abstract: 'Background Centers for Medicare \& Medicaid Services (CMS) began

  encouraging governors to implement work requirements for Medicaid

  enrollees using section 1115 waivers in 2018. Significant controversy

  surrounds such attempts, but we know little about the perceptions and

  experiences of enrollees. Objective To characterize experiences of work

  and its relationship to participation in Medicaid and other public

  programs among potential targets of Medicaid work requirements. Design

  In-depth, semi-structured, one-time qualitative interviews. Participants

  35 very low-income, non-disabled Medicaid expansion enrollees

  participating in a county-sponsored Medicaid managed care plan as a part

  of a larger study. Approach We used a biographical narrative

  interpretive method during interviews including questions about the use

  of employment and income support and other public programs including

  from state and federal disability programs. Our team iteratively coded

  verbatim transcripts allowing for emergent themes. Key Results Interview

  data revealed high motivation for, and broad participation in, formal

  and informal paid work. Eight themes emerged: (1) critical poverty (for

  example, ``I''m not content, but what choices do I have?{''''}); (2)

  behavioral and physical health barriers to work; (3) social barriers:

  unstable housing, low education, criminal justice involvement; (4) work,

  pride, and shame; (5) inflexible, unstable work (for example, ``Can I

  have a job that will accommodate my doctor appointments? horizontal

  ellipsis Will my therapy have to suffer? You know? So it''s a double

  edged sword.{''''}); (6) Medicaid supports the ability to work; (7) lack

  of transparency and misalignment of program eligibility (for example,

  ``It''s not like I don''t want to work because I would like to work. It''s

  just that I don''t want to be homeless again, right?{''''}); and (8)

  barriers, confusion, and contradictions about federal disability.

  Conclusions We conclude that bipartisan solutions prioritizing the

  availability of well-paying jobs and planful transitions off of public

  programs would best serve very low-income, work-capable Medicaid

  enrollees.'
affiliation: 'Vickery, KD (Corresponding Author), Hennepin Healthcare Res Inst, 701
  Pk Ave,S9-104 S2-311, Minneapolis, MN 55415 USA.

  Manivannan, Alan; Vickery, Katherine Diaz, Univ Minnesota, Med Sch, 631 SE Oak St,
  Minneapolis, MN USA.

  Adkins-Hempel, Melissa; Vickery, Katherine Diaz, Hennepin Healthcare Res Inst, 701
  Pk Ave,S9-104 S2-311, Minneapolis, MN 55415 USA.

  Shippee, Nathan D., Univ Minnesota, Sch Publ Hlth, 420 Delaware St SE,MMC 729 Mayo,
  Minneapolis, MN USA.'
author: Manivannan, Alan and Adkins-Hempel, Melissa and Shippee, Nathan D. and Vickery,
  Katherine Diaz
author-email: Katherine.Vickery@hcmed.org
author_list:
- family: Manivannan
  given: Alan
- family: Adkins-Hempel
  given: Melissa
- family: Shippee
  given: Nathan D.
- family: Vickery
  given: Katherine Diaz
da: '2023-09-28'
doi: 10.1007/s11606-020-05921-z
earlyaccessdate: MAY 2020
eissn: 1525-1497
files: []
issn: 0884-8734
journal: JOURNAL OF GENERAL INTERNAL MEDICINE
keywords: Medicaid; work; poverty; income; social determinants of health
keywords-plus: HEALTH; WORKFORCE
language: English
month: OCT
note: Academy-Health Annual Research Meeting, Washington, DC, JUN 02-04, 2019
number: '10'
number-of-cited-references: '26'
orcid-numbers: 'Shippee, Nathan/0000-0002-9885-3663

  Adkins-Hempel, Melissa/0000-0002-9157-4469'
pages: 2983-2989
papis_id: 459d36de26fc7d6052a5513b76fab087
ref: Manivannan2020experienceswork
times-cited: '1'
title: Experiences with Work and Participation in Public Programs by Low-Income Medicaid
  Enrollees Using Qualitative Interviews
type: Article; Proceedings Paper
unique-id: WOS:000536323100009
usage-count-last-180-days: '0'
usage-count-since-2013: '10'
volume: '35'
web-of-science-categories: Health Care Sciences \& Services; Medicine, General \&
  Internal
year: '2020'