Tax Help Available at BMC Through StreetCred
StreetCred improves the health and well-being of American children by helping families build assets and access evidence-based government programs shown to reduce poverty and improve life trajectories for vulnerable youth.
Lucy Marcil is a pediatric resident at Boston Medical Center who co-founded the StreetCred program alongside Mike Hole. StreetCred is a volunteer based program offering free tax preparation and help to BMC patients. One of the primary goals of StreetCred is to help people eligible families gain access to unknown tax credits. Lucy has an MD from Penn and an MPH from Johns Hopkins.
Mike Hole is also a pediatric resident, and co-founded StreetCred alongside Lucy. He holds an MD/MBA from Stanford University.
Learn more about Lucy Marcil, MD & Mike Hole, MD
Melanie Cole (Host): Kids growing up poor face lots of problems and among them, poor brain development and school issues, but they can receive help from their pediatric offices in the form of Earned Income Tax Credit. My guests today are Dr. Lucy Marcil and Dr. Mike Hole. Both are pediatric residents at Boston Medical Center and co-founders of the “Street Cred” program. Welcome to the show, Doctors. Dr. Marcil, I’d like to start with you. What are some of the issues that kids that grow up poor face that other kids do not necessarily face?
Dr. Lucy Marcil (Guest): Thank you. Poverty is really a pervasive problem that impacts children's lives throughout their entire life course and almost every health issue you can think of. For example, at birth, babies are born to poor mothers often are more likely to be premature or have low birthweight. They struggle more in school. They struggle more with problems like asthma, and obesity, and ADHD. They’re less likely to graduate, and then they earn less money as adults. It really is a huge problem in our country.
Melanie: And Dr. Hole, what are some of the current state of families being able to access some of the evidence-based government programs that are shown to reduce poverty and improve their life trajectories?
Dr. Mike Hole (Guest): Sure, so we’re really lucky to live in a country like the United States that has a lot of programs that are meant to support low-income families and pull children from poverty, but underutilization plagues most of our countries’ most effective programs, unfortunately, because of a variety of issues. As you can imagine, a lot of the forms that you have to fill out to get access to these programs are confusing. Families are struggling with transportation issues to get to the different offices across a large city that are often not open in the hours that they need to be there. When they get there, there’s long lines often and they have to navigate multiple different aspects of these different programs, which means that some of our most effective programs have underutilization rates upwards of 20-25% sometimes.
Melanie: So people have heard about Earned Income Tax Credit. They do not know what that is. Dr. Hole, what is that?
Dr. Hole: The Earned Income Tax Credit is basically, Federal money is available to low-income working families and individuals. If you are in our country and you’re making less than $54,000 a year and you’re filing your taxes, at the end of the year if you file those taxes and that credit amount is more than you owe the government, you’ll get a refund back from our government that can be used for anything that the family wants to use it for. Essentially, that credit has been shown to have a lot of positive effects for children in terms of their health and education and long-term financial outcomes.
Melanie: And Dr. Marcil, as Earned Income Tax Credit would be difficult to figure out -- I mean, taxes are confusing to the people that even know what they’re doing. Tell us about your “Street Cred” program and how that can help families get back some of the money they actually should be getting anyway.
Dr. Marcil: Right, so we recognize that it’s really difficult to do your taxes -- we struggle with our own taxes -- and we’re really interested in the impact we saw poverty having on our kids’ health. I started asking patients about what they knew about the Earned Income Credit, how they were getting it, and a patient of Dr. Holes’ actually tried to go get help getting taxes done and did not succeed, ended up paying hundreds of dollars to get her taxes done by a for-profit company. Unfortunately, that’s pretty much the norm. Over half of families who get the Earned Income Tax Credit pay a paid preparer and a recent national study found that they end up spending about $400, which amounts to almost $2 billion a year of the Earned Income Credit that’s going into the pocket of companies, not to promote child health. We decided, “Why can’t we do this in a pediatric hospital?” And we’ve been able to do that because the IRS wants families to get their taxes done for free. We partnered with the Boston Tax-Help Coalition, which is an umbrella group that administrates free tax clinics all over the city. Through learning through their expertise and partnering with them, we’ve been able to train volunteers to prepare taxes in the clinic who then help our families get their taxes and make sure they’re getting back all of the credits they’re eligible for. We call families, have doctors recommend it to their patients because we found patients will listen to their doctors when they make recommendations and if families are interested, we’ll even do their taxes while they’re there for a preexisting appointment, but they can also come in at a different time. Last year we were able to return over $400,000 to families.
Melanie: Dr. Hole, tell us about the 2016 model and what are some of the steps that you identified to get started?
