Table 2.

Themes Extracted From Focus Group and Key Informant Interviews (N = 46)

Themes	Subthemes		Source*	References†
Theme I: HIL levels low	Total		21	53
	System literacy		8	9
	Low education		7	7
Theme II: Consumer barriers to access	Total		31	76
	Understanding		30	98
		Literacy/language barriers	11	16
		Confusion	8	10
	Purchasing/enrolling		20	65
		Costs	8	12
	Using		25	130
		Costs	12	18
	Social determinants of health		16	129
		Transportation	13	39
		Internet and computer access	11	16
Theme III: Provider barriers to assisting consumers	Total		29	114
	Lack of knowledge and understanding		15	16
	Constant changes in health insurance and health systems		12	25
	Time constraints and decision making		8	9
	Loss of Kynect		7	12
Theme IV: Needed resources	Total		27	159
	In‐person assistance		15	26
	Centralized source for information		12	15
	Training		10	11
	Better communication and support from state		9	12
Theme V: State Medicaid waiver impact	Total		27	217
	Confusion and stress for consumers		19	29
	Confusion for providers		15	36
	System designed for failure		15	29
	Premiums and copays		13	21
	Work requirements		11	17

^*Sources refer to the number of participants whose quotes were included under each theme and subtheme.

^†References refer to the number of total quotes in each theme and subtheme.