Encourage Infant Well-being; Support Fragile Families

March 18, 2002

Author: Susan C. Antos

Amend §514 of the Family Court Act to Ensure that Support Collection Units Do Not Pursue Recoupment of Confinement Costs in Medicaid Cases

The Family Court Act §514 permits a mother to recover costs associated with her pregnancy and childbirth from the father of her child. In the case of a child born out of wedlock, such a proceeding can not be brought until paternity has been established. This law predates the Medicaid program and is reasonable and fair when a mother has had to bear the financial cost of childbirth on her own.

When a child is born out of wedlock and the mother is a Medicaid recipient, Support Collection Units (SCU) have used §514 to recover Medicaid birthing expenditures from the father. Utilizing the law in this manner runs counter to two other important public policy goals. First, it discourages low income mothers from seeking prenatal care because they fear that the broad liability provisions will result in the father of their child being liable for the entire cost of their care and the delivery. This undercuts the state's policy of improving infant health by providing good prenatal and post-partum medical services to low income pregnant women.

Secondly, it places unbearable financial stresses on fragile families. National research shows that at the time of a child's birth over 60% of children born out of wedlock have fathers who either live with them or who visit frequently. Of those fathers, 96% say they plan to help raise the child, and 97% of the mothers want the father involved. These numbers drop dramatically just two years after the birth of the child.(1)

Although researchers are still studying the reasons for this decline of father involvement, we have witness first hand the deleterious effect that the vigorous pursuit of confinement costs under §514 has had upon low income fathers who have acknowledged paternity. Even fathers who are living with their children and who are themselves eligible for Medicaid, have been saddled with confinement cost liability of thousands of dollars. This has resulted in fathers who are reluctant to acknowledge paternity. Low income fathers who support live with or support their children find their earnings garnisheed to pay back a medicaid debt, not only removing support from the small child who needs it the most, but also eroding the fragile foundation of this new family.

Both of these results have been documented in the Report, "What One Hand Giveth, the Other Hand Taketh Away: How New York's Pregnancy Related Medicaid Recoupment Policy Hurts Low Income Families" (Greater Upstate Law Project, March, 2001).(2) The Report of the Medical Child Support Working Groups Report to Congress, "21 Million Children's Health: Our Shared Responsibility," not only concurs in those conclusions but makes a national policy recommendation that State child support enforcement agencies should not pursue recoupment of pregnancy and birth related costs in medicaid cases.(3)

At least half of the social services districts in the state do not recover birthing costs routinely. Only $7 million dollars is collected annually and half of this must be returned to the federal government.(4) Yet the cost to fragile families is immense.

The time has come to recognize that the recovery of birthing expenses is detrimental to infant health and family formation. We recommend that section 514 of the Family Court Act be amended to exclude the recovery of Medicaid costs from its scope, as follows:

AN ACT to amend the family court act in relation to liability for confinement costs for those who have acknowledged paternity:

Section 514 of the Family Court Act is amended to read as follows:

§514. Liability of father to mother. The father is liable to repay the reasonable expenses of the mother's confinement and recovery and such reasonable expenses in connection with her pregnancy as the court in its discretion may deem proper, provided, however, where the mother's confinement, recovery and expenses in connection with her pregnancy were paid under the medical assistance program on the mother's behalf, the father (may) will not be liable to the social services district furnishing such medical assistance and to the state Office of Temporary and Disability Assistance for the (full amount) of medical assistance so expended. (as the court in its discretion may deem proper.)

End Notes

1. Ron Mincy, Ph.D., Columbia School of Social Work, October 20, 2001, Keynote address, "the Road Ahead: Opportunities in Federal And State Welfare Policy for Low-Income Families," Washington, D.C.
2. Available at www.empirejustice.org .
3. The recommendation regarding confinement costs is recommendation number 20 and also appears in the Overview of recommendations on page xiii. In the full report the recommendation and analysis appears at page 3-29 through 3-31.
4. March 7, 2002 telephone conversation with Lee Sapienza, Chief of Policy and Planning, Division of Child Support Enforcement, Office of Temporary and Disability Assistance. Mr. Sapineza was a member of the Medical Support Working Group that made the Report to Congress mentioned in footnote two.