A Flint program believed to be the nation’s first universal prenatal and infant cash transfer program has lowered the risk of evictions and decreased reports of postpartum depression, according to a new study authored by the program’s organizers.
Rx Kids, a public-private partnership that began in 2024, gives moms $1,500 in a direct cash transfer during mid-pregnancy, followed by $500 a month for the first year of the baby’s life. Virtually 100% of families eligible for the program in Flint are enrolled, making it essentially a universal program in the city. There are no strings attached to the cash, and no income requirements, though Rx Kids says the majority (57%) of families enrolled report making less than $10,000 per year.
Similar programs have now expanded to ten additional communities in Michigan, including several counties in the eastern Upper Peninsula, Clare County in mid-Michigan, and the cities of Kalamazoo, Pontiac, Hazel Park and Royal Oak township.
Now, in a peer-reviewed article published in the American Journal of Public Health, researchers with Michigan State University and the University of Michigan found moms who were eligible to receive the cash aid (because they lived in Flint and had a baby in 2024, when the program began) reported a 4 percentage-point lower risk of eviction, and a 14 percentage-point reduction in screening positive for postpartum depression.
That’s compared to those who had a baby in 2023, before the program started, and those who lived in surrounding communities outside of Flint (and thus weren’t eligible for the program.) More than 1,000 moms completed survey questions about housing and food security, as well as maternal mental health and well-being.
“Back in 2023, when Flint was compared to the surrounding region, they had a bigger risk of being evicted,” said Luke Shaefer, co-director of Rx Kids and the director of poverty solutions at the University of Michigan Ford School of Public Policy.
“And then in 2024, we see this huge shock downwards, that they’re actually less likely to be evicted. So mamas in Flint who have access to Rx Kids, who are significantly more poor than those in the surrounding region, are actually less likely to report that they were evicted since their child was born. It’s pretty incredible.”
Flint moms in 2024 also showed a statistically significant improvement on five out of 11 “hardship measures,” including the amount they owed on rent or mortgage, and the proportion reporting they did “not have enough of the kinds of foods we want,” compared to Flint moms in 2023.
Moms exposed to Rx Kids in 2024 were also more likely to rate their general mental health as “excellent” or “very good,” compared to Flint moms who had a baby in 2023. But non-Flint moms from the surrounding area also “saw a similar improvement” between 2023 and 2024.
Flint moms in 2023 were also more likely to screen positive for post-partum depression, compared to those in neighboring communities. But in 2024, “this disparity was completely erased,” the study finds, with a 14 percentage-point decrease in moms screening for post-partum depression.
“Rx Kids may be helping a community with lower income and education levels ‘catch up’ to its wealthier and more highly educated neighbors,” the researchers concluded.
Early evidence suggests improved health outcomes for babies, too
Rx Kids organizers have also authored a second study looking at whether the cash transfers can improve birth outcomes, including preterm birth and low birthweight in Flint. Those findings haven’t been peer-reviewed or published in an academic journal yet. But an early version of the study found the program was associated with a 2.7 percentage-point decrease in the preterm birth rate, and a 4 percentage-point decrease in the proportion of infants born with low birthweight, compared to babies born in similar cities and overall state trends.
“From 2021, the proportion of infants born preterm is increasing in Flint, and after 2024, after implementation of Rx Kids, this trend entirely changes directions,” said Dr. Sumit Agarwal, a co-author of the study and a health economist at the University of Michigan. “So now, since 2024, the proportion of infants born preterm is actually decreasing in Flint. And this is in stark contrast to what's going on elsewhere in Michigan, and in other similar cities where that trend is stable or slightly increasing.”
Researchers found a similar reduction in neonatal intensive care unit (NICU) admissions, translating to 68 prevented admissions during the study period. They hypothesized that could be due to an increase in prenatal care utilization, as well as a reduction in study participants who reported smoking during the third trimester, “which is a known risk factor for preterm birth and low birth weight,” Agarwal said.
“From a healthcare perspective, preterm births and low-birthweight births are expensive,” he said, "and so for the city of Flint, this means avoiding $2.6 million annually for preventing preterm births that are instead born at term, and avoiding $6.2 million annually for preventing low birthweights that are instead born with normal birth weights.”
Dr. Mona Hanna, codirector of Rx Kids and associate dean for public health at Michigan State University medical school, touted the findings as evidence that the program could be cost-effective for the state, which contributes matching TANF (Temporary Assistance for Needy Families) dollars to participating communities that raise local and philanthropic funding.
“Often when we talk about kids and doing good things for kids, we talk about long-term societal savings,” Hanna said. “Like, ‘They'll be healthier later, decades later they'll do better in school, they'll have increased economic productivity.’ So this is an example of how an intervention is saving money today.”
