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
The plaintiff and all class members are legal aliens who claim to be in need of publicly funded, nonemergency medical assistance (medical assistance)
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.
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.
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.
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).
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
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).
In response to the federal government's adoption of the five year rule in the Welfare Reform Act, this state, in 1997, created SMANC, a state funded program that afforded medical coverage exclusively to qualified aliens who otherwise were categorically eligible for federal Medicaid but who were barred from participating in federal Medicaid because of the federal five year rule. Spec. Sess. P.A. 97-2, § 146. Essentially, SMANC covered those indigent aliens who otherwise met the categorical eligibility requirements for federal Medicaid because they were blind, disabled, pregnant, a parent of a dependent child, or under the age of twenty-one or sixty-five years of age or older, but who lost their federal Medicaid coverage as a result of the federal five year rule. Because SMANC covered only this subgroup of aliens, no citizens and no aliens who had resided in the United States for five or more years could participate in SMANC. See General Statutes (Rev. to 2009) § 17b-257b. Prior to the adoption of Spec. Sess. P.A. 09-5, § 64, SMANC provided coverage similar to that provided by federal Medicaid but was administered and funded exclusively by the state. In response to budget concerns in 2009, the legislature
In addition to federal Medicaid, state law provides for a separate, state medical assistance program, commonly referred to as SAGA-medical, which provides coverage for certain categories of indigent individuals who do not meet the categorical eligibility requirements for federal Medicaid. See General Statutes § 17b-192 (a). Before the legislature enacted Spec. Sess. P.A. 09-5, the SAGA-medical statute provided that coverage under that program would be available to "persons ineligible for [federal] Medicaid." General Statutes (Rev. to 2009) § 17b-192 (a). Through the enactment of Spec. Sess. P.A. 09-5, § 55, the legislature altered the statutory eligibility requirements for SAGA-medical such that it currently provides coverage to only those indigent individuals who do not meet the categorical eligibility requirements for federal Medicaid. General Statutes § 17b-192 (a). Unlike federal Medicaid, SAGA-medical has no citizenship or United States residency requirements. See generally General Statutes § 17b-192. Thus, SAGA-medical provides coverage to citizens and indigent qualified aliens who do not meet the categorical eligibility requirements of federal Medicaid.
The class members currently are ineligible for any of these publicly funded medical assistance programs. The class members are barred from receiving federal Medicaid because of the five year rule in the Welfare Reform Act. They are ineligible for assistance under SMANC because Spec. Sess. P.A. 09-5, § 64, substantially repealed SMANC, thereby eliminating its coverage for the class members. Furthermore, the class members are ineligible for SAGA-medical because they are categorically eligible for federal Medicaid notwithstanding the federal five year rule, which bars them from participating in federal Medicaid. In the present case, the plaintiff challenges only the latter two eligibility limitations and not the federal five year rule in the Welfare Reform Act.
On December 1, 2009, the plaintiff filed a lawsuit, which subsequently was certified as a class action, seeking to enjoin the defendant from enforcing §§ 55 and 64 of Spec. Sess. P.A. 09-5. The plaintiff claimed that those sections unlawfully discriminate against her and others similarly situated because of their status as aliens, in violation of the equal protection clauses of the federal and state constitutions.
The plaintiff claimed that Spec. Sess. P.A. 09-5, §§ 55 and 64, discriminated against her on the basis of her alienage because similarly situated citizens continued to receive publicly funded medical assistance through the federal Medicaid program, whereas she no longer received such assistance as a result of the implementation of Spec. Sess. P.A. 09-5, §§ 55 and 64. The plaintiff further claimed that case law required courts to apply strict scrutiny to state classifications based on alienage and that the state could not establish a sufficient justification for the challenged classification. For this reason, the plaintiff sought a declaration that the challenged sections of Spec. Sess. P.A. 09-5 were unconstitutional and an injunction preventing their enforcement.
