Case Studies
June 9, 2026
Improving infant and maternal health through unconditional cash payments: Flint, MI
Published on: June 9, 2026
- Issue Areas
- Early childhood Financial security
- Outcomes
- Stable and healthy families
MORE ABOUT THE STRATEGY USED IN THIS CASE STUDY Supports for expecting parents and families with young children
Overview
Summary
- Flint, Michigan has long experienced high rates of childhood poverty and disparities in maternal and infant health outcomes. By 2020, over half of children were born into poverty, and infant mortality rates in the city were more than double those for the state overall. The expanded Child Tax Credit launched in 2021 under the American Rescue Plan Act temporarily alleviated some of these challenges, but its expiration in 2022 left a critical gap in support and stalled progress toward reducing childhood poverty.
- To improve maternal and infant health, Rx Kids launched in Flint in 2024, providing no-strings-attached financial support to pregnant mothers and families with infants in their first year of life. Rx Kids “prescribes” $1,500 to individuals during pregnancy and $500 per month during their infant’s first 6 to 12 months of life, depending on the community and funding availability. Philanthropic investments helped prove the concept in Flint and secure additional public funding, which enabled the program to quickly grow from one city to a statewide model for pre- and post-natal cash prescriptions. All pregnant individuals and new mothers in participating communities are eligible to receive funds.
- Despite some initial skepticism from funders and policymakers about Rx Kids’ universal, unconditional approach, the program has built widespread bipartisan support as an economic multiplier and pro-family investment. Other keys to success include the program’s focus on dignity, joy, and love; partnerships with community champions to engage participants; and an operational model that supports efficient program administration.
- Co-founded by two universities, Rx Kids is built on a strong research backbone, allowing the program to measure its impact on families and communities. Survey research and administrative data analyses show that Rx Kids positively impacts infant health outcomes – including by reducing rates of preterm births, low birth weights, and neonatal intensive care admissions – while also improving mothers’ physical and mental well-being.
Results and Accomplishments
2,600+
As of June 2026, Rx Kids has served over 2,600 families in Flint (and over 11,000 total families across the state) since its launch in 2024.
29%
Rx Kids has led to a 29% (4.4 percentage point) reduction in admissions to neonatal intensive care.
14.0
Rx Kids reduced the likelihood of screening positive for postpartum depression by 14.0 percentage points.
- Improved infant health outcomes: A 2026 study found that Rx Kids led to an 18% decrease in preterm births, a 27% decrease in the proportion of infants born with low birth weights, and a 29% reduction in admissions to neonatal intensive care units (NICU). Rx Kids also led to a 32% decrease in the rate of allegations of infant maltreatment in Flint compared to a group of control cities.
- Maternal health and well-being: A 2025 study found that exposure to Rx Kids reduced the risk of eviction, reduced the likelihood of screening positive for postpartum depression, and increased trust in institutions among participating mothers.
- Near-universal enrollment: Among expecting and new families, Rx Kids has seen 100% uptake in Flint and 98% uptake across all communities served.
- Economic returns to society: Across Michigan, estimates suggest that Rx Kids creates 100-200 jobs per year and yields at least a $1.60 return for every dollar invested, with effects concentrated locally. These economic returns are largely driven by increased personal income leading to increased spending, which in turn creates jobs.
Solution
What was the challenge?
- High rates of child poverty in Flint: In 2023, nearly 60% of children in Flint were born into poverty, more than three times the statewide child poverty rate. Families in poverty generally experience poorer infant and maternal health outcomes (such as higher rates of preterm birth and maternal mortality) due to inadequate nutrition, lack of access to prenatal care, and toxic stress related to housing and financial instability.
- Disparities in infant and maternal health outcomes: Around the same time, Flint’s infant mortality rate was more than double the statewide average. Within the city, the infant mortality crisis disproportionately affected Black families. Before Rx Kids, only 57% of Flint mothers received prenatal care during the first trimester – nearly 20 percentage points fewer than the statewide rate.
