You asked for a summary of Aliessa v. Novella, a recent New York Court of Appeals case concerning medical assistance for legal aliens.

SUMMARY

Earlier this month, New York's highest court ruled unanimously that a law denying Medicaid benefits funded solely by the state (“state Medicaid”) to plaintiffs based on their status as legal aliens violates both the state constitution's guarantee of aid to the needy and the state and federal constitutions' Equal Protection clauses (Aliessa v. Novella, 2001 WL 605188 (N.Y. Ct. of App. 2001)).

FACTS OF CASE AND COURT PROCEEDINGS

The 12 plaintiffs filed suit on behalf of legal aliens and non-citizens “permanently residing under color of law” (PRUCOL, an Immigration and Naturalization Service designation for aliens of whom it is aware but has no plans to deport). Their complaint alleges that each has a potentially life-threatening illness and would qualify for state Medicaid except for Section 122 of New York's Social Services Law (§ 122), which bars them from participation for their first five years in the United States. They claimed that this provision deprives them of otherwise available ongoing medical care in violation of (1) the state constitution's guarantee of care for the needy (NY Const., Art. XVII, §1) and (2) equal protection guaranteed by the state and federal constitutions (NY Const., Article XVII, § 3; US Const. Amend. XIV).

The trial court (known in New York as the supreme court) ruled in the plaintiffs' favor, declaring that § 122 violated all of these constitutional provisions. Finding the law classifies New Yorkers based on alienage, the judge analyzed the plaintiffs' equal protection claims under the rigorous “strict scrutiny” standard, which requires the state to show a “compelling need” for the classification and that the law is narrowly tailored to meet this need.

In a different case decided three days later, New York's Appellate Division (the state's lower appeals court), rejected an equal protection challenge to a state law excluding legal aliens from its food assistance program (Alvarino v. Wing, 261 A.2d 255). Finding that the New York legislature enacted the food assistance law in direct response to federal law, the Alvarino court determined that the deferential “rational basis,” rather than strict scrutiny, test was the appropriate standard for judicial review. Under that test, courts must uphold state laws if they bear a rational relationship to a legitimate state interest. The food assistance law met this standard, according to that court.

The Aliessa court withdrew its decision in light of the Alvarino ruling. It allowed the parties to re-argue the case, including the question of whether the state Medicaid law was passed to implement federal welfare reform legislation (the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, PRWORA). It concluded that it was, and applying the rational basis, rather than strict scrutiny test, it found no equal protection violation. But it left intact its holding that § 122 violated the state constitution's guarantee of aid to the needy. The Appellate Division reversed that portion of its decision, finding no constitutional infirmities. The plaintiffs appealed to New York's highest court. On June 5^th, that court announced its decision, finding § 122 to be in violation of all three constitutional provisions.

ANALYSIS

Federal Welfare Reform – Alien Provisions and State Implementation

The high court began its analysis with a review of the Medicaid program and its implementation in New York. It noted that until the passage of PRWORA, the federal welfare reform legislation that severely restricted the eligibility of aliens for a variety of federally-funded public assistance benefits, New York had a long tradition of providing Medicaid to its needy residents, without distinguishing between legal aliens and citizens.

The court then discussed PRWORA's immigrant provisions, contained in Title IV of that law. It quoted from its preamble, in which Congress declared that it had a “compelling interest” in ensuring that aliens did not immigrate to the United States solely to avail themselves of public assistance. With respect to Medicaid, Title IV divides immigrants into two groups: “qualified aliens” (many of whom are permanent residents) and “non-qualified aliens” (including most PRUCOLs). Qualified aliens are further divided in to two sub-categories: those lawfully in the United States on August 22, 1996 (the day PRWORA went into effect) and those arriving later. The late-arrivals are generally ineligible for federally-funded Medicaid (the federal government reimburses most states one-half of their Medicaid expenditures) for five years; non-qualified aliens are ineligible until they become U.S. citizens.

The federal law permits states to impose longer disqualification periods or to exclude non-citizens from their Medicaid programs altogether. It authorizes states to set their own eligibility rules for immigrant participation in state or local means-tested programs, so long as they provide access to emergency medical treatment to both qualified and non-qualified aliens.

