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| Common Questions About Birth Cost Recovery in Wisconsin (2004) by: Scott Sussman and Michael Rust TABLE OF CONTENTS INTRODUCTION QUESTIONS AND ANSWERS INTRODUCTION This guide is based on Wisconsin law and policy. It deals with the Medicaid-paid birth cost recovery policies of Wisconsin. It was written on April 2, 2004, and does not reflect changes in the law or policy since that date. This guide gives only general legal information. It is not advice about your legal situation. It would most likely help you to have a lawyer to deal with the issues discussed in the guide. You may read the entire guide or just specific questions. QUESTIONS AND ANSWERS Eligibility for Healthy Start and a Condition of Receiving Healthy Start What is Healthy Start? Healthy Start pays for medical care for pregnant women, babies, and children under 19 years of age. It covers most babies until they are a year old, even if the family’s income goes up. Healthy Start is part of the Medicaid program. In Wisconsin pregnant women may also be eligible for other programs. This will depend on their income levels, other insurance, employment, and other issues. These other programs are BadgerCare, Medically Needy, AFDC-Medicaid, or even SSI. You should know that Medicaid is NOT MEDICARE. What does Healthy Start cover? Healthy Start pays for:
If you have other health care insurance, Healthy Start will make your insurance pay first. Your health care providers will send to Medicaid any bills that remain after insurance pays. Even if the insurance payment does not cover the entire cost, if the insurance has paid as much as Medicaid would pay, you cannot be billed for the outstanding balance. I am pregnant. Can I get Healthy Start to pay the medical costs? Your family’s gross (before taxes and deductions) income determines whether Healthy Start will cover your medical costs. This includes income from all sources. There is no asset test. An asset is something like a car or a savings account. This coverage is for a pregnant woman whose family’s gross income is below 185% of the federal poverty level. In January 2004, this meant that a pregnant woman’s income must be below the amount shown in the following chart for her family size:
Each year the federal poverty level changes and this means that the gross monthly income amounts in the chart will change. Families with higher incomes may qualify if they pay for childcare or have outstanding medical bills or medical debt. This is called the “deductible.” In addition, pregnant women and their children may be eligible at even higher income limits because of a special, individualized income test called the “FFU” (Family Fiscal Unit). For more help, and to learn of other possible situations where you may be eligible, you should call ABC for Health at one of these phone numbers:
ABC for Health can help you to apply for Healthy Start. I am pregnant. If I use Healthy Start will I have to cooperate with the child support agency to establish who is the legal father? Most likely yes. If a mother uses Healthy Start she must cooperate with the child support agency. Yet no child can lose any benefits because the mother refuses to cooperate, and the mother cannot lose any benefits while she is pregnant. Also, if she refuses to cooperate and then loses access to BadgerCare and Food Stamps, she can still become eligible for Healthy Start again if she gets pregnant again. She will not have to cooperate with the child support agency if
the welfare agency finds she has good cause to not cooperate. Good
cause can be found if cooperation is likely to cause physical or
emotional harm to the child or mother; makes it harder for the mother
to leave domestic abuse; or punishes unfairly a domestic abuse victim.
Also, good cause can be found if the child was the result of incest
or sexual assault; the mother is deciding whether to terminate her
parental rights and in the last three months she has sought help
from a social service agency; or a court is considering whether
to grant an adoption of the child. Reimbursment of Government for Healthy Start I am pregnant. If I use Healthy Start will I have to pay back the help it gives me? No. A mother who uses Healthy Start for pregnancy costs cannot be ordered to pay back these costs. The only rare exception is if a court finds that the medical assistance given to her was incorrectly paid.Will the father have to pay the child support agency for the birth costs paid by Healthy Start? Generally yes. Yet sometimes a father may not have to pay for Healthy Start-paid birth costs. (This guide outlines some of these situations below.)Will the father have to pay the Medicaid-paid birth costs if he and the mother live with their child? Yes. The child support agency can seek payment of these costs even if the father and the mother live with their child.If they are married when the mother applies for Healthy Start, will the father have to pay back the Medicaid paid birth costs? No. In this instance, neither parent must pay the child support agency.If they are married when the baby is born, will the father have to pay the child support agency? The father still may have to pay the Medicaid-paid birth costs. Some courts will not make him pay these costs if the parents marry before the birth of the baby.Should I find out how much Medicaid paid for the birth of the baby? Yes. You should be sure that the child support agency is not charging you more than Medicaid paid. This may be a problem when the mother’s or father’s insurance paid a portion of the birth costs.Should I find out how much of the bill was paid by insurance? Yes. This may be very important. The policy is that the county child support agency first determines the maximum amount you should have to repay, then the agency is supposed to subtract from that amount any payments made by insurance.I am an unmarried pregnant woman and a member of one of Wisconsin's 11 federally recognized Native American tribes. Can the county I live in make my child's father repay birth costs? It depends. If Medicaid paid for the birth costs, the county will seek recovery of those costs from the child's father. If Indian Health Service paid for those costs through the Contract Health Services (CHS) program, that program does not seek repayment.Here's how it works: Your tribe's CHS program will probably require you to apply for Wisconsin Medicaid (Healthy Start) to cover the birth costs. It is advisable that you include the father’s income on your Medicaid application. If your income is low enough to qualify for Medicaid and you are determined to be eligible, then the county will seek repayment from the father. If your application for Medicaid is denied, and the Indian Health Service pays for the costs of your pregnancy through the CHS program, then the father will not be asked to repay those costs. We are about to have another child. Does the father have to pay Medicaid back for this child’s birth costs, too? It depends. When the mother applies for Medicaid she should be sure to include the father’s income on her Medicaid application. If she does this, the child support agency is not supposed to seek him to pay the Medicaid-paid birth costs. You should be aware that there are some different interpretations of this policy. A brochure from the state agency (Bureau of Child Support) says the following: “The exception to the requirement for an unmarried father to repay birth costs is the situation in which:
Some counties may use other interpretations. If you have questions about this you may want to contact the Center
for Family Policy and Practice at 608-257-3148. I am a father who got a notice that asks me to agree to repay the government. Can I make any arguments so I will not have to pay this? It is always best to have a lawyer when dealing with legal matters. One argument you or your lawyer may want to make is that you cannot afford to pay this debt. The law limits when a father should pay it. It provides that the court should include “An order requiring the father to pay or contribute to the reasonable expenses of the mother's pregnancy and the child's birth, based on the father's ability to pay or contribute to those expenses.” You may want to argue that your financial situation should stop the court from ordering you to pay Medicaid-paid birth costs. If you have questions about this you may want to contact the Center
for Family Policy and Practice at 608-257-3148. What will happen to make the father repay the birth costs? The child support agency will start one of two types of cases against the father. If the father has not already acknowledged his paternity, the child support agency will start a paternity case against him. If the father has acknowledged the paternity of his child, the child support agency will start a child support case against him. No matter which of the two types of cases are started, this case will resolve a number of things. To learn more about paternity and child support cases and child support matters, visit www.cffpp.org and look in the legal assistance section for two handbooks. One handbook deals with paternity and child support matters and another deals with custody matters for noncustodial parents in Wisconsin. You may also call the Center on Family Policy and Practice at 608-257-3148 to obtain a copy of the handbooks. One thing the child support agency will ask the father to do is
pay some or all of the Medicaid-paid birth costs. Whether he should
agree to the amount they ask for depends on his situation. If he
does not agree, he will have to go to a court hearing. Some of the
previous questions in this guide outline times when he may not want
to agree to the amount they ask from him. It is important to understand
that in any paternity or child support action it is always best
to get a lawyer to help you make any legal arguments. For help to
determine whether you should agree to pay the Medicaid-paid birth
costs, you can contact the Center for Family Policy and Practice
at 608-257-3148. Payment of Court-Ordered Reimbursement of Healthy Start What is the most that the father will have to pay to the child support agency in birth costs? It depends on a number of factors:
There are maximum amounts that the father can be ordered to pay.
The maximum amounts may vary by county. No matter how difficult
or expensive the pregnancy, the child support agency is supposed
to not seek more than these maximum amounts. The father should probably
make sure that in his case they are not going beyond these maximum
amounts. Will the father have to pay this amount all at once? No. A court will order him to pay the birth costs. Then he will have to pay an amount each month until he pays the total amount. For instance, he may owe a total of $2,500 at the rate of $100.00 each month. He will owe this money to the child support agency. He will also have to pay an additional $35 each year to the child support agency.If the father is ordered to pay birth costs, does he then automatically get to spend time with the child? No. A court’s decision about how much time a noncustodial parent spends with his or her child(ren) is separate from a court’s decision about how much a father pays in birth costs. If you go before a court, the court will likely address these questions in the same hearing but they are separate issues that should not impact each other.How do I pay this bill? If you have a job, money will be taken from your paycheck. The amount your employer takes will be what the court orders to be taken from every paycheck. For instance, a court may order you to pay $400 each month in child support and $100 towards your birth cost bill. Each week you will owe $125. Of this, $100 will go to the mother and $25 will go to the child support agency. If you are self-employed or unemployed, you likely will need to mail a payment in each month. You should make checks and money orders payable to WI SCTF and mail to:
Write your KIDS personal identification number (PIN) on the memo
line of your check or money order and be sure to enclose your billing
coupon so the WI SCTF can properly credit your account. I am a father who the child support agency wants to pay Medicaid-paid birth costs. I do not have a lot of money. Do I have to begin making payments even if my income is low? Generally, no. A father whose income level is below 185 percent of the federal poverty level should not have to immediately pay the Medicaid-paid birth costs with monthly payments (called “periodic payments”). To determine this, the child support agency and court should look at two factors. The first factor is the father’s income. The child support agency and court just look at the father’s income, not at household income. The second factor is whether the father lives with the mother and baby. If the father does not live with the mother and baby, then the first income level is used. If the father lives with the mother and baby, then the second income level is used.
Each year the federal poverty level changes and this means that the gross monthly income amounts in the chart will change. The father will still owe this money. Yet he should not have to pay it each month until his income gets above this level. If the father believes this is an issue, he should ask the court to limit when he has to pay this debt. If the court agrees, it can include language in the order that he does not have to pay the birth costs until his income reaches above the levels in the chart. He will then have to show the child support agency each year that his income has not gone above the levels in the chart. Some child support agencies may make him give proof each month. They still will take his tax refunds. (See next question.) Will they take the father’s tax refunds to pay this debt? Yes. Both federal and state tax refunds will be taken to pay this debt. They will take federal tax refunds if the amount owed is more than $500. They will take state tax refunds if the amount owed is more than $150. It does not matter that the father’s income level is below 185 percent of the federal poverty level. (See question above.) This is called a tax intercept, and there are special rules governing the father’s ability to claim that a mistake has been made. These rules are part of the tax code.Will interest be charged if I do not pay all of this debt immediately? No. |
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