Free Tax Services in Pediatric Clinics

Published in: Pediatrics, Volume 141, Issue 6 (June 2018), e20173608. doi: 10.1542/peds.2017-3608

Posted on RAND.org on July 03, 2018

by Lucy E. Marcil, Michael K. Hole, Larissa M. Wenren, Megan S. Schuler, Barry Zuckerman, Robert J. Vinci

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Research Questions

  1. What is the feasibility of StreetCred's model of integrating free tax preparation services into pediatric and community clinics?
  2. Do clients and clinic staff find StreetCred Services acceptable?
  3. What is the impact of StreetCred, in terms of total money refunded and Earned Income Tax Credit returned?

Objectives

The earned income tax credit (EITC), refundable monies for America's working poor, is associated with improved child health. Yet, 20% of eligible families do not receive it. We provided free tax preparation services in clinics serving low-income families and assessed use, financial impact, and accuracy.

Methods

Free tax preparation services ("StreetCred") were available at 4 clinics in Boston in 2016 and 2017. We surveyed a convenience sample of clients (n = 244) about experiences with StreetCred and previous tax services and of nonparticipants (n = 100; 69% response rate) and clinic staff (n = 41; 48% response rate) about acceptability and feasibility.

Results

A total of 753 clients received $1,619,650 in federal tax refunds. StreetCred was associated with significant improvement in tax filing rates. Of surveyed clients, 21% were new filers, 47% were new users of free tax preparation, 14% reported new receipt of the EITC, and 21% reported new knowledge of the EITC. StreetCred had high client acceptability; 96% would use StreetCred again. Families with children were significantly more likely to report StreetCred made them feel more connected to their doctor (P = .02). Clinic staff viewed the program favorably (97% approval).

Conclusions

Free tax services in urban clinics are a promising, feasible financial intervention to increase tax filing and refunds, save fees, and link clients to the EITC. With future studies, we will assess scalability and measure impact on health. StreetCred offers an innovative approach to improving child health in primary care settings through a financial intervention.

Key Findings

  • This pilot study found that integrating tax preparation services into pediatric clinics through StreetCred is a feasible intervention to help reduce poverty.
  • The majority of clients reported that StreetCred services were convenient, efficient, provided adequate privacy, and made them feel more connected to their doctor.
  • Most clinic staff reported that the financial services either did not impact, or had a positive effect on, clinical work flow.
  • During 2016 and 2017, StreetCred clients received over $1.6 million in federal refunds, including nearly $500,000 in EITC.

Recommendation

  • Future studies should evaluate whether StreetCred affects health care utilization and health outcomes, as well as evaluate cost-effectiveness and replicability of this pilot intervention in other settings.

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