Wisconsin s Birth Cost Recovery Policy

Transcription

1 Wisconsin s Birth Cost Recovery Policy Implications for Health Disparities in Infant Mortality Meghan Pesko, MD

2 Outline Background Health disparities in infant mortality in Wisconsin Life-course perspective Project involvement and methods Results BCR policy Definition Total collections yearly Magnitude of impact Discussion: Interaction of BCR policy with prematurity risk factors Conclusion Acknowledgements Questions

3 Health Disparities in Infant Mortality

4 Background Disparities in IMR between African-Americans and whites in Wisconsin is among largest in nation Largest cause of excess infant mortality among African-Americans is prematurity Positive correlation between preterm birth and Maternal stress Socio-demographic factors (being unmarried, being young, living in poverty) Lack of father involvement in pregnancy Life course perspective suggests that investments need to be made throughout the course of a woman s life

5 Project Methods How does policy impact health? My involvement in this project qualitative analysis Data sources utilized Medical literature Social science literature State statute and administrative code documents LFB and other state reports Key informant interviews State Medicaid data on demographics of pregnant women National and state databases on birth outcomes

6 BCR Policy Birth cost ( lying-in cost ) = all Medicaid-related medical bills and expenses associated with prenatal care, pregnancy, and birth of a child Mother cannot be charged directly State is permitted to re-coup charges from father after the birth if the couple is unmarried Recovery effort from father is through local child support agencies (CSAs) Birth cost debt becomes a child support arrearage owed to the state and cannot be waived Majority of recovered funds goes to Medicaid; 15% goes to county for its own use

7 Results: National BCR Collections $20,000,000 $18,000,000 $16,000,000 $14,000,000 $12,000,000 $10,000,000 $8,000,000 $6,000,000 $4,000,000 $2,000,000 BCR Collection by State in 2009 or 2010 (NCCSD 2010 Survey) $- Source: National Council of Child Support Directors, Member Survey, August 2010

8 Results: Yearly BCR Collections in Wisconsin Total Wisconsin BCR Collections, $40,000, $35,000, $30,000, $25,000, $20,000, $15,000, $10,000, $5,000, $ Source: Data for odd-numbered years -- Wisconsin Legislative Fiscal Bureau. Informational Paper 45, Child Support Enforcement Program. Data for even-numbered years communication from individuals within the Bureau of Budget and Policy, Wisconsin Department of Children and Families

9 Results: Magnitude of Impact BCR impacts unmarried women who have prenatal care paid for by Medicaid In 2008, 31.3% of all births state-wide Differential impact by county or subpopulation In Milwaukee county, BCR affects 48.5% of deliveries Because African-Americans are more likely to be unmarried, they have greater likelihood of being impacted by BCR Source: communication with individuals within the Wisconsin Department of Health Services, Dec 2011 and March 2012.

10 Discussion

11 Discussion: Policy Consequences Policy benefits: Immediate $$ savings to Wisconsin taxpayers/medicaid program Policy costs: Increased poverty to low-income families Reduced child support compliance among low-income fathers Potential for decreased paternal support during pregnancy and beyond Reports of delayed entrance to prenatal care by pregnant women Confusion regarding sanctioning and decreased interconceptional care among high-risk women Increased risk of prematurity through interactions with multiple risk factors Increased total health care costs (more $$ paid by taxpayers) Increased health disparities in infant mortality in Wisconsin

12 Conclusions BCR policy has multiple unintended consequences that could contribute to poor infant health outcomes BCR policy collects ~$18 million from low-income familes yearly and is widespread Impacts 30% of births occurring yearly in Wisconsin African-Americans have greater likelihood of being impacted by policy Elimination of BCR policy should be considered as part of Wisconsin s multi-faceted strategy towards improving health disparities in infant mortality

13 Acknowledgements Thanks to my capstone committee: Tom Oliver, PhD, MHA Bobby Peterson, JD, Executive Director of ABC for Health Suzanne Krasovich, MD, Residency Program Associate Faculty

14 Questions?