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From Health Law Daily, April 29, 2014

Termination of MaineCare for ineligible aliens not a constitutional violation of rights

By Melissa Skinner, JD

The termination of MaineCare, Maine’s Medicaid programs, to certain aliens that are ineligible for federally-funded Medicaid was not a violation of constitutional rights under the equal protection clause. The First Circuit affirmed a district court’s refusal to grant a preliminary injunction for aliens in Maine whose benefits were termination based on the finding that the matter would not succeed on the merits. Previously, MaineCare made medical benefits available to aliens that were made ineligible for federally- funded Medicaid by Congress with the implementation of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) (P.L. 104-193). The challenge of the termination of state-based benefits to aliens was rejected because the aliens who lost their benefits could not prove they had been treated differently than similarly situated individuals since the court found that the two programs—one that provided traditional Medicaid benefits to citizens and one that provided state-based benefits to PRWORA ineligible aliens—were separate and distinct (Bruns v Mayhew, April 28, 2014, Howard, J).

PRWORA. In 1996, Congress passed PRWORA, which had the effect of restricting certain ineligible aliens from obtaining Medicaid funds, including those which did not meet a five-year residency requirement. While the federal government mandated that states adopt the PRWORA limitations with regard to federal Medicaid funds, it allowed states to continue to extend benefits to those ineligible under PRWORA with state funds.

MaineCare. In 1997, Maine passed a law which extended state-funded medical benefits to aliens that were excluded from receiving traditional Medicaid under PRWORA. The benefits were purely state funded but were administered through MaineCare alongside the distribution of federally funds to citizens. In 2011, the Maine legislature terminated the extension of these state-funded benefits, which essentially repealed the 1997 law.

Challenge. Hans Bruns and Kadra Hassan filed suit against Maine’s Department of Health and Human Services and its Commissioner, Mary Mayhew, in her official capacity (DHHS) challenging the termination of the extension of benefits to PRWORA-exempted aliens. Specifically, Bruns and Hassan alleged that the termination of the benefits constituted a violation of the equal protection clause in that it provided for the continuation of benefits to citizens but terminated the availability of those benefits to certain aliens, who were similarly-situated individuals. The district court denied Bruns and Hassan’s request for a preliminary injunction finding that the matter was unlikely to succeed on its merits and that they had not established a potential for irreparable harm. The district court found that MaineCare “effectively operated two separate medical assistance programs and that the… PRWORA-ineligible aliens receiving separately-funded benefits from a state program, were not similarly situated to recipients of federal Medicaid.”

Preliminary Injunction. The First Circuit agreed with the district court’s reasoning and affirmed its denial of the preliminary injunction based on the analysis that revealed the PRWORA-ineligible aliens were not similarly situated individuals because MaineCare maintained separate and distinct programs. The court noted that typically any classification based on alienage is suspect and must withstand strict scrutiny. Yet strict scrutiny did not apply in this scenario because: (1) PRWORA was a congressional act that distinguished on the basis of alienage and was predicated on immigration policy and (2) the court agreed with the separate and distinct programs under MaineCare that excluded the termination of benefits to aliens from scrutiny because the citizens and aliens were not considered similarly situated individuals. Although Bruns and Hassan argued that MaineCare was a single-state health care program, the court ultimately found that the public perception and common administration of MaineCare as a single program was not indicative of its true nature. Thus, when Maine terminated the benefits to PRWORA exempt aliens it only deprived those recipients and no other individuals retained those benefits. As such, the First Circuit affirmed the denial of the preliminary injunction and remanded to the district court for dismissal. Similarly, the Ninth Circuit recently ruled that the equal protection rights of “nonimmigrant aliens” were not violated when Hawai’i created a health benefit plan with fewer benefits for the class.

The case number is 13-1456.

Attorneys: Jennifer A. Archer (Kelly Remmel & Zimmerman) for Hans Bruns. Justin B. Barnard, Maine Attorney General's Office, for Mary C. Mayhew in her official capacity.

Companies: Maine Department of Health and Human Services

MainStory: TopStory EligibilityNews MedicaidNews CMSNews CoverageNews MaineNews MassachusettsNews NewHampshireNews PuertoRicoNews RhodeIslandNews

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