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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.

Milwaukee County stops program that orders unwed fathers to repay Medicaid for childbirth costs (Wisconsin Public Radio, February 14, 2024)

Wisconsin leads nation in birth cost recovery (Wisconsin Public Radio - The Morning Show, January 18, 2024)

Dane, Milwaukee counties stop making unwed fathers pay for Medicaid birth costs (Wisconsin State Journal, December 4, 2023)

PRESS RELEASE: Birth Tax Medical Collections Curtailed in Wisconsin's Largest Counties (ABC for Health, November 15, 2023)

Milwaukee County stops taking fathers to court to pay back Medicaid for childbirth costs (News from the States, A Project of States Newsroom, November 14, 2023)

Milwaukee County Adopted 2024 Budget Discontinues Birth Cost Recovery for Fathers Press Release, November 9, 2023

Citing Racial Bias, County Ends Birth Cost Recovery Program Urban Milwaukee, November 10, 2023

Merchants of Debt: Wisconsin Counties and the Birth Tax Featured Report, December 14, 2022

Birth Tax Video Featured Pulse Newsletter, July 11, 2022

Stop the Birth Tax Pulse Newsletter, June 21, 2022

Partners Update Oct. 5, 2020

Partners Update Sept. 23, 2020

Partners Update Sept. 15, 2020

Partners Update July 23, 2020

Office of Minority Health Report June, 2020

Partners Update July 22, 2020

Partners Update July 17, 2020

Partners Update July 14, 2020

Partners Update June 29, 2020

Office of Minority Health Report June 29, 2020

Partners Update May 28, 2020

Partners Update May 27, 2020

Milwaukee Must Eliminate the Birth Tax May 27, 2020

Partners Update May 19, 2020

Partners Update March, 2020

Celebrating the Elimination of Birth Cost Recovery in Dane County at the HealthWatch Wisconsin Awards Ceremony March, 2020

Partners Update February, 2020

Office of Minority Health Progress Report January, 2020

December Progress Report Office of Minority Health, December 2019

Is "Birth Cost Recovery" On Its Way Out? Wisconsin Examiner, November, 2019

Partners Update November, 2019

Partners Update October, 2019

Bill Seeks Payments from Unwed Fathers September 11, 2019

Recovering Birth Costs from Men September 11, 2019

Partners Update June, 2019

End of Collecting Child Support Birth Costs Proposed in Evers Budget March 16, 2019

Partners Update March 12, 2019

Medicaid Birth Cost Recovery: New Rules Affect Unmarried Parents March 12, 2019

Tony Evers Proposed Budget - See page 11, February 28, 2019

Advocacy Group: Wisconsin' Birth Cost Recovery Program 'A Move In The Wrong Direction' February 13, 2019

WisEye Morning Minute: Study Committee on Child Placement & Support - Birth Cost Recovery February 13, 2019

A Birth Tax is Bad Policy for Wisconsin February 11,2019

Proposal to Roll Back Tax on Unmarried Pregnant Women Creates Controversy February 11, 2019

Why Some WI Fathers Have to Pay Back Costs of Their Child's Birth to Medicaid February 11,2019

Partners Update, February 2019

Partners Update, August 2018

"Journal Times editorial: Favor young lives over dollars" Journal Times, August 5, 2018

"State Pares Birth-Cost Collection from Men, But Group Says State Should End the Practice," Wisconsin State Journal, July 24, 2018

"Birth Cost Recovery," HealthWatch Pulse Report, December 6, 2017

"PRESS RELEASE: Birth Cost Recovery is Not Child Support," HealthWatch Wisconsin, December 6, 2017

"[ABC] Points to Wisconsin Policy as Contributing Factor to Infant Mortality," Capital Times, April 10, 2017

"Group Calls to End of Collecting Birth Costs from Fathers," Badger Herald, February 28, 2012

"Birth Cost Recovery," HealthWatch WI Reporter, February 27, 2012

"Birth Cost Recovery: A Guide for Pregnant Women on BadgerCare Plus," ABC for Health

"Good Cause Exemption," ABC for Health

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.

    Birth Cost Recovery: It's Not Child Support. February 27, 2018. Shepherd Express

    Wisconsin’s Birth Cost Recovery Policy: Implications for Health Disparities in Infant Mortality.  May 17, 2012.  Capstone Manuscript, University of Wisconsin School of Medicine and Public Health.

    Cancian, Maria, et.al.  2009.  Does Debt Discourage Employment and Payment of Child Support?  Evidence from a Natural Experiment.  Institute for Research on Poverty, University of Wisconsin – Madison

    Congressional Research Service.  December 18, 2013.  Medical Child Support:  Background and Current Policy.  Report No. R43020

    Bartfield, Judy.  2005.  Arrearages, Lying-in Orders, and Child Support Compliance among Fathers of W-2 Children in Wisconsin.  Institute for Research on Poverty, University of Wisconsin – Madison.

    Boggess, Jacquelyn.  2017.  Low-income and Never-Married Families.  Service and support at the intersection of family court and child support agency systems.  Center for Family Policy and Practice.

    The Medical Child Support Working Group’s Report. June 2000. 21 Million Children’s Health: Our Shared Responsibility

    Roberts, Paula. May 2011. An Ounce of Prevention and a Pound of Cure: Developing State Policy on the Payment of Child Support Arrears by Low Income Parents.

    Mistry, Ritesh et al. July 2007. Parenting-Related Stressors and Self-Reported Mental Health of Mothers with Young Children.

    Solomon-Fears, Carmen. Medical Child Support: Background and Current Policy. December 18, 2013.

    Birth Cost Recovery Poverty Matters

    Schlenker, Thomas, et al. The Effect of Prenatal Support on Birth Outcomes in an Urban Midwestern County. Wisconsin Medical Society, 2012, The Effect of Prenatal Support on Birth Outcomes in an Urban Midwestern County.

    Medicaid-Paid Deliveries to Unmarried Women 2009-2014

    CHRIS RICKERT | Wisconsin State Journal | crickert@madison.com | 608-252-6198 | @ChrisRickertWSJ. “Chris Rickert: In birth cost debate, children should be the focus.” Madison.com, Wisconsin State Journal, 1 Mar. 2012.

    DAVID WAHLBERG | Wisconsin State Journal | dwahlberg@madison.com | 608-252-6125. “Report urges end to birth cost collection from some men to aid women on Medicaid.” Madison.com, Wisconsin State Journal, 27 Feb. 2012.

    WISH System

    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:

  • Wis. Stat. 49.22: child and spousal support and establishment of paternity
  • Wis. Stats. 59.53(5)&(6)
  • Wis. Stat. 767.80(6m): CSA is required to file a paternity action for any case in which the father is not listed.
  • DCF 150.01(1)
  • 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.

  • BadgerCare Plus 5.3
  • Good Cause Claim Form
  • Dane County Child Support Manual on Good Cause & Non-Cooperation
  • 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.


  • Court Case Ending the Birth Tax in Idaho
  • FOIA Response


  • FOIA Response


  • FOIA Response

    New York

  • FOIL Response


  • Final Response Letter
  • Interm Response Letter


  • FOIA Response

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