Mobile Citizens: Medicaid Home and Community-Based Services Users Desire and Pursue Cross-State Moves

Abstract

This article provides empirical evidence that Medicaid home and community-based services (HCBS) users with physical disabilities both express desire for, and engage in steps to, move across states, driven primarily by opportunity. These opportunities include employment, schooling, and proximity to social support. Grounded theory techniques were used to explore transcripts from interviews with 18 HCBS users with physical disabilities. Findings are presented as a series of trajectories that connect opportunity with plans for, or action taken to engage in, cross-state moves. The move stories offered by participants illustrate that for Medicaid HCBS users with physical disabilities, opportunity may be dreamed, missed, delayed, or pursued. Stories depicting each of these four opportunity arcs are provided. The article concludes with a discussion of the importance of recognizing the agency of Medicaid HCBS users as they wish to pursue opportunities across states, as well as the structural barriers presented by interstate variation and intrastate confinement. Suggestions are offered to advance research, policy, and practice to honor the dignity and self-determination of Medicaid HCBS users with physical disabilities as they consider opportunities across states.