Forum explores Flint’s effort to combat poverty using cash payments for mothers and infants

“Poverty is a policy choice. It’s a choice that unfortunately that we’ve made for decades and it’s a choice that we don’t have to make,” Monique Stanton, president and CEO of the nonpartisan Michigan League for Public Policy (MLPP) said in her introduction at the league’s 2024 policy forum. 

The 2024 forum spotlighted focused on issues of poverty and economic justice, examining a recently established program in Flint, which supporters said was the first of its kind in the nation. 

Enrollment for Flint’s Rx Kids program opened on Jan. 10, opening a citywide cash payment program aimed at improving infant and maternal health and addressing childhood poverty within the city. 

‘An infusion of joy’: How a Flint pediatrician hopes to improve health and dismantle poverty

The program provides pregnant mothers in Flint with $1,500 mid-pregnancy and $500 a month once the baby is born for the first year of their life. In order to apply, residents must provide documents showing their identity, and proving their residency in Flint as well as their status as someone who is pregnant, or a guardian. According to the program’s website, Rx Kids is expected to serve up to 1,200 families a year. 

Dr. Mona Hanna-Attisha, a pediatrician who helped uncover the Flint water crisis, is leading the initiative. In crafting the program, Hanna-Attisha said the things she does at her work as a pediatrician are centered around ensuring a bright future for the children she cares for. However, that can be difficult when a child is born into a community that has a high rate of poverty.

Flint has repeatedly ranked among the nation’s poorest cities. According to U.S. Census Bureau data, the city’s population is more than 56% Black. Population estimates from July 2023 listed the city’s median income as $35,451, with 33.3% of the population living in poverty. 

“When you’re born into and when you grow up in poverty, it really alters your entire life course. So for a long time, I had wished for the antidote — the prescription — to prescribe away poverty, and that’s how this idea came together,” Hanna-Attisha said. 

Luke Shaefer, the co-director of Rx Kids and the director of Poverty Solutions at the University of Michigan, noted that countries across the globe have programs that begin by acknowledging that raising kids is expensive. 

As part of its efforts to provide relief in the course of the COVID-19 pandemic, the expansion of the child tax credit was seen as a boon, providing families with $250 to $300 a month for each child depending on their age. These payments resulted in rates of food insufficiency and financial instability dropping among adults with children, who were shown to experience higher rates of hardship during the pandemic than those without children. 

The expanded child tax credit fundamentally changed how aid was delivered, Shaefer said. 

“We lifted millions and millions of children out of poverty. We saw the lowest rates of families saying they were struggling to put food on the table that we’ve ever seen in the nation’s history,” Shaefer said. “Credit scores hit their all-time high at the end of 2021. The number of Americans with bad credit in particular, fell to an all-time low.”

“We showed what was possible with a set of policies that people said was pie in the sky just a few years earlier. But then, as a nation, we decided to go back to the way that we were doing things before and the expanded child tax credit was not extended,” Shaefer said. 

The Rx Kids initiative is the first universal cash transfer program in the nation, Hanna-Attisha said, noting that the cost is likely one of the reasons it hadn’t been done before. 

“Even though we narrowed it to moms and babies, we needed to raise at least $9 million a year which is just the cost of the cash prescriptions. And we wanted to make sure that we could do this for at least five years so our funding goal was $55 million before we started the program,” Hanna-Attisha said. 

The initiative has since raised $43 million, and supports more than 500 moms and babies, Hanna-Attisha said, with Shaefer noting that the program had a 90% uptake rate.

As far as funding the program, $15 million came from a challenge grant from the Charles Stewart Mott Foundation, which required Hanna-Attisha and Shaefer to raise another $15 million. Another chunk of that funding came through the Temporary Assistance for Needy Families (TANF) program, which is a block grant program established by the 1996 welfare reform law.

“We were thinking this could be a great way to bring some of these dollars back to families back to poor families, but in a different way,” Shaefer said.

“Our welfare programs have always been stigmatized. They come with all of these different requirements and all of this incredible history, right, a history that’s just imbued with racism and stigma,” Shaefer said. 

