Barriers to Cross-state Movement for Disabled People and Their Families: A Social Problem

Abstract

Research on geographic mobility in the US has neglected disabled people, missing their experiences of abridged citizenship as their desires to move across states are frustrated by social policy barriers. To illustrate how meso- and macro-level factors impact individual lives, I review three publicly-reported stories of Medicaid home and community-based services (HCBS) users. To advance research in this area, I analyzed these three stories and developed an original conceptual model, Moves in Context. The model attends to the individual cross-state move trajectories of disabled people, and HCBS users, in particular. Moves in Context focuses on the individual journey (i.e., impetus, ability, and success of move; and the influence of the move story) in relation to both social position/personal resources and social structure/ideology. Through the model, I introduce and explain intrastate confinement, a term to describe the geographic immobility resulting from policy variations across states. I conclude with a discussion of the broader implications of both the Moves in Context model and intrastate confinement for further research on disabled people and interrogating other social problems.

Keywords

• Geographic mobility
• personal care attendant services
• Medicaid home and community-based services (HCBS)
• citizenship
• interstate variation