The Illusion of Interstate Care
THE CLAIM: What are they telling us? The original article, an opinion piece from a parent in 2022 to 'The Hill,' highlights a distressing reality: a disabled child's access to critical home care services is jeopardized simply by moving across state lines. The parent argues this geographic restriction creates an undue burden, forcing families to choose between necessary medical support and
geographic mobility, often for reasons unrelated to care quality (e.g., family support, employment). The prevailing narrative from policymakers often focuses on 'state control' and 'Medicaid flexibility' as beneficent principles. THE EVIDENCE: What does the public record actually show? Medicaid, the single largest payer for long-term services and supports (LTSS) in the US, is a federal-state
partnership. While the federal government provides matching funds, states administer their own programs. This means eligibility criteria, covered services, reimbursement rates, and the availability of waivers (which fund most home and community-based services, HCBS) vary dramatically from state to state. For instance, in 2021, over 800,000 individuals with disabilities were on waiting lists for
HCBS in the US, a testament to the chronic underfunding and variation in state commitments (KFF, 2021 data). When a family moves, they must reapply for services, often facing new waiting lists, different covered services, and entirely new provider networks. THE CONTRADICTIONS: Where does the official narrative break down? The official narrative of 'state flexibility' as a strength often disguises