Lewis v. Grinker, 571
| Decision Date | 02 April 1992 |
| Docket Number | No. 571,D,571 |
| Citation | 965 F.2d 1206 |
| Parties | Lydia LEWIS; Andre Francis; Emiline Forbes; Clara Solano; Wilson Flores, Jr., by his next friend Wilson Flores, Sr.; Norah Murphy by her next friend Eileen Broderick; Alberto Colbourne Cattons; Yoshi Nakanishi; Letitia Morgan; Ada Williams, by her next friend Brenda Liaping; Lech Ciesluk; Carlos Gonzalez, by his next friend Rosa Reid Narvaez; Hutton Griffith; Alexander Bernshtein; Celia Teran; Patricia Arias, by her next friend Phyllis Attale; Carla Coe, on behalf of themselves and all other persons similarly situated, Plaintiffs-Appellees, City of New York and New York City Health and Hospitals Corporation, Plaintiff-Intervenor, v. William GRINKER, individually and as Commissioner of the New York City Department of Social Services; Cesar Perales, individually and as Commissioner of the New York State Department of Social Services; Alice Amrheim, individually and as Commissioner of the Suffolk County Department of Social Services; Richard N. Durose, individually and as Commissioner of the Oneida County Department of Social Services, Defendants, Louis W. Sullivan, M.D., Secretary of the United States Department of Health and Human Services, Defendant-Appellant. ocket 91-6176. |
| Court | U.S. Court of Appeals — Second Circuit |
Colin Bull, Attorney-in-charge, Lynn M. Kelly, Director of Litigation, The Legal Aid Soc., Harlem Neighborhood Office, New York City (Jane E. Booth, Director of Litigation, Richard Blum, of counsel, The Legal Aid Soc., Civil Appeals & Law Reform, Nancy Morawetz, Washington Square Legal Services, New York City for plaintiffs-appellees.
O. Peter Sherwood, Corp. Counsel of the City of New York (Pamela Seider Dolgow, Elizabeth S. Natrella, Hilary B. Klein, New York City, of counsel) for plaintiffs-intervenors-appellees.
Robert Abrams, Atty. Gen. of the State of N.Y. (Marion R. Buchbinder, Asst. Atty. Gen., New York City, of counsel) for defendant-appellee.
Charles S. Kleinberg, Asst. U.S. Atty., E.D.N.Y. (Andrew J. Maloney, U.S. Atty., Robert L. Begleiter, Warren D. Ausubel, Asst. U.S. Attys., E.D.N.Y.) for defendant-appellant.
Cary LaCheen and Herbert Semmel, New York Lawyers for the Public Interest, Inc., New York City, filed a brief amicus curiae on behalf of the American College of Obstetricians and Gynecologists, the American Medical Ass'n, the American Public Health Ass'n, the Greater New York March of Dimes Birth Defect Foundation, the New York State Perinatal Ass'n, the New York State Before: OAKES, Chief Judge, and FEINBERG and WALKER, Circuit Judges.
Public Health Ass'n, and the Public Health Ass'n of New York City.
Eleven years ago, plaintiffs, a group of aliens living in New York, initiated this In this appeal, we are called upon to decide only a single narrow question. Did Congress, in enacting the Omnibus Budget Reconciliation Act of 1986, P.L. 99-509, 100 Stat. 1874 (OBRA '86), intend to prevent otherwise eligible pregnant women who are residing in this country without the approval of the Immigration and Naturalization Service (INS) from receiving Medicaid sponsored prenatal care, even though their children, if born in the United States, will become United States citizens? After reviewing the language of the statute, the legislative and statutory background, and the relevant administrative interpretations, we conclude that Congress did not intend to bar these women from receiving Medicaid sponsored prenatal care. Accordingly, we affirm the permanent injunction issued by the district court.
lawsuit on behalf of themselves and all similarly situated persons seeking to enjoin the Secretary of Health and Human Services (the Secretary) from denying them Medicaid coverage based on their alienage status. Since the suit was filed, the Medicaid statute has been amended in relevant ways five times, the district court has issued three different injunctions and four separate opinions, the Secretary has announced a host of new regulations, and yet questions persist about the precise contours of aliens' entitlement to Medicaid coverage
In order to understand the complex question presented by this appeal, it is necessary to explore in some depth the structure of the Medicaid statute, the development of Medicaid coverage for prenatal care, and the origins of the alienage restriction at issue here.