The defendant responded that §§ 55 and 64 of Spec. Sess. P.A. 09-5 do not discriminate on the basis of alienage. Specifically, the defendant argued that § 64, which substantially eliminated SMANC, an alien-only medical assistance program, did not discriminate against aliens in favor of similarly situated citizens because only aliens, and not citizens, could participate in the program, and, consequently, the state did not provide assistance to any citizens through that program. The defendant also argued that § 55, which amended the statutory eligibility requirements for SAGA-medical in a way that barred participation by the plaintiff, did not discriminate on the basis of alienage because the eligibility requirements for that program are not based on citizenship status and apply equally to citizens and aliens alike. The defendant further contended that, even if it was assumed that §§ 55 and 64 of Spec. Sess. P.A. 09-5 did discriminate against aliens, a court should review those sections to determine only whether the legislature had a rational basis for enacting those sections rather than use the strict scrutiny analysis traditionally applied to state classifications based on alienage. The defendant, citing recent case law from other jurisdictions, argued that rational basis review was proper because the federal government, under its broad constitutional authority to regulate immigration, had validly authorized any discriminatory treatment by the states in the provision of state funded medical assistance. It is undisputed that, if a court subjected the challenged provisions to rational basis review, they would survive such review, and, conversely, if a court
The case was tried to the court in December, 2009, with the parties offering two joint stipulations of fact describing the relevant characteristics of the class members and the legislative background, as well as extensive oral and written arguments. On December 18, 2009, the trial court issued a memorandum of decision, in which it certified the plaintiff's action as a class action and concluded that the challenged sections of Spec. Sess. P.A. 09-5 violated the federal constitution. The trial court certified the class to include those legal aliens who (1) have resided in the United States for fewer than five years, (2) otherwise would be eligible for federal Medicaid but for the federal five year rule, and (3) have lost their state funded medical care as a result of the implementation of Spec. Sess. P.A. 09-5, §§ 55 and 64.
The trial court then concluded that Spec. Sess. P.A. 09-5, §§ 55 and 64, discriminated against the class members on the basis of their status as aliens because the challenged provisions eliminated state funded medical assistance to the class whereas similarly situated citizens continued to receive publicly funded medical assistance through federal Medicaid. Having concluded that §§ 55 and 64 of Spec. Sess. P.A. 09-5 discriminated on the basis of alienage, the trial court further concluded that the federal government's authorization to the states to discriminate against aliens in determining eligibility for state funded medical assistance could not shield the state's classification from strict scrutiny review. Upon applying strict scrutiny, the trial court concluded that the state had not established a compelling government interest in drawing the classification between aliens and citizens and that §§ 55 and 64 of Spec. Sess. P.A. 09-5 violated the equal protection clause of the federal constitution. The trial court did not address the plaintiff's claims under the state constitution. Thereafter, the trial court rendered judgment in favor of the plaintiff and permanently enjoined the defendant from enforcing the challenged provisions.
The defendant claims that the trial court incorrectly concluded that §§ 55 and
We begin with the standard of review and relevant equal protection principles. A facial challenge to the constitutionality of a statute presents questions of law over which our review is plenary. See, e.g., Kerrigan v. Commissioner of Public Health, 289 Conn. 135, 155, 957 A.2d 407 (2008). To establish a claim of facial invalidity, the party challenging the statute must demonstrate "that the law is invalid in toto—and therefore incapable of any valid application." (Internal quotation marks omitted.) State v. McKenzie-Adams, 281 Conn. 486, 499, 915 A.2d 822, cert. denied, 552 U.S. 888, 128 S.Ct. 248, 169 L.Ed.2d 148 (2007). "[A] validly enacted statute carries with it a strong presumption of constitutionality, [and] those who challenge its constitutionality must sustain the heavy burden of proving its unconstitutionality beyond a reasonable doubt. . . . The court will indulge in every presumption in favor of the statute's constitutionality.. . . Therefore, [w]hen a question of constitutionality is raised, courts must approach it with caution, examine it with care, and sustain the legislation unless its invalidity is clear." (Internal quotation marks omitted.) Id., at 500, 915 A.2d 822.
The equal protection clause of the fourteenth amendment to the United States constitution provides that "[n]o State shall . . . deny to any person within its jurisdiction the equal protection of the laws." U.S. Const., amend. XIV, § 1. Courts have interpreted the term "person" in this provision to include aliens as well as citizens within the jurisdiction of the state in which they reside. Graham v. Richardson, 403 U.S. 365, 371, 91 S.Ct. 1848, 29 L.Ed.2d 534 (1971); Barannikova v. Greenwich, 229 Conn. 664, 675, 643 A.2d 251 (1994). To prevail on an equal protection claim, the plaintiff first must establish that the state is affording different treatment to similarly situated groups of individuals. See, e.g., Stuart v. Commissioner of Correction, 266 Conn. 596, 602, 834 A.2d 52 (2003). "Thus, [t]o implicate the equal protection [clause] . . . it is necessary that the state statute . . . in question, either on
The defendant claims that the trial court incorrectly concluded that § 64 of Spec. Sess. P.A. 09-5, which substantially eliminated SMANC, discriminates on the basis of alienage. In support of this claim, the defendant argues that § 64 does not discriminate against aliens in favor of similarly situated citizens because only aliens, and not citizens, ever were eligible for SMANC. The defendant further contends that the trial court improperly looked beyond the state funded program at issue and improperly compared the treatment of the class members under § 64 with the federal government's treatment of individuals under the separate federal Medicaid program. The defendant maintains that, because the state does not have to remediate the effects of the federal Welfare Reform Act, the equal protection clause does not require the states to "fill the gap" in coverage for the class members that the federal government had created under the Welfare Reform Act. The defendant further argues that, because the equal protection clause does not require the state to provide its residents with coverage under SMANC, the substantial elimination of that program cannot violate the equal protection clause. The plaintiff responds that the trial court correctly concluded that § 64 discriminates on the basis of alienage because it deprives the class members of publicly funded medical assistance while similarly situated citizens continue to receive such assistance under federal Medicaid. We agree with the defendant.
