2023-09-28 14:46:10 +00:00
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abstract: 'Background Centers for Medicare \& Medicaid Services (CMS) began
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encouraging governors to implement work requirements for Medicaid
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enrollees using section 1115 waivers in 2018. Significant controversy
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surrounds such attempts, but we know little about the perceptions and
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experiences of enrollees. Objective To characterize experiences of work
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and its relationship to participation in Medicaid and other public
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programs among potential targets of Medicaid work requirements. Design
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In-depth, semi-structured, one-time qualitative interviews. Participants
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35 very low-income, non-disabled Medicaid expansion enrollees
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participating in a county-sponsored Medicaid managed care plan as a part
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of a larger study. Approach We used a biographical narrative
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interpretive method during interviews including questions about the use
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of employment and income support and other public programs including
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from state and federal disability programs. Our team iteratively coded
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verbatim transcripts allowing for emergent themes. Key Results Interview
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data revealed high motivation for, and broad participation in, formal
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and informal paid work. Eight themes emerged: (1) critical poverty (for
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example, ``I''m not content, but what choices do I have?{''''}); (2)
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behavioral and physical health barriers to work; (3) social barriers:
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unstable housing, low education, criminal justice involvement; (4) work,
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pride, and shame; (5) inflexible, unstable work (for example, ``Can I
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have a job that will accommodate my doctor appointments? horizontal
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ellipsis Will my therapy have to suffer? You know? So it''s a double
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edged sword.{''''}); (6) Medicaid supports the ability to work; (7) lack
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of transparency and misalignment of program eligibility (for example,
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``It''s not like I don''t want to work because I would like to work. It''s
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just that I don''t want to be homeless again, right?{''''}); and (8)
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barriers, confusion, and contradictions about federal disability.
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Conclusions We conclude that bipartisan solutions prioritizing the
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availability of well-paying jobs and planful transitions off of public
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programs would best serve very low-income, work-capable Medicaid
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enrollees.'
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affiliation: 'Vickery, KD (Corresponding Author), Hennepin Healthcare Res Inst, 701
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Pk Ave,S9-104 S2-311, Minneapolis, MN 55415 USA.
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Manivannan, Alan; Vickery, Katherine Diaz, Univ Minnesota, Med Sch, 631 SE Oak St,
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Minneapolis, MN USA.
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Adkins-Hempel, Melissa; Vickery, Katherine Diaz, Hennepin Healthcare Res Inst, 701
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Pk Ave,S9-104 S2-311, Minneapolis, MN 55415 USA.
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Shippee, Nathan D., Univ Minnesota, Sch Publ Hlth, 420 Delaware St SE,MMC 729 Mayo,
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Minneapolis, MN USA.'
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author: Manivannan, Alan and Adkins-Hempel, Melissa and Shippee, Nathan D. and Vickery,
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Katherine Diaz
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author-email: Katherine.Vickery@hcmed.org
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author_list:
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- family: Manivannan
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given: Alan
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- family: Adkins-Hempel
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given: Melissa
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- family: Shippee
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given: Nathan D.
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- family: Vickery
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given: Katherine Diaz
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da: '2023-09-28'
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doi: 10.1007/s11606-020-05921-z
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earlyaccessdate: MAY 2020
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eissn: 1525-1497
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files: []
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issn: 0884-8734
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journal: JOURNAL OF GENERAL INTERNAL MEDICINE
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keywords: Medicaid; work; poverty; income; social determinants of health
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keywords-plus: HEALTH; WORKFORCE
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language: English
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month: OCT
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note: Academy-Health Annual Research Meeting, Washington, DC, JUN 02-04, 2019
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number: '10'
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number-of-cited-references: '26'
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orcid-numbers: 'Shippee, Nathan/0000-0002-9885-3663
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Adkins-Hempel, Melissa/0000-0002-9157-4469'
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pages: 2983-2989
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papis_id: 459d36de26fc7d6052a5513b76fab087
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ref: Manivannan2020experienceswork
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times-cited: '1'
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title: Experiences with Work and Participation in Public Programs by Low-Income Medicaid
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Enrollees Using Qualitative Interviews
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000536323100009
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usage-count-last-180-days: '0'
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usage-count-since-2013: '10'
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volume: '35'
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web-of-science-categories: Health Care Sciences \& Services; Medicine, General \&
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Internal
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year: '2020'
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