New York's § 122 requires legal aliens who entered the United States after August 22, 1996 and PRUCOLs to wait five years before they can qualify for the state Medicaid program. The state provides “safety net” services and emergency medical care during this period.

Constitutional Claims

Aid to the Needy. The court examined the plaintiff's constitutional claims. It looked first at the state constitution's guarantee that “aid, care and support of the needy are public concerns and shall be provided by the state…in such manner and by such means as the legislature…may determine” (NY Const., Art. XVII, Sec. 1). This clause had previously been interpreted as prohibiting the legislature from effectively denying aid to those people whom it had classified as needy by imposing overly burdensome eligibility conditions (Tucker v. Toia, 43 NY2d 1, 8 (1977)) (declaring unconstitutional a rule delaying a minor's eligibility for cash assistance until often-lengthy support proceedings against his parents are concluded)).

The state argued that unlike the rule found unconstitutional in Tucker, the five-year restriction of Medicaid coverage to safety net and emergency medical services was an exercise of its discretion to set levels of assistance. The court rejected this argument, finding that § 122 denies aliens access to ongoing medical care altogether for this five year period, thereby denying them a “basic necessity of life.” In addition, the court distinguished the burden imposed by the five-year bar from legitimate burdens associated with a state's efforts to identify the needy (such as making participation in work activities an eligibility requirement). It found no justification for an eligibility rule that draws a distinction between citizens and non-citizens.

State and Federal Equal Protection. The court moved to the question of whether § 122 also denied the plaintiffs equal protection guaranteed by both the state and federal constitutions. The crucial issue was whether it should apply the strict scrutiny or rational basis test, as the state conceded that it could not justify the law under the stricter standard. The state argued that under U.S. Supreme Court precedents, rational basis was the appropriate test, since § 122 simply implements federal immigration policy set forth in Title IV of PRWORA. The plaintiffs argued that another line of Supreme Court decisions mandated strict scrutiny, because the New York law created classifications based on alienage and Title IV did not insulate it from strict scrutiny because it does not promote uniformity in immigration matters.

The court noted that ordinarily the U.S. Supreme Court uses strict scrutiny to examine laws creating classifications based on alienage. This is because aliens are among the groups of “discrete and insular minorities” that can be shut out of the political processes that ordinarily are used to “bring about the repeal of undesirable legislation.” (see United States v. Carolene Products Co. (304 US 144 (1938)). It cited the landmark case of Graham v. Richardson, in which the Supreme Court used the heightened standard to strike an Arizona law's 15-year residency requirement for aliens participating in a federally-funded disability program the state administered (403 US 365, 372 (1971)).

It also found Graham's reasoning central to its rejection of the state's argument that § 122 was implementing PRWORA's federal immigration policy. The state of Arizona had argued in Graham that its residency rule was “impliedly” authorized by federal law, and thus should pass equal protection muster. The Supreme Court rejected this contention, holding that a federal statute authorizing discriminatory treatment of aliens at state option would “present serious constitutional questions.” That court recognized that the federal government has broad constitutional power to set uniform immigration rules, but “a congressional enactment construed so as to permit state legislatures to adopt divergent laws on the subject of citizenship requirements for federally supported welfare programs would appear to contravene this explicitly constitutional guarantee of uniformity.” (403 US 382 (1971)) The court in the present case cited other Supreme Court precedents distinguishing between state and federal powers to regulate immigration, including the statement in Mathews v. Diaz that “a division by a state of a category of aliens has no apparent justification, whereas, a comparable classification by the federal government is a routine and normally legitimate part of its business (426 US 67, 82 (1976)).

Analyzing PRWORA's immigration provisions in light of Graham and its progeny, the Court of Appeals concluded that Title IV of PRWORA is not a reflection of a uniform national immigration policy. Instead, it leaves the states free to discriminate in their programs – producing not uniformity, but potentially wide variation based on “localized or idiosyncratic concepts of largess, economics, and politics.”

Thus, the court determined that Title IV cannot insulate § 122 from the strict scrutiny review mandated for state laws classifying people based on their alienage. Under that test, it held that the law violated both the state and federal Equal Protection clauses because it denies state Medicaid to otherwise eligible PRUCOLs and lawfully admitted permanent residents based on their status as aliens.