We conclude that, in substantially eliminating SMANC, the state did not draw a classification on the basis of alienage because that program does not benefit citizens as opposed to aliens. To draw a classification on the basis of alienage, the state statute in question typically must afford some benefit to citizens but deny that benefit to at least some aliens because of their status as noncitizens. Decisions of the United States Supreme Court are instructive on this issue. For example, in Graham v. Richardson, supra, 403 U.S. 365, 91 S.Ct. 1848, the court invalidated statutes in two different states that provided for public assistance to citizens but denied such assistance to aliens simply on the basis of their citizenship status. Id., at 376, 91 S.Ct. 1848. One state statute precluded resident aliens who had resided in the United States for fewer than fifteen years from receiving benefits; id., at 367, 91 S.Ct. 1848; and the other statute barred aliens from receiving benefits regardless of the duration of their residency. Id., at 368 and n. 3, 91 S.Ct. 1848. The court concluded that each statute drew a classification on the basis of alienage because citizens were able to participate in the programs on less restrictive terms than aliens merely because of their citizenship status. See id., at 371, 91 S.Ct. 1848. The court, relying on its previous cases, applied strict scrutiny and concluded that the states had not provided sufficient justification to withstand such scrutiny. Id., at 376, 91 S.Ct. 1848.
Since Graham, the United States Supreme Court has continued to find discrimination based on alienage in state programs
This court likewise has invalidated a classification based on alienage similar to those invalidated by the United States Supreme Court. See Barannikova v. Greenwich, supra, 229 Conn. at 690-91, 643 A.2d 251. In Barannikova, this court reviewed a challenge to a classification in an entirely state funded public assistance program for both citizens and aliens. See id., at 673-74, 688, 643 A.2d 251. The program at issue in Barannikova applied certain eligibility restrictions to aliens who were required to have sponsors when they were admitted into the United States, but those restrictions did not apply to citizens or to those aliens who were not required to have sponsors.
Unlike the programs in Barannikova and the foregoing United States Supreme Court cases, which all provided assistance to citizens but denied assistance to certain groups of aliens or all aliens, SMANC is a state medical assistance program that provides assistance only to aliens who are barred by the federal government from participating in federal Medicaid. See General Statutes (Rev. to 2009) § 17b-257b. No citizens receive benefits under SMANC, and, indeed, that program never has provided assistance to citizens because citizens never were eligible for the program. Following the substantial elimination of SMANC by § 64 of Spec. Sess. P.A. 09-5, the only group continuing to receive assistance under the program are those aliens who applied for or were receiving nursing facility or home care as of the date that § 64 was enacted. See Spec. Sess. P.A. 09-5, § 64. Because the state is not providing a benefit to citizens through that program that it denies to some or all aliens, the state cannot be discriminating against aliens in favor of citizens.
Although it is true, as the plaintiff argues, that only aliens are harmed by the elimination of SMANC, this fact alone does not establish discrimination based on alienage. When a state establishes an assistance program that benefits only aliens, the elimination of that program does not violate the equal protection clause simply because the state is taking a benefit away from aliens. The relevant question in determining if state action discriminates on the basis of alienage is not whether the state is taking action that harms only aliens but, rather, whether the state program provides a benefit to citizens that it does not provide to some or all aliens because of their status as noncitizens. See Nyquist v. Mauclet, supra, 432 U.S. at 3-4, 12, 97 S.Ct. 2120 (finding discrimination based on alienage in state program that provided benefit only to citizens and aliens who had applied for citizenship); Graham v. Richardson, supra, 403 U.S. at 367-68, 376, 91 S.Ct. 1848 (finding discrimination based on alienage in state programs that provided assistance to citizens but denied assistance to some or all aliens); Barannikova v. Greenwich, supra, 229 Conn. at 673, 688, 643 A.2d 251 (finding discrimination based on alienage in state assistance program applying eligibility requirement to certain aliens but not to citizens or other aliens). Thus, in Barannikova, we concluded that the requirement at issue discriminated on the basis of alienage because it singled out a subclass of aliens for treatment that was different from that afforded to similarly situated citizens within a single program. See Barannikova v. Greenwich, supra, at 688, 643 A.2d 251.