- Mistrust in institutions: The 2014 Flint water crisis damaged residents’ trust in institutions, which is linked to decreased social cohesion and vulnerability to misinformation. In a survey of moms who gave birth in Flint in 2023, less than 10% reported a high degree of trust in government.
What was the approach?
- Beginning with a bold idea: As a practicing pediatrician, Dr. Mona Hanna saw firsthand that poverty was a key root cause of infant and maternal health disparities. In a 2018 article, she proposed that policymakers should aim to cut child poverty in half. Within a few years, she partnered with Professor Luke Shaefer, a nationally recognized expert on poverty solutions and cash transfer programs, to build out the concept that would eventually become Rx Kids. Together, they began leveraging their collective networks to raise funds and build public support for the program.
- Prescribing away poverty: Rx Kids launched in Flint in January 2024 as the first community-wide program with a goal to “prescribe away poverty.” Pregnant individuals receive a $1,500 one-time prenatal payment, starting mid-pregnancy, followed by $500 monthly payments during infancy. Funds are unrestricted, and research shows that common uses include baby supplies (such as diapers and clothes), food, and rent/housing. As a place-based program designed to uplift entire communities, participation in Rx Kids is not means-tested, meaning that all pregnant and new mothers in participating areas are eligible. Applicants are required to provide proof of residency and pregnancy status (or proof of recent infant birth). Program administrator GiveDirectly offers support to help applicants navigate the enrollment process.
- Unlocking public dollars to achieve scale: At the program’s inception, Rx Kids estimated that it would require $55 million for the first five years of operations. To augment philanthropic funds raised, program leaders and Senator John Cherry designed a policy proposal that would allow Rx Kids to leverage federal Temporary Assistance for Needy Families (TANF) funds through a mechanism called non-recurrent short-term benefits, which permits the distribution of TANF funds for acute economic hardship, including childbirth. Through this approach, the state of Michigan approved $16.5 million in TANF funds for Rx Kids in Flint (covering five years of support) as part of its FY24 budget. In subsequent years, Michigan has committed additional TANF funds plus $250 million from the Healthy Michigan Fund to support the program’s expansion to other communities across the state.
- Seamlessly administering funds: Rx Kids receives funding from multiple philanthropies as well as local, state, and federal governments. GiveDirectly administers the program on technical infrastructure built by AidKit, which braids together funding on the back end to create a seamless user experience for those receiving funds. Rigorous safeguards are also built into the platform to prevent fraud, protect privacy, and ensure dollars are going to the intended recipient. Applicants can opt to receive payment through direct deposit or a prepaid debit card, allowing families flexibility to choose the option that works best for them.
- Scaling rapidly across the state: Rx Kids was designed to be simple to administer and broadly scalable. The program also quickly demonstrated its impact, with two early evaluations showing that Rx Kids strengthened financial security and improved maternal well-being. In just two years, the program expanded to serve dozens of communities across Michigan. As demand grew, Rx Kids began hosting public information sessions for interested communities along with conducting targeted outreach to high-need places. As Rx Kids selects communities for expansion, it prioritizes places with: (1) Demonstrated barriers to infant and maternal health, (2) Local funds to match state and federal dollars, and (3) A dedicated community champion who can support local outreach and engagement. In communities outside of Flint, the program duration ranges from 6 to 12 months after birth, depending on local funds raised. A digital startup guide offers a blueprint for interested communities beyond Michigan.
Who was involved?
- University leaders: Rx Kids was founded by Dr. Mona Hanna, a pediatrician at Hurley Medical Center and Michigan State University professor known for her role in exposing the Flint water crisis, and co-founded by Professor Luke Shaefer of the University of Michigan Ford School of Public Policy. Dr. Hanna’s vision shaped the "cash prescription" framework based on her experience treating children in poverty, while Professor Shaefer brought policy experience to help design a high-impact child cash transfer model at scale. University researchers have also helped evaluate Rx Kids’ impact, disseminate findings, and build momentum for scaling across the state. Dr. Mona and the MSU team lead Rx Kids, overseeing design, policy, implementation, research, communications and expansion.
