Photo credit: George Ruiz
Birth Cost Recovery (BCR) is a government-sponsored collections process in Wisconsin that takes money away from unmarried parents to reimburse Medicaid-paid birth expenses. County child support agencies pursue unmarried fathers, often minority and low-income fathers who typically lack legal representation, to collect birth expenses through judgments, garnishments and tax intercepts. Married parents on Medicaid face no such consequence. The vast majority of states across the country abandoned or strictly limited birth cost recovery actions to avoid hurting children and families. In contrast, Wisconsin leads the nation in vigorously pursuing unmarried fathers for these medical bills.
Wisconsin collected more than $16 million in birth costs in 2016. From 2011-2016, Milwaukee County’s total birth cost collections amounted to more than $21 million, accounting for 20% of the statewide total. The county retained $3.2 million. Birth cost judgments disproportionately impact low income and minority populations and siphon money from low-income households with infants even if both parents live together and are well below Medicaid-qualifying income levels. This is wrong.
BCR is Not Child Support!
No dollars collected from BCR go to the families. Instead, these collections support government agencies. Local child support offices keep 15% of collections as a “bounty,” with the remainder going to the state and federal government. BCR is not about collecting child support from deadbeat dads; it’s about collecting government support from mostly unrepresented, low-income fathers without evaluating parental support contributions. The legal process, judgments and garnishments promote a cycle of poverty and financial pain that makes it practically impossible for families to advance out of debt.
Wisconsin’s pernicious BCR policy harvests resources from already financially strapped families and discourages some fathers from assuming an active role in parenting and family support. Worse yet, the policy creates enormous family stress and deters mothers from securing Medicaid benefits and seeking out critical prenatal care. The results of delayed prenatal care can be devastating, leading to poor birth outcomes and increased risks of infant mortality.
The unintended consequences of Wisconsin’s BCR policy—perpetuating family poverty, contributing to parental discord and lack of paternal support and delayed entry into prenatal care—may contribute to Wisconsin’s dismal infant mortality rate. Although Medicaid birth cost recovery is only one piece of the puzzle exacerbating infant mortality, it is a piece we can change. What, then, can be done?
Increased Discretion
Child support agencies must exercise increased restraint and discretion about the decision to pursue birth cost recovery orders.
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Support Intact Families
Child support agencies must not pursue orders where the father is a member of an intact family unit at the same time of paternity establishment, and he contributes to the support of the mother and child through income or in-kind services.
Proactive Education and Outreach
In order to maintain Medicaid eligibility, mothers are required to provide information about fathers in order to establish and enforce child support obligations—including BCR efforts. Child support agencies should help educate mothers about “Good Cause” exemptions from child support cooperation requirements and reduce the burden for mothers to establish proof of good cause.
BCR policy discourages prompt prenatal care, deters fathers from participating in family support and drains resources from low-income households. The consequences for child and maternal health outcomes exacerbate social service needs for years into the future. Now is the time for Wisconsin to join the vast majority of states that recognize the harms to low-income, unmarried families caused in part by aggressive BCR collection efforts. Birth cost recovery is not child support.
Robert A. Peterson Jr. is the executive director of ABC for Health, Inc.