The plaintiff argues that the state is providing a benefit to citizens that it does not provide to certain aliens insofar as the state continues to participate in federal Medicaid, which provides assistance to citizens but not to the class members. The plaintiff claims that, as long as the state provides such assistance to citizens through federal Medicaid, the equal protection clause requires the state to provide an equivalent level of assistance, through a state program, to the class members. The state's failure to do so, according to the plaintiff, means that the state is treating the class members disparately solely on the basis of their status as noncitizens. We disagree for two reasons. First, we conclude that the plaintiff's argument improperly compares the treatment of the class members within a program funded and administered exclusively by the state to the treatment of citizens within a separate, federal-state cooperative program governed by federal law and funded in substantial part by the federal government. Second, even if we were to look to the federal Medicaid program to determine whether the state is providing a benefit to citizens that it denies to aliens, we nevertheless conclude that the state's participation in federal Medicaid does not discriminate against the class members on the basis of their status as noncitizens. We further discuss each of these conclusions in turn.
The plaintiff argues that the state's treatment of the class members within a program funded and administered exclusively by the state should be compared to the treatment of citizens within the separate, federal Medicaid program. We disagree.
The equal protection clause requires only that the state treat individuals in a manner similar to that which the state treats other similarly situated individuals. See, e.g., Graham v. Richardson, supra, 403 U.S. at 371, 91 S.Ct. 1848; Barannikova v. Greenwich, supra, 229 Conn. at 675,
In Doe v. Commissioner of Transitional Assistance, supra, 437 Mass. at 528, 773 N.E.2d 404, the Massachusetts Supreme Judicial Court concluded that Massachusetts, in imposing an eligibility limitation on aliens receiving assistance under an alien-only program administered exclusively by the state, did not discriminate against aliens in favor of citizens, who received similar assistance under a separate, federal-state cooperative benefit program that did not have such eligibility limitations. The plaintiffs, a group of aliens who were ineligible for the alien-only public assistance program administered exclusively by the state (alien-only program) because of a six month state residency requirement, claimed that that residency requirement violated the equal protection clause in that it discriminated between aliens and citizens insofar as citizens, who were covered under the separate, federal-state transitional aid to families with dependent children (TAFDC) program, were not subject to such residency requirements. Id., at 522-24, 773 N.E.2d 404. Similar to the federal Medicaid program, the TAFDC program is governed by federal law and funded by the federal government and the state. Id., at 522-23, 773 N.E.2d 404. The plaintiffs were ineligible for the TAFDC program, however, because of the five year rule in the Welfare Reform Act. See id., at 522, 524, 773 N.E.2d 404. The alien-only program, which Massachusetts created to help cover those aliens displaced by the federal five year rule, imposed a six month state residency requirement on any participants, whereas the federal-state TAFDC program imposed no such residency requirement on citizens covered under that program. See id., at 523, 773 N.E.2d 404. The plaintiffs argued that the application of a six month residency requirement to the plaintiffs while citizens continued to receive benefits through TAFDC without such a restriction demonstrated that the state was discriminating against the plaintiffs on the basis of their alienage. See id., at 532-33, 773 N.E.2d 404. The court rejected the plaintiffs' comparison to citizens covered under TAFDC and concluded that "[t]he fact that citizens are eligible to receive benefits from a different program (TAFDC) on conditions less restrictive than those imposed on [the plaintiffs] is a direct result of the enactment of uniform [f]ederal policies . . . and does not affect [the court's] analysis of the proper standard of review to be used in evaluating [the alien-only program]." Id., at 533, 773 N.E.2d 404. The court, looking only at the treatment of individuals within the alien-only
The Tenth Circuit Court of Appeals expanded on this reasoning in Soskin v. Reinertson, supra, 353 F.3d 1242. In Soskin, the court held that a state's decision to treat aliens differently from citizens in the provision of optional federal Medicaid assistance did not discriminate against aliens in favor of citizens because, following the passage of the Welfare Reform Act, a state's different treatment of aliens within an alien-only program should not be compared to the treatment of citizens under federal Medicaid. See id., at 1255-56. In Soskin, the court addressed a claim regarding Colorado's decision to eliminate certain optional assistance for qualified aliens under the federal Medicaid program while citizens continued to receive such assistance through federal Medicaid. See id., at 1244, 1246. As a result of the Welfare Reform Act, federal Medicaid requires states to cover certain qualified aliens under federal Medicaid and allows states the option to extend coverage to certain other groups of qualified aliens. Id., at 1245-46; see 42 U.S.C. § 1396a (a)(10)(A)(ii) (2006). Following the passage of the Welfare Reform Act, Colorado initially opted to cover certain optional groups but, facing a budget shortfall, subsequently decided to eliminate this optional coverage. Soskin v. Reinertson, supra, at 1246.
