A Wisconsin bill that would expand a program that requires unwed fathers to help pay for the cost of a mother’s pregnancy and delivery — even when the father and mother live together — is drawing criticism from health and child welfare advocates, but defense from supporters.
The program is called birth-cost recovery (BCR), and while other states have moved away from the practice, finding it punitive and potentially harmful to the child, Wisconsin is among just a handful of states that use it.
Through birth-cost recovery, the state collected $16 million in 2016 — significantly more than the handful of other states that still use it. And legislators are now seeking the controversial program’s expansion
Some child welfare advocates criticize birth-cost recovery as unduly burdening parents who are already poor, which in turn hurts the child. But its defenders argue that the poorest families aren’t affected by the program and that, used judiciously, it can bolster families while ensuring that healthcare safety nets like Wisconsin’s BadgerCare program are sustainable and takes pressure off county budgets that fund child support enforcement services.
The practice of birth-cost recovery is allowed, but not required, under the federal Social Security Act, which authorizes states to enlist child support agencies to take action against unmarried fathers in order to collect up to half the medical costs that the mother incurs in childbirth—costs typically borne by Medicaid or its Wisconsin equivalent, BadgerCare.
Senate Bill 350 came out as one of around a dozen bills from the Joint Legislative Council’s Study Committee on Child Placement and Support, and is now making its way through the state Senate. It would allow child support agencies to pursue childbirth-cost recovery in families that are intact, just as they can do when fathers are absent.
Why states abandon birth cost recovery
ABC for Health, a Madison nonprofit that works with low- and moderate-income people to seek resources for health care and navigate the health-care system, has long been critical of the overall practice of birth-cost recovery. In December 2017, the organization, along with Health Watch Wisconsin, jointly published a paper investigating and critiquing the system, Birth Cost Recovery, It’s Not Child Support.
“ABC for Health is concerned that the policy has long been harming efforts to reduce infant mortality, lift families out of poverty and encourage unmarried fathers to play an important, supportive role in their children’s lives,” the organization states on its website. Defenders of birth-cost recovery assert that those claims lack evidence.
The former federal child support commissioner during the Obama administration is also skeptical of the practice.
“The idea that a marginally employed, low-income parent can afford to pay back Medicaid birth costs out of pocket is absurd,” said Vicki Turetsky, who in addition to her work for the federal government has spent most of her career studying child support policy.
“This is a practice that has been abandoned across the United States,” ABC for Health Executive Director Bobby Peterson told Wisconsin Examiner. “There are very few states that do it anymore. Some were prevented by litigation. Others stopped because they recognized it was not in the best interests of the child.”
Wisconsin goes in the opposite direction
Wisconsin is an exception to the trend. The state collects on average $15.7 million annually from birth-cost recovery, according to Jim Sullivan, director of child support for Milwaukee County, with 85% going to bolster the state Medicaid budget. The remaining 15% goes to the county child support agencies that collect it.
Sullivan argued that birth-cost recovery doesn’t hurt poor people and benefits families as well as helping to strengthen BadgerCare’s funding.
The Senate bill and its lower house companion, Assembly Bill 103, would repeal a 2018 state administrative rule that called it “inappropriate” for child support agencies to try to recover birth costs in cases when the family is “intact.”
The bill grew out of a legislative Study Committee on Child Placement and Support, chaired by state Rep Robert Brooks (R-Saukville). State Sen. Lena Taylor (D-Milwaukee) was the study committee’s vice chair. Notes from the committee’s deliberations can be found on its webpage. The bill passed committee with bipartisan support including Brooks and Taylor, on a vote of 9 – 4.
The Wisconsin Counties Association and the Wisconsin Child Support Enforcement Association have registered to lobby for the bill. The Wisconsin Alliance for Women’s Health and Kids Forward have registered to lobby against it.
Contributing to child’s birth
At an Aug. 27 public hearing on the bill, Brooks defended returning to a policy permitting the use of birth cost recovery actions against fathers even when families are intact.
“Like child support itself, the birth cost recovery program stems from the notion that parents should be the ones responsible for their children, not the taxpayers when they have the ability to pay,” Brooks stated.
The question of “ability to pay” is one of the sticking points between critics of the practice and its supporters.
Peterson contends pursuing birth-cost recovery payments deprives poor families of financial resources that would go toward their and their children’s care. It also subjects those families, already struggling at the margins, to having to prove their income.
The minimum income for someone to be assessed birth-cost recovery payments is 150% of poverty level, so, argued Milwaukee County’s Sullivan, the poorest people would not be affected Sullivan was a member of the Legislative Council study group whose work led to the proposed legislation.
A birth-cost recovery order also cannot exceed 5% of a person’s income over a three-year period, Sullivan said. Along with including intact families as eligible for birth-cost recovery, the measure “would take into consideration the actual income and its relation to the federal poverty level.” He also said that child support agencies collect birth cost recovery only after current and past child support payments, “many times after the child support order itself has run its course and the child has reached the age of majority.”
In a two-week period in May in Milwaukee County, 117 orders were issued for birth-cost recovery, he noted. Of those, “94 orders for cost reimbursement were for $500 or less.” The sole person assessed the maximum $3,100 — payable in installments — had an income of $140,000 a year, Sullivan said. “If you’re making $140,000 you should probably contribute something cost of your own child’s birth.”