Association for Public Policy Analysis & Management

Low-income parents who face substantial debt and wage withholding are less willing and able to cooperate with child support enforcement agencies (Bartfeld, 2005; Waller & Plotnick, 2001). Greater medical debt, in particular, substantially reduces child support payments by noncustodial fathers (Cancian, Heinrich, & Chung, 2013). To improve child support payment compliance, there may then be potential value in pursuing public policy channels that improve the financial well-being of non-custodial parents and are beyond the scope of traditional enforcement tools.

Under the Affordable Care Act (ACA), roughly half of all states expanded Medicaid coverage to nonelderly, non-disabled adults without dependent children whose income was below 138 percent of the federal poverty line (FPL). These Medicaid expansions improved health insurance rates and health outcomes, especially among men without dependent children (including noncustodial fathers) and low-income custodial fathers (Dworsky & Eibner, 2016; Gates, McMorrow, Kenney, & Karpman, 2016; Simon, Soni, & Cawley, 2017).

A quickly growing literature is also showing improvements in financial well-being from these Medicaid expansions, including lower debt, fewer delinquencies, and improved credit (Allen, Swanson, Wang, & Gross, 2017; Brevoort, Grodzicki, & Hackmann, 2017; Fitzpatrick & Fizpatrick, 2017; Hu, Kaestner, Mazumder, Miller, & Wong, 2016), all of which may improve the ability to pay child support.

Finally, there may also be a variety of programmatic effects of Medicaid expansions on child support payments such as administrative efficiencies for both programs, changes in how child support payments and income are treated in determining Medicaid eligibility, and having to establish a medical support obligation as part of a child support order for parents newly eligible for Medicaid. With substantial overlap in the population that is typically obligated to pay child support and the population that has strongly benefited from the ACA Medicaid expansions, there may be potential implications for child support enforcement.

In this study, I examine the effect of public health insurance eligibility on a variety of child support outcomes. I exploit state-level variation in ACA Medicaid expansion to compare child support outcomes in Medicaid expansion states to non-expansion states before and after the expansions. I utilize aggregate data from the Office of Child Support Enforcement (OCSE), supplemented with individual-level data from the American Community Survey (ACS). I will also conduct semi-structured interviews with state Medicaid and child support enforcement offices to understand the mechanisms through which Medicaid expansion has affected child support.

Preliminary results suggest Medicaid expansions increased the rate of current support distributed, the percent of cases with a health insurance order, and the percent of cases in which health insurance was provided as ordered. The results of this study are important for understanding how public policy beyond traditional child support enforcement levers affects child support outcomes. This study is also timely in that it contributes to growing literatures on cross-program interactions between large social programs in the U. S. and the non-health effects of ACA Medicaid expansion.