Wait, Lilo & Stitch Is About Medicaid and Family Separation?

A strange sort of policy logic powers the new Disney remake.

Would you believe me if I told you Disney's new live-action Lilo & Stitch remake was actually about Medicaid and family policy? 

Oh, sure, there's the requisite hijinks with the furry little destructive alien of the title, a big-eared blue puffball of chaos who resembles both a puppy and a toddler but is, we are supposed to believe, actually a bioengineered superweapon. It's predictable but cute, no match for the hand-animated original, but fine as far as these things go. 

Certainly, it's better than the awful recent Snow White remake. When I left the theater, I didn't exactly want to watch Lilo & Stitch again, but I didn't question whether life was even worth living. So if nothing else, it's an improvement over the previous Disney remake. 

But the movie's plot is powered by a strange sort of policy logic. Lilo, you see, is a six-year-old girl who recently lost her parents. She lives in Hawaii with her 19-year-old sister, Nani, who is also her legal guardian. But that relationship is threatened by a social worker, Mrs. Kekoa, who sees their somewhat chaotic lives and Nani's less-than-perfectly-stable employment as grounds for potentially separating them and putting Lilo in some sort of foster care. 

When Kekoa makes a home visit to judge the situation, she finds a mess and a misbehaving kid. She tells Nani that if there's any chance for the sisters to stay together, Nani will have to clean up, get her life organized, and sign up for health insurance. 

Later, in one of the film's big turning points, Lilo goes surfing with Stitch and nearly drowns. She turns out fine, but the emergency room doctor tells Nani she'll need to present her insurance to pay for the visit. Nani, of course, has not yet signed up. 

It's a crisis, but Kekoa has a solution: Nani can sign Lilo up for state-backed health insurance, presumably Medicaid. But she'll have to give up custody and allow the two sisters to be separated. In Kekoa's exact words: "There's a way that the state will pay for all of this. But that means you have to officially relinquish Lilo." 

It's true that Medicaid, a jointly funded state-federal program for the poor and disabled, does offer retroactive coverage in some cases for qualifying medical expenses up to three months prior to when a beneficiary signs up. And Medicaid's incentive structure does sometimes produce perverse outcomes, like so-called "Medicaid divorces," or Medicaid non-marriages, in which a couple chooses not to be officially married in order to preserve benefits. 

But why would enrolling in Medicaid suddenly require giving Lilo over to state-appointed guardianship? I have covered Medicaid fairly extensively, and couldn't think of a way for Medicaid to interact with family policy this way. 

I didn't report this out extensively, but I emailed several friendly policy experts familiar with Medicaid, none of whom could come up with an answer. It's possible that I simply missed or misunderstood some explanatory plot beat—I didn't go back to the theater for a second viewing to watch the health insurance subplot more closely and take more detailed notes. 

But in the end, the movie presents this fateful choice as a difficult but fundamentally good and responsible decision—letting the state step in to pay for medical bills but also to take over the care and supervision of little Lilo. Even aside from the strange policy implications, it's a bizarre narrative choice, especially given that older sister Nani is an adult who is shown to be in a little over her head but fundamentally quite loving and responsible, applying for new jobs when she loses one, dealing with her little sister's chaotic outbursts and little kid defiance with exasperation but what amounts to an awful lot of warmth and patience. The two sisters aren't rich, and their lives are messy, but the relatively modest untidiness of their home is a far cry from the sort of truly troubled disorder that is common in difficult family separation cases. 

In the end, the movie resolves and mostly brushes away any concerns by having Lilo's guardians turn out to be the kindly neighbors—no actual traumatic family separation required. It's a Disney movie with a happy ending. But it's safe to say that's not how state-mandated family separations often work. 

Lilo & Stitch is a cuddly kid-friendly movie about a furry alien pet, so in some ways, you can excuse its policy blunders and the way it papers over the difficulties of family breakups. But it's pretty weird that a movie whose big theme is about finding the meaning of family basically suggests that the best thing to do for a kid is turn their life and fate over to state supervision. It's hardly a happy ending. But I guess it's better than Snow White.