The plaintiffs in Soskin, all qualified aliens whose federal Medicaid coverage was eliminated in 2003, filed a class action, claiming that Colorado's decision to eliminate their coverage discriminated against aliens in favor of citizens who remained eligible for coverage under federal Medicaid. See id., at 1247. The court rejected this claim. See id., at 1255-56. The court concluded that the elimination of the optional coverage did not discriminate between aliens and citizens because, as a result of the Welfare Reform Act, coverage within the federal Medicaid program for aliens and citizens should be considered separately. See id. The court reasoned: "What Congress has done in the [Welfare Reform Act] is, in essence, create two welfare programs, one for citizens and one for aliens. Within the aliens-only program, states have the option of including more or fewer aliens. The decision to have separate programs for aliens and citizens is a Congressional choice, subject only to rational-basis review. See Mathews [v. Diaz, 426 U.S. 67, 96 S.Ct. 1883, 48 L.Ed.2d 478 (1976)]. A state's exercise of the option to include fewer aliens in its aliens-only program, then, should not be treated as discrimination against aliens as compared to citizens. That aspect of the discrimination is [Congress'] doing—by creating one program for citizens and a separate one for aliens. Rather, what the state [of Colorado] is doing is discriminating within the aliens-only program against one class of aliens as compared to other classes of aliens. . . . This discrimination among subclassifications of aliens is not based on a suspect classification (such as alienage). The discrimination, rather, is based on nonsuspect classifications. . . ." (Citation omitted.) Soskin v. Reinertson, supra, 353 F.3d at 1255-56. The court thus applied the rational basis test to Colorado's nonsuspect classification, namely, the state's choice to cover certain groups of qualified aliens on the basis of their work history or military service, and concluded that the classification was constitutional. See id., at 1256.
The only appellate decision of which we are aware that holds that a state may not
We find Ehrlich to be unpersuasive to our analysis on this issue because that case did not address the issue of discrimination. The defendants in that case did not contest the plaintiffs' argument that eliminating the funding for the alien-only program discriminated on the basis of alienage. See id., at 709-11, 908 A.2d 1220. Thus, the court in Ehrlich did not have the benefit of any argument by the parties on the subject of discrimination or any reason or occasion to analyze this issue. Because this issue was not contested in the appeal before the court, the court did not provide any significant discussion or analysis as to whether the decision to eliminate funding for the alien-only program discriminated against aliens in favor of citizens who received coverage under federal Medicaid.
Moreover, the substantial federal reimbursement component of federal Medicaid provides an essential level of funding with which the state may provide medical assistance to a significant portion of its indigent population. In Connecticut, federal Medicaid is the largest publicly funded medical assistance program available. According to figures cited by the plaintiff, coverage and administration of the federal Medicaid program in the 2008-2009 fiscal year cost the state approximately $3.8 billion,
In light of the scope of federal control over the federal Medicaid program and the extent to which the federal government funds that program, we agree with the conclusions of other courts that have addressed similar comparisons and conclude that, at least for purposes of an equal protection analysis, the state's treatment of individuals within SMANC cannot be compared to the state's treatment of individuals within the separate federal Medicaid program, which is governed and funded substantially by a different government.
The cases on which the plaintiff relies in support of her claim that the substantial elimination of SMANC discriminates on the basis of alienage involve different factual predicates and are inapplicable to the issue presented. As we subsequently will discuss more fully in this opinion, the cases that the plaintiff cites, like Graham, involve claims of discrimination against aliens in favor of citizens within a single, state funded and state controlled program that provides assistance to aliens and citizens alike and do not involve claims based on how citizens are treated under a different program.
The plaintiff first argues that this court's decision in Barannikova v. Greenwich, supra, 229 Conn. 664, 643 A.2d 251, directly controls our analysis in the present case. We disagree. As we previously discussed, Barannikova did not involve a classification like the classification at issue in the present case, and, therefore, it does not impact our resolution of the issues presented by this appeal.
Other authorities on which the plaintiff relies are unhelpful to our analysis. See Aliessa v. Novello, 96 N.Y.2d 418, 754 N.E.2d 1085, 730 N.Y.S.2d 1 (2001); Korab v. Koller, United States District Court, Docket No. 10-00483 JMS/KSC, 2010 WL 5158883 (D.Haw. November 10, 2010). The plaintiff's reliance on these cases is misplaced because, like Barannikova, they involved claims by aliens who were treated differently from similarly situated citizens under a single program administered and funded exclusively by a state that provided assistance to both aliens and citizens alike; those cases simply do not involve claims of discrimination in the treatment of aliens as compared to citizens covered under a federal-state cooperative program.
