Although the child support enforcement program has been increasingly successful in obtaining health care coverage for children, changes in the labor market, family structure, health care delivery systems, and social welfare policy require new approaches to ensure that children obtain appropriate health care coverage. This report of the Medical Child Support Working Group identifies impediments to the effective enforcement of medical child support, and recommends solutions to these impediments. The report is organized into nine chapters. Chapter 1 addresses the scope of the problem. Chapter 2 provides an overview of the current system from the perspective of the Child Support Enforcement Program (IV-D) as well as from the perspective of the employer and plan community; this chapter also offers a new paradigm for ensuring health care coverage for all child support-eligible children. Chapter 3 offers a detailed analysis and comprehensive reform of how health care is included in a child support obligation and how that order is drafted. Chapter 4 discusses the National Medical Support Notice, the enforcement tool for IV-D medical support orders. Chapter 5 is a broader discussion of enforcement of the health care provisions in a child support order. Chapter 6 discusses improving coordination and communication among private and public health care coverage. Chapter 7 examines funding of child support activities directly related to medical support. Chapter 8 identifies additional strategies and research required to ensure ongoing improvements in assuring health care coverage for children in single parent families. Chapter 9 provides a brief conclusion to the report. Eight appendices include the list of 76 recommendations, a glossary of relevant terms, and a description of the legislative history of major medical support provisions. (KB)