In seeking a different way to provide cash, Shaefer said the program pulls funding from a mechanism called non-recurring short-term benefits, which provides cash aid to families for a short amount of time during an acute economic crisis. 

“So what’s the acute economic crisis? Childbirth,” Shaefer said. 

Shaefer explained that families are poorest at childbirth, as income and earnings go down and expenses rise.

“Everybody knows having a baby is expensive, and so that perfect storm means families are the poorest in that first year,” Shaefer said. 

This is the most critical period in a child’s development, with a baby’s brain doubling in size within the first year of life, Hanna-Attisha said. As a result of this definition of an economic crisis, the program is able to leverage funding from the state, she said. 

The program is already seeing success, Hanna-Attisha said, with one family using the funds to purchase a car seat, a baby monitor, diapers and to establish a child savings account. 

“I had another dad in clinic. I asked him ‘What do you like best about this program?’… he said ‘What I love the most is that it’s for everyone. I love that it’s not just for folks who make less than a certain amount of money because we’re all struggling,’” Hanna-Attisha said. 

The universal design of the program and the lack of strings attached helps center the program on dignity, trust and autonomy without stigma or shame, Hanna-Attisha said. 

For those skeptical that people may have more children to receive more money, Shaefer noted that child benefits have been used by different countries to try and improve the birth rate to no success. 

Cash-based benefits also empower families to use them in ways they know will be the most effective, Shaefer said. These programs are also simple from an administrative standpoint, because they’re not vetting people based on their income or working to ensure they spend the money in certain ways, which saves costs, he said. 

“If you’re for limited government, if you’re for small and efficient government, this is the program for you,” Shaefer said. 

Hanna-Attisha and Shaefer also discussed other policies aimed at helping families, such as paid family leave and expanded child tax credits. 

Hanna-Attisha shared another recent story from the clinic when a family with a 4-day-old premature baby did not show up to an appointment. When they asked the family why they had missed the appointment, the mother said she needed to go back to work after four days. 

“And that’s not uncommon. So we absolutely need paid family leave programs to support families during childbirth but also during other kinds of family crises,” Hanna-Attisha said. 

She also said she would like to see a state-level child tax credit to support children beyond the first year of life. 

Shaefer also discussed a recently proposed working parents tax credit, which would provide families with $10,000 in work earnings with a $5,000 per child fully-refundable tax credit for children between the ages of zero and three, and a $2,500 fully-refundable credit per child for children between the ages of three and six.

While well-intentioned, this proposal goes in the wrong direction, effectively including a work requirement, Shaefer said. 

“One of the things we’ve seen in the RX kids data is 60% of the families coming in our doors have annual incomes under $10,000. … We are going to disproportionately exclude — if we have an earnings requirement of $10,000 — disproportionately exclude Black Michigan families, Hispanic Michigan families, rural communities, as well,” Shaefer said. 

As for the Rx Kids program, Flint is only the beginning, Hanna-Attisha said. In her proposed state budget for Fiscal Year 2025, Democratic Gov. Gretchen Whitmer has allocated $24 million dollars to the program through TANF funding to expand the initiative in other communities. 

“We’re working on where those communities will be but right now it will likely be Detroit — which is huge — Dearborn, Saginaw, Benton Harbor, Kalamazoo and representing rural Michigan, which we know is very important, the Eastern Upper Peninsula,” Hanna-Attisha said. 

The dollars from these initiatives will also be spent in local communities, acting as a trickle-up intervention or community development program, Hanna-Attisha said. In addition to tracking how the program impacts the local economy, researchers can examine how it impacts community safety and gun violence, which are linked to poverty, she said. 

The Rx Kids program also acts as a way to reestablish trust between individuals and government institutions, Hanna-Attisha said. 

“As a pediatrician, one of my favorite sayings is that we’re the ultimate witnesses to failed social policies. So in the patients I care for in their bodies I see the consequences of this, you know these long standing inequities,” Hanna-Attisha said. 

“So the beauty of Rx kids is it turns it upside down. You know, it is anti racist, it’s preventative, it is inclusive. And it also kind of shifts a lot of these policies to make it that way, so that we can start to write these historic wrongs and hopefully start seeing the impact in our communities,” she said.