Caring Like a State: Publicizing Family Caregiving through Medicalization

Abstract A growing number of Medicaid programs have expanded to employ family members to provide long-term home care to individuals with disabilities, challenging the traditional wisdom that the law systematically denies the economic value of family caregiving. This article qualitatively studies a novel dataset of fair hearing records arising out of one of these programs—New York State’s Consumer-Directed Personal Assistance Program (CDPAP)—and makes two contributions to the literature on care, disability, and the welfare state. First, this article explores the new public/private boundary of care when the state limitedly expands its public care responsibility by compensating some family caregiving, providing a more nuanced picture of how the legal system both values and undervalues care. Second, it contributes to disability law scholars’ debate about medicalization by studying how medicalization works as a state legibility project in the context of state-supported disability care. Especially for traditionally undervalued social goods such as care, medicalization provides some metrics, albeit highly constrained, to make its value visible. Meanwhile, through capturing care recipients and their families’ more expansive understandings of care’s value, this study reveals the constraints of these metrics and supports making the relational dimension of care legible to the state.