“Cash for Moms and Babies”: How it Works & Why  

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Mark (00:04)
How does giving money with no strings attached to all pregnant women in a city help improve their health and
the health of their baby? Michigan is home to the nation's first community-wide prenatal and infant cash
prescription program, and new research shows it's leading to impressive results.

Dr. Mona Hanna (00:22)
This is built on mountains of evidence that when we trust families, when we trust women and mothers, they
make the, you know, best decisions for themselves and their families.

Margaret Flintere (00:33)
Our guest is Dr. Mona Hanna, who's the founder and the director of Rx Kids, which she created in response to
the Flint water crisis of 10 years ago.

Dr. Hanna (00:43)
This is a really, really consequential time window. What happens in this really brief window shapes your whole
life course when it comes to especially health. so, this is just an upstream effort to improve health outcomes.

Margaret (00:54)
This is Conversations on Health Care.

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Mark (01:07)
Well, Dr. Hanna, welcome back to Conversations on Health Care.

Dr. Hanna (01:11)
It's great to be here with you all. Thank you for having me.

Mark (01:14)
Absolutely. You know, you say that Rx Kids is more potent than a prescribed pill and that it aims to improve
health, hope, and opportunity. I'm wondering if you could tell us exactly how it works and how much money are
we talking about?

Dr. Hanna (01:28)
Yeah. So, it's a really simple concept that, to be able to ensure that we have healthy patients and healthy
communities, that we really have to treat those root cause issues that makes it hard for, especially children to
grow up healthy and successful. so Rx Kids is, is prevention at its finest. So, we are addressing, perinatal
poverty, which is the worst period of economic instability in a life course, by giving every pregnant mom in a
community $1,500 in mid-pregnancy. And then once the baby's born, it's $500 a month, either for six months or
12 months depending on location. so, this is the poorest time in a life course, but also for those of us, especially
in pediatrics and obstetrics and really anybody who understands anything about science and medicine and public
health, like, this is a really, really consequential time window. What happens in this really brief window shapes
your whole life course when it comes to especially health. so, this is just an upstream effort to improve health
outcomes.

Margaret (02:30)
Well, one of the things that really, is very striking is that this is a no-strings-attached program, which gives the
mom, one would think, a lot of agency in this situation to decide what they need. But I wonder, does that mean
there's no requirements about how the mother spends the money, on maternal health needs, on baby care, or on
whatever she feels is necessary at that time? Tell us about that.

Dr. Hanna (02:56)
Yeah. That's a great question. So, this program is really built on dignity and trust, and really mountains of
evidence. So, this concept of child allowances or, paid leave for moms, this is done around the world. we're the
only peered country that doesn't have maternity leave and we're, the only, peered country that doesn't have child
allowances. 70% of countries in the world have unconditional child allowances. so, this is built on mountains of

evidence that when we trust families, when we trust women and mothers, they make the, you know, best
decisions for themselves and their families. so, some families need help with rent, some families need help with
diapers, some families need help with transportation to go to the doctor, and some families need to pay their
bills. so this empowers families to make their own decisions, which is contrary to a lot of the other programs
that we have out there that are often paternalistic and really assume that we know what's best for families. but
that's not actually built on evidence. And in addition, those programs are really bureaucratic. They require lots
of staff and lots of administration to figure out who's in, who's out, what are people spending their money on.
And this kind of upends all that by respecting the science on cash transfers and, and really once again
empowering families.

Mark (04:13)
Well, that's great. Margaret, I think those of, our listeners who've been, watching us for a while remember the
Flint, Michigan water crisis that, happened, and we were glad to interview you after your research exposed the
Flint lead water crisis, and the effect on children. and interestingly, there's a connection between that crisis and
this program, and I'm wondering if you can, share how that connection came to be.

