When Angela Sintery first learned about Rx Kids, a program for new mothers in her home town of Flint, Michigan, she thought someone must be trying to scam her.
"I had some teacher friends that kept sending me links saying: 'You need to apply for this. It's a brand-new program. We think you qualify,'" Sintery said. But it seemed too good to be true.
The program promised $1,500 for all expectant mothers during pregnancy and $500 per month for the first year of their infant's life. All Sintery had to do was upload a copy of her ultrasound and ID. Pregnant with her second child 19 years after she'd had her first, Sintery needed all new baby supplies. And as a preschool teacher, she'd be grateful for any help she could get paying for all of it.
It wasn't too good to be true. Researchers at Michigan State University had just launched the United States's first community-wide, unconditional cash transfer program for new families, and Sintery - who gave birth to her daughter Jolene Love in May 2024 - qualified.
"It took so much stress away," said Sintery. "I used that money to buy my car seat, to buy her bassinet and her crib." She was also able to take the first 14 weeks of her daughter's life off from work, and afford diapers and wipes in the months to come. The extra money helped Sintery "step back and enjoy my pregnancy".
This week, researchers at Michigan State University published two studies formalizing what Sintery felt. Their results showed that Rx Kids lowered rates of maternal postpartum depression, stabilized families' housing and improved infant outcomes - saving millions of dollars in NICU spending.
The town of Flint made headlines a decade ago when pediatrician Mona Hanna discovered lead levels in local children's blood had risen dangerously after the city switched its water supply to the Flint River. The coalition that came together to protect children then continued to advocate for children after the water crisis resolved, Hanna said.
"Rx Kids was born out of the same spirit that a community came together and said: 'We're not OK with poisoned water'" and later would say "we're not OK with our babies being born into poverty", she said.
But it wasn't until Congress implemented the expanded child tax credit in 2021, to support families during the Covid-19 pandemic, that Hanna said she realized the United States could do something nearly 70% of countries worldwide already do: give money to parents of young children.
"As a pediatrician, I have wanted for decades to be able to prescribe away poverty," she added. "Poverty is a pathogen. It makes kids sick."
The expanded child tax credit cut child poverty in the United States in half. But when Congress chose not to renew it, Hanna said she and her fellow researchers felt an urgent need to "keep this work in the public imagination".
Now director of the Michigan State University-Hurley Children's Hospital Pediatric Public Health Initiative, Hanna and her colleague Luke Shaefer, a professor of social justice and social policy at the University of Michigan and director of the university's Poverty Solutions program, decided they wanted to try something that actually would prescribe away poverty.
They founded Rx Kids, with the support of the non-profit GiveDirectly, a US-based group focused on ending extreme poverty through unconditional cash transfers. In the 10 years that it's been active, GiveDirectly has delivered $900m to families in 15 countries, such as Bangladesh, Liberia, Rwanda and Uganda. Rx Kids was the first time the program decided to operate in the United States.
"The need for these types of programs is a testament to the fact that we're not as ahead as we think we are, especially relative to our wealthy peer nations," said Laura Keen, the group's US program director.
She cites the fact that the United States is one of few countries in the world without a universal child benefit and the country's high child poverty rate relative to peer nations. The US is also one of only seven countries in the world without a paid maternity leave policy. In Flint, she notes, three in five children live in poverty.
Other cities and counties have piloted similar cash transfer programs in the United States, but Rx Kids is believed to be the first universal, community-wide cash transfer program in the country. Rather than prescribing cash transfers for low-income residents only, the Flint program is open to every pregnant resident. And because the sign-up process is streamlined and well-advertised, 100% of eligible residents in Flint sign up for it. That take-up rate is notable compared with other child welfare programs, such as WIC, where only about 50% of those eligible sign up for the benefit.
"This is a place-based intervention. This is not for poor people. It's for poor places," said Hanna.
That approach reduces shame and stigma and tells residents "we trust you; we know how hard it is to have a kid; there's a whole village; society; walking alongside you; investing in you," she said.
The approach also has helped Rx Kids rebuild trust in the city's institutions, Keen says, especially after the water crisis. Regardless of income, "pregnancy and childbirth are hard for everyone," she said. The program aims to acknowledge that "families are poorest in this perinatal period, leading right up to birth and then following the birth of a child" but also that the same "period conversely is such a critical developmental window for the baby".
Hanna adds that the universality makes the program easy to administer; even as it's expanded to new communities, it hasn't had to hire more staff - which has won it wide bipartisan support. The size of the program has also created a large dataset for Michigan State researchers to assess its impacts.
In one paper published Monday in the American Journal of Public Health, Hanna and her co-authors found that no low-income families were evicted after childbirth and postpartum depression levels fell 14% among mothers who participated in Rx Kids.
The perinatal period can be one of the most financially unstable times for families, as they take time off work to give birth and care for newborns but also see the rising costs of diapers, formula and childcare.
In a second, preprinted analysis published on the Social Science Research Network, Hanna and her colleagues found that those same cash transfers translated to better infant outcomes, which saved millions of state dollars. Infants whose families were enrolled in Rx Kids experienced lower rates of prematurity and low birth weight, which resulted in fewer NICU admissions, saving the city of Flint up to $6.2m a year.
Hanna hopes these two studies are just the first of many. Although Rx Kids began in Flint, the program has since expanded to 11 communities across Michigan and is near launching in six others.
"What we started in Flint was never just about Flint," said Hanna, adding it was instead proving that unconditional cash transfers could be done on a large scale in the United States.
"Nothing that we're doing is new and exciting," she added. "This work is done around the world because nations understand that it's for their best interest" to invest in children. "We have the most expensive healthcare system in the world. It is a sickness-based system. It is reactive. And really we should be funding and supporting interventions like Rx Kids, which is prevention-driven."
Hanna and her colleagues are hopeful that the success of the expanded child tax credit and programs like Rx Kids are creating a growing base of support for similar programs in the United States - across party lines. During the 2024 presidential campaign, both Donald Trump and Kamala Harris campaigned on promises of giving larger tax credits to families of newborns. "Caring for babies is a nonpartisan issue," Hanna said, noting that Rx Kids has begun having conversations with lawmakers in red and blue states about replicating the program elsewhere.
"People see different virtues in it that reflect their distinct viewpoints. So we have senators that make a pro-life case advocating for Rx Kids. We have others that make a libertarian case advocating for it," said Keen. "Our goal is to expand to a red state to show that this isn't predicated on certain political conditions."
Today, Sintery's daughter Jolene is 16 months old and attending daycare at the same preschool where Sintery works. She says Jolene is outgoing, talkative and curious - and that as her mom, she's "having a blast". She credits that feeling in part to Rx Kids.
"It really takes a lot of stress away from you being a mom," said Sintery. "I was very fortunate and grateful" that "I had this come along to help me".