We at ABC for Health read with great concern the April 2 article by David Wahlberg titled “High death rate for black babies in Dane County frustrates health officials.” We are a nonprofit public interest law firm dedicated to connecting Wisconsin families with health coverage and care.
Addressing infant mortality is a perplexing social problem that continues to challenge local health providers and the public health departments. Though our community has in the past seen progress toward addressing the disparity in death rates between African-American newborns and white newborns, hope has turned to alarm as infant death rates rise again in the African-American community.
ABC for Health has long been concerned about one potential piece of the infant mortality puzzle that has yet to be addressed by local policy makers — Wisconsin’s Medicaid Birth Cost Recovery (BCR) policies. Wisconsin is one of only a few states in the country that authorizes local child-support agencies to pursue unmarried fathers for childbirth expenses paid by Medicaid. In fact, Wisconsin leads the nation by a wide margin.
While on the surface this practice may seem fair, birth-cost judgments are not the same thing as child support. Amounts recovered go directly to the state and county. Low-income fathers are saddled with debt and payment obligations that reduce their ability to support the mother and child.
Sadly, Dane County also vigorously targets unmarried mothers, too often low-income and minority residents, to identify non-custodial fathers for the repayment of Medicaid-related birth costs. Mothers fearing the potential for negative physical, social or emotional consequences from identifying the birth father may forgo Medicaid enrollment and the critical prenatal care necessary to promote healthy birth.
Exemptions from the identification requirement are buried in the bureaucratic weeds and almost never used. Women who refuse or cannot meet the burden of proving eligibility for an exemption risk losing access to Medicaid, FoodShare and other support resources while their babies are only 2 months old.
The unintended consequences of Wisconsin’s BCR policy cost taxpayers and society so much more than the comparatively tiny sums that manage to flow back to the state’s Medicaid fund. For that reason, I have recently written Dane County Executive Joe Parisi and Madison Mayor Paul Soglin to offer assistance from ABC for Health to work to modify the Dane County policy and practice around Birth Cost Recovery.
Together we can develop proactive strategies that promote responsible fatherhood while also encouraging low-income, pregnant moms to seek early prenatal care. We need to put together every piece of the puzzle to promote healthy birth outcomes in the African-American community.