Dr. Hanna (04:41)
Yeah. Mark, thank you for that. so, I think a lot of folks think of Flint and the water crisis as, like, this failure,
right? Like, that place that poisoned its children. And from the moment of really uncovering the crisis, our, our
focus as a community has been to really be remembered by what we've been able to do next. to think out of the
box creatively of how can we do better as a society of really caring for our children. so we've been able to put
into place so many different interventions to not only mitigate the impact, impact of the crisis and but really
kinda share our best practices. rather than reacting to problems, how do we prevent problems? So, for example,
a lot of my work has been around Infrastructure Act. You know, getting the nation to replace lead pipes and
strengthening laws and paying attention to issues. And that's all been amazing and it's had wonderful ripple
effects across the country. but there continued to be this frustration that despite all this goodness that we've
done, especially in Flint, especially after the water crisis, we've once again been unable to treat this root cause
issue that continues to make it really hard for our kids to grow up healthy and successful. So, in the same spirit
of resisting poisoned water, which very much that Flint water crisis story is, that it was about using science, to
speak truth to power, about, you know, about exposing this crisis, about building a better tomorrow for our kids.
In that same spirit of resisting the status quo, came this program, where we are no longer okay with our babies,
you know, being born into poverty. We're the richest country in the history of the world. You know, poverty is a
policy choice. We can do better. So, in that same spirit, w- you know, w- this program was created, and the
really neat thing is that, like, I get calls almost every single day saying, "Hey, we wanna be like Flint." And
never would I thought, like, 10 years ago- Isn't that great? ... that other communities now wanna be like Flint.
But you know what? That was always our intent.

Mark (06:42)
Speaking of doing better, uh...... was there improvement in, I know there was an allocation issue on money on
the lead pipe issue. Did it find its, rightful lo-, place in terms of, the investment that needed to be made?

Dr. Hanna (06:57)
so, our, our pipes have by and large been replaced. It took about a decade. It took a long time. Yeah. Took a,
took a while for the money to get there. but re- that, you know, beautifully has raised the nation's consciousness
on, uh- Yes. ... drinking water issues, on lead in water, environmental justice issues. So wonderful, amazing
things have happened since then. But yes, our pipes are by and large replaced. Our water is- Right. ... much
better. but we as a nation still need to do better in terms of strengthening, especially environmental and public
health regulations, so we can make sure every kid, no matter where they live, turns on their tap and is confident
in, in what they're drinking.

Margaret (07:34)
Well, all power to you in Flint because-

Mark (07:36)
Absolutely.

Margaret (07:36)
... I remember that conversation. It's one of the hardest conversations we've had in the, many years that we've
been doing the show. So con-, congratulations for, for moving it in this direction. but, you know, people want to
know about the results and, you know, appreciate the research, whether it was on the water, crisis or this. So,

JAMA Network, the Journal of the American Association- ... Network Open, has published a study that found
that after Rx Kids launched, prenatal care increased and there was a decrease in infant deaths. Which is the
most, of course, that we want to see. So maybe you could describe the findings in detail. Tell us a little bit about,
other associated findings. We're all ears.

Dr. Hanna (08:19)
Thank you, Margaret, I'd love to. So, this is so exciting. I'm still a boring academic, so I love doing the research.
Although, like I don't re-, this, on cash for kids and f- families with young children, there's mountains of
evidence, but we knew that we needed to bring out our own evidence as well. the really neat thing, and I think
the most important data point, is that we have a near 100% take-up rate for the program. that, and we do data
matches with birth certificates, so we know how many babies are born in a community and we can kind of
compare them to how many babies are in the program, and it's near 100%. So that in and of itself is pretty
amazing, and we actually have a paper forthcoming on that. if you compare other programs in this window, like
WIC or home visiting programs, they have about a 50% take-up rate for WIC or a 20% take-up for home
visiting programs. For sort of the most, the, the most kind of exciting thing is that everybody who should be in
the program is in the program. And because we have 100% take-up rate, our research can really lean on the big
administrative data. the big data, for example, from vital records, which is birth certificate data, which tells us a
lot. And the research that you're talking about that was published in JAMA Network Open looked at that big
administrative data, looked at the babies born, from Flint and compared them to about babies in 21 control cities
and compared them to babies in the state. So, this is really, you know, robust research with control populations.
And what we found is that when Rx Kids started in Flint, when it started in January 2024, at a population level,
not just a sample size of like 20 or 30 or 100, at a population level, we are seeing improvements in prenatal care
access. Mamas are going earlier, in the first trimester, even before the program starts. They're going more often,
so there's more of an adequacy of prenatal care. And we have less of no prenatal care, so less mothers who have
had no prenatal care. With that same vital records data, we're also seeing significant population improvements in
birth outcomes, which as you said, is the goal. We have less premature babies, less low birth weight babies, less
NICU admissions, and that already is translating into healthcare cost savings. in survey research that we've
done, which relies on surveys also with control populations, we're seeing improvements in family financial
stability, which one would expect by giving families, you know, cash during this window. We had a significant
decrease in evictions, which is phenomenal because even the threat of eviction in the community can, lead to
preterm delivery. Right. So, we had less evictions, we had more food security, and it's, nutrition's so important
for pregnant mamas and babies. we had improvements in maternal mental health like postpartum depression and
less stress and less anxiety. And then we also had improvements in what we touched on earlier. Our mamas feel
more empowered. They feel more respected. They feel more loved, which was, you know, once again, also part
of this work. So, lots of great big data, showing population improvements in, in some of these stubborn
measures. It's, it's often hard to improve preterm, you know, delivery rates and we're doing it, and we're doing it
fairly quickly.

