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From Health Law Daily, August 14, 2013

Withdrawal of state-funded assistance from nonqualifying aliens upheld

By Michelle L. Oxman, JD, LLM

The New Jersey legislature could properly terminate a program funded entirely by the state that provided health benefits to noncitizens with less than five years’ lawful residence in the United States (Guaman v Velez, August 13, 2013, Reisner, S). The legislature was simply exercising power given to it by Congress to further federal policy concerning immigration.

Federal distinction. Before enactment of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) (PL 104-193), federal benefits such as cash assistance and Medicaid were available to noncitizens who were lawful residents of the United States if they met the eligibility requirements. PRWORA implemented a congressional policy to promote individual responsibility and self-sufficiency by requiring five years of continuous residence in the United States as a condition of eligibility for assistance. Congress allowed the states to provide Medicaid benefits to children, their parents, and pregnant women with less than five years’ residence in 2009 in the Children’s Health Insurance Program Reauthorization Act (CHIPRA) (P.L. 111-3).

The New Jersey program. After enactment of PRWORA, the New Jersey legislature amended its laws to exclude noncitizens who were not eligible under federal law. However, in 2005, the legislature found that the costs of charity care had risen substantially because of the bar to Medicaid eligibility for the first five years that noncitizens lawfully reside in the United States. Therefore, the state provided medical assistance to noncitizens who met all federal eligibility requirements except for five years’ residence; the state paid for the program entirely with state funds.

In 2010, the state suffered a budget shortfall, and the legislature reinstated the bar to Medicaid coverage for most noncitizen adults during the first five years of residence. Children, pregnant women, and certain adults with life-threatening illnesses continued to receive the state-funded assistance. The state also closed another medical assistance program, NJFamilycare, to all adults who were not eligible for federal Medicaid funding. This group included both noncitizens and citizens.

The litigation. Individuals who had been eligible under the 2005 state legislation challenged the 2010 law as unlawful discrimination against noncitizens in violation of the Equal Protection Clause of the Fourteenth Amendment to the United States Constitution. In 2011, the Appellate Division had upheld the state legislation and denied an injunction that would have required the agency to restore benefits. The court rejected the plaintiffs’ argument that discrimination against noncitizens should be reviewed with the strict scrutiny required with racial discrimination and other suspect classifications.

The ruling. In the current decision, made after trial on the merits, the court maintained its original decision and the reasoning behind it. Because the constitution gives Congress specific authority to address issues of immigration, the New Jersey courts must defer to its decisions in matters of immigration policy, including the rights of lawful residents who are not yet citizens. Therefore, the law must be upheld if it is rationally related to the federal purpose.

The court found that Congress had made a policy choice to encourage self-reliance and independence by barring immigrants from receiving federal benefits during their first five years of lawful residence. A state that enacts laws consistent with the federal policy toward immigrants by giving immigrants no greater rights than they have under federal law does not violate the Equal Protection Clause. The court rejected the argument that terminating optional assistance was different constitutionally from denying assistance initially.

The case number is A-1870-10T2.

Attorneys: Melissa H. Raksa, Assistant Attorney General, for Jennifer Velez, Commissioner of New Jersey Department of Human Services.

Companies: New Jersey Department of Human Services

MainStory: TopStory EligibilityNews MedicaidNews NewJerseyNews

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