Joint Legal Custody and Medical Decisions: Who Makes the Decisions?

Parents with joint legal custody collaborate on medical decisions for their children. They talk to one another before setting vaccine appointments, approving some types of surgeries, or choosing a child’s therapist. 

Clear communication is critical for successful joint custody partnerships. If you don’t agree with your partner on an important medical decision, a mediator can help you find common ground. 

Understanding child custody and medical decisions 

Two forms of custody exist in the United States: physical and legal. A parent who has physical custody resides with the child. A parent who has legal custody makes decisions for the child. Parents who share physical custody often share legal custody, too. 

Close to 35% of divorced people share custody. Typically, these plans are determined by courts during the divorce process. 

Most states (such as Alaska) assess a child's best interests when crafting a custody plan. They examine a child's needs, your ability to meet them, and your relationship with the child. 

If a parent has ever neglected or abused their child, they might lose legal or physical custody during the divorce. They still have rights and are expected to maintain a relationship with the child through regular visits, but their decision-making abilities are limited. 

Read every document you're presented during your divorce to understand your rights. If your ex has sole legal custody of your child, you can't make most medical decisions. 

Medical financial responsibilities in joint legal custody

Both parents have a responsibility to provide adequate healthcare for their dependents. The details of who pays what are typically outlined in custody agreements, parenting plans, or court orders. The specifics of these requirements can vary based on state laws, the child's healthcare needs, and the financial circumstances of the parents. 

Here's an overview of how health insurance premiums, medical bills, and child support calculations are typically handled, including the implications of the Affordable Care Act (ACA).

Health insurance premiums and medical bills

Health insurance coverage

  • Primary insurance: Usually, one parent is the primary provider of children’s health insurance coverage. This parent enrolls the child in a plan and pays the premiums.
  • Secondary coverage: If both parents have health insurance, the other parent may need to contribute to the cost of additional coverage or copayments.

Medical expenses

  • Shared responsibility: Usually, parents must share the cost of medical bills not covered by insurance, such as deductibles, copayments, medications, and non-covered treatments.
  • Agreed upon split: Custody agreements or court orders often specify what each parent is responsible for, taking into account their finances and the child's needs.

State guidelines and financial responsibilities

State-specific guidelines

  • Income-based calculations: Some states use income-based guidelines to determine each parent's financial responsibility for medical expenses.
  • Healthcare standards: States may have specific methods for allocating medical expenses between parents, using factors such as the child's health, insurance coverage, and out-of-pocket costs.
Examples of State Guidelines:

State A: Requires parents to share medical expenses equally if both parents have comparable incomes and access to healthcare coverage.

State B: Utilizes a pro-rata approach, where each parent contributes a percentage of medical expenses based on their income relative to the combined parental income.

Affordable Care Act (ACA) implications

The ACA mandates that children under the age of 26 can be covered under their parent's health insurance plan, regardless of marital status, residency, or financial dependence. This provision expands access to coverage for children of divorced or separated parents.

The ACA established health insurance marketplaces where individuals such as non-custodial parents or those without employer-provided options can purchase affordable insurance plans for their children. Non-custodial parents may need to show proof of coverage or contribute to premiums as part of custody agreements or court orders.

Overview of joint legal custody

Joint legal custody is a legal arrangement in which both parents share the decision-making responsibilities regarding their child's upbringing, welfare, and major life decisions. Joint legal custody differs from physical custody, which refers to where the child primarily resides. 

Parents with joint custody have equal rights and responsibilities to make important decisions about their child's education, healthcare, religious upbringing, and general well-being. Here's a detailed overview of joint legal custody:


  1.  Education: Both parents can participate in decisions regarding the child's education, including choosing schools, educational programs, extracurricular activities, and handling academic issues.
  2.  Healthcare: Both parents have the authority to make healthcare decisions for the child, such as choosing healthcare providers, medical treatments, and what to do in medical emergencies.
  3.  Religion: Both parents can decide on practices, ceremonies, education, and participation in religious activities.
  4.  Major life decisions: Both parents can make decisions related to relocation, travel, name changes, and other significant life events.


Parents with joint legal custody are expected to communicate effectively and share information regarding the child's well-being, progress, and any important matters that may impact the child's life. They are encouraged to cooperate in the best interests of the child and make collaborative decisions.

