Cash Transfers in the Perinatal Period and Investigations of Infant Maltreatment

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.