Margaret (11:31)
I just want to underline that this is the kind of study that one can only hope for with a large dataset. Pretty much
everybody's in the dataset. Yeah. You implemented the program in 2022, you looked at big data in 2024 and
you're reporting on it in 2025, which is almost unheard of in highly meaningful research areas like this.

Dr. Hanna (11:53)
Yeah, no, we're grateful. We've had, wonderful data use agreements and, you know, all those check-, you know,
checks that we have to do. But, we have, we get almost a, a quarterly feed from the state, so we get the vital
records and we're trying to share back this data as quickly as possible. and it's our ability to share that, back this
data th- that has allowed us to really expand the program. So, what started in Flint, about as of, gosh, a few
hours ago, we just, actually just this morning launched in six communities in Wayne County. It's our biggest
expansion ever. Wayne County is where the City of Detroit is. So, we're now in 17 communities in Michigan.
So that research has really been able to inform policy. And you can't sit on this research. You know, we have,
we, it was our goal to be able to share back data as quickly as possible.

Mark (12:40)
Rem- remind our listeners how big Michigan is. 17 counties, is that half of Michigan, all of Michigan, and
what's your, what are your plans for expansion?

Dr. Hanna (12:48)
(laughs) ... my plan is world domination. Or at least national, national expansion. So, Michigan has, gosh, I don't
know, I think it might be 53 counties. Okay. Or 83 coun- Michigan has 83 counties. we have 100,000 babies

born a year. we at, at this point, we have prescribed almost $20 million to about 4,000 families. the Michigan
budget, which passed a couple weeks ago in Michigan, included $270 million for this program to expand over
the next three years. So, we hope to touch about one in three families over the next three years.

Mark (13:28)
So, it's really got bipartisan support, it sounds like. People

Dr. Hanna (13:32)
It does. Y- yeah. I, I think, yeah, I'm sorry…

Mark (13:35)
What's your, what's your secret sauce for that?

Dr. Hanna (13:37)
Well, it's babies, right? It's babies. So, we actually, we have tremendous bipartisan support because everybody
loves babies. this program is also really time limited, so it's not a long program. It's administratively super-
efficient, which appeals to a lot of, folks who don't want big government. But one of the, the other data points
that we've been able to share is that it's an economic development program. You can think of it as a trickle-up
program. Money is going directly into the hands of mamas and families. It's being spent locally on childcare and
small businesses and grocery stores. We even had a report, come out a couple weeks ago, it's creating jobs
because, hey, the childcare people need to hire more people, and the landlord needs to hire a property manager.
The list goes on. So, we're creating hundreds of jobs and it's a, it's a stimulus to local economies.

Mark (14:27)
So, it's a force for- force multiplier, every dollar equals-

Dr. Hanna (14:31)
Yes.

Mark (14:31)
... two or three dollars.

Dr. Hanna (14:33)
100%. Yeah.