Dispute resolution

If parents reach an impasse about a major decision, they may be required to participate in mediation or alternative dispute resolution processes to reach a resolution. If this fails, court intervention may be necessary. In such cases, a judge will consider the child's best interests, and make decisions on behalf of the child.

Legal documentation

Joint legal custody is often established through court orders or parenting plans. These documents outline the specific rights, responsibilities, and decision-making processes of each parent.

Responsibilities and limitations

  1.  Non-interference: While joint legal custody grants equal decision-making rights, it also means respecting each other's decisions and not interfering with the other parent's parenting time or decision-making authority.
  2.  Informing each other: Parents must inform each other about important matters concerning the child and consult with each other before making significant decisions.
  3.  Best interests of the child: The overarching principle here is always the best interests of the child. Decisions should prioritize the child's well-being, safety, emotional needs, and development.

Modification and enforcement

Joint legal custody arrangements may be modified if there are substantial changes in circumstances or if one parent demonstrates an inability to fulfill their decision-making responsibilities.

Courts can enforce joint legal custody orders and parenting plans, ensuring that both parents comply with their responsibilities and that decisions are made in accordance with the agreed-upon terms or court orders.

Who decides if a child gets vaccinations?

Many medical appointments for young children involve vaccines. The national vaccination rate among young children is declining, and for some parents, these shots are contentious topics. You may want a child to get a vaccine, and your ex may disagree. 

If you have joint legal custody, you must collaborate and decide together whether or not your child gets vaccinations. Your parenting plan may include an explicit mention of vaccines, but if it does not, you must come together and decide. 

If you have sole legal custody, you can vaccinate your child (or not) regardless of your ex's opinion. The decision is yours and yours alone. 

Worksheet: Create a Co-Parenting Plan

Which parent has legal authority in a medical emergency?

Parents sharing legal custody are both equipped to make decisions when a child is sick or hurt. If you don’t have time to tell your ex about a child’s health and need to make a decision, you can do so. But you must notify the other parent as soon as possible and keep them apprised of your child’s progress. 

Even parents without joint or sole legal custody can make emergency medical decisions in states like California. But communication is critical. You can’t keep a parent with sole or shared joint custody out of medical decisions indefinitely. You must tell them what’s happening as soon as possible. 

The rights of a non-custodial parent in medical emergencies

The rights of a non-custodial parent can vary based on factors such as custody arrangements, court orders, and state laws. Here are some general guidelines regarding the rights of a non-custodial parent in medical emergencies:

  1.  Emergency medical care: Non-custodial parents typically have the right to authorize emergency medical treatment for their child when the custodial parent is unavailable or when immediate medical attention is necessary. 
  2.  Access to medical information: Non-custodial parents may have the right to access their child's medical records and information related to medical treatment.
  3.  Notification of medical emergencies: Custodial parents are generally required to notify non-custodial parents promptly in the event of a medical emergency involving the child. This notification allows the non-custodial parent to be aware of the situation, provide input on medical decisions if necessary, and offer assistance or support as needed.
  4.  Decision-making authority: In non-emergency situations, decision-making authority may be specified in custody agreements or court orders.
  5.  Legal documentation: Non-custodial parents must maintain up-to-date legal documentation, such as custody orders, parenting plans, and medical authorizations. These documents can guide healthcare providers and ensure that the child receives appropriate care. See more on this below.

Note: Legal rights and responsibilities may vary based on individual circumstances, court orders, and state laws. Non-custodial parents may want to seek legal advice to understand their rights, obligations, and options in medical emergencies involving their child.

The importance of documenting all health-related expenses and communications

Documenting all health-related expenses and communications between parents is crucial for maintaining legal and financial clarity. Here's why:

