Child Support and the Affordable Care Act

Over half of all children in the U.S. will live apart from a parent at some point in their childhood (Andersson, 2002), suggesting a large portion of children may be eligible for child support. Child support paid by the nonresident parent (typically the father) is a substantial source of income for mothers and children, accounting for nearly 60 percent of annual income for custodial parents below poverty who receive full child support. But in 2015, of those who were due child support, only 43 percent received full payments (Grall, 2018). To improve child support payment compliance, there may then be potential value in pursuing policy channels beyond the scope of traditional enforcement tools.

Low-income parents who face substantial debt 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). The Affordable Care Act (ACA) 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). The expansions also improved the financial well-being of low-income individuals, including lowered debt, reduced delinquencies, and improved credit (Allen, Swanson, Wang, & Gross, 2017; Brevoort, Grodzicki, & Hackmann, 2017; Caswell & Waidmann, 2017; Fitzpatrick & Fizpatrick, 2017; Hu, Kaestner, Mazumder, Miller, & Wong, 2016), all of which may improve the ability to pay child support.

There may also be programmatic effects of Medicaid on child support payments such as administrative efficiencies, changes in how child support payments and income are treated in determining Medicaid eligibility, and Medicaid offices no longer seeking birth cost recovery from noncustodial fathers. 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.

In this study, I examine the effect of public health insurance eligibility on child support outcomes. I utilize state-level data from the Office of Child Support Enforcement (OCSE), supplemented with individual-level data from the Current Population Survey. I find that ACA Medicaid expansions increased the rate of current child support due by 2.5 percent and the rate of support distributed as arrears by 9 percent. The expansions also increased the likelihood of child support receipt among unmarried mothers by 7 percent. These results 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.