Margaret (14:35
and the savings on NICU admissions, which I think we saw in Colorado with some of their interventions and
birth homes.

Dr. Hanna (14:39)
Right, and child welfare. We're preventing child welfare involvement. That system is really expensive. So, we're
preventing dependency on government and we're boosting local economies. But really most importantly, we're
improving health.

Margaret (14:53)
Yeah. Well, I'm gonna go back to the research for a minute. research in the American Journal of Public Health
stated that pregnant mothers fared better on multiple measurements, related to emotional wellbeing than
mothers, who didn't receive the cash. And tell us about that, and, and pull the thread on the impact that has not
just on the moms, but on the kids.

Dr. Hanna (15:14)
Yeah. so, not in that research, but really built on that research is what we hear from our families. our mamas,
who say that they can breathe, that a weight has been lifted off their shoulders. that poverty and, not having,
enough to make ends meet is, is expensive and it takes away their bandwidth and time and, and it is a, a massive
stress for the families. so, you, we see moms, I see moms all the time in clinic who say like, "I don't have to
choose between paying rent and buying diapers." "I don't have to choose between put- putting food on the table
and, you know, getting formula for my baby." so all of these, all of these beautiful statements from our mothers
is translating into the data wh- which was in that American Journal of Public Health article that shows, moms
have less postpartum depression, less stress, less anxiety, and improvements in wellbeing. And that is, that is
great for families, that's great for health, and that's absolutely so important for children.

Margaret (16:19)
Well, and it's so important to children's development, right?

Dr. Hanna (16:21)
Absolutely. And, and that is, it's-

Margaret (16:23)
Maternal, maternal depression, postpartum depression.

Dr. Hanna (16:25)
Yeah. It's critical for kids to grow up in an environment where they feel safe, secure, that is stable. you know,
that a parent is there and attentive. but when a family, is struggling, that's very difficult. I'll give you one
example. Before we started this program, I had a newborn, coming into clinic, was a premature baby who was
just five pounds and was coming in for the four-day checkup. The baby was just four days old. And they were a
no-show. They didn't come to clinic, so m- the office staff tracked them down and the mom had to go back to
work at four days of age. Mm. So she had just given birth four days ago and she had to go back to work because
for her, the choice was, it was more important for her to make men- en- ends meet than to go to that doctor's,
important doctor's visit. So this is giving families a cushion, a little bit of breathing space to be able to be there,
maybe to stay home a little longer or pay for childcare, to breastfeed longer when maybe they weren't going to,
to go to the doctor's visits, to get their vaccines, to, you know, all these different things. and, and we're seeing
that play out in the data.

Mark (17:30)
That's great. You know, we're big followers of Robert Putnam. He wrote the book Bowling Alone, said basically
people are bowling the same amount, but they're bowling not in leagues, they're bowling alone. And he's very
focused in on community and civic engagement. I'm wondering what has other research found about payments
helping to drive civic eng- engagement and long-term economic gains?

Dr. Hanna (17:53)
Oh, I love this question. So, on election day, last week, we released a report on civic engagement, our impact on
civic engagement. So, in that American Journal of Public Health article, we also had measures of trust in there.
and we found that our ARKs kids' exposed mothers had more trust in government and in healthcare systems
than, non-exposed mothers. and then, you know, I've, I've c- you know, I've, I think of this program like a way
to restore that social contract, right? That relationship that individuals have, especially with government and
how there's been such lost trust and people don't believe that government's working for them or helping them.
So, we actually, worked closely with a political science professor who is an expert on voting, research. And he
looked at our, he looked at what was happening in Flint compared to other, controlled populations and compared
to the state. And in the November 2024 election, women of childbearing age in Flint voted more than older
women voted more than men. They voted more than in similar demographics in other cities. And then when we
compared those, our participants to their voter files, our RX Kids Mamas voted more than non-RX Kids Mamas.
This is amazing. This is restoring democracy. and we're gonna be looking at other measures of social cohesion
and what's happening at the community level. but it's a bit like a panacea. Like, I don't like to use that word, but
here is this really, really simple program that is impacting all of these different domains, including civic
engagement.

