Luke Shaefer on the RX Kids Cash Transfer Program

Siers-Poisson [00:00:05] Hello, and thanks for joining us for the Poverty Research and Policy podcast from the Institute for Research on Poverty at the University of Wisconsin-Madison. I’m Judith Sears-Poisson. Unconditional cash transfer programs are being piloted across the country. For this episode, we’re going to be talking with Dr. Luke Shaefer about RxKids, the nation’s first-ever community-wide prenatal and infant cash prescription program, which is taking place in Michigan. Luke Shaefer is the Hermann and Amalie Kohn Professor of Social Justice and Social Policy at the Ford School of Public Policy at the University of Michigan. He’s also the Director of Poverty Solutions and is co-director of RxKids. Luke is also an IRP affiliate. Luke, thanks for joining us today.

Shaefer [00:00:53] It’s my pleasure.

Siers-Poisson [00:00:54] Can you start us off with a general explanation of the RxKids program?

Shaefer [00:01:01] RxKids is the nation’s first community-wide prenatal and infant cash transfer program. It started in Flint in 2024 and now has expanded to eight other communities, Kalamazoo, Pontiac, five counties in the eastern Upper Peninsula, another county in western Michigan, rural county in Western Michigan. It provides every expectant mom $1,500 in the second or third trimester of pregnancy. And then $500 a month after birth for six months to a year, depending on funding availability in the communities we’re in. So it’s really a program that provides help and support to all families with women who are pregnant and families with a new baby in disadvantaged communities.

Siers-Poisson [00:01:52] And how is that money distributed? How do they receive it?

Shaefer [00:01:56] We have an incredible partner in GiveDirectly. So GiveDirectly is a world sort of best-in-class cash transfer non-profit. So, expected moms find out about the program. They can go to an online application. It’s been mom attested over and over again. It takes about 15 to 20 minutes to get through the application. And the only things you have to do is prove that you’re pregnant, or prove that you’ve had a baby, and prove that you live in an RxKids community. And then folks get the choice to either receive the money direct deposited to a bank account or a reloadable debit card. So we actually have been impressed with the great fraction of people who choose direct deposit. It’s something like 75% in Flint, 25% reloadable debit card, but in some of our other communities, it’s like 99%. So this is a program, especially, you know, given I got to talk to you about my last book, The Injustice of Place, that we can roll out in rural communities as well as urban communities, because there’s no like physical touch point. GiveDirectly is also amazing at program integrity, so they have a lot of things in place to make sure that the folks who are applying for the program are eligible. I would say something like 99% of the people who do apply to RxKids are expectant moms or families with a new baby. But there is a small number of folks that are trying to cheat the system. And so we really rely on them and appreciate how seriously they take that, to getting money to people in a timely manner and protecting the program.

Siers-Poisson [00:03:37] And are there any restrictions on what the moms can spend the money on?

Shaefer [00:03:42] No restrictions, it’s unconditional cash. Families can use it for whatever they deem that they need the most. And we came to that decision based on a reading of the global literature and the domestic literature in terms of both what we see families spend it on. So we have a huge amount of evidence on child cash transfers in particular, which I really distinguish from UBI or guaranteed basic income. Child cash transfers is a type of program that countries all over the world use. It starts with this very simple premise, shocking premise, that raising kids is expensive. And one of the best ways that we can help families is to provide a little bit of money that they can use as they see fit. And the use of money really sort of flows from libertarian principles. You can go back and listen to great segments of Milton Friedman describing the fact that some families really need food, but they’re okay on housing, and other families are really good on food, but they have housing security challenges. So by providing cash, we can provide an effective benefit for both kinds of families. So it builds on principles of efficiency, that it can more effectively help families with a diverse set of needs. And also, I think the literature really indicates the spending, that especially moms are really good stewards of money. And then the values that are sort of imbued in that too, that we want it to be a program that really supports families where moms feel like they’re valued, that the work they’re doing is important. And we believe that the evidence is that unconditional cash transfer does that more effectively than one that says, we don’t trust you to do this or that, and we’re going to sort of require that you do it.

Siers-Poisson [00:05:33] So RxKids targets the immediate pre and postnatal periods in these families’ lives. What is it that makes that such a critical time?