In Aliessa, the New York Court of Appeals addressed a challenge to New York's exclusion of a class of aliens from a medical assistance program, funded exclusively by the state, that provided assistance to citizens and certain aliens but not to the plaintiffs, all of whom were aliens excluded from participating in the program. See Aliessa v. Novello, supra, 96 N.Y.2d at 422, 427, 730 N.Y.S.2d 1, 754 N.E.2d 1085. The plaintiffs claimed, inter alia, that the state's decision to exclude them from the state funded program violated the equal
Indeed, the New York Court of Appeals itself emphasized the distinction between these two situations in a subsequent decision. See Khrapunskiy v. Doar, supra, 12 N.Y.3d 478, 881 N.Y.S.2d 377, 909 N.E.2d 70. In Khrapunskiy, the court addressed a claim similar to that made by the plaintiff in the present case and reached a conclusion consistent with that which we reach. Khrapunskiy involved a claim by the plaintiffs, all of whom were legal aliens barred from participating in the federal Supplemental Security Income (SSI) program, which provided cash payments to certain categories of needy individuals along with additional payments funded by the state of New York (ASP). Id., at 482-83, 881 N.Y.S.2d 377, 909 N.E.2d 70. The plaintiffs were barred from receiving benefits under the SSI program by virtue of the five year rule established by the Welfare Reform Act and were barred from receiving benefits under the ASP program by virtue of state law because of their ineligibility under the SSI program. Id. As a result of their ineligibility for SSI and ASP (collectively SSI/ASP), the plaintiffs instead received benefits under a "`safety net assistance'" program, administered exclusively by the state, that provided cash payments to the plaintiffs at a significantly lower rate than that provided to citizens under SSI/ASP. Id., at 483, 881 N.Y.S.2d 377, 909 N.E.2d 70. The plaintiffs claimed that the purported classification violated the equal protection clauses of the federal and New York constitutions because the statute at issue discriminated against the plaintiffs in favor of similarly situated citizens who continued to receive a higher level of assistance through the federal-state SSI/ASP program. See id., at 483-84, 881 N.Y.S.2d 377, 909 N.E.2d 70. The plaintiffs further argued that, to remedy the violation, the state must provide a level of assistance equivalent to that received by citizens under SSI/ASP. See id., at 484, 881 N.Y.S.2d 377, 909 N.E.2d 70. The court rejected the plaintiffs' arguments and concluded that, following the passage of the Welfare Reform Act, the state was under no obligation to provide, under the state funded program, the same level of coverage that citizens received under the federal-state program. Id., at 488-89, 881 N.Y.S.2d 377, 909 N.E.2d 70. In reaching its decision, the court first determined that Aliessa did not apply because that case "involved a state-funded program"; id., at 488, 881 N.Y.S.2d 377, 909 N.E.2d 70; whereas Khrapunskiy involved a comparison between the treatment of certain aliens under a state funded program and the treatment of citizens under a separate federal-state program.
The decision by the United States District Court for the District of Hawaii in Korab v. Koller, supra, United States District Court, Docket No. 10-00483 JMS/KSC, is similarly inapposite. In Korab, the court addressed a Hawaii law that rendered the plaintiffs, who all were aliens in need of public medical assistance, ineligible for certain state funded medical programs (old programs) that formerly had provided assistance to both aliens and citizens. That law placed the plaintiffs in a different state funded program that provided less assistance than citizens continued to receive under the state's old programs. The plaintiffs claimed that the state's decision to reduce the assistance that the state formerly had provided to the plaintiffs violated the equal protection clause of the fourteenth amendment because the state continued to provide greater assistance to citizens under the old programs. The court, in a ruling on a motion to dismiss filed by the director of the Hawaii department of human services, agreed with the plaintiffs and concluded that the state had discriminated between aliens and citizens by rendering them ineligible to receive benefits from state programs that continued to provide greater assistance to citizens. For these reasons, the court held that the plaintiffs' complaint set forth a sufficient legal claim, and the court denied the motion to dismiss. Thus, unlike the present case, Korab involved discrimination within medical assistance programs that were funded and administered exclusively by the state and did not involve a claim that the state was treating aliens differently than citizens who received assistance under federal Medicaid. Consequently, Korab, like the other authorities on which the plaintiff relies, does not impact our analysis or conclusions with respect to this issue.
Consistent with those decisions that actually have addressed the issue of discrimination in circumstances similar to those in the present case, we conclude that the trial court improperly compared the treatment of the class members under § 64 of Spec. Sess. P.A. 09-5 to the treatment of citizens under the wholly separate federal Medicaid program.
Even if we were to compare the treatment of the class members under Spec.
The plaintiff argues that, notwithstanding the difference between the two programs, the state is discriminating against the class members insofar as it chooses to participate in federal Medicaid and to spend approximately $1.9 billion of its own money for medical assistance to citizens eligible for Medicaid while no longer providing any funds for medical assistance to the class members following the substantial elimination of SMANC. The plaintiff argues that, because the substantial elimination of SMANC harmed certain aliens by eliminating their publicly funded medical assistance while citizens continue to receive such assistance under federal Medicaid, the state's continued participation in federal Medicaid discriminates against the class members on the basis of alienage. 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. The plaintiff thus contends that the state must remediate the effects of the federal five year rule by filling the void in coverage created by the federal government and guaranteeing public medical assistance for the class members, through state funds alone, at a level equal to that provided to citizens and other aliens under the federal Medicaid program.
