5 creepy thoughts about interstate LTC migration

2. Interpreting the privileges and immunities clause is complicated.

The analysts say there have been many court cases involving the provisions. “The sense of these cases is that the clause protects the basic rights of a person who goes from one state to another to travel, transact business or live,” the analysts say. “It does not necessarily protect ‘non-basic’ rights such as the right to a hunting or fishing license.”

Because a long-term care program meets a basic need, it “is not likely to be seen as a fringe program or one in the realm of recreation or conservation,” the analysts say. “There are grounds for legitimate concern that any program created which dramatically restricts benefits to persons who came to Hawaii from elsewhere in a way not parallel to the provision of benefits to Hawaii residents would be subject to a serious challenge on the basis of denial of fundamental rights. In principle, any policy provision intended to deter migration for purposes of claiming long-term services and supports should treat old residents of the state and new residents the same.”

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3. Experts aren’t sure whether any differences in welfare benefits, let alone LTC benefits differences, affect interstate migration

In Hawaii, the analysts note that some authors see little welfare gap effect on migration, and that others see substantial evidence of welfare-driven migration. 

Newer, better-designed studies “showed very substantial attraction from welfare differences,” the analysts say. 

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4. Interstate migration patterns already differ from state to state.

Hawaii can be an isolated, expensive place to live. From 1995 to 2000, it lost 201,293 residents to out-migration and gained 125,160, for a net loss of 76,113 people. Now, the state is attracting about 17 people more than it loses per day, and many of the newcomuters have high socioeconomic status.

Some young people move to Hawaii for jobs, but many older people retire in Hawaii, and about 69 percent of those people say they would prefer to stay in their homes as they age, the analysts say. 

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5.  The analysts believe a state can use a vesting period to control access to a public LTC benefis program.

If anyone who participates in the program stays in it, and earns a “stipulated share of a program benefit for each year the individual has been a ‘member’ of the program, that procedure should be consistent with federal equal treatment standards, the analysts say.

The vesting period protects both against predatory benefits migration and constitutional challenges, the analysts say.

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