Rx Kids’ “cash prescription” aims to give babies a stronger start

This piece was written by Eric Shaw and originally appeared on the Office of the Vice President of Research website

When Tatiana Lopez-Marshall and her husband welcomed their son Matteo, both parents were working at Hurley Hospital, but the math still didn’t work. Daycare wasn’t an option, so her husband cut his work hours to stay home with the children. Lopez-Marshall wasn’t sure she could afford to take a full 12 weeks of maternity leave.

Then a payment arrived through Rx Kids, a program that Lopez-Marshall had enrolled in to receive unconditional cash to pregnant people and new parents in the places it serves.

“I was stressed out on how I was going to make it,” Lopez-Marshall told Rx Kids. “The thought of going on maternity leave should be a happy thought, but instead I was overwhelmed with lots of stress and anxiety.”

Her story is one of many in Flint, where Rx Kids launched in January 2024 with a simple premise: give families cash during pregnancy and a baby’s first months, then study whether that support measurably improves health and stability.

The program was founded and is led by two-time U-M alumna, Dr. Mona Hanna, director of Michigan State University’s Pediatric Public Health Initiative and co-founded with Luke Shaefer, who led Poverty Solutions at the University of Michigan at the time and has since moved on to lead similar efforts in Detroit. Payments are administered by GiveDirectly, the global leader in delivering cash transfers.

The lead economist on the Rx Kids research team at U-M, Dr. Sumit Agarwal, is also an assistant professor of internal medicine in the University of Michigan Medical School and an assistant professor of health management and policy in the U-M School of Public Health. He came to this work through both clinic experience and policy frustration. Agarwal’s research focuses on how policy decisions shape the health of patients long before they reach an exam room.

A physician who wanted a bigger prescription pad

Agarwal trained in primary care as the Affordable Care Act was reshaping the system. During residency, he worked in a state that chose not to expand Medicaid, and he saw patients who would have qualified for coverage elsewhere. It pushed him toward health policy and health economics, and toward a career trying to answer a stubborn question: Why do some people stay healthy, and others struggle, even when the medical care looks similar?

Even among patients who do have insurance, Agarwal said, “issues outside of health care affect their health, things outside the four walls of the clinic that I can’t necessarily intervene upon.”

That gap between what a clinician can treat and what a family actually needs became the driving question of his research career. Cash transfers stood out as an intervention that is simple on paper but can touch everyday realities like housing stability, nutrition, transportation and stress.

“As a primary care physician, I wish I could write a prescription that addresses economic hardship. I see how poverty affects the health of my patients and their families,” he said. “And we know that poverty is a policy choice.”

While completing his doctoral work at Harvard University, Agarwal got involved in a major cash transfer experiment, publishing findings in JAMA that a small cash transfer reduced emergency room visits, redirecting care to other more appropriate providers. Upon arriving at U-M, he was immediately recruited to the Rx Kids research team by Shaefer, one of the program’s co-founders.

Why Rx Kids focuses on pregnancy and infancy

Rx Kids is built around trust and flexibility. The money is unconditional. There are no required purchases and no spending restrictions.

The timing is deliberate.

“The time right around childbirth is one of the most economically vulnerable periods in the entire life course,” said Agarwal, who is a faculty affiliate of Poverty Solutions at U-M.

Income can drop when a parent takes time off work or reduces hours, while expenses rise at the same moment. It is also a high stakes window for infant development, when stress and instability can shape health and well-being for both parent and child.

In Flint, the program provides $1,500 during pregnancy and $500 per month after a baby is born, with the monthly payments running for up to a year. Enrollment is designed to be quick, with a simple application and payments delivered by direct deposit or a debit card.

Agarwal points to the program’s 98% participation rate as evidence that the low-barrier design matters. If you can make help easy to access and non-stigmatizing, he argues, more families will use it.

Program provides for basic needs, ‘peace of mind’

Families in Flint and in other Michigan communities where Rx Kids has expanded describe the program as relief that shows up in practical choices.

For Yaquelin Vargas, the timing aligned with a surprise life turn. She and her husband already had three children and didn’t expect another baby. When baby Hope arrived in spring 2024, three weeks early, Vargas said the family’s immediate needs included more time off work and a larger vehicle that could fit multiple car seats so they could get to appointments and handle daily errands.

Rx Kids made that possible, she said.

For Melina Royal, support looked like insulation. After housing costs pushed her family to relocate to Michigan’s Upper Peninsula, she said Rx Kids helped them prepare for winter.

“Rx Kids gave us the ability to insulate their room before the next harsh winter without worrying how we were going to afford it,” Royal said.

Others describe the program less as one purchase and more as breathing room.

“As a mom, I’d never want to have to choose between keeping a roof over my kids’ heads or putting food on our table,” said Alana Turner, a Flint mom and participant. “Rx Kids has given me the peace of mind that I can provide the best possible life for my kids, even when times are tough.”

In participant stories and program surveys, the most common uses are often basic needs: food, rent, utilities, clothing and baby supplies. The specifics vary, but the themes repeat. Families link the payments to lower stress, safer homes and a steadier postpartum period. Those conditions can shape health in ways that do not show up on a prescription pad.

Measuring what changes, and what’s still unknown

A community-wide program creates a research challenge. You cannot randomly assign some Flint families to receive benefits and others not to. Instead, researchers use population-level methods that compare outcomes in Flint before and after Rx Kids began with outcomes in similar communities over the same period.

The logic is straightforward. If birth outcomes, health care use or other indicators shift in Flint more than they shift in comparable places, that is evidence the program may be contributing to the change. Like any real-world evaluation, it relies on assumptions, including that nothing else changes in Flint in a way that is meaningfully different from comparison cities during the same time window. On the other hand, such a real world has some advantages to controlled experiments that may not have the same effects when implemented at scale.

The larger question behind Rx Kids is whether enough of those individual shifts can add up to measurable changes in long-term health and well-being across a city. Flint is where the program began. The partnership behind it suggests the idea is being taken seriously, not just as a feel-good story, but as a research-backed approach that could inform how Michigan supports families during the earliest months of life.

Early analyses are highly encouraging, Agarwal said, especially for outcomes that matter both immediately and long-term, such as preterm birth and low birth weight. The team is continuing to analyze outcomes as more births and more months of follow-up data accumulate.

For Agarwal, the work circles back to the frustration that first nudged him toward policy. In exam rooms, he can treat asthma, infections and high blood pressure. But he cannot write a prescription for rent, childcare or a month’s groceries, except now, through a program designed to treat financial instability as a health issue.

“When we trust moms, when we give them support, it makes families stronger,” he said.

Lopez-Marshall does not describe Rx Kids in terms of study design. She describes time. Time to recover, time to parent and time not spent doing impossible math. With less panic pressing in, she said, maternity leave became closer to what it was supposed to be.

“Rx Kids lifted the weight off my shoulders,” she said.

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