To be sure, the reason why the federal government excluded the class members from federal Medicaid is on account of their status as noncitizens. This, however, is not a result of any state action. Instead, it results from the federal government's decision to exclude them from federal Medicaid through the enactment of the federal five year rule in the Welfare Reform Act, which was enacted pursuant to Congress' broad authority over naturalization and immigration. See Mathews v. Diaz, supra, 426 U.S. at 79-80, 96 S.Ct. 1883.
In Mathews, the United States Supreme Court addressed an equal protection challenge
Thus, through the Welfare Reform Act, Congress, in a valid exercise of its plenary authority over immigration, has reduced the availability of federal-state public assistance programs to certain classes of aliens in order to promote self-sufficiency by immigrants and reduce the burdens that the provision of these programs has placed on federal, state and local governments.
Insofar as the state's participation in federal Medicaid draws a classification on the basis of an individual's eligibility for federal Medicaid, as determined by the federal government, this classification is not based on alienage or any other suspect factors. The plaintiff has not claimed that this classification is irrational or without a legitimate purpose. We therefore conclude that this classification does not violate the equal protection clause of the fourteenth amendment.
If the state's decision to cover only those eligible for federal Medicaid does not violate the equal protection clause, then the equal protection clause does not require the state to enact separate, state-only programs to provide an equivalent level of assistance to those who are ineligible for federal Medicaid as federal Medicaid provides to those individuals who are eligible for that program. For this reason, the equal protection clause did not, and still does not, require the state to enact the SMANC program or an equivalent program to fill the void created by the federal government. If the equal protection clause did not require the state to enact SMANC, then the state's decision to eliminate that program or to reduce its scope does not violate the constitutional rights of those formerly eligible for assistance under the program because the provision of public assistance does not establish a right to continue receiving assistance. See, e.g., Moore v. Ganim, 233 Conn. 557, 594, 660 A.2d 742 (1995) ("the fact that the benefit has been made available for a length of time [does not, itself] create an unqualified right to continue to receive such benefits"). We therefore conclude that the equal protection clause imposed no obligation on the state to enact SMANC and that the subsequent curtailment of that program by virtue of the passage of § 64 of Spec. Sess. P.A. 09-5 does not violate the equal protection clause.
Courts that have addressed similar claims similarly have concluded that the equal protection clause does not require the state to provide assistance to aliens displaced by the federal Welfare Reform Act. See Khrapunskiy v. Doar, supra, 12 N.Y.3d at 489, 881 N.Y.S.2d 377, 909 N.E.2d 70 ("[T]he right to equal protection does not require the [s]tate to create a new public assistance program in order to guarantee equal outcomes under wholly separate and distinct public benefit programs. Nor does it require the [s]tate to remediate the effects of [the federal Welfare Reform Act]."); see also Soskin v. Reinertson, supra, 353 F.3d at 1255-56 ("A state's exercise of the option to include fewer aliens in its aliens-only program . . . should not be treated as discrimination against aliens as compared to citizens. That aspect of the discrimination is [Congress'] doing. . . . Rather, what the state is doing is discriminating within the aliens-only program against one class of aliens as compared to other classes of aliens. . . . This discrimination among subclassifications
For the foregoing reasons, we conclude that the plaintiff has not met her burden of establishing that the state is discriminating against aliens in favor of similarly situated citizens. The plaintiff has advanced no other theory of discrimination based on suspect classifications. As such, any discrimination against the class members as a result of the substantial elimination of SMANC would fall along nonsuspect lines. The plaintiff has not claimed that the classifications arising from the passage of Spec. Sess. P.A. 09-5, § 64, are irrational. Therefore, we conclude that the state's enactment of Spec. Sess. P.A. 09-5, § 64, does not violate the equal protection clause of the federal constitution.
The defendant claims that the trial court incorrectly concluded that Spec. Sess. P.A. 09-5, § 55, which altered the statutory eligibility guidelines for SAGA-medical, creates a classification based on alienage because the eligibility criteria as amended by § 55 apply equally to aliens and citizens alike. The plaintiff responds that the trial court correctly concluded that § 55 discriminates on the basis of alienage because citizens who are ineligible for federal Medicaid receive coverage under SAGA-medical whereas the class members do not. We agree with the defendant.
