If you bring a baby into the Hurley Children’s Center pediatric clinic in downtown Flint, Dr. Mona Hanna will find you. The pediatrician, who helped uncover the city’s water crisis in 2015, strides across the waiting room in her white lab coat, eyes lasered on the chubby baby in their unsuspecting parents’ lap.
“Hi! I’m Dr. Mona!” she says warmly. “Any chance you guys live in Flint?” Uh, no, the parents respond, seeming confused. They’re from neighboring Grand Blanc.
Wrong answer. “That’s so sad!” says Dr. Mona, who also directs Rx Kids and is the associate dean of public health at Michigan State University College of Human Medicine. “You should move to Flint! And have another baby! And you could be part of the Rx Kids program!” The parents chuckle politely. But Dr. Mona is not kidding.
Billed as the first-ever citywide cash aid program for pregnant moms and babies, Rx Kids gives Flint residents $1,500 mid-pregnancy, and $500 each month for the baby’s first year. There are no strings attached. No income limits. It’s universal; nearly every baby born since the program launched in January is enrolled.
Parents who bring their babies in for checkups at this clinic rattle off the ways the money’s helped, from the cribs, diapers, clothes and wipes they’ve bought, to how it’s “kept them afloat” during maternity leave or provided crucial income when a spouse died.
But the true goal of Rx Kids goes far beyond Flint, as Dr. Mona acknowledged, scooping up one of the Rx Kids babies she finds in an exam room. “Do you think we should do this for babies everywhere? What do you think?” she asks, cooing. The baby gurgles happily, smiling. “Did you get that?” Dr. Mona turns to me, the reporter in the room with a microphone. “...That was an affirmative yes.”
Cash payments and reducing child poverty
Lots of other countries, including Austria, Belgium, Canada, Sweden, Germany, Ireland, France, Norway and the United Kingdom already offer a child cash benefit. The U.S. essentially did, too, during the COVID-19 pandemic: The 2021 expanded child tax credit gave low and middle-income families (including those who were previously excluded due to insufficient income) hundreds of dollars per kid in direct, monthly payments for six months.
Child poverty rates fell to historic lows, until Congress couldn’t get the votes to renew the program.
For Luke Shaefer, the director of Poverty Solutions at the University of Michigan’s Ford School of Public Policy and a longtime advocate of child cash benefits, it was the “the most brutal day” of his career, “when I realized we were going to see what it could do, and we were going to go back to the way we were before.” Soon after, he got an email from Dr. Mona, asking if he wanted to collaborate on a program that would become Rx Kids. Think of the program as an adorable, baby-filled Trojan Horse, aimed at getting donors, lawmakers and local voters excited about how child cash benefits could help their communities.
The list of the recently-converted includes Republican State Senator John Damoose (R-Harbor Springs), who’s become an outspoken advocate for expanding Rx Kids. As “a pro-life person, I sure as heck better be concerned about making it easier for mothers to make the decision to have their children,” Damoose said. “We've been accused [as a party] for years about being pro-birth, not pro-life. And I think that's not without merit. We need to put our money where our mouth is and support these children and support their mothers.”
What once seemed like a moonshot, is already gaining some traction: Shaefer and Hanna say their communications with Democratic presidential nominee Kamala Harris’ campaign helped shape Harris’ recent “baby bonus” proposal. Former President Donald Trump’s campaign also supports expanding the child tax credit. Meanwhile, the state of Michigan has budgeted some $20 million in federally allocated TANF funds to help expand Rx Kids to a shortlist of communities, if those areas can raise local matching funds.
Which means the next phase of Rx Kids is crucial, as the program looks to expand beyond cities like Flint, to rural areas like the remote eastern Upper Peninsula. “We want to make the tent as big as possible,” Dr. Mona said.
But some U.P. health officials were initially wary of the millions of dollars in private donations currently needed to start, much less sustain, the program in their community. “It could be a good thing,” Leann Espinoza, the maternal infant health program manager for the eastern U.P., said in late August. “But I’m not getting my hopes up. I know that sounds terrible.”
In the Upper Peninsula, some families “fall through the cracks”
In the wood-paneled rec room of the Clark Township Community Center, about 35 miles east of the Mackinac Bridge, Espinoza broke the news to her team this summer: Rx Kids is not a program the eastern Upper Peninsula will be able to fund on its own.
It’s about “$3 million dollars that we would need to raise,” she said, looking at the three other staff members sitting on metal folding chairs, who all work with the regional LMAS District Health Department.
