How One Physician Started A Tax-Filing Service To Help Improve Patients’ Health

Michael Hole helps low-income patients apply for the earned income tax credit, which has been linked with reduced rates of infant mortality.

By Margaret NicklasApril 10, 2019 12:14 pm,

With Tax Day just five days away, on April 15, some may be scrambling to make a payment, or just trying to get all the right forms filled out. While tax season can be stressful for many, it doesn’t affect most people’s health. But it can, for families living in poverty.

Austin-based pediatrician Michael Hole says he’s long seen the connection between poverty and ill health. It frustrated him that he could not do more for his patients.

“I could maybe write a prescription for a child with asthma for Albuterol, a medicine that we commonly use, but if he or she goes back to their housing situation and their neighbors smoke and there’s cockroaches and there’s something to exacerbate that asthma, they are just going to end up right back in my office,” Hole says.

So, he looked for non-medical interventions that would help.

“Taxes are one of those things, as are food and housing and the environment in which they live,” Hole says.

That led Hole to co-found the program StreetCred to help his patients file their taxes. It currently operates in four states, including Texas.

A key part of the program is informing families about the Earned Income Tax Credit, or EITC. Elizabeth Skillen is a senior advisor in the Policy Research, Analysis and Development Office at the Centers for Disease Control and Prevention, or CDC.

“The federal earned income tax credit has been praised as one of the largest, most effective anti-poverty programs for families in the U.S.,” Skillen says. 

In the 2018 tax year, an eligible working family could receive a little more than $6,400 through the EITC, enough to make a real difference. Kristie Tingle is a research associate with the Center for Public Policy Priorities in Austin.

“The poverty line for a family of four is about $25,000. Getting an extra $3,000 could be the difference between being able to make their car payments and get where they need to go, or make that repair that they need to make, get their child health care — any of that — and not being able to do it,” Tingle says.

Such an infusion of funds can also help alleviate some of the constant stress poor families and children experience day to day, which can lead, in some cases, to something experts call “toxic stress,” and negatively affect a child in other ways.

“So, if a family doesn’t have enough money to keep food on the table and a child doesn’t know where their next meal is coming from, that can be really damaging both for their development and their learning. It’s really hard for hungry kids to learn in a classroom,” Tingle says.

Across the U.S., 18% of kids live in poverty. Tingle says it’s an even bigger problem in Texas.

“In Texas, we have about 1.5 million kids living in poverty. That’s 21% of all Texas children,” she says.

Skillen of the CDC says poverty can affect all areas of a person’s life.

“Low-income families are not only not able to afford health insurance and health care, but they also don’t have sufficient income to live in safe communities or have access to adequate housing or schools or access to healthy food or parks or physical activity. So, you can think about these opportunities of alleviating poverty as increasing access to the means of living a healthy, more fulfilling life,” Skillen says.

She says the EITC can make a big difference for these families. For one, it’s been shown to have very specific health benefits for infants.

“There’s evidence that shows that each time the federal earned income tax credit increased by 10%, infant mortality dropped by about 22 per 100,000 births,” Skillen says.

But federal statistics suggest only about 80 percent of those who are eligible to receive the credit actually do. That’s where Michael Hole’s program is useful. He found that simply telling patients about the benefits of filing was not enough, so StreetCred offers free tax-preparation services right in doctors’ offices.

“We’re aiming to, obviously, make it cheaper for those families, but also make it more convenient since pediatricians’ offices are some of the most frequented and trusted spaces in our communities, and often one of the very few locations that are visited by families with children ages 0-5,” Hole says.

Right now, the program in Texas is small. StreetCred helped file just 75 tax returns in 2018 in Austin. But it also helped low-income families and individuals claim roughly $130,000 through the tax credit. And Hole says he knows these credits help.

“We had one mom, one of our very first patients that used our service, that used the moneys to buy ‘luxuries’ as she described them, like a winter coat for her child during the winter,” Hole says.

 Hole is working to expand StreetCred’s tax preparation services to the Rio Grande Valley and other parts of Texas. The program may also soon offer financial literacy services. All this may seem like an unusual project for a pediatrician. But the idea is that a healthier bottom line for families leads to better health for children.


Support for Texas Standard’s “Spotlight on Health” project is provided by St. David’s Foundation