Effects of Refundable State Earned Income Tax Credit on Access to Health Care and Dental Services of Single Mothers of Two Or More Children: A Quasi-experimental Study

Abstract

Abstract Background Low-income women face access constraints to timely medical and dental services particularly not covered by Medicaid. Less is known about how small to moderate income changes from state EITC in low-income households affect health care access and utilization. This study aims to examine the effects of refundable state EITC on access to care among low-income mothers and evaluate how the effects vary across different interview months depending on the length of effective EITC exposure time window.Methods The sample included single low-educated mothers aged 18–44 with at least two children. From 1996–2019 Behavioral Risk Factor Surveillance System (BRFSS). A two-way fixed effects model is employed to estimate the overall effects of state EITC on access to medical and dental care services pooling across the last 12 months. Next we estimate the effects for those interviewed during May to December and June to November, anticipating larger effects due to longer effective EITC exposure time.Results Our findings demonstrate differential treatment effects on access to medical and dental care. Overall, we do no find positive effects of refundable state EITC programs on access to medical and dental services in models pooling across the last 12 months. However, when focusing on those interviewed during May-December, our results show a 10 percentage-point increase in refundable state EITC is associated with 0.2 percentage-point reduction in forgone medical visit (95% CI: -0.007,0.003), 0.3 percentage-point reduction in routine medical checkup (95% CI: -0.007,0.0002), and 1 percentage-point increase in dental visit (95% CI: 0.003,0.02). Effects are larger among those interviewed June-November, suggesting longer effective EITC exposure time window are associated with larger EITC benefits.Conclusion Our findings provide some albeit limited evidence of small economic benefits from refundable state EITC programs on access to medical and dental services within the months immediately following disbursement of refunds. Effects are larger for interviewed months June-November, compared to interview months May-December. Overall, however, effects are small, and estimates can rule out moderate to large effects. And changes in healthcare utilization are likely to be short term.