"It's confusing as hell": a qualitative study of barriers accessing poverty alleviation benefits through the US Earned Income Tax Credit.

Background: The Earned Income Tax Credit (EITC) is the largest US poverty alleviation program, with positive effects on health equity. Over 20% of eligible households do not receive benefits. Methods: In this qualitative study, we explored benefits of and barriers to EITC receipt among EITC-eligible families through analysis of 40 semi-structured interviews with EITC-eligible parents in California using the immersion-crystallization method. Results: We identified 3 categories of findings: (1) perceived benefits of EITC; (2) administrative barriers leading to low EITC take-up among eligible families, eg, learning, compliance, and psychological barriers; and (3) suggestions to improve EITC take-up. Participants reported the EITC helped families meet needs, make larger purchases, and alleviate perceived stress. Learning barriers were most salient, especially lack of information or understanding. Participants described compliance barriers (eg, tax-filing rules) and psychological barriers (eg, complexity, cognitive load, stress). Participants suggested that the EITC could be improved with more and clearer information, a streamlined system to automatically provide benefits to those eligible, and increased benefit levels. Conclusion: The EITC supports social determinants of health among recipients, yet is difficult to obtain for too many. Improving program knowledge and streamlining access for eligible households may improve take-up and health equity.