Shaefer [00:05:43] Yeah, I mean, this was kind of news to me. I have been studying child cash transfers for a long time, but there’s really two pieces of this. The first is that this is an incredibly important developmental window. So babies’ brains double in size in that first year. There’s a huge amount of evidence that the prenatal period is really critical for the development of kiddos over the life course. We have a great study that was in the quarterly journal of economics that finds like an extra $1,300 during that first year of life translates to higher earnings in people’s 20s, like pays for itself easily in the 20s with these higher earnings alone. And also, it showed higher educational outcomes. There’s other studies that have happened, some great stuff about the food stamps sort of roll out from the 1970s, especially during the early years, right? Martha Bailey et al. study shows that access to food stamps in the early years, which we really think of as income support, leads to better health over the life course. So there’s just growing evidence of the importance of this critical window, the prenatal period, the first year of life, in addition to a lot of evidence that income support during that year can have long-term effects. So we combine that with the fact that some new research by our colleagues at Columbia, Chris Weimer et al, that finds this first year of life is also the time when families are poorest. And Alex Stanczak at the Center for Equitable Growth has an incredible chart that shows household income really starts to plummet before birth, in the last couple of months, as a lot of women have to reduce their work hours for a variety of reasons, health-related reasons, whatever it might be. It hits a trough right at the time of birth and then slowly starts to rise but stays below sort of the pre-level up through age one. So families are actually poorest during this window. So it’s like a perfect storm, right? Where you have just a fundamentally important window for the development of a child. You have a lot of evidence that income support during this period alone can have positive impacts over the life course, and the fact that it is the time when families are poorest. So if we’re going to sort of intervene with a short-term program at any part in the life course, there’s just a lot of evidence saying this is the window that we should do it.

Siers-Poisson [00:08:12] I just want to pause for a moment and ask, why did you choose to call the program RxKids?

Shaefer [00:08:19] The program really started not from me, but from Dr. Mona Hanna, who played a fundamental role in turning the tide in the Flint water crisis with research that she had done. And she and her team at Michigan State University, this is a partnership program, RxKids really is led by her team at Michigan state in collaboration with Poverty Solutions at the University of Michigan, the initiative that I run, so it’s Michigan and Michigan State coming together as sort of our form of bipartisanship. You know, people in Michigan will be familiar with how testy those relationships can be, at least in football, but we’re all on team kids for this. She’s a pediatrician, she’s a researcher, a scholar, a faculty member at Michigan State School of Public Health. And it really came out of a desire to figure out what could we do that could really make a difference in the health of especially vulnerable, disadvantaged families. And she was having a number of conversations with groups that she has through this incredible research infrastructure that she’s built in Flint and was talking to moms and saying like, what would help? You know, what would really make a difference? And around the time that she was having those conversations, we had just had the expanded Child Tax Credit, which is a program that I got to be involved in the development of, you know, with many, many other scholars. And they were saying, you know what, that was incredibly helpful, right? This sort of flexible, modest, but flexible amount of money every month to buy diapers or childcare or food, whatever it might be, really reduced stress and helped us, like, care for our kids. And so it was out of that success of the Child Tax Credit that the interest in the Flint community started and I was just lucky to get to be a part of it. Of course, I had been doing a lot of work on the expanded Child Tax Credit, so Mona and her team, they reached out to me, and we started to have conversations. Originally, actually, we wanted to do it up through H5, so we’re really looking at the early years of the time when we could provide added support. Those numbers got really, really big, really, really quickly, and so we followed the science down to this critical perinatal period, critical for all the reasons I was just mentioning. And those numbers were still big, but we’re able to package it together in terms of support from the state of Michigan and philanthropy, and in some cases, local municipalities.

Siers-Poisson [00:10:47] That’s a really good point because I think there’s often concern about what money is being used, where the funding is coming from, especially when it’s these unconditional cash transfers. And it seems like there has been some resistance to using taxpayer dollars. But it sounds like it’s a whole combination of that in this particular case. Did it need to be sold to legislators or to policymakers that this was a good use of taxpayer money?