Dr. Hole: Yeah, so it was our first year, so we were learning as we went along, but most of our model consisted of getting the help of our volunteers who would set up phone banks essentially to call patients with upcoming appointments and tell them, “Hey, I know you have an appointment with Dr. Marcil coming up on Tuesday. If you’ll bring ‘X-Y-Z’ documents with you to that appointment, we’ll help you get your taxes done while you’re here in an effort to make sure you get the really valuable tax credits that are really good for your children's’ health and education going forward. And that worked for some of our families. A lot of our other families were referred by providers within the clinic itself. They would hand them a little sheet of paper that said, “Hey, if you bring these documents to your next appointment we’ll help you get your taxes done.” And then some families just called the phone number at our front desk and said, “Hey, I want to make an appointment.” Then they would bring those documents in. Sometimes families would come just for their tax appointment. Sometimes, as Dr. Marcil mentioned, they would come to the hospital, drop off their tax documents with us, go and wait on their Doctor, go and see their Doctor, and come back. And hopefully by the time we were done, our volunteers had completed their tax return and they could review the return with our on-site coordinator, who’s our tax expert on site. We had a team of basically, a site coordinator, which is an IRS physician, and then volunteers who were trained and IRS-certified through the curriculum by the Boston Tax Help Coalition. The volunteers would do the first pass of the tax return and the site coordinator would review the return with the families and then they would submit to the IRS and go on their way. And all of this was meant to have a “one-stop-shop” for this anti-poverty tool while they were in the Doctor’s office so before they left, we knew as pediatricians that these families had the tools they needed to raise healthy children by the time they walked out our doors.
Melanie: Dr. Marcil, what are some of the measurements you used to assess the results and how can it help kids at every stage of their life?
Dr. Marcil: Right, so we collected some pilot data on our outcomes. Some of the things we looked at were as simple as how much money were we actually returning to families and whether we were getting credits back to them. We also asked families about whether they knew if they’d gotten the tax credits in the past and then looked at whether they got them this year. For example, only 20% of families knew that they had gotten the Earned Income Credit in the year prior, but in the same sample that we looked at, we had gotten 43% of families, so double the rate. We also asked families whether the service was acceptable to them, so did they like it? Did they feel comfortable? Was it private? Was the tax preparer knowledgeable? In all of those questions, about 90% of people said, “Yes.” We also asked our clinic staff if they felt like the service was appropriate and something they would want to continue because clinics are busy and there are lots of important services providers are trying to offer. We found that 96% of our providers said, “Yes, this is an important service that we should be offering to our families.” And then we also asked people who declined our services, so the families Dr. Hole mentioned that we called and said, “We could do your taxes,” and they said, “No, thank you.” We asked them, “Well, why not.” And what we found was a majority of them had already done their taxes and that 80% said they would be interested in using our services again in the future. We have some initial data that people liked the services and said it’s effective. What we’re looking to do in the future is collect more in-depth both qualitative and quantitative data around how this is impacting financial stress for families and how that empowers them to engage more with raising their children so that they hopefully have healthier futures.
Melanie: And Dr. Hole, give us your wrap-up on the “Street Cred” program and what you want families to know about this wonderful pediatric program that’s available to families to help them with their taxes.
Dr. Hole: Well, thanks again for having us on here. I’m really excited about this program mostly because of the impact that we’re seeing it have on the families we’re trying to serve. We have a lot of really memorable stories and interactions with families who learned something about being eligible for a credit that they didn’t know they were eligible for or who are going to now claim the credit when before, their ex-husband across town, who wasn’t taking care of the kids, was claiming the credit. We’re really excited about getting families easier, faster, cheaper access to not only the Earned Income Tax Credit but other services, too while they’re in the Doctor’s office. We want to leverage the trusting relationship a lot of families have with their pediatricians to make sure that these children have access to the types of support that our government believes in, that our government funds and we know is going to make a difference as they grow into healthy adult members of society. We’re trying to add services to our portfolio helping families with the SNAP application, which is formally food stamps, or the FAFSA application, which is financial aid for college if kids are going off to a university. We plan to continue to add onto that services portfolio and add different sites around the city of Boston -- hopefully across the country -- so that more and more kids can look towards the future and see it brightly because of some of these services that we’re trying to offer.
Melanie: And Dr. Marcil, your wrap-up, where do you see this going? And give us your best advice about children growing up poor and why this is such an important program for families to help those children to grow up just a little bit better than they might have before.
Dr. Marcil: Sure, thank you so much for having us. We are really optimistic, as Dr. Hole said, that this program can become even more than just a tax service. We can really provide an integrated service that will allow families to involve in all the social resource programs that they are eligible for so that they don’t have to spend all their precious time and energy stressing about how to access food, how to access housing, how to get their utility bills paid, how to get their taxes done. Instead, they can focus on raising their children because I think what we see as pediatricians is parents engaging with their children is really the most important job that we have here in the United States. If we can help parents do that, as a country, we will have a much healthier, and happier future. I think as a society we owe it to ourselves to invest in these children and to look at it as something that we’re doing not only for them but for ourselves.
Melanie: Thank you both, so much, for being with us today. For more information on the “Street Cred” program, you can go to MyStreetCred.org/Program, that’s MyStreetCred.org/Program. Or you can call 617-414-5170. You’re listening to Boston Med Talks with Boston Medical Center. For more information, you can go to BMC.org, that’s BMC.org. This is Melanie Cole, thanks, so much, for listening.