 NEW YORK COURT RULES DENYING MEDICAID TO LEGAL IMMIGRANTS VIOLATES CONSTITUTION
This week the New York State Court of Appeals, the highest court in the state, issued a decision finding that a state law denying Medicaid benefits to legal immigrants violates the Equal Protection Clause of the US Constitution. The case, Aliessa v. Novello, was brought by 12 legal residents of the state, all of whom suffer from serious illnesses and would qualify for Medicaid coverage but for the state law.
The Medicaid program is run jointly by the federal government and state governments. Under it, the federal government provides some funding to the states, but the states must conform their Medicaid programs to the federal standards to remain eligible for federal funds. States are free to provide Medicaid benefits to people not eligible under the federal program, but they must do so at their own expense.
The suit stems from a 1996, welfare reform law, which included provisions making legal immigrants ineligible for social services, including Medicaid, until they have resided in the US for five years. Responding to this change, New York changed its Medicaid laws to include the same restriction. The plaintiffs in this case argued that this restriction violated the Equal Protection Clause.
Equal Protection requires that laws that establish classifications among people be scrutinized to see if they meet constitutional muster. Laws that create classificiations based on alienage – that is, whether a person is a US citizen or an immigrant – are subject to what is known as strict scrutiny. This means that for such a law to be constitutional, it must further a compelling governmental interest, and do so in the least restrictive way possible. This standard is applied to noncitizens because they they are an easily identifiable minority who lack a voice in the political process because of their inability to vote.
The state, feeling that it could not defend its law under this level of scrutiny, argued that the appropriate standard of review was what is known as the rational basis standard. Under this standard, the government need only show that there is some valid reason for the law, and that the law advances this purpose.
In determining which was the proper standard of review, the court examined the relationship of federal and state authority to deal with issues concerning immigration. It is axiomatic that Congress has plenary power over immigration. States can pass laws dealing with immigration, but they must adhere to the standards established by Congress, and cannot impose additional burdens. Based on this scheme, New York argued that it was only following Congress’s lead in restricting its Medicaid program. The plaintiffs argued that the state was going beyond the will of Congress and was, on its own, determining which immigrants would be eligible for the state Medicaid program.
The court reasoned that since the primary reason for federal control over immigration was the need for uniformity. Consequently, the states cannot impose requirements or classifications that are not part of the federal scheme. The federal welfare reform law allowed the states to extend state Medicaid benefits to immigrants not eligible for federal benefits. However, it also allowed the states to withhold state benefits from immigrants who were eligible for federal benefits. The court found that that the federal scheme failed to create uniformity, and that, therefore, the need for uniformity was not seen as important to Congress in passing welfare reform. Because of this, the court found that strict scrutiny was the proper standard of review. Under this standard, the state law failed to meet constitutional standards.
The effect of the decision will be to require New York to extend Medicaid benefits enjoyed by citizens to legal immigrants. New York Governor George Pataki has pledged to do this. He has denounced Congress’s decision to eliminate Medicaid coverage for legal immigrants and has called upon Congress to reverse itself.
Advocates hope that other states will see the New York decision and pass laws extending Medicaid benefits to all legal immigrants, regardless of how long they have been in the US. A number of states, including California, already do so. Other states, including Florida and Texas, extend benefits to all immigrant children, but not to adults. The advocates argue that it is much cheaper to provide continuing medical coverage, especially to people with chronic diseases, than to provide costly emergency room treatment, which must be provided to every person, regardless of their immigration status.
While there appeared to be widespread support for welfare reform in 1996, including the widely held notion that needy immigrants were coming to the US for social services, political support for the harsher provisions of the law is beginning to wane. A number of studies have shown that immigrants are no more likely than citizens to use Medicaid and indeed, welfare reform created so much confusion that many immigrants are failing to take advantage of benefits for which they are eligible. Just last month, the National Governors’ Association urged Congress to restore federal Medicaid benefits to immigrant children and pregnant women.
The opinion is online at http://www.law.cornell.edu/ny/ctap/I01_0059.htm.
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