Pham v. Starkowski

• Decision Date: 05 April 2011
• Docket Number: No. 18582.,18582.
• Citation: 16 A.3d 635,300 Conn. 412
• Court: Connecticut Supreme Court
• Parties: HONG PHAMv.Michael P. STARKOWSKI, Commissioner of Social Services.

300 Conn. 412

16 A.3d 635

HONG PHAM

v.Michael P. STARKOWSKI, Commissioner of Social Services.

No. 18582.

Supreme Court of Connecticut.

Argued Nov. 30, 2010.Decided April 5, 2011.

Hugh Barber, assistant attorney general, with whom, on the brief, were Richard Blumenthal, former attorney general, and Deeona Gaskin, law student intern, for the appellant (defendant).Nicholas P. Yorio, with whom were Susan Garten and, on the brief, Gregory L. Bass, Hartford, for the appellee (plaintiff).Mara Youdelman and Tanya Broder filed a brief for the National Health Law Program et al. as amici curiae.ROGERS, C.J., and NORCOTT, PALMER, ZARELLA, McLACHLAN and EVELEIGH, Js.ZARELLA, J.

This appeal arises from a class action lawsuit filed by the plaintiff, Hong Pham, individually and on behalf of all others similarly situated, against the defendant, Michael P. Starkowski, the commissioner of social services, challenging the constitutionality of Public Acts, Spec. Sess., September, 2009, No. 09–5, §§ 55 ¹ and 64 ² (Spec.Sess. P.A.09–5), which effectively terminated certain state funded medical assistance for members of the class who are all legal immigrants residing in the state, who are in need of publicly funded medical assistance and who have resided in the United States for fewer than five years. The defendant appeals ³ from the judgment of the trial court, which granted the plaintiff's request for class certification and concluded that §§ 55 and 64 of Spec. Sess. P.A. 09–5 violate the equal protection clause of the fourteenth amendment to the United States constitution ⁴ because those sections impermissibly discriminate against the class members ⁵ on the basis of their status as legal aliens. The trial court permanently enjoined the defendant from enforcing the challenged sections of Spec. Sess. P.A. 09–5. On appeal, the defendant claims that the trial court incorrectly concluded that §§ 55 and 64 of Spec. Sess. P.A. 09–5 discriminate against the class members on the basis of alienage. Alternatively, the defendant claims that, if §§ 55 and 64 of Spec. Sess. P.A. 09–5 do discriminate on the basis of alienage, the trial court improperly applied strict scrutiny review in reaching its conclusions because the unique circumstances of this case demonstrate that such discrimination is subject only to a more deferential rational basis standard of review rather than the traditional, more searching strict scrutiny review normally applied to state classifications based on alienage. The plaintiff responds that the trial court correctly concluded that §§ 55 and 64 of Spec. Sess. P.A. 09–5 violate the equal protection clause of the fourteenth amendment and claims, as an alternative ground for affirming the judgment of the trial court, that the challenged sections of Spec. Sess. P.A. 09–5 also violate article first, § 20, of the constitution of Connecticut.⁶ We reverse the judgment of the trial court.

IFACTS, LEGISLATIVE BACKGROUND AND PROCEDURAL HISTORY

The plaintiff and all class members are legal aliens who claim to be in need of publicly funded, nonemergency medical assistance (medical assistance) ⁷ because they are indigent but are ineligible for such assistance through the federal Medicaid program, which bars aliens who have resided in the United States for fewer than five years from participating. Prior to December 1, 2009, the state provided medical assistance to these individuals through the state medical assistance for noncitizens program (SMANC).⁸ See Public Acts, Spec. Sess., June, 1997, No. 97–2, § 146 (Spec.Sess.P.A.97–2), codified as amended at General Statutes (Rev. to 2009) § 17b–257b. In response to budgetary concerns, however, the legislature, in 2009, passed Spec. Sess. P.A. 09–5, which substantially repealed SMANC and altered the statutory eligibility requirements for the state administered general assistance medical program (SAGA-medical), effectively eliminating all state funded medical assistance for the class members as of December 1, 2009. ⁹ The plaintiff claims that this action by the state discriminates against her and the class members on the basis of their status as aliens, in violation of the federal and state constitutions.

The issues presented in this appeal require an examination of a number of state and federal medical assistance programs and a number of state and federal statutory provisions affecting those programs. For this reason, we first set forth an overview of the statutory programs and relevant legislation at issue before turning to the trial court proceedings and our analysis of the specific claims of the parties.

