Cash Transfers in the Perinatal Period and Child Welfare System Involvement Among Infants: Evidence from the Rx Kids Program in Flint, Michigan

Abstract

Infants are most vulnerable to child maltreatment, which may be due in part to economic instability during the perinatal period. In 2024, Rx Kids was launched in Flint, Michigan, achieving near 100% aggregate take up and providing every expectant mother with unconditional cash transfers during pregnancy and infancy. Synthetic difference-in-differences was used to compare changes in allegations of maltreatment within the first six months of life in Flint before and after implementation of Rx Kids relative to the corresponding change in control cities without the program. In the three years prior to the implementation of Rx Kids, the proportion of infants with a maltreatment allegation within the first six months of life was 21.7% in Flint and 19.5% among control cities. After implementation of Rx Kids in 2024, the maltreatment allegation rate dropped to 15.5% in Flint, falling below the maltreatment allegation rate of 20.6% among the control cities. Rx Kids was associated with a statistically significant 7.0 percentage-point decrease in the maltreatment allegation rate (p = 0.021), corresponding to a 32% decrease relative to the pre-intervention period. There was a decrease in the rate of neglect-related, non-neglect-related, and substantiated allegations; these were directionally consistent with the primary outcome but not statistically significant. Results were robust to alternative model specifications. The Rx Kids prenatal and infant cash prescription program led to a significant reduction in allegations of maltreatment among infants. These findings provide important evidence about the role of economic stability in preventing child welfare system involvement.