Kennith Onstot v. Erin Piska

IN THE COURT OF APPEALS OF IOWA

No. 24-1978
Filed September 4, 2025

KENNITH ONSTOT,
Petitioner-Appellant,

vs.

ERIN PISKA,
Respondent-Appellee.
________________________________________________________________

Appeal from the Iowa District Court for Polk County, Patrick D. Smith,

Judge.

The petitioner appeals the denial of his request to waive an arrearage

related to his obligation to pay medical support. AFFIRMED.

James T. Munro of Munro Law Office, P.C., Des Moines, for appellant.

Ashley Tollakson and Emelia Edwards of Tollakson Law, PLLC, West Des

Moines, for appellee Piska.

Brenna Bird, Attorney General, and Justin D. Walker and Gary Otting,

Assistant Attorneys General, for appellee HHS.

Considered without oral argument by Greer, P.J., and Badding and

Chicchelly, JJ.
2

GREER, Presiding Judge.

The interplay between the statutory requirement for cash medical support1

and a parent’s choice to pay for private health insurance can be tricky, as Kennith

Onstot has discovered. He contends that he paid health insurance premiums for

coverage of his and Erin Piska’s child during a time when he was court-ordered to

pay cash medical support payments under Iowa Code chapter 252E.1(3).2 The

district court concluded it did not have statutory authority to retroactively waive the

cash medical support payments that accrued even though Kennith paid for private

health insurance and otherwise would not have been required to maintain cash

medical support. Kennith appeals from that decision.

While sympathetic to Kennith’s concerns, we agree with the district court

that our case law and the statutes that govern the medical support obligation do

not allow us to retroactively change his court-ordered obligations.

I. Background Facts and Proceedings.

Erin and Kennith are the unmarried parents of one child. On May 3, 2022,

Kennith petitioned to establish his parental rights under Iowa Code chapter 600B.

1 “‘Medical support’ means either the provision of health care coverage or the

payment of cash medical support.” Iowa Code § 252E.1(11) (2022).
2 Iowa Code § 252E.1(3) states:

“Cash medical support” means a monetary amount that a
parent is ordered to pay to the obligee in lieu of that parent providing
health care coverage, which amount is five percent of the gross
income of the parent ordered to pay the monetary amount or, if the
child support guidelines established pursuant to section 598.21B
specifically provide an alternative income-based numeric standard
for determining the amount, the amount determined by the standard
specified by the child support guidelines. “Cash medical support” is
an obligation separate from any monetary amount a parent is
ordered to pay for uncovered medical expenses pursuant to the
guidelines established pursuant to section 598.21B.
3

On November 7, the district court approved the parties’ stipulation that set out

custody, visitation, and various support provisions among other rights and

responsibilities. Because medical coverage for the child was provided through a

state-managed insurance program (Title 19),3 part of that approved stipulation

required Kennith to pay cash medical support of $281.67 per month. The parties

also stipulated: “In the event either party has health insurance coverage available

to them through their employer at a reasonable cost, they shall be required to

obtain said coverage for the child.” The stipulation did not contain any statement

that if private health insurance was provided the cash medical support payment

would automatically end.

To stop the cash medical support obligation, on April 4, 2024, Kennith

moved to modify the medical support order and indicated that “[w]ithin 1–3 months

following the entry of the Decree, [Kennith] had medical insurance made available

to him through his employment and at that time, enrolled himself and the minor

child on his insurance.” Later in the proceedings, Kennith asserted that he

obtained private health insurance on October 10, 2022, so he should not have

been required to make any payments towards the cash medical support obligation

or the arrearage that he now owed HHS. HHS terminated that obligation in

April 2024—after it learned that Kennith had private health insurance for his child.

3 The Medicaid program is sometimes referred to as the Title 19 (or XIX) program.

Cf. TLC Home Health Care, L.L.C. v. Iowa Dep’t of Hum. Servs., 638 N.W.2d 708,
711–12 (Iowa 2002) (“The Medicaid program was established by Congress as part
of Title XIX of the Social Security Act.”). Medicaid is an assistance program that
pays for certain medical and health care costs for people who qualify. Iowa’s
Medicaid program is funded by the federal and state government and is managed
by the Iowa Department of Health and Human Services (HHS). Overview of
Medicaid, People’s Law Library, https://perma.cc/5SPB-9JWR.
4

And as a further measure to avoid these payments, Erin and Kennith entered into

a stipulation on August 7, 2024, to remove the cash medical support obligation,

agreeing that Kennith was paying for private health insurance coverage for the

child at the same time. Because Kennith had not paid all the cash medical support

payments to HHS, there remained an arrearage that had accumulated between

2022 and 2024.

