Guaman v. Velez

Decision Date13 August 2013
Citation432 N.J.Super. 230,74 A.3d 931
PartiesManuel GUAMAN, Maria Guaman, Nadia Chery, Deyinira Valenzuela, Rosa Rodriguez and Keithion Blake, Plaintiffs–Appellants, v. Jennifer VELEZ, Commissioner of New Jersey Department of Human Services and John Guhl, Director of Medical Assistance and Health Services, Defendants–Respondents.
CourtNew Jersey Superior Court

OPINION TEXT STARTS HERE

Jennifer B. Condon argued the cause for appellants (Seton Hall University School of Law Center for Social Justice and Gibbons, P.C., attorneys; Lawrence S. Lustberg, Newark, of counsel and on the brief; Ms. Condon and Rachel Lopez, on the brief).

Melissa H. Raksa, Assistant Attorney General, argued the cause for respondents (Jeffrey S. Chiesa, Attorney General, attorney; Ms. Raksa, of counsel and on the brief; Dianna Rosenheim, Deputy Attorney General, on the brief).

Judah Skoff argued the cause for amicus curiae New Jersey Appleseed Public Interest Law Center; New Jersey Policy Perspective; New Jersey Citizen Action; State Parent Advocacy Network; Family Voices of New Jersey; Next Step; New Jersey Working Families Alliance; Blue Wave; South Jersey Chapter of the National Organization of Women; The Unitarian Universalist Legislative Ministry of New Jersey; The Lutheran Office of Governmental Ministry in New Jersey; Latino Action Network; and Democracia (McCarter & English, LLP, attorneys; John C. Kelly and Mr. Skoff, Newark, of counsel and on the brief).

Ronald K. Chen argued the cause for amicus curiae American Civil Liberties Union of New Jersey (Rutgers Constitutional Litigation Clinic Center for Law & Justice, attorney; Mr. Chen, Trenton, on the brief).

Before Judges REISNER, YANNOTTI, and HARRIS.

The opinion of the court was delivered by

REISNER, P.J.A.D.

The issue in this case is whether, consistent with the United States Constitution and the New Jersey Constitution, the State may eliminate state-funded Medicaid benefits for adult legal permanent resident aliens who do not qualify for federally-funded Medicaid benefits, i.e., adult legal aliens who do not meet the federal five-year residency requirement set forth in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), 8 U.S.C.A. § 1601 to 1646.3In a prior opinion denying plaintiffs' application for preliminary injunctive relief, we found they were unlikely to prevail on the merits of their constitutional claims. Guaman v. Velez, 421 N.J.Super. 239, 23 A.3d 451 (App.Div.2011)( Guaman I ). We agree with the legal analysis in Guaman I, and this opinion is intended to be read together with Guaman I. Based on that analysis, and the additional reasoning set forth in this opinion, we conclude that the State's action is consistent with both the Federal and State Constitutions, and we affirm.4

The State's limitation on benefits to aliens is based on PRWORA, which imposed a five-year residency requirement before most permanent legal aliens could qualify for Medicaid. The federal limits were succinctly described in A.B. v. Div. of Medical Assist. & Health Servs., 407 N.J.Super. 330, 343, 971 A.2d 403 (App.Div.), certif. denied,200 N.J. 210, 976 A.2d 386 (2009): 5

In 1996, Congress enacted legislation that had a profound effect upon aliens' access to medical benefits. [PRWORA] was designed to reduce the impact of “aliens ... applying for and receiving public benefits from Federal, State, and local governments at increasing rates.” 8 U.S.C.A. § 1601(3). PRWORA “imposes several limitations on the availability of Medicaid benefits to aliens.” Soskin v. Reinertson, 353 F.3d 1242, 1245–46 (10th Cir.2004).

There are two classes of aliens: “qualified aliens” and “unqualified aliens.” The definition of “qualified aliens” includes, among others, aliens who were “lawfully admitted for permanent residence under the Immigration and Nationality Act.” 8 U.S.C.A. § 1641(b)(1)-(4). “Unqualified aliens” are all aliens who do not fall within the definition of “qualified aliens.” Id. at § 1611(a). Only qualified aliens are eligible for most federal means-tested public benefits. Soskin, supra, 353 F.3d at 1245; 8 U.S.C.A. § 1611(a).

Qualified aliens entering the United States on or after August 22, 1996, are “not eligible for any Federal means-tested public benefit for a period of 5 years beginning on the date of the alien's entry into the United States,” 8 U.S.C.A. § 1613(a), unless they were receiving benefits as of that date, in which case the states were required to continue their benefits until January 1, 1997, id. at § 1612(b)(2)(D).

