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Cash Transfers in the Perinatal Period and Investigations of Infant Maltreatment
Sumit Agarwal1,2, H Luke Shaefer2,3, Samiul Jubaed2,3
1Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor.
Insights
The Rx Kids program, providing unconditional cash transfers to expectant mothers, significantly reduced investigated child maltreatment allegations by 32% in infants. This highlights economic stability
Area of Science:
- Public Health
- Social Policy
- Child Welfare
Background:
- Infants face high vulnerability to child maltreatment, often linked to perinatal poverty.
- The Rx Kids program in Flint, Michigan, provided unconditional cash transfers to expectant mothers during pregnancy and infancy.
- The program achieved near-universal adoption among eligible participants.
Purpose of the Study:
- To evaluate the association between the Rx Kids program and child welfare system involvement.
- To determine if prenatal and infant cash assistance impacts investigated maltreatment allegations.
Main Methods:
- A cross-sectional study utilized administrative data from Michigan's Children's Protective Services for infants born between 2021 and 2024.
- Synthetic difference-in-differences analysis compared Flint (treated city) to control cities before and after Rx Kids implementation.
- Primary outcome: investigated maltreatment allegations within the first six months of life.
Main Results:
- The investigated allegation rate in Flint decreased from 21.7% pre-Rx Kids to 15.5% post-implementation.
- Rx Kids was associated with a statistically significant 7.0-percentage-point decrease in investigated allegations (32% reduction).
- Secondary outcomes (neglect, non-neglect, substantiated allegations) showed consistent but not statistically significant decreases.
Conclusions:
- The Rx Kids program demonstrated a significant association with reduced investigated maltreatment allegations in infants.
- Findings underscore the critical role of economic stability, facilitated by cash transfer programs, in preventing child welfare system involvement.
- This study provides evidence supporting cash assistance as a strategy for child maltreatment prevention.
Importance:
Infants are most vulnerable to child maltreatment, in part due to poverty during the perinatal period. In 2024, the prenatal and infant cash prescription program Rx Kids was launched in Flint, Michigan, achieving nearly 100% aggregate uptake and providing every expectant mother with unconditional cash transfers during pregnancy and infancy.
Objective:
To examine whether implementation of the Rx Kids prenatal and infant cash prescription program was associated with changes in child welfare system involvement.
Design, Setting, And Participants:
This cross-sectional study used administrative data from Children's Protective Services in Michigan among infants born January 1, 2021, through December 31, 2024. Synthetic difference-in-differences-a robust method for aggregate-level data and a single treated city-was used to compare changes in outcomes in Flint before and after implementation of Rx Kids relative to the corresponding change in control cities without the program. Data analysis was conducted from March 19, 2025, to March 4, 2026.
Exposure:
Flint residence among infants born in 2024 after Rx Kids implementation.
Main Outcomes And Measures:
The primary outcome was investigated maltreatment allegations within the first 6 months of life. Secondary outcomes included type of allegation (neglect vs nonneglect) and substantiated allegations.
Results:
In the 3 years prior to the implementation of Rx Kids, 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) among 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) among the control cities. Rx Kids was associated with a statistically significant 7.0-percentage-point decrease (95% CI, -12.9 to -1.0; P = .02) in the investigated allegation rate, corresponding to a 32% decrease relative to the preintervention period. There was a decrease in the rate of neglect-related, nonneglect-related, and substantiated allegations; these were directionally consistent with the primary outcome but not statistically significant. Results were robust to alternative model specifications.
Conclusions And Relevance:
In this study, the Rx Kids prenatal and infant cash prescription program was associated with a significant reduction in investigated allegations of maltreatment among infants. These findings provide important evidence about the role of economic stability in preventing child welfare system involvement.
