Tax Help in Pediatric Clinics Can Improve Children's Health

By Ronnie Cohen

March 28, 2022

(Reuters Health) - Pediatrician Dr. Lucy Marcil prescribes and provides free tax preparation for parents of her patients in her Boston clinic, and the service is paying off in increased tax refunds, a new study finds.

Clinic parents who used the service in the clinic waiting room received $730 more last year in child tax credits than clinic parents who did not use the service, the study published in JAMA Pediatrics found.

"The poorest children and racial and ethnic minority children are the most likely to miss out on tax filing, and we can help," said lead author Dr. Marcil of Boston Medical Center. "One way to help people get this money is to embed these services in a setting people know and trust, like a pediatric clinic."

The idea to bring tax preparers into her clinic came from a patient who had taken two buses and a train with her infant and toddler to a free tax-preparation site only to find it closed, Dr. Marcil said. When the young mother made the journey a second time, she was missing necessary documents. She wound up paying $400 - a significant percentage of her annual income - to a nearby tax preparer.

Frustrated, the mother asked Dr. Marcil's colleague, Dr. Michael Hole: "Why can't you do it here?"

"She was really smart," Dr. Marcil said. "One of our biggest problems in healthcare is that we think we know what people need, and we don't listen to them enough."

In 2015, Dr. Marcil and Dr. Hole started StreetCred. The nonprofit seeks to improve the health of families by locating free tax-preparation services in pediatricians' offices and lifting barriers to government programs, such as tax credits and college savings accounts. (

StreetCred volunteers must pass an IRS exam to prepare taxes in health clinics, which must register as tax-preparation sites. Beside tax assistance, volunteers inform families about tax credits - up to thousands of dollars a year that qualified families often don't know they can claim.

For the study, Dr. Marcil and her team compared the 2021 tax returns for 88 patients who used StreetCred's tax service to the 2021 tax returns of 98 patients who did not use the service.

StreetCred clients received an average $1,150 in child tax credits compared to an average $420 for clinic patients who did not use the free tax preparation, the study found.

Dr. Marcil sees the results as evidence that physicians and clinics can help lift families out of poverty when they incorporate free tax-preparation services in waiting rooms.

"Healthcare has a role in addressing financial stability, which is one of the most direct ways to prevent future health problems and improve health," she told Reuters Health in a phone interview.

Elaine Maag, a senior fellow at the Urban Institute who was not involved with the study, agreed that embedding tax preparation services into pediatric clinics could be helpful. But, in an email, she cited the study's limitations.

The researchers acknowledge the limitations. Study participants had to consent to release their tax information, and the self-selection could introduce bias as could self-reported tax data from participants who did their taxes outside of the clinic. In addition, the number of dependents differed significantly between the two groups.

Dr. Marcil called for a randomized clinical trial to confirm her findings. Meanwhile, she urged other doctors and clinics to provide similar services. "We should not wait for perfect data before trying to figure out how to best serve families," she said.

Since starting StreetCred seven years ago, the nonprofit claims to have returned more than $11 million in tax refunds and credits to 5,000 families. It has partnered with 20 clinics in 10 states to start up similar services, Dr. Marcil said.

The first family StreetCred served was a woman with custody of her toddler grandson. The $2,400 she received in a tax refund allowed her to buy what she described to Dr. Marcil as "luxuries" - a winter coat and fresh vegetables.

SOURCE: JAMA Pediatrics, online March 21, 2022.


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