Supreme Court: State can cut medical benefits to legal noncitizens

The Connecticut Supreme Court has ruled that the state can cut off medical assistance to legal noncitizens who have been in the country fewer than five years, clearing the way to implement a 2009 budget cut that had been stalled because of legal action.

Since the 1996 federal welfare reform law, states have been prohibited from providing Medicaid coverage to noncitizens who had lived in the country fewer than five years. Beginning in 1997, Connecticut provided coverage with state funding to legal noncitizens who met the qualifications for Medicaid except for not having been in the country long enough.

But in 2009, lawmakers attempting to trim the budget effectively eliminated the coverage. More than 4,800 people lost their medical benefits.

Attorneys with Greater Hartford Legal Aid filed a class action lawsuit, arguing that the change violated the noncitizens’ right to equal protection. Superior Court Judge Grant Miller agreed, ruling in December 2009 that sections of the law were unconstitutional and that the plaintiffs “will suffer irreparable harm if they are denied access to health benefits.” He issued an injunction and the state reinstated the medical assistance program.

But the state Supreme Court disagreed, and in a unanimous ruling released this week, directed the trial court to rule for the state. Because the medical assistance program served only noncitizens, eliminating it did not leave the state providing a benefit to citizens that it denied to noncitizens, the court ruled.

The program currently covers 3,700 people. Funding for it is not included in Gov. Dannel P. Malloy’s proposed budget for the next two fiscal years.

Plaintiff attorneys plan to file a motion asking the court to reconsider the case. They could also attempt to bring the case to the U.S. Supreme Court, but have not decided whether to pursue it, said Nicholas Yorio, one of the plaintiff attorneys.

“Obviously we’re very concerned about the clients,” Yorio said. “They’re individuals who are either elderly, blind, disabled, all likely to have medical needs.”

State lawmakers could also act to preserve the coverage, Yorio said, although he acknowledged that the state’s budget deficit makes it a difficult time to ask for money for a program.

“These people are a group that relies on that safety net, and for whom the safety net probably was designed,” he said. “They’re people who have very limited income, little or no assets, and who have these medical needs that can become very serious things, very serious conditions and very significant emergencies.”

“Our clients are here legally, they live in Connecticut, they work here, they pay taxes, they go to school here,” he added. “They are full members of our Connecticut society, except that they can’t vote.”

Before the 2009 law change, legal noncitizens who could not receive Medicaid could get medical assistance through two different programs. State Medical Assistance for Noncitizens, or SMANC, offered coverage to people who were needy, had been in the U.S. fewer than five years, and were either over 65, under 21, the parent of a dependent child, pregnant or disabled.

Legal noncitizens could also get coverage through the state-administered general assistance program, or SAGA, which provided coverage to people who were ineligible for Medicaid.

The 2009 law changed that. It eliminated SMANC for all but people receiving home care or living in nursing homes, although children and pregnant women were able to maintain coverage. The law also changed the requirements for SAGA so it would not be open to people whose only reason for not receiving Medicaid was how long they were in the country.

The lawsuit argued that eliminating SMANC and excluding the plaintiffs from SAGA violated the Equal Protection clauses of the state and U.S. constitutions by discriminating against them because they are noncitizens.

Attorneys for the state argued that because the SMANC did not provide benefits to citizens, eliminating it would not treat citizens and noncitizens differently.

But Miller, the Superior Court judge, ruled that the law distinguished between citizens and non-citizens.

A key issue in the case was the standard the court should use to evaluate the law. Attorneys for the state argued that the law should be allowed as long as it was rationally related to a government purpose. But Miller ruled that it must meet a higher standard, under which a law is only permissible if it is necessary for a “compelling state interest.” The need for government cost savings does not meet that standard, he wrote.

The Supreme Court avoided the question of what standard to use because it ruled that the law did not treat citizens and noncitizens differently since SMANC was never available to citizens. Justice Peter T. Zarella wrote the opinion.

Plaintiff attorneys argued that since the state provides Medicaid to citizens, it has to provide an equal level of assistance for noncitizens.

But the court ruled that it was improper to compare Medicaid, which is funded by both the federal and state governments, to a state-funded program. It also said the plaintiffs’ reasoning would require the state to provide state-funded coverage to people ineligible for Medicaid because of how long they have been in the country.

“Essentially, the plaintiff argues that, when the federal government rendered the class members ineligible for federal Medicaid through the passage of the Welfare Reform Act, the equal protection clause required, and still requires, the state to provide a level of assistance to the class members that is equivalent to the level of assistance that citizens continue to receive under federal Medicaid,” Zarella wrote. “…We disagree.”