Shaefer [00:11:16] Yeah, I mean, there’s a whole story to tell about that, and I’ll sort of go through it briefly here. We were able to access TANF dollars. So that’s Temporary Assistance for Needy Families, is the block grant that came out of the 1996 welfare law. And at the time, we thought what welfare was, time-limited, welfare-to-work type program. And maybe for the first couple of years, that’s what it was. But through the course of the 2000s, states realized something. They realized, “huh, you know, I can provide cash assistance for poor families.” That’s not something that’s terribly popular, you know, when thought of as welfare. And if I do that, the federal government has lots of restrictions and I have to do tons of reporting. Or, it turns out there are these other purposes in TANF, like promoting marriage, something that the federal government with lots of effort has failed to do effectively as far as the evidence base suggests, reducing out-of-marriage births, reducing welfare dependency. And if states use money for those things, they have a massive amount of flexibility in what they can spend the money on. So that sort of evolved over time, as it often does, to states taking TANF dollars and essentially replacing their general fund dollars on things that they were already spending on. So lots of states spend a lot of TANF dollars on their child welfare systems or foster care systems. You know, in Michigan, the famous example was we were spending 100 to 120 million dollars on college scholarships. Most of these funds were going to higher income families or typical like median income families. And all we had to do was say, “oh, if you provide college scholarships you reduce welfare or dependency in the long run.” No evaluation, no argument, one way or the other, if that was effective. So essentially it became a really flexible funding stream that really wasn’t doing much in a lot of places except helping states balance their budgets. And so that’s why policymakers from Paul Ryan, when he was Speaker of the House, to Barack Obama, have called for like a fundamental change in how we allocate TANF dollars. But, you know, that’s not really popular with governors. No governor is going to say, yes, please take this flexible money that you gave me that supposedly is supposed to be for poor families, but really I can use for things I was going to spend on and then have other dollars to spend on other things, and make it harder for me. So, it really, I think, requires a new vision of what we can do with the money. And so in comes RxKids. So I had been spending a lot of time talking about how states should right the ship in terms of how they spend their TANF dollars, with zero success, if I’m being honest. But RxKids becomes like this very different model. It’s fundamentally different. It’s not welfare. It’s a time-limited program, right? It’s sort of like surgically for this perinatal period. And it’s very clear how much you get. So that’s another thing that’s different is there’s no like benefits cliffs. You know exactly what you get. $1,500 in pregnancy and then $500 a month for six months or a year, depending on where you are. It’s clear from the start, clear from end. And I think there’s just more alignment that this first year of life is a time when families could use a bit more support. So rather than going and search for new legislation, right, trying to create a new law to create this, we did what I think is usually the right thing to do, is look for a way to do it within the current existing structure. And it turned out there’s a provision in the TANF law called non-recurrent short-term benefits that allows you to provide aid to families during an acute economic crisis. You can only do it for four months, but you can do it for an acute economic crisis. So, I’m going to let listeners think for a second, what is the acute economic crises? And it’s childbirth, right? For all these reasons, the research from the Columbia Shop and Center for Equitable Growth showing the economic hardship of having a baby. So we were able to get the federal government to agree to an NRST during the perinatal period that includes the $1,500 payment during pregnancy and the first three payments of $500 a month. Now TANF can only be used for low-income kiddos, but it doesn’t define, the legislation is silent on what needy or low-income means. So, in our case, for efficiency’s sake, we define that as kids on Medicaid. So TANF, in all the communities that we’re in, pays for the first three payments for families with babies that were born on Medicaid. And then philanthropy sprinkles in on top for higher income kids in those communities and fills out the rest of the time period. And the philanthropic dollars do a second thing, which is to help us protect other public benefits. So you don’t lose your SNAP, your Medicaid isn’t affected by getting RxKids. And just to be clear for listeners, the front door to RxKids, families just know what their benefit is, they know the state is a part of it, they know philanthropy is a of it. But they don’t know, “oh, I’m getting TANF dollars or I’m not.” On the back end, we figure out who to bill it to. And so, it really becomes sort of a simple, sort of streamlined structure for the families as they’re applying. So, the one thing that has been really exciting about RxKids is how much bipartisan support it has gotten. So State Senator John Damoose is a Republican from the Upper Peninsula. He has been one of our biggest champions, and wrote a really beautiful guest commentary in the Detroit Free Press about why he supports RxKids as a pro-life policymaker. There are a number of other sitting Republican policymakers who have spoken in public about why they support Rxkids. Governor Gretchen Whitmer, a well-known Democrat, has also lifted up RxKids as one of the things she’s most excited about in her most recent State of the State address. And the Mackinac Center is a libertarian think tank in Michigan, also just published an op-ed. So, support among Democrats, support among Republicans, support with think tanks from across the spectrum, it’s just really been interesting to think about why this program brings people together in a way that a lot of other efforts, as you said, sometimes can face challenges.