AFederal Medicaid Program

The federal government created the federal Medicaid program through the enactment of Title XIX of the Social Security Amendments of 1965, Pub.L. No. 89–97, § 121, 79 Stat. 286, 343–52, codified as amended at 42 U.S.C. § 1396 et seq. (2006 and Sup. III 2009). Federal Medicaid is an optional federal and state cooperative medical assistance program pursuant to which a state that elects to participate receives federal funding to assist it in providing publicly funded medical assistance to certain groups of indigent individuals who meet eligibility criteria and possess at least one of the categorical eligibility characteristics generally required for coverage.¹⁰ The phrase “categorical eligibility” generally refers to those who are disabled, blind, pregnant, a parent of a dependent child, or an individual under twenty-one years of age or sixty-five years of age or older. See 42 U.S.C. §§ 1396a (a)(10) and 1396d (a) (2006 and Sup. III 2009); see also 42 C.F.R. § 435.100 et seq. (2010). The members of the class all meet the categorical eligibility requirements for federal Medicaid.

Federal law governs the federal Medicaid program and determines the eligibility requirements for that program. See, e.g., K & A Radiologic Technology Services, Inc. v. Commissioner of the Dept. of Health, 189 F.3d 273, 277 (2d Cir.1999). States that adopt federal Medicaid agree to administer the program in accordance with federal law and regulations in order to receive a substantial reimbursement from the federal government to subsidize the cost of the program. See id.; see also 42 U.S.C. § 1396a (a) (2006). Federal Medicaid provides the states certain options for coverage, and each state is required to submit its own plan that outlines the terms of the state's participation in the federal Medicaid program. See 42 U.S.C. § 1396a (a) (2006). The federal government must approve that plan before the state may participate. See 42 U.S.C. §§ 1396 and 1396a (b) (2006 and Sup. III 2009). Although the amount of federal funding varies by state, Connecticut, which, in 1965, authorized the state to participate in the federal Medicaid program; see Public Acts 1965, No. 357, § 1; currently receives a reimbursement from the federal government at a rate of approximately 50 percent of the cost of Connecticut's federal Medicaid program.¹¹ Cf. 42 U.S.C. § 1396d (b) (2006). The General Assembly has charged the defendant with administering federal Medicaid, in accordance with federal laws and regulations. See General Statutes § 17b–260. Until 1996, federal Medicaid provided assistance to many indigent individuals meeting the categorical eligibility requirements without regard to citizenship status or durational residency requirements.

On August 22, 1996, Congress enacted the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Welfare Reform Act), Pub.L. No. 104–193, 110 Stat. 2105, which, as President William J. Clinton put it, was designed to “end welfare as we know it....” (Internal quotation marks omitted.) P. Kilborn & S. Verhovek, “Clinton's Welfare Shift Ends Tortuous Journey,” N.Y. Times, August 2, 1996, p. A1. Title IV of the Welfare Reform Act substantially impacted the provision of public welfare assistance to certain immigrants. See generally 8 U.S.C. § 1601 et seq. (2006 and Sup. III 2009). In enacting the Welfare Reform Act, Congress included several statements regarding national immigration policy indicating that Congress favored self-sufficiency by immigrants, immigrants were applying for and receiving public assistance at greater rates and, through the Welfare Reform Act, Congress intended to discourage immigrants from relying on publicly funded assistance. 8 U.S.C. § 1601 (2006).¹²

Whether an alien is eligible for public assistance depends on a number of factors, including whether the alien entered the country lawfully, the particular legal status under which the alien entered, the date that the alien entered, and the amount of time that the alien has resided in the United States. See 8 U.S.C. §§ 1612, 1613, 1621, 1622 and 1641(b) (2006 and Sup. III 2009). The Welfare Reform Act divides aliens into two groups: qualified and nonqualified aliens. See 8 U.S.C. § 1641(b) (2006) (defining “qualified alien”). Qualified aliens are generally those aliens lawfully admitted to the United States for permanent residence and those admitted pursuant to certain statutes. 8 U.S.C. § 1641(b) (2006). Any alien not considered a qualified alien is a nonqualified alien, which includes illegal aliens. See 8 U.S.C. § 1641(b) (2006). All nonqualified aliens are ineligible for federal public assistance, including federal Medicaid, subject to certain exceptions.¹³ 8 U.S.C. § 1611(a) and (b) (2006). The class members in the present case are all qualified aliens.

The Welfare Reform Act further distinguishes qualified aliens depending on their length of residency in the United States. Any qualified alien who has resided in the United States for five or more years is eligible for federal public assistance. See 8 U.S.C. § 1613(a) (2006). Aliens who have resided in the United States for fewer than five years, however, generally are barred from receiving federal public assistance until they have resided in the United States for five years (five year rule).¹⁴ See 8 U.S.C. §...