- GiveDirectly: Working closely with program’s co-founders, GiveDirectly leveraged their experience with cash transfers to design the implementation plan for Rx Kids. As the primary implementation partner, GiveDirectly oversees verification, enrollment, customer service, cash delivery, and recipient safeguarding for Rx Kids, while also supporting fundraising.
- AidKit: AidKit is a technology provider that supports a range of public benefit and cash assistance programs and serves as the technical backbone for Rx Kids. AidKit’s technology enables GiveDirectly to collect applications, verify eligibility (including through data integration with other benefits systems), mitigate fraud, disburse payments, and report on disbursements.
- Flint Mayor and City Council: Flint Mayor Sheldon Neeley was a key early adopter, advocating to the City Council for $1 million in American Rescue Plan Act funds to help launch the program in Flint. Mayor Neeley continues to be a prominent public champion for the program, including serving as the Grand Marshal for Flint’s “Baby Parades” celebrating the city’s newest residents.
- State legislature: State Senator John Cherry (D), whose district includes Flint, was instrumental in working with his Senate colleagues across political parties to secure support for state funding. Other state leaders have since become vocal champions for scaling the program across the state. For example, Senator John Damoose (R) penned a 2024 op-ed in support of Rx Kids and played a key role in bringing Rx Kids to his district in the state’s upper peninsula.
- Philanthropic partners: The Charles Stewart Mott Foundation served as the primary catalytic funder for Rx Kids in Flint, providing a cornerstone $15 million grant to kickstart the initiative. This early "big bet" created a runway for the program to demonstrate its effectiveness as it secured additional public and private funding. As the program has expanded across the state, dozens of other national and local foundations have contributed to the program in their respective communities.
- Community champions: In each community it serves, Rx Kids engages community champions to help with outreach, engagement and celebration. Led by CEO Jim Ananich, the Greater Flint Health Coalition (GFHC) served as a key champion in Flint. GFHC utilized their network of healthcare providers and community leaders to serve as trusted messengers, ensuring residents felt safe participating in the program.
How was this approach funded?
- Philanthropy as an early backer: Initial funding from the Charles Stewart Mott Foundation in Flint was structured as a $15 million challenge grant, requiring matching funds to unlock these dollars and ensure that the program could deliver on its commitment to serve all eligible individuals. As the program has scaled to other communities, several other philanthropic foundations have come on board in support.
- Local governments offer additional support: Flint supported initial startup through funding from the American Rescue Plan Act. As the program has scaled across the state, other city, county, and tribal governments have contributed funds at various levels through mechanisms such as county commissions and city general funds.
- State government’s commitment enables scale: TANF funds administered through Michigan’s Department of Health and Human Services cover up to four months of Rx Kids benefits for eligible individuals in participating communities. TANF funds are braided with state, local, and philanthropic funding to provide coverage for the full program period and eligible population (although Rx Kids is universal, only "needy" families as identified via Medicaid enrollment receive TANF funds; others are fully supported through other funding streams). With bipartisan support, the State of Michigan’s FY26 budget allocated an additional $250 million from the Healthy Michigan Fund to expand Rx Kids over a three year period.
Timeline
During an interview with Politico, Dr. Mona Hanna stated that if she could do one thing to address the root causes of health disparities, it would be to cut childhood poverty in half within ten years.
Michigan State University issued a call for "big ideas" to address health equity without budget constraints, providing the formal platform for Dr. Mona Hanna to conceptualize a universal child cash prescription for families.
Dr. Hanna and Professor Shaefer teamed up to approach the Charles Stewart Mott Foundation, a national funder with deep roots in Flint. The Mott Foundation’s early $15 million commitment jump-started fundraising momentum for Rx Kids.
Along with Senator John Cherry and Lieutenant Governor Garlin Gilchrist, Rx Kids leaders announced at a press conference that Michigan’s FY24 budget would include $16.5 million in TANF block grant funding for Rx Kids.