Originally enacted in 1965, Medicaid is a "cooperative federal/state cost-sharing program designed to enable participating states to furnish medical assistance to persons whose income and resources are insufficient to meet the costs of necessary medical care and services." DeJesus v. Perales, 770 F.2d 316, 318 (2d. Cir.1985), cert. denied, 478 U.S. 1007, 106 S.Ct. 3301, 92 L.Ed.2d 715 (1986). In order to provide Medicaid coverage to its citizens, a state must first adopt a state Medicaid plan and submit the plan for approval by the Secretary. Once the state plan is approved, the federal government will partially reimburse the state for expenditures made pursuant to the state plan.
The Act authorizes state plans to extend coverage to two basic categories of individuals, the categorically needy and the medically needy. As the district court explained in Lewis v. Gross, 663 F.Supp. 1164, 1174 (E.D.N.Y.1986) (Lewis I ), "[r]oughly speaking, the categorically needy are those who earn no more than that necessary to cover the necessities of life; the medically needy differ in that it is only the expense of necessary medical care that strains their ability to pay for basic necessities." The Medicaid statute provides a complex set of standards for the way that participating states must provide coverage to categorically and medically needy individuals.
First, 42 U.S.C. § 1396a(a)(10)(A)(i) requires participating states to provide Medicaid to a sub-group of the categorically needy, the "mandatory categorically needy." This group is mostly made up of those already receiving some other government benefit, such as aid to families with dependent children (AFDC), or supplemental security income (SSI). Women who meet the statutory definition of "qualified pregnant women" are also considered mandatory categorically needy. § 1396a(a)(10)(A)(i)(III).
Second, § 1396d(a)(i) defines a group of categorically needy individuals to whom the state may, at the state's option, choose to provide Medicaid coverage. "Generally speaking ... the optionally needy subgroup includes minors, the elderly, the blind, the disabled, pregnant women, [and] the spouses of SSI recipients or AFDC-related caretaker relatives, if they are 'needy' according to the income and resource requirements of the AFDC and SSI Third, the medically needy category includes the same groups of individuals that the states may cover as optional categorically needy, but applies less stringent financial and resource requirements. While medically needy coverage is generally optional with the states, once a state chooses to provide coverage to some medically needy individuals, it must provide, inter alia, prenatal and delivery services to medically needy pregnant women. § 1396a(a)(10)(C)(ii) & (iii).
cash benefit programs." Lewis I, 663 F.Supp. at 1177.
Under current law, pregnant women seeking prenatal care may be eligible for Medicaid under any of the three categories, depending on their financial status. However, this was not always the case. Before 1981, pregnant women were not even identified as a special eligibility group under the Medicaid statute. Instead, states simply had the option to extend prenatal care directly to the fetus, under the assumption that fetuses were optional categorically needy as "persons under the age of 21." In order to assess properly Congressional intent in enacting the immigration restriction of OBRA '86, it is first necessary to examine more carefully this shift from a fetal centered to a maternal centered approach to prenatal care.
Before the Medicaid statute was enacted in 1965, federal sponsorship of prenatal care came largely under AFDC. AFDC required participating states to provide benefits to needy, dependent children. Federal law defined a "dependent child" as:
a needy child (1) who has been deprived of parental support or care by reason of death, continued absence from the home, or physical or mental incapacity of a parent, and who is living with [relatives] ..., in a place of residence maintained by one or more such relatives as his or their own home, and (2) who is (A) under the age of eighteen or (B) under the age 21 and ... a student.
42 U.S.C. § 606(a) (1976).
Beginning in the 1940's, the Department of Health, Education, and Welfare (HEW) reimbursed those states that chose to provide AFDC benefits to fetuses as dependent children.
Until 1975 it was unclear whether federal reimbursement for state AFDC expenditures to fetuses was mandatory because fetuses were dependent children within the definition of § 606(a) or simply optional with the Secretary pursuant to his "general authority to make rules for the efficient administration of the Act." Burns v. Alcala, 420 U.S. 575, 584, 95 S.Ct. 1180, 1186, 43 L.Ed.2d 469 (1975).
In Burns, the Supreme Court ruled that fetuses were not dependent children within the meaning of the AFDC statute and thus the states were not required to provide AFDC to pregnant women. The court viewed the question of whether the states retained the option of treating fetuses as dependent children as not properly presented in the case but suggested that HEW could authorize optional coverage of pregnant women under AFDC via its general regulatory powers.
Between 1975 and 1981, HEW continued to allow states the option of treating fetuses as dependent children in order to provide AFDC to pregnant women. However, the Secretary never adopted...
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