TOPLINE:

Implementation of Rx Kids, a universal prenatal and infant cash prescription program in Flint, Michigan, was associated with a 7.0-percentage-point decrease in investigated maltreatment allegations within the first 6 months of life. This represents a 32% reduction compared with the preintervention period, with the investigated allegation rate dropping from 21.7% to 15.5% in infants born in 2024.

METHODOLOGY:

• Researchers used a cross-sectional study design with administrative data from Children’s Protective Services (CPS) in Michigan for infants born January 1, 2021, through December 31, 2024, totaling 404,292 infants across the study period.
• A synthetic difference-in-differences method was used to compare changes in outcomes in Flint, Michigan, before and after Rx Kids implementation relative to corresponding changes in 21 control cities without the program.
• Exposure was defined as Flint residence for infants born in 2024 after Rx Kids implementation, which provided expectant mothers with $1500 during pregnancy (after 20 weeks’ gestation) and $500 monthly for 12 months after birth, totaling $7500 in unconditional cash transfers.
• The primary outcome was investigated maltreatment allegations within the first 6 months of life, with secondary outcomes including type of allegation (neglect vs nonneglect) and substantiated allegations.
• Data analysis was conducted from March 19, 2025, to March 4, 2026, using city-level aggregated data from health systems in the US, specifically Michigan.

TAKEAWAY:

• Rx Kids was associated with a statistically significant 7.0-percentage-point decrease (95% CI, 1.0-12.9; P = .02) in the investigated allegation rate, corresponding to a 32% decrease (95% CI, 5% to 59%) relative to the preintervention period.
• In the 3 years prior to Rx Kids implementation, the proportion of infants with an investigated allegation within the first 6 months of life was 21.7% (646 of 2971 infants) in Flint and 19.5% (3921 of 20,124 infants) in control cities.
• After implementation of Rx Kids in 2024, the investigated allegation rate decreased to 15.5% (165 of 1065 infants) in Flint, falling below the investigated allegation rate of 20.6% (1303 of 6317 infants) in control cities.
• Decreases in the rates of neglect-related, nonneglect-related, and substantiated allegations were directionally consistent with the primary outcome but not statistically significant, and results were robust to alternative model specifications.

IN PRACTICE:

“Rx Kids, the nation’s first communitywide, unconditional prenatal and infant cash transfer program, was associated with a substantial population-level decline in the proportion of infants with an investigated maltreatment allegation within the first 6 months of life…. These findings underscore the importance of providing economic support during the perinatal period to improve child health and well-being,” the authors of the study wrote.

SOURCE:

The study was led by Sumit Agarwal, MD, MPH, PhD, Institute for Healthcare Policy and Innovation, University of Michigan, and H. Luke Shaefer, PhD, Poverty Solutions, University of Michigan in Ann Arbor, Michigan. It was published online on May 7 in JAMA Pediatrics.

LIMITATIONS:

Because Rx Kids was not allocated randomly, there may be residual confounding unaccounted for by the quasi-experimental study design. The primary outcome from administrative data, investigated allegations of child maltreatment, reflects not only the actual occurrence of maltreatment but also reporting practices and CPS capacity, screening, and investigation practices, raising the possibility of confounding if there are concurrent and differential changes in CPS capacity or practices. The primary analysis focused on births between 2021 and 2024, a relatively short study duration with a single postperiod year, and researchers were unable to demonstrate sustainability of the results with a single year of postperiod data. Exposure was defined as Flint residence among infants born in 2024 after Rx Kids implementation rather than actual enrollment in the program, and defining exposure based on residence assumes that the city in which an infant resides at the time of an investigated allegation 6 months into life is the same city in which the mother resided when the infant was born, which could produce outcome measurement error if there is migration into or out of communities. The analysis may not have been well powered for the secondary outcomes in which researchers observed nonsignificant declines in the subcategories of investigated allegations.

DISCLOSURES:

The research received support from the Doris Duke Foundation and the Michigan Department of Health and Human Services. Agarwal disclosed receiving grants from the Doris Duke Foundation during the conduct of the study, and grants from Mott Foundation, Kellogg Foundation, and Kresge Foundation outside the submitted work. Shaefer disclosed receiving grants from the Doris Duke Foundation during the conduct of the study, and grants from Mott Foundation, Kellogg Foundation, and Kresge Foundation outside the submitted work. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.