  1.  Legal compliance: Ensures that both parents comply with court orders, parenting plans, or custody agreements. This documentation serves as evidence of adherence to legal responsibilities and can be crucial in case of disputes or legal proceedings.
  2.  Transparency and accountability: It provides a clear record of financial contributions, healthcare decisions, and communications related to the child's health and well-being, reducing misunderstandings and conflicts.
  3.  Financial clarity: Documenting health-related expenses, such as medical bills, prescriptions, insurance co-pays, and healthcare services, helps track the financial contributions of each parent. This information is essential for determining each parent's share of healthcare costs and ensuring equitable financial responsibility. If one parent pays for medical expenses, proper documentation allows for reimbursement requests and ensures that expenses are fairly shared according to the custody agreement or court order.
  4.  Legal protection: In case of disagreements or disputes, clear records can support claims, demonstrate compliance with legal obligations, and protect parental rights during legal proceedings or mediation.
  5.  Clear communication records: Keeping a record of verbal and written communications, such as emails, text messages, or letters, regarding health-related matters ensures that important discussions and agreements are documented. It prevents misunderstandings and provides a reliable reference for past conversations. 
  6.  Consistency and continuity: Allows for the tracking of medical histories, treatment plans, follow-up appointments, and communication between providers and parents.
  7.  Future reference: Provides a historical record of the child's healthcare needs, treatment outcomes, and parental involvement, which can be beneficial for monitoring progress and planning for future care.

What if you disagree after divorce?

Custody decisions made during a divorce are difficult to change. In most states (including Connecticut), you must prove that something is substantially different since your divorce. A simple disagreement is rarely enough to convince a court to give one parent sole custody and cut the other out. 

Ask your child's doctor, nurse, or medical professional to explain why one treatment (or lack of treatment) is better than another. Medical professionals may be uncomfortable mediating between arguing parents, but they can help you both to understand why one option is preferable from a health perspective.

Professional mediators can also help you find common ground. Experts say people like this can settle more than 75% of disputes before they go to trial, saving people money and time. A meeting with a mediator could help you settle one question, such as a medical decision about your child, and this process could set the stage for better future collaboration. 

Potential disputes and how to resolve them

Here are two fictional examples of common joint legal custody disputes, along with how they were resolved:

Example 1: Unclear duration of medical support payments

Scenario: Frances and Ingrid share joint legal custody of their child, Lucy. A dispute arises when Lucy needs ongoing medical treatment for a chronic condition, and Frances believes that Ingrid should continue making medical support payments indefinitely. Ingrid argues that her financial responsibility should have a specific end date.

Resolution: To resolve the dispute, they consult their custody agreement, which outlines the terms of medical support payments. The agreement specifies that Ingrid is responsible for medical expenses until Lucy turns 18 or graduates from high school, whichever comes later. Since Lucy is 16 and expected to graduate in two years, Ingrid continues making medical support payments until Lucy graduates from high school.

Example 2: Routine therapy expenses in question

Scenario: Sarah and David disagree on how to handle their son Mack’s routine therapy expenses. Sarah believes that Mack should undergo weekly therapy sessions, while David thinks that he only requires monthly sessions.

Resolution: Sarah and David consult with a child psychologist to assess Mack’s needs objectively. After a thorough evaluation, the therapist recommends bi-weekly sessions initially, with the option to increase or decrease the frequency in two months, based on Michael's progress.

In both examples, effective communication, adherence to legal agreements or court orders, and consideration of expert recommendations were key factors in resolving co-parenting disputes related to medical support payments and routine therapy expenses under joint legal custody.

Joint legal custody can be both rewarding for the family unit and frustrating for co-parents who aren’t on the same page. For more information, read the following resources. 


Increases in Shared Custody after Divorce in the United States. (June 2022). Demographic Research. 
Parenting and Custody. (April 2019). Alaska Court System. 
How Distrust of Childhood Vaccines Could Lead to More Breakouts of Preventable Diseases. (August 2022). Association of American Medical Colleges. 
Basics of Custody and Visitation Orders. Judicial Branch of California. 
Motion for Modification. (March 2020). State of Connecticut Superior Court. 
Appellate Mediation: Why Is It So Hard to Settle During an Appeal? (September 2019). American Bar Association.
Head of Content
Communication, Relationships, Personal Growth, Mental Health
As Hello Divorce's Head of Content, Katie is dedicated to breaking down the stress and mess of divorce into clear, helpful content that delivers hope rather than fear. Katie most often writes about the emotional toll of divorce, self-care and mindfulness, and effective communication. Katie has 20+ years of experience in content development and management, specializing in compelling consumer-facing content that helps people live better lives. She has a Master's in Media Studies from the University of Wisconsin. Katie lives in Texas with her husband and two adorable cats, and you can find her hiking and bird watching in her free time.