Her husband worked as a roofer and earned $12 an hour. His seasonal income fluctuations left Susan hovering near the Medicaid eligibility cap, which came out to around $20,600 annually at the time, in 2007. She already had briefly lost coverage during their marriage because her eligibility was based on household income. The cancer diagnosis was the tipping point. Susan's husband had recently switched companies and earned a pay increase to $14 an hour. Warmer spring months would bring additional construction work. But more income wasn't necessarily good news. Instead, it surfaced the nagging anxiety that Susan could lose Medicaid eligibility again, just when her medical bills were about to skyrocket.