3 ms·

It is fraud to move to California for the sole purpose of education[1]. Likewise, genuinely moving to California for the sole purpose of benefiting from univers

It is fraud to move to California for the sole purpose of education[1]. Likewise, genuinely moving to California for the sole purpose of benefiting from universal healthcare is also, in my opinion, fraud. People genuinely moving to California would presumably pay out of state healthcare fees until their residency was established. Don't you agree that these fees could be set in a way that served as a barrier to doing what you suggest? Is there a case that isn't covered by this that you're thinking about? 1. Cal. Code Regs. Tit. 5, § 54022 - Physical Presence. "Physical presence within the state solely for educational purposes does not constitute establishing California residence regardless of the length of that presence." https://www.law.cornell.edu/regulations/california/5-CCR-54022 https://www.law.cornell.edu/regulations/california/5-CCR-540...

ceejayoz 1y ago
That just means college students living off-campus don't suddenly get in-state tuition rates after a year or two. Sick people are allowed to like California's weather enough to move there. The ADA would also apply when trying to restrict residency in a way it would not for education.
- kelseyfrog 1y ago
  > Sick people are allowed to like California's weather enough to move there. Perfectly fine. They shall pay out of state rates until they meet the threshold. > The ADA would also apply when trying to restrict residency in a way it would not for education. Can you elaborate? In the best case, it's difficult to predict how courts would rule on this. Any relevant case law? Legislation?
  - ceejayoz 1y ago
    > They shall pay out of state rates until they meet the threshold. I'm not arguing they'll move and obtain residency on day one. I'm arguing it may still make sense to move, pay out of pocket for the 366 days, and gain residency for some folks. The ADA's Title II would seem to forbid "you can't be a resident, ever, if you've got expensive healthcare costs" sort of rules at the state level, yes? That would clearly not be equal treatment for people with medical disabilities.
    - kelseyfrog 1y ago
      > I'm arguing it may still make sense to move, pay out of pocket for the 366 days, and gain residency for some folks. It's trivial to construct a threshold and out of state pay structure which cancels this case out. What number of days and out of state pay structure do you feel would cover these cases? How many of these cases do you suspect will occur annually and what is the projected cost? It's a relatively easy problem to solve once we get down to the specifics. > "you can't be a resident, ever, if you've got expensive healthcare costs" Great! I'm not arguing for "ever". I think we're in the clear here. Edit: Let's estimate the volume of this effect using migration after Medicad expansion as a proxy. Over 10 years (2009 to 2019) we find 56,659 interstate moves after Medicaid enrollment growth[1]. In other words, 0.23 percentage points greater annual population growth in the target population. Another study found an in-migration rate(to CA) of 1.4% for medicaid recipients. Being generous and taking the higher of the two, and multiplying it by California's net immigration of 500,000–600,000 annually, gives us an estimated 7000-8400 medicaid migrants a year a fraction of which are migrating primarily for medical purposes. What would you estimate the annual medical expenditures for this group would be and if an "new arrivals" insurance pool was formed, what would the marginal monthly premium cost be to its members? I estimate that a CA new arrivals insurance pool would have $4B in annual disbursements, and $4-20M in annual residency fraud. Using averages, we can estimate a monthly premium for this group would be about $667/month. This is roughly on par with unsubsidized ACA premiums for adults in many states. For comparison, ACA benchmark premiums for a 40-year-old in California in 2024 are about $450–$600/month. 1. https://pubmed.ncbi.nlm.nih.gov/39893838/ https://pubmed.ncbi.nlm.nih.gov/39893838/ 2. https://pmc.ncbi.nlm.nih.gov/articles/PMC4011649/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4011649/?
      - dgfitz 1y ago
        I think there is a lot of time to flesh this idea out, California apparently has more people moving out than moving in at the moment.
        kelseyfrog 1y ago
        Absolutely. While it was unsurprising to find that housing costs are now one of the biggest reasons for CA emigration. It's those who are lower income, and have just a high school education. Among high earners, working from home has a huge influence on emigration from California. Conversely, higher earners are least likely to move out of CA.

ceejayoz 1y ago

That just means college students living off-campus don't suddenly get in-state tuition rates after a year or two. Sick people are allowed to like California's weather enough to move there. The ADA would also apply when trying to restrict residency in a way it would not for education.

kelseyfrog 1y ago
> Sick people are allowed to like California's weather enough to move there. Perfectly fine. They shall pay out of state rates until they meet the threshold. > The ADA would also apply when trying to restrict residency in a way it would not for education. Can you elaborate? In the best case, it's difficult to predict how courts would rule on this. Any relevant case law? Legislation?
- ceejayoz 1y ago
  > They shall pay out of state rates until they meet the threshold. I'm not arguing they'll move and obtain residency on day one. I'm arguing it may still make sense to move, pay out of pocket for the 366 days, and gain residency for some folks. The ADA's Title II would seem to forbid "you can't be a resident, ever, if you've got expensive healthcare costs" sort of rules at the state level, yes? That would clearly not be equal treatment for people with medical disabilities.
  - kelseyfrog 1y ago
    > I'm arguing it may still make sense to move, pay out of pocket for the 366 days, and gain residency for some folks. It's trivial to construct a threshold and out of state pay structure which cancels this case out. What number of days and out of state pay structure do you feel would cover these cases? How many of these cases do you suspect will occur annually and what is the projected cost? It's a relatively easy problem to solve once we get down to the specifics. > "you can't be a resident, ever, if you've got expensive healthcare costs" Great! I'm not arguing for "ever". I think we're in the clear here. Edit: Let's estimate the volume of this effect using migration after Medicad expansion as a proxy. Over 10 years (2009 to 2019) we find 56,659 interstate moves after Medicaid enrollment growth[1]. In other words, 0.23 percentage points greater annual population growth in the target population. Another study found an in-migration rate(to CA) of 1.4% for medicaid recipients. Being generous and taking the higher of the two, and multiplying it by California's net immigration of 500,000–600,000 annually, gives us an estimated 7000-8400 medicaid migrants a year a fraction of which are migrating primarily for medical purposes. What would you estimate the annual medical expenditures for this group would be and if an "new arrivals" insurance pool was formed, what would the marginal monthly premium cost be to its members? I estimate that a CA new arrivals insurance pool would have $4B in annual disbursements, and $4-20M in annual residency fraud. Using averages, we can estimate a monthly premium for this group would be about $667/month. This is roughly on par with unsubsidized ACA premiums for adults in many states. For comparison, ACA benchmark premiums for a 40-year-old in California in 2024 are about $450–$600/month. 1. https://pubmed.ncbi.nlm.nih.gov/39893838/ https://pubmed.ncbi.nlm.nih.gov/39893838/ 2. https://pmc.ncbi.nlm.nih.gov/articles/PMC4011649/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4011649/?
    - dgfitz 1y ago
      I think there is a lot of time to flesh this idea out, California apparently has more people moving out than moving in at the moment.
      - kelseyfrog 1y ago
        Absolutely. While it was unsurprising to find that housing costs are now one of the biggest reasons for CA emigration. It's those who are lower income, and have just a high school education. Among high earners, working from home has a huge influence on emigration from California. Conversely, higher earners are least likely to move out of CA.