Dad and baby

Report criticizes counties that continue to claw back Medicaid birth fees – Wisconsin Examiner

Despite campaigns to end the practice, Wisconsin counties continue to sue some single parents to reimburse the cost of their Medicaid-covered childbirths, according to a new report released Wednesday.

The report, produced by ABC for Health, says that, overall, counties in Wisconsin have won judgments declaring unmarried parents owed $106 million to pay off the mother’s birthing hospital bills. Medicaid had paid.

The judgments are part of a policy called birth cost recovery. The policy focuses on unmarried parents of newborn children whose mothers are enrolled in Medicaid while a child’s other parent has resources to pay some or all of those costs.

Architects and proponents of the policy see it as another form of child support, ensuring that parents, usually fathers, take financial responsibility for their children, regardless of their relationship to the mother.

The authors of the new ABC for Health report dispute this premise, however. ABC for Health is a Madison-based nonprofit organization that helps low-income Wisconsin residents obtain health care coverage and works to combat medical debt. The organization has for years opposed to childbirth cost recovery policies – qualifying the concept as a “birth tax”.

Birth cost recovery claims are pursued when a child’s parents are unmarried and are expected to live apart. The policy sends a message that “if you’re married, we’re not going to worry about it,” says Bobby Peterson, executive director of ABC for Health, who authored the report with the organization’s CEO Brynne McBride. “If you’re not married, we’ll get you.”

To compile the new report, “Merchants of Debt: Wisconsin Counties & The Birth Tax,” ABC for Health conducted an open records request from the state Department of Health Services for the total number of judgments on file demanding reimbursement. families with a child whose birth was covered by Medicaid.

The data, which includes cases dating back decades, showed 78,549 such judgments, totaling $106 million statewide.

In 2020, when there were 58,872 births, 52% of them, or 30,703, were covered by Medicaid, according to the report. Two-thirds of Medicaid births were to unmarried parents, making them potentially subject to birth cost recovery judgments.

The report notes that among black Medicaid patients who give birth, 88% were unmarried and therefore potentially subject to a birth cost recovery judgment. Among Native American and Alaska Native births covered by Medicaid, 85% involved unmarried parents, while 58% of white Medicaid births involved unmarried parents.

County child support agencies sue to recover birth costs and report the information to the state’s Department of Health Services (DHS).

The report argues that outside of Wisconsin, childbirth cost recovery has become less common.

“Wisconsin is one of the few states to pursue this policy and is by far the most aggressive,” the report said. “Most states across the country have abandoned this practice, concluding that it is not in the best interest of infants, parents and families.”

Although the money is collected by child support agencies, ABC for Health argues that the money should not be considered child support, “because none of the money collected supports direct care or protection of the child”.

The collection of childbirth costs “plunges families into poverty and discourages single fathers from playing an important supporting role in the life of their child”.

Peterson says ABC for Health has worked with clients who were inappropriately targeted for a recapture of Medicaid dollars in childbirth cost recovery because authorities mistakenly perceived them as uninvolved in the life of their child. child when personal circumstances such as work or other responsibilities take them away from home for long periods of time.

He likened the state’s projected $6.5 billion surplus to “going after those families who have very little money.”

The report finds Milwaukee County collected $69.2 million in Medicaid birth cost recovery judgments and Dane County collected $6.8 million.

He points to Dane County for particular criticism, noting that County Executive Joe Parisi said in late 2019 that the county would not file new birth cost recovery cases.

Peterson said in conducting the study, ABC for Health found that the county continued to pursue cases that were already in progress, however. During the COVID-19 pandemic, the county intercepted stimulus checks and supplemental unemployment benefits as part of the satisfaction of county judgments.

In September 2020, after the Milwaukee County Board appeared on the verge of ending the collection of birth fees, the board reversed direction. County Director of Child Support Jim Sullivan argued at the time that birth cost recovery judgments were only pursued against absentee fathers who had sufficient income and should be held financially responsible for their children.

Peterson says that argument did not convince him. The claim that fathers who were ordered by the courts to reimburse Medicaid costs for the birth of their children had higher incomes has been “exaggerated”.[ed] out of proportion,” he says.

“We’ve always said that at some point, if child support agencies apply prosecutorial discretion correctly, there may be cases that you pursue,” Peterson says. “But the vast majority of these cases are poor or working-class people who don’t have the resources to come forward. [in court].”

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