Siers-Poisson [00:17:45] Thanks for that, Luke. That’s all really interesting, and I want to tease out one thing that you said. So you talked about using TANF funds for families where the birth was covered by Medicaid, using philanthropic dollars for others. My understanding is that many programs like this target only lower income families, but it sounds like, from what you said, that any family who has an impending or recent birth in any of these RxKids communities is eligible to participate. Is that right?

Shaefer [00:18:17] That’s absolutely correct. And let me just sort of lay out our thinking on that. So I have come to believe that providing cash is a really fundamental piece of the puzzle. But how you provide the cash actually matters a great deal too. So think about the difference about how the Earned Income Tax Credit is perceived versus welfare. Okay, maybe that’s not a perfect example for people because the EITC is tied to our work. There’s a, I think, a really interesting study done by a colleague of mine, co-authors Catherine Thomas. It’s not in the United States, but it was a cash transfer that was delivered with three different messages. And one was, you’re getting this because you’re poor. The second was, you’re giving this because everyone needs support and with their family. And I believe the third was, you’re getting this to better your community, to help build your community. And then people were given cognitive tests afterwards, and the folks that got the cash transfer with the second two framings, they perform very differently on that than the folks that got the cash transfer sort of signaling you’re poor, right? You think about like, what is the message that we’re saying when we say, “you’re getting this because you can’t handle your business, you’re low income, you need help and other people don’t.” Another really interesting thing about having a test like that, a means test, is I have also come to believe that it creates a tremendous amount of animosity among people who are above the line but still struggling. So if we were to set the line and say, you get this if you’re below the poverty line, it creates a huge amount of animosity among families that are at, you know, one and a half times the poverty line, 150% of the poverty of line. If you set the like at 150% of the property line, you create a lot of animosity among families that are at 200% of the poverty in line, because they say, “you know what, diapers are expensive even if I have a job.” And because a lot of our programs phase out at that point, I think a lot families are upset that they don’t get the help and they see other people who don’t. And I think it creates a division. So a final thing is that doing those types of income tests, right? They are inefficient. They take a lot time. So if we’re going to say we’re only going to do this for people who are under the poverty line, we have to spend a lot of time figuring out who’s above and who’s below the poverty line. And that creates inefficiencies. And there’s a good chance we’re probably not going to do it very well. And then we get ourselves into trouble. And government does this all the time, where they set some threshold, and then people’s lives are complicated. Incomes change, and so they give benefits to people who quote unquote they shouldn’t. And then that creates a lot of challenges in and of itself. So of course, the benefits of having an income test is that it costs less. And so you would really rather not give a lot of money to somebody who’s really going to be okay anyways. Why would you do that? And so that’s the argument on the other side. So we tried to bridge the gap with RxKids. Rxkids, we call it targeted universalism, and we’re targeting on the community. It’s sort of based on the idea of school lunches. And when you hit a certain threshold of kiddos being eligible for free and reduced-price lunch, the entire school becomes eligible for free and reduced-price lunch. And so we’re doing what we think is sort of a similar thing in targeting RxKids to poor communities. So, in every single community, the child poverty rate is much higher than the state average in Michigan. And there’s a lot of other challenges that families face. So, if you live in Flint and you make $100,000, you’re eligible for RxKids. But the population of people that we’re serving in Flint is exceptionally poor. Something like 60% of the families that are reporting incomes below $10,000 a year, right? So like really, really very low income. So we believe that it’s better to give that benefit to somebody making 100,000, which is a tiny fraction of the sample in order to not have this sort of income testing. So we think it’s sort of more efficient and also allows us to send a very different message in order do this community level sort of means testing. So, it’s almost like having our cake and eating it too, or whatever the phrase is, for the means tested slash universal type approach.

