Table 2.

Work-Related Themes and Definitions from People on Medicaid with Very Low Income

	Theme	Definition	Example quote
I. Context complicating work	1. Critical poverty: “I’m not content, but what choices do I have?”	Critical poverty shared by all participants limited life choices	“With $97 a month I have to be pretty creative in order to, you know, make it through to the next month.”
	2. Behavioral and physical health barriers to work	Physical health conditions caused pain, limited mobility, and other challenges that limited work. Mental health and substance use caused other barriers.	“I cannot go back to waitressing as an alcoholic. Schlepping drinks was not a good idea for me.” “And I’ve done it [manual labor] but then I pay for days, you know.”
	3. Social barriers: unstable housing, low education, criminal justice involvement	Unstable housing and homelessness, low educational attainment, and interactions with the criminal justice system further limited work options.	“Once you lose a place, it’s really hard to come up from that.” “I just got out of prison in [year] so it is kind of hard for a felon to try and get employment out here.”
II. Work experience	4. Work, pride, and shame	Desire for work is high and tied to self-worth. People seek formal and informal work to meet this need. Shame and stigma was expressed by those who were not working.	“I really, really, really want to work”
	5. Inflexible, unstable work	Available work is limited and provides no time off for appointments, rarely are any benefits offered.	“Can I have a job that will accommodate my doctor appointments? You know? Will my therapy have to suffer? You know? So it’s a double edged sword.”
III. Experience with public programs	6. Medicaid supports the ability to work	Health insurance is essential and needed to work or look for work	“It’s crucial for me to maintain my health care so that plays a factor in me going out and actually finding a job.”
	7. Lack of transparency and misalignment of program eligibility	Participation in public programs relied on eligibility guidelines which were not transparent	“They’re not going to tell you how much you can make though, right? So it is, it’s a big trap.”
	8. Barriers, confusion, and contradictions about federal disability	Federal disability was sought by many but obtained by few. Complicated application processes, repeated denials, and inconsistent advice from different medical providers and courts caused frustration.	“Yes, do all the hoops and still, after a couple of years, it is still the same thing and it is just stuck.”