Tonya Winberg, the public health nurse for Mackinac County, looked stunned. “Where does that $3 million come from?” Winberg asks the obvious. Other potential Rx Kids expansion sites, like Kalamazoo, have wealthy private foundations that can pay millions to help fund the program. The eastern U.P. does not.
“And how do we sustain it?” Espinoza added. “We hate to start programs, and then the funding is gone and we have to tell people, ‘It's not here anymore. We can't do it anymore.’”
The Upper Peninsula is used to feeling a little forgotten. There’s a running joke about how often it gets mislabeled as Canada or Wisconsin on maps. It’s ruggedly beautiful, bordered by three of the Great Lakes, with thousands of miles of dense forests, dramatic waterfalls, and pristine beaches. But the sheer scale and sparse population (the U.P. is about a third of Michigan’s land mass, with just 3% of its residents) mean getting to work can take hours, and the options for food, housing, and childcare are limited. Poverty rates are higher than the state average in much of Espinoza’s territory, and the region has some of the highest rates of neonatal abstinence syndrome in the state, according to the state health department.
But for all Espinoza’s purported wariness, she does, in fact, have her hopes up about Rx Kids. At the community center, she and her health department colleagues start listing all the ways it would be a “lifesaver” for families in the U.P. Some families will make slightly too much to qualify for WIC one month, “so they call the next [month, saying] ‘I didn’t get overtime this month,” asking if they can now requalify for the food assistance program for women and young children, said Tracci Thomas, the personal family health clerk in Mackinac County.
There are so many working families who have some income and some resources, but “don’t make enough to make it,” Espinoza said. “The fall-through-the-cracks families. And those are the ones that I really, really, really think this program would benefit, especially up here.”
Espinoza’s next meeting is with one of those families. Jessica Kline and her 16-month-old daughter, Aurora, live in Munising, a tourist town on Lake Superior. “She’s got a big personality, and her hair is red, so she came with a warning label,” Kline said of her daughter, laughing.
Aurora is a tiny force, speeding around the family’s apartment, unfazed by the nasal tube that connects her to an oxygen machine. She was born early, at just 24 weeks gestation, weighing less than two pounds. “Just the beautifulest, tiny little baby you’ve ever seen,” Kline said.
None of the hospitals in the U.P. were equipped to care for a preemie that young. So Aurora and her parents spent seven months at a hospital in Ann Arbor, five hours south of their home. “We didn't have a reliable vehicle,” Kline said. “We didn't have a source of income.” The hospital social services provided $19 a day for food, which Kline would save up to buy supplies for Aurora. “We'd be able to get groceries in her food. We’d be able to go to Once Upon a Child and get preemie clothes. We used that $19 a day to survive.”
When they finally got Aurora home to the U.P., their house had been vandalized, the copper pipe stripped out. Espinoza’s team helped them find housing, and drove them to get groceries. Every day is a series of small battles, from finding the medical supplies Aurora needs to figuring out how to get to a revolving door of specialists hundreds of miles away. Still, Aurora’s dad has a job here in town. They’ve got family nearby. They’re making it work, Kline said.
But having a program like Rx Kids could have made a huge difference in her daughter’s first year. “Five hundred dollars a month would have been enough to actually be able to get ourselves on our feet,” she said. “But it was really hard. And it’s been really hard. You just bury it a little bit after a while.”
After Espinoza leaves Kline’s apartment, she drives south to her office in Manistique, as the sun is beginning to lower over Lake Michigan. It’s late. Everyone else has gone home. Espinoza sits at her desk, trying to be pragmatic. She knows Rx Kids wouldn’t magically solve the lack of childcare and housing and all the things you need to break the cycle of poverty. But it would fix Jessica’s car. It would help.
There will also be critics, Espinoza said — people who believe that parents will just use this money to buy drugs. “‘What did they do to earn it?’” she imagines them saying. “'You're just giving them free money, and they didn't do anything to get it?’ Because they don't understand. They don't understand the barriers. They don't understand that sometimes the choice isn’t always yours. Like, I've talked to moms who desperately want to go to work, and they want to support their family, but there's no childcare. And so they have no other choice.”
Espinoza recently got an update from Dr. Mona: thanks largely to private foundations outside the U.P., they’ve raised enough money to fund a “perinatal” version of Rx Kids for five counties in the eastern U.P. The perinatal program would provide the $1,500 payment mid-pregnancy, plus $500 a month for a baby’s first three months. “But the goal really is the full program, so we are still raising money,” Dr. Mona said via email.
“I think it’s fantastic if we even just get the perinatal version to start,” Espinoza said Monday. “If people see that it works and it makes a difference, then there will be more push for the longer version.”
