A Hospital Waiting Room Turned Into a Tax Prep Site
“Finding help with my taxes.”
You wouldn’t expect to hear that as an answer to a question in a doctor’s office. But Dr. Michael Hole, a pediatric resident at Boston Medical Center, remembers the first young mother who told him it was one of the things worrying her at her newborn’s appointment.
Hole referred the woman to a free tax prep center across the city.
At a later visit, he learned from the mom that she, along with her toddler and newborn, took two buses and a train to reach the center, only to find it closed. When she tried again the next day, she hadn’t brought the documents she needed. In the end, this mother paid hundreds of dollars — a big chunk of her annual income — to file her tax returns at a more convenient tax-prep business.
Frustrated by her story and other patients with financial worries, Hole and his colleague, Dr. Lucy Marcil, established StreetCred in 2015 to make tax services more accessible to their patients.
In partnership with the Boston Tax Help Coalition, an IRS-sponsored Volunteer Income Tax Assistance (VITA) program, StreetCred enlists trained volunteers and staff to help families file taxes and maximize refunds while they’re at the doctor’s office for their children’s appointments. In its first tax season last year, StreetCred returned over $400,000 in tax refunds to nearly 200 Boston families.
Most of those savings came from applying the Earned Income Tax Credit (EITC), the largest and arguably most effective anti-poverty program for working families. A primary goal of the EITC is to increase the household incomes of low-wage workers and lift children in these families out of poverty.
Research demonstrates that the EITC helps families at virtually every stage of life. The credit has been linked to improved infant birth weight, less maternal stress, higher employment among single mothers and improved school performance. Children in families receiving a larger EITC tend to be healthier and have higher odds of finishing high school and going on to college.
Yet 20% of eligible families don’t take advantage of the tax credit, which averages $2,400 (and can be as much as $6,242). Many families who get the credit pay someone to prepare their tax returns for them, at significant expense. Almost $2 billion of EITC refunds each year goes to the for-profit tax preparation industry — money that families could use for other needs if they didn’t have to pay for help filing their taxes.
“We’re not doing anything that unusual,” Marcil says. “StreetCred is taking resources already in place and making them more accessible to families so that we can improve child health.”
As Jason Purnell writes in a chapter of the book What It’s Worth called “Financial Health is Public Health,” if we want people to live healthy lives, we must invest in resources that support financial well-being.
When children are lifted from poverty, it’s no surprise that their health improves.
“Our primary responsibility as pediatricians is to ensure that by the time these families leave our office, parents have an opportunity to raise healthier kids,” Hole says. “That’s why we created StreetCred.”
Tax season is when innovations to improve financial well-being are most critical because it’s the moment when low-income families often have the largest amount of cash and ability to save.
Midway through its second tax season, StreetCred has already surpassed last year’s returns and more families are streaming in as the April 18 tax deadline approaches. The program has expanded its services to three new locations: Boston Children’s Hospital, South End Community Health Center, and St. Mary’s Center for Women and Children.
Hole and Marcil share three lessons they learned over the past year for offering financial services to families in need.
1. Start Early and Get Creative.
Market to families as early as possible — even before tax season starts.
Through a variety of outreach strategies, StreetCred ensures that every family who walks through the clinic doors knows about the program. Volunteers and staff call families ahead of their child’s appointment to remind them about the free tax services. Pediatricians tell parents about StreetCred at participating clinics. When StreetCred staff schedule appointments over the phone, they explain what documents people need to bring so they’re prepared and don’t have to come in multiple times. And StreetCred accepts walk-ins, too.
“EITC families are a population we can reach,” Marcil stresses, “We just have to look for more innovative ways to make our services accessible to them.”
2. Meet People Where They Are.
More than 92% of kids see a pediatrician at least once a year, giving Marcil, Hole and their colleagues a chance to ask parents whether they know about the EITC, just like they ask about seatbelts, nutrition and childproofing a home.
By embedding StreetCred’s tax services in the clinic’s waiting room, parents can access their refunds at no cost and save time.
“Time is scarce for working, poor families,” says Hole. “Getting basic resources from public assistance programs often entails significant barriers, such as navigating public transportation, waiting in long lines and filling out confusing forms.”
3. Trust is Key.
Most people don’t like to discuss money. It’s personal. But Marcil and Hole find that patients are open to the idea of seeking help in a medical setting.
“Doctors are in a privileged position to make lasting change for children and families. The key is taking advantage of a moment that might be uncomfortable for us: asking about finances,” Marcil says.
Hole and Marcil believe that working under the umbrella of Boston Medical Center, New England’s largest safety net hospital, has been invaluable. BMC has a longstanding commitment to addressing community health needs and serves a large number of disadvantaged patients. Families trust BMC and other StreetCred clinics to do their best to help kids lead healthier lives.
“The lesson here is that partnerships with trusted organizations pay off,” says Hole. “I think StreetCred would be in a very different position if we were just a standalone shop on the corner.”
In future tax seasons, StreetCred will pilot new services. After filling out tax forms, volunteers will check to see whether families qualify for social programs like Medicaid or SNAP benefits. They hope to eventually develop a software that can use individuals’ tax data to determine eligibility for other services — ranging from college financial aid to housing vouchers — and integrate them with applications for those programs.
This kind of service development and innovation, while strong in markets that cater to the affluent, is far less evident in the nonprofit sector. Yet it’s precisely what’s needed to help lower-income families navigate their everyday life challenges.
“There are so many Uber-style tech innovations that make our lives easier, but a single mom with two kids can’t afford them,” Hole explains. “We want to change that.”