Siers-Poisson [00:22:49] So Luke, what kind of participation are you seeing in these RxKids communities?

Shaefer [00:22:55] It’s pretty amazing. So all of the data nerds in your listenership, which is what, if we’re being honest, like 95%, right? All of the data-nerds will enjoy this insight that I only got through this, which is we know a lot. We actually know the universe of babies in every community because of vital records data. And we know lot about the babies that are being born, race, educational attainment, actually, I believe, Medicaid status, all of these things, from birth certificates. So there’s just such an incentive to get a birth certificate, whoever you are, right? We don’t have to worry about missing undocumented babies who are born in the United States, because that’s one of the groups that we really worry about with the census. So we can track exactly who the babies are who are being born. It’s actually public information, and that’s what we use to estimate how much it will cost to enter into a community. So we can track how many babies are born and we can compare it to our population. And that’s sort of the standard way to do take up. And the take up rate is 100%. So every family in the study of Flint is on the program. Now, when we look at the exact people, in some cases we are able to do an exact data match, and what we see is that there are a small number of families who got the benefit and at birth are no longer in Flint, or did not get the benefit but came to Flint. And so, you know, if we look at it that way, we’re maybe at 80, 90%. We know there’s a massive amount of residential instability among this group. So, if we looked at sort of the aggregate take-up rate for most other programs, like, take something like home visiting, it’s something that we’ve put a lot of research into, a lot investment into and nationally, I think it’s between 15 and 30% of eligible families are signing up for the program. So when we’re at, you know, using the same type of calculation, 100% of families enrolled, it’s incredible. And I think, it’s a testament to a couple of things. One is, it’s something people value, right? Money is useful to people. And so, I think people, you now, researchers and policy entrepreneurs should also think of money as an invitation in. If you want to connect with people, money is something people value and it can be, I think, a way to start a conversation about other things. In our case, the second thing is it’s very clear if you’re eligible or not. So families, I know through my work, express a lot of uncertainty. Am I eligible for this benefit? Am I not? I have to go through a long arduous process and there’s a good chance I’m not going to be eligible. So, you know, I often think it’s not that people decide not to apply for a benefit, but I think they don’t do it sometimes because they’re like, “oh, I’m going to do that tomorrow,” “oh, I don’t know if I’m going to get this or not,” “I’ll do it next week.” And then you never do it, right? We probably all have things like this in our life. And with RxKids, it’s very clear. If you live in the community and if you’re pregnant or have a baby, you’re eligible for the program. And then the final thing is that the application process is very streamlined, can take 15 to 20 minutes. So the very cool thing is that we can see, when we ask people, how did you hear about the program? The single biggest answer by far is friends and family. So information is spreading. So I think it really, to me, it really turned on its heels this notion that there’s these hard-to-reach people for any sort of benefit we might want to offer, we have to come up with very sophisticated social media campaigns or, you know, very targeted algorithms and messaging. I think if you have a benefit that people value, and it’s clear to them that they’re eligible or they’re not, and the process is straightforward and clear about how to apply for it, you can find everyone. We did it in the city of Flint, and we’re seeing the exact same thing in the five rural counties in the Eastern Upper Peninsula. We’re seeing exact same in Kalamazoo and Pontiac.

Siers-Poisson [00:26:57] Now let’s dig into what kind of results you’re seeing for RxKids so far. What are you finding?

