415 U.S. 250 (1974)
In early June 1971, appellant Henry Evaro, an indigent suffering from a chronic asthmatic and bronchial illness, moved from New Mexico to Phoenix in Maricopa County, Arizona.1 On July 8, 1971, Evaro experienced a severe respiratory attack and was sent by his attending physician to appellant Memorial Hospital, a nonprofit private community hospital in the county.2 Memorial notified the Maricopa County Board of Supervisors of the indigent patient in its charge and requested Evaro's transfer to the county's public hospital facility, while also claiming reimbursement of $1,202.60 for services rendered.3
Arizona law imposes on each county the mandatory duty to provide necessary hospital and medical care to its indigent sick.4 Eligibility for free nonemergency care requires that the indigent have resided in the county for the preceding twelve months.5 Maricopa County refused to admit Evaro to its public hospital or to reimburse Memorial solely on the ground that he had not satisfied the one-year residence requirement.6 Appellees do not dispute that Evaro is indigent and a bona fide resident of the county.7
Appellants Memorial Hospital and Evaro then brought this action against Maricopa County to determine the county's obligation to provide care for Evaro or to reimburse the hospital for its costs.8 The trial court held the durational residence requirement unconstitutional under the Equal Protection Clause.9 A prior federal district court decision had reached the same conclusion with respect to Pinal County, yet the Arizona Supreme Court upheld the requirement as applied to Maricopa County.10
To resolve the conflict between the federal court and the state supreme court, the United States Supreme Court noted probable jurisdiction.11
Whether Arizona's one-year county residence requirement for nonemergency hospitalization or medical care at county expense violates the Equal Protection Clause?12
The Equal Protection Clause forbids a state from imposing a durational residence requirement that penalizes the exercise of the right to interstate travel unless the requirement is shown to be necessary to promote a compelling governmental interest.13 Under the analysis established in Shapiro v. Thompson, a classification that creates two classes of needy residents distinguishable only by length of residence triggers strict scrutiny. This occurs when the newer class is denied basic necessities of life, because the classification impinges on the fundamental right to migrate and resettle.14
Yes. The Arizona statute creates two classes of indigent residents who are indistinguishable except that one class has resided in the county for twelve months while the other has not.15 Because the one-year waiting period penalizes the right to interstate travel by denying nonemergency medical care, a basic necessity of life, to new residents such as Evaro who moved from New Mexico in June 1971, the classification must be justified by a compelling state interest.16 Appellees failed to carry that burden. The asserted interests in fiscal integrity and administrative convenience do not suffice when the means chosen are overinclusive, treating every new resident as though he arrived solely to obtain free care, and when less drastic alternatives exist to verify bona fide residence without burdening the right to travel.17
The denial of nonemergency care also cannot be saved by the exception for emergency treatment. Allowing a serious chronic condition to deteriorate until it becomes an emergency subjects the indigent patient to substantial and potentially irreversible harm.18
The one-year county residence requirement for nonemergency medical care violates the Equal Protection Clause.19
Related opinions on this issue
In his concurrence Justice Douglas concluded that the critical issue is invidious discrimination against the poor rather than the right to interstate travel.20 He observed that Arizona's durational requirement fences the poor out of metropolitan counties possessing modern hospital facilities by erecting a one-year barrier to nonemergency care even for long-term state residents who merely change counties.21 Although acknowledging the enormous legal and economic complexities of medical care, Douglas noted that federal Hill-Burton funds received by Maricopa County carry conditions requiring services to all residents in the area and a reasonable volume of free care for the indigent, conditions that the durational requirement appears not to satisfy.22
He expressed the view that political processes rather than equal-protection litigation ultimately must resolve such allocation questions, yet in this setting the discrimination against the poor remains the decisive constitutional flaw.23
In his dissent Justice Rehnquist argued that the majority improperly expanded the right-to-travel doctrine beyond its prior limits.24 He distinguished Shapiro and Edwards, noting that Arizona's statute imposes no direct barrier such as criminal penalties for assisting indigent entry and that newcomers remain eligible for welfare benefits and emergency medical care.25 Rehnquist maintained that nonemergency hospital care does not equate to the "very means to subsist" at issue in Shapiro and that states must retain latitude to allocate finite public resources among competing claims of longtime residents, marginally ineligible residents, and recent arrivals.26
He criticized the majority for rejecting traditional state interests in fiscal responsibility, budget predictability, and fraud prevention without demonstrating that the one-year rule erects anything more than a remote and incidental effect on travel.27