After the August 2024 stipulation was filed, Kennith asked the court waive

the “outstanding cash medical balance.” Erin did not resist the motion, but HHS

did,4 pointing to Iowa Code section 252E.11, which provides that “[i]f medical

assistance is provided by the department to a dependent pursuant to

chapter 249A, rights to medical support payments are assigned to the

department.” And although Erin and Kennith both maintain they did not understand

that the cash medical support payments were accruing every month even when

Kennith had private insurance coverage for their child, HHS argued that Erin could

not waive the medical support obligation.

The district court denied Kennith’s motion to waive the outstanding cash

medical balance, concluding, “There is no statutory authority permitting the waiver

of a cash medical balance in these circumstances.” Kennith appeals.

II. Standard of Review.

“Generally, in paternity actions, we review issues ancillary to the question

of paternity, such as support, de novo.” Markey v. Carney, 705 N.W.2d 13, 19

(Iowa 2005) (cleaned up). So, we examine the entire record and decide anew the

4 Both in the district court proceedings and here on appeal, HHS is represented by

the office of Iowa’s Attorney General.
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legal and factual issues properly presented and preserved for our review. In re

Marriage of Rhinehart, 704 N.W.2d 677, 680 (Iowa 2005).

III. Discussion.

Kennith first argues that cash medical support cannot be awarded when a

parent has private medical insurance. He draws our attention to one of our

unpublished cases: Seward v. Hane. No. 16-1686, 2017 WL 6516672, at *5 (Iowa

Ct. App. Dec. 20, 2017) (rejecting an order for cash medical support that was in

lieu of a health insurance plan that the court knew was available). But Seward is

distinguishable. Unlike here, in that case, the parent alerted the district court to

the private health insurance. See id. And the issue on appeal was that the

custodial parent had agreed to pay for health insurance at a cost that was greater

than what the child support guidelines required, yet the district court still ordered

the non-custodial parent to pay the cash medical support. Id. at *5–6. Here, the

district court was not apprised of any existing private health insurance being

provided by Kennith. And Kennith’s argument ignores the 2022 stipulation—that

he signed and the court approved—requiring him to pay a cash medical support

payment. In 2024, the district court could not turn back time and change its

approval of that earlier court-ordered obligation.

Second, Kennith argues that the district court incorrectly believed it had no

authority to retroactively waive or cancel the cash medical support obligation. In

response, HHS argues there is case authority that restrains courts from

retroactively changing support orders. Kennith again points to Seward to support

his argument, but we have distinguished that case and it does not apply to this

second argument either. He also points to In re Marriage of Kakavandi as an
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additional authority. No. 09-1482, 2010 WL 3894236, at *6 (Iowa Ct. App. Oct. 6,

2010). Again, this case is different than what we are considering here. Kakavandi

dealt with a dissolution modification action that required the payor parent to pay

cash medical support after the children were no longer covered by a private health

insurance plan because he quit his employment. Id. at *1–2. The district court

made the obligation for cash medical support retroactive to April 2009. Id. at *3.

But because the children were covered by medical insurance through the end of

June 2009, on appeal, a panel of our court modified the start date to when the

insurance ended. Id. at *6. Here, we are not addressing a request to correct a

cash medical support order originally challenged on appeal.

Instead, we find HHS’s argument more compelling. It argues:

“The retroactive forgiveness of child support liability that [the
appellant] proposes would fly in the face of our long-standing rule
that a court has no authority to divest the parties of rights accrued
under the original decree.” Newman v. Newman, 451 N.W.2d 843,
845 (Iowa 1990). “Modification of a decree for support payments
operates prospectively and not retrospectively.” Wren v. Wren, 127
N.W.2d 643, 646 (Iowa 1964). “Even where a decree is modified and
a change is made the payments that have accrued up to that time
cannot thereby be affected.” Id.

The district court concluded it had no authority to retroactively satisfy or waive

Kennith’s support obligations as established in the 2022 court order. See In re

Marriage of Stanley, 411 N.W.2d 698, 701 (Iowa Ct. App. 1987) (noting that when

payments for support are ordered, modification of those payments operates

prospectively and not retrospectively). Based on this reasoning, we agree; the

district court had no authority to cancel, waive, or otherwise reimburse Kennith for

his ongoing medical support obligation that had accrued but not been paid.
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We affirm the district court decision.

AFFIRMED.