Shaefer [00:27:05] We are blessed with having this close to 100% take up because we can really look at impacts on a community level. We can do it in some administrative data and we can do through surveys. But we have to worry less about these questions of like, how do we match people who take it up versus people who don’t? And how do we that in control communities? Our primary thing is to look at changes in the city of Flint versus changes in other communities. So, the typical approach is a difference in differences type approach. So one of the first things that just come out in the American Journal of Public Health was the result of a survey that was conducted in partnership with Hurley Medical Center, so that’s a primary birthing hospital for Flint and the surrounding region, a survey of new moms from 2023 in Flint and also in the surrounding area, in 2024. And we’ve just finished data collection on one here in 2025, but I’m reporting about the results looking at 2024 and 2023. So we can compare outcomes for families with a new baby from 2023 to 2024 in Flint, weren’t eligible in 23, were eligible in 24, and for the surrounding region. So we see if they improved their relative position. We have a series of hardship questions. So, we saw a really big improvement in families saying they have enough of the kinds of the foods that they want and they need. We saw some movement in some of the food insecurity questions that are more standard use, but not to a statistically significant degree. We saw a huge improvement in household housing security. So this is a question that was developed by my colleague Natasha Pilkowska, asking “how much do you owe in back rent?” And I think it’s a much better question than we’ve had. There’s a lot of hardship questions that ask, “did you not pay your full rent this month?” And this question about like, “how much do you owe in back rent” is just a lot more precise. And we see a very big reduction in back-owed rent that’s also combined with a big reduction in families reporting eviction. So, actually during the survey, after RxKids had been in the field for about seven months, among the low-income sample in our survey of folks that got RxKids, there were zero evictions, which was incredible. You can’t get better than zero. And in all of these things that I’m talking about, the Flint group that had access to RxKids really improves its relative position to the surrounding region. Then we saw a very big reduction in testing positive for postpartum depression. There is a validated scale. So we see Flint improved both compared to itself in 2023 and relative to the change in the surrounding region. And then some of my favorite ones are because we think the messaging is so incredibly important. This is a program, you know, if you go to the website, you will see it’s all about love and it’s about support. So, I think the message is incredibly different from other social welfare programs. Most of all of the measures I just described have been measures used in the literature that we thought were sort of best in class. But we put some questions on there about like, do you feel loved? Do you feel respected? Do you feel valued? And we saw huge improvements in all of those questions in Flint from the previous year, and in comparison to the surrounding region. So the other set of findings that we have coming out are on prenatal care and birth outcomes. And there’s some exciting stuff in here. So in Flint, this is based on vital records, so this is population level. We compare Flint to 21 comparison cities, which are all higher poverty cities, with demographic profiles that sort of approach what we see in Flint, that are mid-sized cities. So, in this case, we know in Detroit, there’s huge amounts going on on infant and maternal health, so we thought that’s not a helpful comparison, because they have their own things going on. They have a massive amount of philanthropy. So we look at sort of mid-sized cities in the state of Michigan. There’s 21 cities that sort of match. And we’re trying to use that consistently as much as we can as a comparison group for our diff and diff across every study so that we’re consistent and we’re not, like, picking and choosing. We see something like a nine percentage point increase in prenatal care adequacy. So pregnant people in Flint, after RxKids, they started going to their prenatal care appointments earlier, more first-trimester initiation. They go to more of their appointments as well. So there’s this Kessner index that sort of takes all of these things into account and says what’s adequate and not adequate. So we see this huge increase. So we think the knowledge about RxKids could be driving that sort-of first-trimester initiation, even though the cash payment doesn’t come till second or third trimester. We see a big reduction in smoking during the third trimester since the program developed. And then right now we’re looking at birth outcomes, and we can see, in Flint, the levels of prematurity and the levels low infant birth rate, they’ve been downwards in 2024 and continue to get better into the data we have in 2025 too. We can see, right, from these vital records data, we’re talking about the population in the city, more prenatal care, less smoking in the third trimester, and improvements in low infant birth weight and prematurity.

Siers-Poisson [00:32:36] And Luke, were there any surprises as you were analyzing all this data?

Shaefer [00:32:41] You know, I gotta say, the thing that I’ve been surprised about so far in the results is how big the impacts have been. The impacts on postpartum depression, if our analysis is correct, right, we’re talking about a really big reduction in postpartum depression. And I think a lot of us researchers have done, you know, a lot analysis of programs and just, you know, sometimes you see a lot of, like, modest changes, and that’s kind of what I’ve been conditioned to be. And people can check out our paper, Hardship and Hope and AJPH, and make their own decisions, but the markers look like they’re just significant changes. And then in the vital records data, I’m sort of used to thinking about results for a sample. You’ll often sort of worry, “oh, is the sample like representative of a bigger hole or not?” This huge increase in prenatal care utilization, it’s in the population, right? So you’re talking about the entire population of the city of Flint changing prenatal care utilization and then these improvements in birth outcome. So, population effects that are noticeable that you can see very clearly, it’s a striking difference from most things that I’ve done before.