As we summarized in Guaman I, supra, 421 N.J.Super. at 250, 23 A.3d 451 the State initially responded to PRWORA by excluding legal aliens from the Medicaid program unless they satisfied the Federal five-year residency requirement. See N.J.S.A. 30:4D–3; L. 1997, c. 352; Assembly Appropriations Committee Statement to Senate Bill No. 2170. The State expanded coverage in 2005 to delete the five-year requirement, based on the Legislature's findings that limiting State subsidized healthcare coverage had resulted in increased costs for emergency hospital charity care. Id. at 251, 23 A.3d 451;N.J.S.A. 30:4J–9e.

In 2010, in response to a budget crisis, the State reinstated the five-year residency requirement for most adult legal aliens. However, the State continued to provide coverage for legal aliens who were pregnant women or children under the age of nineteen, and existing enrollees who were receiving treatment for life threatening illnesses or were receiving on-going life sustaining treatment. As part of the economic cut-backs, the State also closed the NJ Familycare program to all adults “whose benefits are not funded or payable under Title XIX of the Social Security Act.” N.J.A.C. 10:78–1.1(a).

In Guaman I, we recognized that ordinarily, alienage is a suspect classification, and discrimination against aliens must be justified under a strict scrutiny standard of review. Guaman I, supra, 421 N.J.Super. at 262, 23 A.3d 451. However, we also acknowledged that due to Congress's broad constitutional power over immigration, the rational basis standard of review applies to Congressional enactments affecting immigrants, and to State enactments authorized by a uniform federal policy:

Even though lawful immigrants comprise a suspect class otherwise triggering strict scrutiny analysis, the Supreme Court applies a dichotomized standard of review. Because of the federal government's plenary power to regulate immigration, classifications based on alienage in federal programs are subject to rational basis review. Mathews v. Diaz, 426 U.S. 67, 85–87, 96 S.Ct. 1883, 1894–95, 48 L.Ed.2d 478, 493–94 (1976). Because the states lack plenary power over immigration policy, similar classifications in a State's benefits programs are subject to strict scrutiny. [Graham v. Richardson, 403 U.S. 365, 376, 91 S.Ct. 1848, 1854, 29 L.Ed.2d 534, 544 (1971).]

Therefore, despite the federal government's broad power over immigration and naturalization, Congress does not have the power to authorize the individual States to violate the Federal Equal Protection Clause. Graham, supra, 403 U.S. at 382, 91 S.Ct. at 1857, 29 L.Ed.2d at 548 (emphasis added);.... However, “if the Federal Government has by uniform rule prescribed what it believes to be appropriate standards for the treatment of an alien subclass, the States may, of course, follow the federal direction.” Plyler, supra, 457 U.S. at 219 n. 19, 102 S.Ct. at 2396 n. 19, 72 L.Ed.2d at 800–01 n. 19 (citing De Canas v. Bica, 424 U.S. 351, 96 S.Ct. 933, 47 L.Ed.2d 43 (1976)).

[Id. at 262–63, 23 A.3d 451 (quoting Plyler v. Doe, 457 U.S. 202, 102 S.Ct. 2382, 72 L.Ed.2d 786 (1982)).]

Noting the difficulty in determining whether Congress had adopted a “uniform policy” with respect to the five-year eligibility requirement, we nonetheless were persuaded that the State scheme was likely to pass constitutional muster. We found convincing the rationale expressed in Soskin v. Reinertson, 353 F.3d 1242 (10th Cir.2004):

[I]n Soskin v. Reinertson, [ supra, 353 F.3d at 1244] the court applied a rational basis standard in reviewing equal protection challenges to a Colorado law that repealed jointly funded Medicaid coverage to otherwise legal aliens. The Soskin court determined that that case fell somewhere between Graham and Mathews, because unlike the state statute at issue in Graham, PRWORA provided specific Congressional authorization for the state's action, and unlike Mathews, it involved a state-administered program. Id. at 1255. The court noted:

Some benefits for aliens are required, some are prohibited. In between, the states are permitted to be more restrictive (or, depending on one's point of view, more generous). Relying on Graham, one could say, as Plaintiffs do, that when a state elects not to provide aliens with the maximum benefits permitted by federal law, it is discriminating against aliens and the federal government's imprimatur for such discrimination cannot reduce the level of scrutiny to which the state's choice is subjected under the Equal Protection Clause....

We do not share that view. The reason for applying rational-basis review to federal law regarding aliens is that such laws reflect national policy that Congress has the constitutional power to enact. Once Congress has expressed that policy, the courts must be deferential. What Plaintiffs fail to consider is that a state's exercise of discretion can also effectuate national policy. Recall that the PRWORA does not give the states unfettered discretion. Some coverage must be provided to aliens; some coverage is forbidden. State discretion is limited to the remaining optional range of coverage. In exercising that discretion each state is to make its own assessment of whether it can bear the burden of providing any optional coverage. When a state determines that the burden is too high and decides against optional coverage,...

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