Updated 2.15.24 - "Milwaukee County Stops Program..." is Now Available in Publications, Press, and Reports
The Birth Tax, formally known as Birth Cost Recovery (BCR), is a practice allowed but not required under title IV-D of the federal Social Security Act that allows states to pursue the recovery of Medicaid supported birthing costs from non-custodial fathers. Most states in the nation have abandoned this practice concluding that it is not in the best interest of infants, parents and families.
Wisconsin is among a small handful of states that continues to pursue this policy, and takes the most aggressive enforcement posture in the nation, collecting over $16 million in 2016. Unlike child support, none of the recovered dollars go to support the children and families – it is all directed to reimburse the government at the federal, state and local level.
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. We have advocated that Wisconsin abandon the policy altogether, or at a minimum, modify it to reduce the negative, unintended consequences to our children and families.
This webpage provides a compilation of links to research materials, publications, correspondence and background materials for individuals interested in the subject of BCR.
Repayment of MA related birth cost expenses is pursued by individual Child Support Enforcement Agencies at the county level. Counties are allowed to retain 15% of annual BCR collections to support child support enforcement programming. The Wisconsin Department of Children and Families provided this spreadsheet breaking out collections by Wisconsin county for the years 2011 through 2016. Use CTRL+/- to zoom or click to expand.
ABC for Health has written a number of background papers on BCR and submitted several editorials over the years pointing to the potential negative consequences of this practice.
ABC for Health has written government officials in Dane and Milwaukee Counties – the two Wisconsin Counties recovering the most in birth cost judgements – asking for opportunities to meet with government staff, discuss concerns about BCR and plan efforts to reduce the potential negative impacts on children and families. Below are letters, correspondence and information pertinent to these two counties. Email us for access to the correspondence.
Wisconsin Department of Health Services
Division of Medicaid Services Response, April 17, 2019
Division of Medicaid Services Response, April 12, 2019
Open Records Request – Division of Medicaid Services, April 11, 2019
Dane County
Letter to Dane County Executive Parisi, March 26, 2019
Letter to Dane County Executive Parisi and Mayor Paul Soglin, March 17, 2017
BCR Collections 2011-2016 Dane County Budget Meeting Parisi Response Email, August 15, 2017
Letter to Dane County Executive Parisi, August 9, 2017
Milwaukee County
Letter to Milwaukee County Executive Abele, April 18, 2019
Letter to Jim Sullivan, Milwaukee Director of Child Support Services, October 24, 2017
Response Letter from Jim Sullivan, Milwaukee Director of Child Support Services, October 2, 2017
Letter to Milwaukee County Executive Abele, August 9, 2017
Letter to Milwaukee County Executive Abele and Mayor Tom Barrett, March 17, 2017
There is a small, but growing, body of evidence which supports the position that BCR is not in the best interest of mothers, fathers, infants and families. Below are a few of the articles that deal with the issue of BCR.
The practice by which states seek repayment of Medicaid related birth costs from third parties, including non-custodial fathers, is authorized in federal statute and regulation.
Wisconsin’s framework for implementing BCR is spelled out in statute and administrative rule. Below are relevant links:
Unmarried mothers who are concerned about the potential negative consequences of identifying the father of their child can request a “Good Cause Exemption.” Below are links that explain the process and requirements for “Good Cause” consideration.
In 2010, a survey indicated that only nine states in the nation continued to practice BCR. A follow-up email survey of these states in 2017 provided more recent insights into their current BCR practices. In 2014, Idaho stopped pursuing BCR completely.
HealthWatch Wisconsin, Inc. | 608.261.6939 | 32 N. Bassett St. Madison, WI
HealthWatch Wisconsin, Inc, a subsidiary of ABC for Health, promotes improved access to health care coverage and services. HealthWatch will continue to track and inform policy developments in a changing landscape of public and private insurance coverage options for the people of Wisconsin.
