Originally posted on Health Affairs Blog.

The American Rescue Plan Act (ARPA) provides a critical opportunity to improve child and family health and well-being by reducing the poverty and food insecurity that too many families, especially families of color, experience. The ARPA expands the benefits and eligibility of the income support programs, the Child Tax Credit (CTC) and the Earned Income Tax Credit (EITC), and extends the 15 percent increase in monthly benefits for the federal nutrition assistance program, the Supplemental Nutrition Assistance Program (SNAP), and provides additional funding for fruit and vegetables for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The eligibility expansion and temporary increase in the CTC for this year ($3,600 for children younger than six years, $3,000 for children ages 6–17 years) is projected to reduce child poverty in the US population by 45 percent. The CTC will also improve racial equity because it is now designed to reach the one-third of children, disproportionately those of color, who were previously excluded from the full benefit because their families earned too little. To ensure these critical benefits reach all families, particularly those with the lowest incomes and greatest barriers to access, health care systems and clinicians need to increase awareness of these expanded programs, promote the positive health impacts of these benefits, and assist families in claiming these tax credits and enrolling in SNAP and WIC.

Tax Credits And Food Subsidies Are Powerful Tools To Promote Health But Are Underused

The CTC, EITC, SNAP, and WIC effectively prevent and reduce poverty and improve health and child development. Participation in SNAP, WIC, and receipt of tax credits are associated with a reduction in low birthweight and improvements in child educational attainment. Despite well-documented benefits of these credits and programs, lack of program and eligibility information, stigma, complex application processes, and fear of the government prevent many from accessing them. The ARPA’s expansion of eligibility for both CTC and EITC will require additional outreach to increase program awareness. Currently, 20 percent of eligible families do not receive EITC, 33 percent of children are newly eligible for CTC, and approximately 50 percent of eligible families are not enrolled in SNAP and WIC. Prioritizing the enrollment of eligible families in these effective programs can reduce economic hardship and food insecurity, ameliorate parental stress and improve parent-child interactions, child health, development, and well-being.

How Health Care Organizations Can Help

Health care organizations can use mass messaging opportunities to increase awareness of CTC, EITC, SNAP, and WIC. For this outreach to be effective, messaging must be engaging, culturally and linguistically appropriate, and address commonly held fears and misperceptions. Additionally, information can be shared by community and clinical navigators during Medicaid and other resource enrollment, and during clinic or care coordination visits. Since all Medicaid beneficiaries are eligible for the tax credits, WIC (if pregnant, or children younger than five years of age) and the majority are eligible for SNAP, health care providers can ask Medicaid beneficiaries if they are currently enrolled in SNAP and WIC and have filed their taxes. Framing these programs as health programs may increase participation and decrease the stigma often associated with SNAP and WIC participation.

Concurrent with awareness-raising efforts, large multidisciplinary practices affiliated with universities or federally qualified health centers and other interested large health systems are well-positioned to provide supportive navigation services to ensure these programs reach those who will benefit most and avoid inadvertently deepening preexisting inequities by race/ethnicity, immigration status, and income. Navigators or community organizations that empower and support families through the entire application process may decrease the trauma many families experience when interacting with complex benefit and tax systems. Health care practices that are less resource-rich, smaller, or physician-only settings can refer to community-based organizations that offer on-site application assistance. When on-site assistance is not possible, health care providers can direct families to websites, apps, and phone support services. For example, the Internal Revenue Service (IRS) website provides a comprehensive list of IRS-sponsored volunteer income tax assistance tax preparation sites to which providers could refer low-income families, and GetYourRefund is a free, online tax filing service. Similarly, online and phone enrollment assistance exists for SNAP and WIC. These sites can be accessed on individual state Human Service and state WIC websites.

Conclusion

The ARPA provides a key opportunity to improve the health and well-being of children and their families by mitigating poverty and food insecurity’s harmful effects. Health care and community organizations can increase awareness of the expanded CTC, EITC, SNAP, and WIC eligibility and benefits and assist their patients in obtaining them. Additionally, health care organizations and physicians can also advocate for the permanent continuation of ARPA’s temporarily expanded tax credits and nutrition benefits to ensure that more children are able to reach their health and education potential.