Dr. Hanna and Professor Shaefer collaborated with GiveDirectly to solidify the program model and build a digital platform capable of handling streamlined enrollment and secure, multi-modal payment delivery.
The program began accepting applications in January, achieving near-universal enrollment of eligible pregnant residents and infants within its first few months of operation.
Rx Kids quickly expanded to reach rural and tribal communities in Michigan's Upper Peninsula and families in Kalamazoo. Key activities included building local coalitions of supporters, raising local funds, and conducting local research to understand how to maximize impact in each unique community.
Rx Kids announced that the state of Michigan’s FY26 budget includes $250 million in state funding to support the next three years of births.
As of summer 2026, the model has scaled to over 60 communities across the state, projected to reach an estimated 23,000 babies annually over the next three years. Program leaders have begun conversations with other states interested in replicating the Rx Kids model, including Mississippi.
Implementation
What were the key components of the program’s design?
- Universal and unconditional eligibility: Unlike traditional assistance programs, Rx Kids is not means-tested: every pregnant person and infant living within the program’s catchment area is eligible regardless of income. There are no restrictions on how funds are used, reflecting a core belief that parents are the experts on their families' needs – whether that is securing stable housing, purchasing a car seat, or catching up on utility bills. The universality minimizes bureaucracy and reflects a belief that all families deserve this kind of support.
- Straightforward enrollment: The application developed by GiveDirectly takes approximately 20 minutes to complete, and utilizes proxied verification where possible to reduce administrative burden – for example, using Medicaid coverage to confirm eligibility for certain funding streams. AidKit’s technical infrastructure is designed to be mobile friendly and reduce the administrative burden that sometimes creates barriers to receiving public benefits.
- User-centered, dignity-first design: The application process was developed based on real user feedback and is available in multiple languages, including Spanish and Arabic. Families have autonomy over how they receive their funds, with the choice between direct deposit to a personal bank account or a prepaid debit card. Applicants can also receive enrollment assistance from GiveDirectly staff throughout the state.
- Community engagement and celebration: The program leverages local "Community Champions" as trusted messengers to lead outreach and engagement, framing Rx Kids around joy and collective investment in the next generation. This is exemplified by community events like Baby Parades, where families, local leaders, and neighbors gather to celebrate the city’s newest residents. This approach positions Rx Kids not just as a policy intervention but as a central part of the community.
- Strategic utilization of TANF funds: By structuring TANF payments as non-recurrent short-term benefits, the distributions do not trigger federal time limits or work requirements, and they can be provided to families who do not otherwise receive TANF benefits (so long as families meet a need threshold, as noted in the funding section of this case study). This creates a sustainable public funding stream that other communities can replicate by following the Playbook for Replicating Rx Kids.
What factors drove success?
- Health focus: From the outset, Rx Kids positioned itself as a maternal and infant health intervention. Led by a pediatrician at a medical school, the program framed cash support as a “prescription” for health, hope, and opportunity. Program leaders emphasize that the perinatal period brings both heightened economic insecurity for families and developmental vulnerability for infants. Framing the program around improving maternal and infant health by reducing poverty helped build broad support and a strong rationale for investing in families during pregnancy and early childhood.
- Efficiency by design: Rx Kids is designed to be highly cost-effective, maintaining low administrative costs by eliminating bureaucratic layers common to many social services. Approximately 85% of funds go directly to families, with the remaining 15% being used for overhead (including accounting, compliance, and IT) and program operations. Because the program uses universal eligibility, administrators do not have to perform the costly and time-consuming tasks of verifying and continuously monitoring income or employment for every applicant. This enables funds to reach recipients quickly and allows the program to quickly scale to new locations with minimal friction.
- Experienced, credible leadership: Dr. Hanna and Professor Shaefer’s partnership combined deep local knowledge with national policy expertise. Dr. Hanna brought valuable experience as a pediatrician and trusted advocate for children, while Professor Shaefer provided the authority of a nationally recognized expert in poverty reduction. Together, their collective networks and credibility gave funders and policymakers the confidence to invest in the program’s vision.