Margaret (19:30)
Very, very impressive. I think you said 3,600 families have been reached already, 11 Michigan communities,
$15 million, in direct support. You've got the bipartisan support. I think that people would love to hear your
strategy, for how, how you went about this because in these particular times we're in, I think everybody's
looking for some opportunities for bipartisan contribution and, and support back. But it doesn't happen
automatically. So maybe, you obviously learned a lot during the water crisis. Maybe, tell us a little bit about,
your strategy to get that support in this instance.

Dr. Hanna (20:09)
Yeah, I think, like you said, this is a, a bright spot. This is a solution when people are really yearning for
solutions. It's addressing so many of the polycrises that folks are facing, that states are facing. number one,
affordability. you know, that is top of issue for families. How can I afford eggs and groceries? And it's
addressing that issue in, once again, one of the most expensive times in a life course. Babies are expensive. They
need a lot of stuff. So, it's addressing the affordability crisis. it's addressing the housing crisis. We have, you

know, data on improved housing stability. It's addressing the childcare crisis, fi- the ability of families to pay for
childcare. It's addressing maternal infant health crisis. We have some of the worst outcomes in this nation when
it comes to maternal health and infant health. It's addressing that. so, I think it's economic development. So, I
think when we are able to frame it in all these different ways as a one single solution, it appeals to all kinds of
folks. It appeals to libertarians who, who, who were champions of cash transfers from the 1940s with Milton
Friedman. They love small government and, and efficient government. it appeals to progressives. It appeals to,
you know, the pro-life folks. It, it appeals to the natalists. So, like, all of these different folks are interested in, in
some different elements. I would say another strategy is, as much as we share the science of this work, I think
we also, you know, we share the stories. And I think that ability to share the real stories of real families who are
struggling, who care for their children and their babies just as much as we all do, has also kind of humanized
this as much as possible. I was in Mississippi last week, and Mississippi just declared a public health emergency
because of rising infant mortality rates. They are the poorest, poorest state in the nation, and their babies are
dying. And the Republican legislature asked me to come to testify, about a solution. And people are ready for
shovel-ready solutions, right? Like, here is something that is working, that's based on evidence, that is really
simple, and that's plug and play. Like, we are ready to go anywhere in this country as long as those funds are at
the table.

Mark (22:24)
Well, I think it's because, the program's authentic and you are as well. Your voice is very important. Margaret, I
was reading The New York Times I think in the last eight or nine months, and I was shocked when I read an
article about, another study about programs called Baby, Baby's First Years, which showed little effect after
providing cash payments to mothers. And this research looked at programs in New York City, New Orleans, and
a few other places. How do you respond to that negative research? Or maybe it's not negative research, but to
that re- to, to those outcomes. what are you doing that's different?

Dr. Hanna (23:02)
Oh, several things. so that was a study that looked at kids, at four years of age, their developmental milestones,
in the Baby's First Year program, which gave $333, to families. And it was a randomized controlled trial. Other
f- other, other families got $20. So, there was no prenatal cash in that program. That just started at birth. But the
biggest issue was that hap- that research, I feel so bad for them, it happened during COVID. It happened during
the pandemic, when there was an infusion of cash. not only was there the expanded child tax credit. There was
the economic stimulus payment. So that was a massive confounder. And the, and COVID also impacted
children's development. So that was another part of it. So that, you know, that was the biggest reason. I would
also say that their dose, they were underdosed. and we learned from them. So, they gave families $333-
Yeah. ... not adjusted for inflation. so, we are giving our families $500, postnatally. so, it didn't start pre-
evidently-

Mark (24:08)
And also, you're, you're doing educational work that they weren't doing as well, is one of the two or three things
that they were not focusing on.

Dr. Hanna (24:16)
Yeah, yeah, I, but the most important thing is it happened during COVID. Yeah. So, the dose was too low. It
was a time of massive disruption. People got cash. It had developmental impact, and it was a small means-
tested, randomized control pio- pilot. Yeah. We are at scale. Our intervention arm or our, the number of people
who are participants is already 10 times greater than that. So, we, you know, science evolves. Science learns. It's
unfortunate that that article got so much attention because I think a lot of people went away like, "Oh, Cash for
Kids doesn't work." Quite the contrary, it's worked for decades, if not a century in other places.

