At a Glance
Birth Cost Recovery (BCR) holds unmarried, non-custodial fathers liable for Medicaid birth costs in Wisconsin, yet there is little known about the impact of this policy on Black birthing people in Wisconsin. This project, led by Tiffany Green, PhD, assistant professor in the departments of Population Health Sciences and Obstetrics and Gynecology, worked to better understand how BCR and other similar social policies impact inequities in health outcomes among low-income Black birthing people in the state of Wisconsin.
Dr. Green and a team of interdisciplinary experts in the fields of economics, population health, pediatrics, social work, clinical/social psychology and community engagement created an evaluation framework for BCR as a way of measuring the impact of this policy and collect evidence that can be useful in informing future policies and improving health outcomes statewide.
The Challenge
One in three US children live with an unmarried parent. Given that unmarried birthing parents and their children are at greater risk for adverse financial, emotional and health outcomes, it is critical to understand how social welfare policies impact this population. One such policy is Birth Cost Recovery (BCR), which traditionally holds unmarried, non-custodial fathers liable for Medicaid childbirth costs. BCR disproportionately impacts Black birthing parents, who are more likely to access prenatal Medicaid and to be unmarried. In Wisconsin, policymakers are debating whether to strengthen or eliminate BCR. However, there is little robust evidence on the impacts of BCR on outcomes among low-income birthing parents, leaving policymakers with an inadequate understanding of its impacts on disparities in health and well-being.
Project Goals
The goal of this project was to conduct a community-engaged pilot study to develop, refine and pilot test a novel survey instrument to evaluate the impacts of Birth Cost Recovery cessation on the financial stability, relationships and health of low-income Black birthing parents.
Results
The research team completed 40 interviews (26 interviews with birthing parents, 14 interviews with taxed parents) to explore understanding and perceptions of BCR policy and its impacts among low-income Black parents in Wisconsin. The team used their qualitative research findings to publish a research brief in support of ending BCR following Governor Evers’ proposed biennial state budget for 2025-2027.
The team finalized a survey instrument designed to quantify the impacts of BCR cessation on financial strain, relationship stability and health outcomes among low-income Black parents. They conducted two rounds of cognitive interviews with eligible participants, each round followed by careful survey refinement based on the results and participant feedback. Researchers launched the test survey instrument and achieved a final sample of 130 responses using a community-based recruitment approach. Formal analysis of the survey results is underway to compare outcomes between BCR exposed Black fathers and their married counterparts.
The research team has fostered and sustained many partnerships and collaborations over the course of this project. They have engaged passionate early-career trainees as well as a community of Black Wisconsinites in their work. Their next goal is to harness the data and findings of this project to secure a larger grant or investment for their team to continue their important work examining the consequences of Birth Cost Recovery on Wisconsinites.