- Early evidence of success: Understanding the importance of data to bolster support for the program, Rx Kids committed to studying participant outcomes from the program’s inception. It was able to demonstrate almost immediate impact: During the program’s inaugural year, Rx Kids released preliminary findings from two studies that showed that Rx Kids strengthened financial security and improved maternal well-being. Subsequent research used administrative data to show that Rx Kids reduced rates of preterm births and low birth weights and child maltreatment investigations, providing the early evidence needed to build support from state legislators, local leaders, and philanthropic funders to scale the model to other communities across Michigan.
- Bipartisan support: Program leaders successfully built bridges across the political spectrum by framing the initiative through multiple value-based lenses. Leaders also shared research findings and direct quotes from participating mothers with state senators, members of the state house, and the governor. By communicating Rx Kids’ value as a pro-family investment and economic multiplier that strengthens local economies, the team built support from both Democrats and Republicans across the state.
What were the major obstacles?
- Concerns about misuse of funds: Rx Kids has met some resistance from skeptics who are concerned about the misuse of funds, given the program’s “no strings attached” approach. Initial concerns have largely been mitigated by data on how recipients use the funds – with 74% reporting spending on baby supplies – and research showing that the social and economic benefits of the program largely outweigh the costs. Nonetheless, a small number of vocal opponents continue to publicly question whether the model is a worthwhile use of public dollars.
- Changing the narrative around poverty: Dr. Hanna noted that one of Rx Kids’ key goals is to reframe the national conversation around poverty away from individual blame and toward a vision of hope, health, and opportunity for entire communities. Rx Kids emphasizes that it aims to reach poor places rather than focusing on poor people, acknowledging the systemic forces that perpetuate disparate health outcomes. Building momentum for this paradigm shift has emerged as a challenge in a culture where poverty is deeply pathologized.
- Limited capacity: Rx Kids operates as a lean team which keeps overhead costs low and allows for rapid scaling. However, interest from communities has exceeded the program’s current financial and operational capacity, which are limited by available state funds. This has led Rx Kids to establish prioritization criteria and create an application process for prospective communities. Furthermore, as Rx Kids looks to expand into other states, it will need to identify influential champions who can steward the program like Dr. Hanna has done in Michigan.
- Limitations of philanthropic funding: While the generosity of philanthropic funders in Michigan has enabled the program’s widespread success to date, the time-bound nature of philanthropic grants creates challenges for sustainability. As the program contemplates scaling to multi-state or national levels, significant public investment will be needed to ensure long-term success.
How was the approach measured and refined?
- Using administrative data for quantitative research: State data from vital records systems allow Rx Kids to track measures like preterm births, NICU admissions, and low birth weight. Researchers have used quasi-experimental methods to compare Rx Kids participants with non-participants, finding that cash support improves birth outcomes. This research is possible because of the nearly universal take-up rate, which enables population-level data analysis.
- Conducting surveys to understand parents’ experiences: Participant surveys yield data on families’ perceptions of and experiences with the program. Findings consistently show that the majority of funds are spent on essential needs like diapers and formula. Separately, additional surveys track mental health indicators among both participant and non-participant groups, revealing improved mental health (including decreased postpartum depression) reduced parenting stress, and reduced diaper hardship among mothers participating in Rx Kids.
- Engaging participants to optimize processes: Rx Kids prioritizes the voices of program beneficiaries through advisory councils and direct feedback loops. This engagement has led to programmatic shifts; for example, the team has shifted how it distributes prepaid debit cards based on feedback from residents in rural areas that traveling to pick up the debit cards was burdensome.
- Showing returns to society through economic analysis: A study by the W.E. Upjohn Institute for Employment Research evaluated the program's economic impact on communities it serves and found that every dollar invested in the Rx Kids in Flint generates a return of 60 cents to $3 to the state’s economy. This "trickle-up" effect is driven by increasing spending at local businesses and job creation. Using the study’s methods, Rx Kids estimates that it has generated over $46 million in total economic activity across Michigan.