimbursement requests are delayed for months or years, courts may deny them under equitable principles because the delay unfairly harmed the other parent or made verification impossible.”

What happens if a parent refuses to pay?

This depends on the nature of the refusal and the communication that went into it. Sometimes you may need to follow the dispute resolution process in the parenting plan. But often you can also file a motion to enforce or hold the parent in contempt. Courts expect strict compliance with reimbursement rules.

Can unpaid expense sharing lead to contempt?

Yes. Failure to pay for necessary medical or childcare expenses can result in contempt, fines, payment plans, and in rare cases, jail.

Can DCS enforce these expenses?

DCS can enforce some medical expenses and premiums, but it cannot enforce all types of extraordinary expenses. Court enforcement is often necessary.

What documentation do I need to prove expenses?

Receipts, invoices, EOBs, insurance statements, and records of communication between parents.

Strategic and Conflict Prevention Questions

Can unpaid medical or childcare expenses be enforced through contempt?

Yes. If the order requires sharing these expenses and a parent refuses to reimburse, courts may enforce compliance through contempt or judgment.

What expenses cause the most conflict between parents?

The most common disputes involve braces, therapy, daycare, extracurriculars, and inconsistent communication about medical bills.

How do I avoid constant fights over receipts?

Talk about expenses before incurring them and attempt to reach agreement as early as possible. Use a shared digital folder or designated email for expenses. Clear, consistent communication prevents misunderstandings.

Why hire an attorney for expense-sharing disputes?

Attorneys ensure expenses are included in the order, enforce unpaid amounts, defend against improper requests, and help parents avoid contempt.

Work With Pacific Northwest Family Law to Resolve Expense-Sharing Disputes

Medical bills, childcare costs, and extraordinary expenses can create significant conflict between parents. Washington expects parents to share these costs, but the rules depend on the specific court order and require clear documentation and consistent communication. If a parent refuses to contribute or if the expenses are overwhelming, an attorney can help enforce your rights, defend you from unreasonable demands, and secure a fair long-term arrangement that reflects your child’s needs.

 

Reviewed by Attorney Zachary C Ashby, Pacific Northwest Family Law, November 2025.