FEDERAL COURT UPHOLDS MEDICAID RESTRICTIONS FOR UNDOCUMENTED IMMIGRANTS
This
week the Second Circuit Court of Appeals issued a decision in a case pending for
more than 20 years dealing with restrictions on the ability of undocumented
immigrants to receive publicly funded prenatal care.
The case, initially filed in 1979, challenged a regulation issued by the
Department of Health, Education and Welfare (since split into the Departments of
Education and Health and Human Services) denying all Medicaid benefits to
undocumented immigrants.
Since the case was first filed, a number of significant changes have been made
to the Medicaid system. In 1981,
Congress authorized state’s to provide Medicaid funds to all pregnant women,
regardless of their immigration status. In
1984, Medicaid coverage for pregnant women was made mandatory, regardless of the
woman’s immigration status. In
1986, a judge in this case ruled that the 1979 regulation denying Medicaid
benefits to undocumented immigration violated the Medicaid statute and issued an
injunction prohibiting its implementation. Shortly after this ruling, Congress amended the Medicaid
statute to bar undocumented immigrants from Medicaid coverage except in cases of
a medical emergency.
In 1996, Congress passed a sweeping welfare reform act, which severely limited
the ability of all noncitizens to obtain federal public benefits.
The exception for emergency care was retained.
However, in a report accompanying the bill, Congress stated that it did
not intend emergency care to include pre-natal or delivery care.
It also eliminated automatic Medicaid coverage at birth once the children
were born. After this law was
passed, the Department of Health and Human Services sought to have the
injunction reversed.
The judge agreed that Congress clearly intended to bar undocumented expectant
mothers from Medicaid, and so proceeded to rule on the constitutionality of that
action. He found that at least some
of the mothers who formed the class action suit could assert the rights of their
unborn children, who would be US citizens, and that the children were harmed by
this outcome, only because of the status of their mother.
The court found that this outcome could not be justified and violated the
Equal Protection Clause of the Constitution.
The Second Circuit first established as facts that the children of mothers who
do not receive proper prenatal care generally have health problems throughout
their lives, and that it is much more cost effective to provide prenatal care
than a lifetime of intensive medical treatment. Despite this, the court found that Congress clearly intended
to, and could, constitutionally deny Medicaid benefits to pregnant women not in
the US legally.
The class members made two primary arguments against the constitutionality of
the Medicaid restriction, first that it was unconstitutional as applied to them,
and second that it was unconstitutional as applied to their unborn children who
would be US citizens. On the first
claim, because of the broad power Congress has over immigration law, there only
had to be a rational basis for its decision to exclude undocumented expectant
mothers from Medicaid coverage. Because
Congress sought to eliminate a possible incentive for undocumented immigration
by denying welfare benefits, the restriction was found constitutional.
The plaintiffs argued that their as yet unborn children would be able to assert
a claim seeking compensation for the denial of prenatal care after they were
born. The court found this argument
without merit, based on the fact that Roe v. Wade declared that a fetus
does not have a constitutional right to be born. The court found this position logically extended to the
proposition that the fetus has no constitutional right to better prospects of
good health after birth. Because
the harm occurs before the child becomes a person as recognized under the
Fourteenth Amendment, before there could be an Equal Protection violation, the
court found it was not actionable.
The plaintiffs also challenged the automatic denial of Medicaid coverage to
their US citizen children once they were born.
Under a 1984 change to the Medicaid statute, all children whose mothers
qualified for Medicaid were automatically qualified for one year.
Because undocumented mothers of US citizen children could not qualify for
Medicaid, the children were denied Medicaid benefits.
The children could still qualify, but because it is not automatic, it
requires forms to be filled out and eligibility requirements to be met.
The Second Circuit found that this restriction caused harm to the US
citizen children.
While the court was not unanimous in the reasoning used to reach the decision,
it found that the denial of automatic Medicaid eligibility to the US citizen
children of undocumented mothers was a denial of Equal Protection.
It remanded the case to the district court judge to modify the
injunction.
The court’s opinion will have a huge impact on the Medicaid programs in the
states in its jurisdiction – New York, Vermont and Connecticut – but the
court said little about the form the changes should take. Its only comment was that “because the alien mother, unlike
the citizen mother, cannot obtain Medicaid coverage for herself prior to giving
birth, it seems likely that the Secretary will have to adopt some procedure
permitting the alien mother, during her pregnancy, to apply for and obtain a
Medicaid number for her child that is automatically effective upon the child’s
birth.
It is estimated that in New York alone more than 13,000 babies a year will be
denied prenatal care. Under the
previous injunction, the federal government reimbursed the state for about 50
percent of the costs of its prenatal Medicaid program, which was offered based
only on income, without regard to immigration status. Officials with the state are concerned that without federal
reimbursement, it will not be able to continue to offer the program to
undocumented women.
Without prenatal care, the cost to the state will also rise substantially.
The cost for prenatal care for 13,000 births last year was about $15.5
million, of a total Medicaid budget of $30 billion.
The average healthy birth cost $1,200, while the cost of a low birth
weight baby of a woman who did not receive adequate prenatal care is anywhere
from $10,000 to $65,000. This does
not include the potential cost associated with a lifetime of medical care.
In the wake of the Second Circuit’s decision, New York State legislators were
examining ways to continue to provide prenatal care to all women in the state,
regardless of their immigration status. One
possible proposal is to provide the care using exclusively state funds, as do
other states, like California.
One interesting side note to the case is that the Second Circuit raised the
issue of Roe v. Wade itself, without either of the parties addressing the
seminal abortion case. Lawyers say
that the Supreme Court could use this case to re-examine Roe.
Indeed, lawyers for the class say they are having a hard time deciding
whether to appeal the case because of the implications for Roe.
INS
TO BEGIN PREMIUM PROCESSING PROGRAM THIS SUMMER
SISKIND'S IMMIGRATION BULLETIN