Siers-Poisson [00:33:57] Data and numbers are great and obviously crucial for assessing a program’s impact. It’s also important to hear from people who are participating in the program about what being in it has meant for them. Luke, what feedback have you gotten from participants?

Shaefer [00:34:15] Yeah, there’s been lots of different opportunities. There is a paper that some colleagues wrote. It uses data just from participants, so there’s no control group or anything, but there’s open-ended response. And there’s really nothing in my career that sort of made me, I think, just cry and be grateful for the opportunity to be a part of something, then to read these responses, when you see hundreds and hundreds of people saying, what a difference this made in their life, how it supported them in their parenting, how that it allowed them to sort of accomplish things that they couldn’t have otherwise. It’s just, even if there weren’t any sort of effects in the aggregate on all these other things I was mentioning, I think it’s something that, as policymakers, as policy scholars, as the general public, that we should think about, is a program valued by the people who receive it. And in this case, it’s very clear. The other thing, which is I think a little different about this, is a lot of times, research will try to zero in on the effects of one thing. So, the biggest part of the intervention of RxKids is the money, obviously. That probably outweighs everything. But then, as I mentioned, all of this language about supporting families, of sort highlighting how hard the work of parenting is and how critical it is, every family gets a welcome packet that includes two onesies and a little note welcoming kiddos, and actually a note from the governor of Michigan also saying “welcome to the state of Michigan.” It’s on really nice card stock from Governor Gretchen Whitmer. The one requirement that communities have to abide by to be a part of RxKids is that they have to host a baby parade. So, baby parades were first conceived of in the late 19-teens. The Children’s Bureau back in 1918-1919 declared it the Year of the Child, and the motto of the Year the Child was “the health of the child is the power of the nation.” And they had baby parades all over the United States to celebrate sort of the importance of babies and the importance of childhood. And so every community does that too. And so, from this standpoint, we’re not able to sort of zero in on only the impact of cash. Because it’s a combination of all of these things, the cash, the messaging around the cash, and then community events. But that’s the way policy really works, right? I’m quite comfortable with that and I think sometimes we as researchers, we miss the fact that these sort of different elements interact with each other and when we’re trying to zero in on the effect of something, which just isn’t true to the way the world works. So that’s, the other sort of piece of evidence is, having been to our first baby parade, getting to talk to moms, like hundreds of families sort of coming out and just celebrating together, and getting to hear directly about what the benefit has meant to people.

Siers-Poisson [00:37:15] So what are the next steps for RxKids?

Shaefer [00:37:19] So, RxKids is just launched in Clare County, which is another rural county in Western Michigan. And this fall, it’s on track to expand to a number of communities in southeastern Michigan, so not Detroit, but in the surrounding area. It’s currently part of budget discussions for the state of Michigan. So the TANF dollars are one time a year, allotment in the budget on an annual basis. So, I think, there’s a lot of support for the program by the governor and by the legislature. There have been some proposals to greatly increase the TANF dollars that are used, but it still remains to be seen. We don’t have a budget yet, so we have to see what’s happening there. So that may make it possible to expand to other places. And then there’s just a huge amount of interest from other states. So the state of Washington actually, as part of their budgeting process, passed a feasibility study about bringing RxKids to Washington. The program has been featured, and I think Mona has testified before hearings in Oregon. We’ve had great conversations with a whole number of states, actually across the political spectrum. So, I think there’ll be continued expansion in Michigan. We’ll be able to start looking at sort of what kind of outcomes we believe are happening in other communities in Michigan, and I think it’s a big goal to expand it to another state in the next couple of years.

Siers-Poisson [00:38:49] Well, Luke, thank you so much for taking the time to discuss RxKids with us. It’s such an interesting program, and I really appreciate you sharing your work with us!

Shaefer [00:38:58] Always such a pleasure.

Siers-Poisson [00:39:00] Thanks so much to Dr. Luke Shaefer. He joined us to discuss RxKids, which is taking place in communities across Michigan. Please note that views expressed by our speakers don’t necessarily represent the opinions or policies of the Institute for Research on Poverty or of any other sponsor, including the University of Wisconsin-Madison. Music for the episode is by Poi Dog Pondering. Thanks for listening.