Responsibility, resentment, and red tape: Exploring stigma experiences among assistance program users in Missouri

Although assistance programs (i.e. Medicaid, SNAP, and food pantries) are proven to ensure access to necessary resources and improve health outcomes, evidence shows that participants experience stigma due to their participation in these programs, creating barriers to participation and further marginalization of low-income families. In the U.S., welfare stigma is rooted in values of personal responsibility that perpetuate harmful stereotypes about assistance users. Internalized, interpersonal, and structural stigma are manifestations of stigma that may be experienced by assistance users. One-on-one, semi-structured interviews were conducted with a geographically stratified sample of adult Medicaid participants in Missouri (n = 72). Interviews were transcribed verbatim and analyzed using inductive and deductive coding. Thematic content analysis was employed to derive and report the main themes. Among our sample, internalized, interpersonal, and structural stigma were experienced through the value of personal responsibility, program design and implementation, and program utilization. Through the value of personal responsibility, participants shared feelings of shame related to using public assistance (internalized stigma) and exceptionalism when comparing themselves to other users of public assistance (interpersonal stigma). Within program implementation, participants reported the prejudice they experienced through interactions with programmatic staff (interpersonal stigma) and described experiencing administrative barriers to accessing programs (structural stigma). Lastly, participants discussed how stigma influenced their utilization of public assistance programs, including decisions to enroll and engage in programs. Our study adds to existing understanding about how assistance users experience stigma and how internalized, interpersonal, and structural stigma impact assistance program uptake and utilization.