Expanded Child Tax Credit, Family Health, and Material Hardships.

Importance: Understanding associations of cash payments with family health and material hardships can inform national policy design to support families' economic stability, including an expanded child tax credit (CTC). Objective: To (1) describe family characteristics, including tax filing and banking status by expanded CTC receipt, and (2) examine longitudinal changes in caregiver and child health and material hardships, including housing stability and food security. Design, Setting, and Participants: In this longitudinal cohort study, data were drawn from the Children's HealthWatch COVID Follow-up Study, a study of families surveyed at baseline and 2 waves (January 2018 to March 2020). Primary caregivers of children (≤48 months) participated in English or Spanish in emergency departments or primary care clinics in 4 US cities (Little Rock, Arkansas; Boston, Massachusetts; Minneapolis, Minnesota; and Philadelphia, Pennsylvania). Follow-up surveys were conducted from September 2020 to June 2021 and September 2021 to June 2022. Data were analyzed from March to April 2025. Exposure: Caregiver-reported CTC receipt. Main Outcomes and Measures: Caregivers reported whether they had a bank account (ie, were banked), filed taxes, and demographic characteristics. Caregivers also reported child physical health, caregiver physical and mental health, household food insecurity, and housing stability, including rent status (current vs. behind). Adjusted multivariable logistic regression via generalized estimating equations to account for repeated measures was used to assess associations of CTC receipt with health outcomes and hardships over time. Results: In this cohort of 5813 caregivers (mean [SD] age, 29 [6] years; 1934 non-Latine Black [34.7%]; 2127 Latine [38.3%]; 1275 non-Latine White [22.8%]), 2519 (44.2%) had education beyond high school and 4177 (73.4%) were US born. Of the 879 surveyed after the CTC was implemented, the majority (663 [75.0%]) reported receiving it. Compared with nonrecipient families, a greater proportion of CTC recipients were married or partnered (308 of 663 recipients [47.5%]; 1845 of 5150 nonrecipients [36.6%]), had filed taxes (631 of 662 recipients [95.3%] vs 84 of 194 nonrecipients [43.3%]), were banked (581 of 661 recipients [87.9%] vs 103 of 194 nonrecipients [53.1%]), or were non-Latine White (183 of 663 recipients [28.5%] vs 1092 of 5150 nonrecipients [22.1%]). CTC recipients had significantly lower adjusted odds of hardships, including food insecurity (adjusted odds ratio [aOR], 0.61; 95% CI, 0.47-0.78), housing instability (aOR, 0.64; 95% CI, 0.49-0.83), and being behind on rent (aOR, 0.62; 95%CI 0.48-0.80). Caregivers had lower adjusted odds of anxiety (aOR, 0.67; 95% CI, 0.51-0.89). Conclusions and Relevance: In this cohort study, CTC recipient families were more likely than nonrecipients to be food secure, stably housed, current on rent, and have caregivers in good mental health, reinforcing associations of increased financial resources with family health and basic needs.