Margaret (24:52)
And, and I would suggest that-

Dr. Hanna (24:52)
And it worked most recently... Sorry. Most recently, it worked when we expanded the child tax credit in 2021,
and millions of kids got unconditional monthly cash allowances. We dropped child poverty to the lowest level
ever, and tons of outcomes happened. So that should be our most recent learning point.

Margaret (25:11)
And I'll, I'll take the, I skew to the optimistic side of the house. As long as the research was sound-It produced
valuable findings. The underdosing piece is a critical piece to know. If this level versus at this level, there's a

different- no different than a clinical trial-

Dr. Hanna (25:26)
We learn.

Margaret (25:27)
…so good for them.

Dr. Hanna (25:27)
We learn. Yeah.

Margaret (25:28)
And also, let's, let's not have another COVID pandemic. But, after, talking about that, I wanna ask you about the
future, right? So, over the next three years, I think you have plans, with Rx Kids to expand to lots of new
communities, reach 100,000 babies, perhaps cover a third of all births in Michigan. I, I assume that means
regardless of economic, income group. Yes. and very importantly, you've developed a roadmap or a, a startup
guide for municipalities, I guess, or counties that wish to implement this. So, what else do you need to make
this work and, and how does a community that is far from Flint take that manual and get that work done? Have
you really laid out a roadmap for people?

Dr. Hanna (26:14)
Yeah. so, you know, we're in, 17 communities right now, urban and rural. our, our, you know, after, you know,
being successful in Flint, we expanded to five counties in the Eastern Upper Peninsula of Michigan, very rural,
very different, mainly as a proof point that this is also possible in rural communities where there's a lot of
challenges, there's a lack of healthcare, lack of birthing hospitals, lack of nonprofits. so, it was really important
that we also were able to be successful there. So, there's more research coming from kind of all of our sites. Our
sample size is exponentially continuing to grow. and we have lots of resources on our website, RxKids.org, to
learn about how, you know, how we can spread this to other places. We would love to, share, once again, this
plug-and-play program that is for entire geographies. It's not, we don't call it for poor people, it's for high-need
places. This is a place-based intervention that really allows us to address the compounded adversity of growing
up in a poor place, poor environmental quality or, you know, unsafe places to play, lack of grocery stores. Sure.
You know, all of these things impact health. So, we wanna be able to do this at a place-based level.

Mark (27:28)
Well, it's, there's no question in our mind you're a visionary. And tell us, how does Rx Kids fit into your broader
vision of what pediatric care should look like in America?

Dr. Hanna (27:38)
Oh, thank you. So, you know, as a pediatrician, this is what, these are the kinds of things I've wished for from
the beginning of, of seeing that first patient. I love seeing her patients, but I got easily frustrated when I was
taking care of a kid admitted with a gunshot injury and not being able to address gun violence. Or I had a kid,
you know, admitted f- with an asthma exacerbation, intubated 'cause we weren't talking about air quality. So, for
me, optimal pediatric care, optimal pediatrics is also very much addressing those social drivers of health. And,
you know, when you, you know, it's frustrating not to be able to do that. We actually did a study this summer
with a medical student, who surveyed our pediatricians and asked them about burnout and wellness in light of
this program. And th- our, our, you know, the doctor said like, "Finally, I have something I can prescribe that is
really gonna help my patients and is even like an antidote to physician burnout." Uh- Wow. ... that they can,
they can do this. So, you know, doing work like this, to me, addressing holistically everything kids need, not
just at the bedside, is, is what pediatrics is to me and why I went into this profession.

Margaret (28:46)
Well, Dr. Hanna, I think that's a great note to end on. Thank you for joining us. Thank you for the work that
you've done in the past, that you're doing now, and what is to come.

Dr. Hanna (28:54)
Thank you.

Margaret (28:54)
And thank you to our audience for being here. Just a reminder, subscribe to our videos on YouTube, find us on
Facebook and X, and please share your thoughts and your comments about this program. Take care and be well.

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Margaret (29:09)
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