We conclude that Spec. Sess. P.A. 09-5, § 55, does not classify on the basis of alienage but, instead, classifies on the basis of an individual's categorical eligibility for federal Medicaid. The eligibility requirement for SAGA-medical, as amended by § 55, provides in relevant part: "The Commissioner of Social Services shall implement a state medical assistance component of the state-administered general assistance program for persons who do not meet the categorical eligibility criteria for Medicaid on the basis of age, blindness, disability, pregnancy, being a parent or other caretaker relative of a dependent child, being a child under the age of twenty-one, or having been screened for . . . and . . . found to need treatment for either breast or cervical cancer. . . ." (Emphasis added.) General Statutes § 17b-192 (a). This language demonstrates that the classification for SAGA-medical eligibility is based on an individual's categorical eligibility for federal Medicaid such that those who meet the categorical eligibility requirements for federal Medicaid—those who are blind, disabled, pregnant, a parent of a dependent child, under the age of twenty-one, or sixty-five years of age or older—are excluded from SAGA-medical, and those who do not meet the categorical eligibility requirements for federal Medicaid—i.e., those who, between the
Despite this recognition by the trial court, it nevertheless concluded that § 55 draws a classification on the basis of alienage because "[§§] 55 and 64, in combination, have created a situation [in which] low-income citizens who are ineligible for federal Medicaid are still eligible for SAGA-medical, but the members of the. . . class, who differ only because they are aliens, are not. . . . [I]t is clear that the result is to deprive the [class members] of all nonemergency health care solely because they are aliens." We disagree.
First, we disagree with the trial court's characterization of the nature of the eligibility requirements for SAGA-medical. The SAGA-medical program does not provide coverage to all low-income citizens who are ineligible to participate in federal Medicaid.
Second, to the extent that the trial court concluded that the state must provide assistance to the class members under SAGA-medical because they are ineligible for federal Medicaid, we disagree with this conclusion for the same reasons that the state is not obligated to provide assistance under SMANC for those aliens who are not eligible for federal Medicaid. See part II A of this opinion. The state has no affirmative obligation under the equal protection clause to provide the class members, through a state only program, the same assistance that citizens receive under a separate federal-state cooperative program. Insofar as the trial court determined otherwise, we conclude that it did so improperly.
Instead of drawing a classification on the basis of alienage, § 55 of Spec. Sess. P.A. 09-5 draws a classification on the basis of an individual's blindness, disability, pregnancy, or status of being a parent of a dependent child, or under the age of twenty-one or sixty-five years of age or
Because we conclude that neither § 55 nor § 64 of Spec. Sess. P.A. 09-5 discriminates on the basis of alienage, we need not determine whether rational basis review or strict scrutiny applies to classifications based on alienage that purportedly are authorized by the federal government.
As an alternative ground for affirming the judgment of the trial court, the plaintiff claims that §§ 55 and 64 of Spec. Sess. P.A. 09-5 also violate the state constitution. In support of her claim, the plaintiff argues that article first, § 20, of the Connecticut constitution prohibits discrimination on the basis of alienage and that a court reviewing a claim of discrimination on that basis must subject the classification created by the challenged provisions to strict scrutiny. Article first, § 20, of the constitution of Connecticut provides: "No person shall be denied the equal protection of the law nor be subjected to segregation or discrimination in the exercise or enjoyment of his civil or political rights because of religion, race, color, ancestry or national origin."
The judgment is reversed and the case is remanded with direction to render judgment for the defendant.
In this opinion the other justices concurred.
"(1) Self-sufficiency has been a basic principle of United States immigration law since this country's earliest immigration statutes.
"(2) It continues to be the immigration policy of the United States that—
"(A) aliens within the Nation's borders not depend on public resources to meet their needs, but rather rely on their own capabilities and the resources of their families, their sponsors, and private organizations, and
"(B) the availability of public benefits not constitute an incentive for immigration to the United States.
"(3) Despite the principle of self-sufficiency, aliens have been applying for and receiving public benefits from Federal, State, and local governments at increasing rates.
"(4) Current eligibility rules for public assistance and unenforceable financial support agreements have proved wholly incapable of assuring that individual aliens not burden the public benefits system.
"(5) It is a compelling government interest to enact new rules for eligibility and sponsorship agreements in order to assure that aliens be self-reliant in accordance with national immigration policy.
"(6) It is a compelling government interest to remove the incentive for illegal immigration provided by the availability of public benefits.
"(7) With respect to the State authority to make determinations concerning the eligibility of qualified aliens for public benefits in this chapter, a State that chooses to follow the Federal classification in determining the eligibility of such aliens for public assistance shall be considered to have chosen the least restrictive means available for achieving the compelling governmental interest of assuring that aliens be self-reliant in accordance with national immigration policy."
We also note that it appears that SAGA-medical has been entirely replaced by the new Medicaid for Low Income Adults program (Medicaid-LIA), which was established by the Patient Protection and Affordable Care Act, insofar as SAGA-medical is no longer entirely controlled or funded by the state. See Patient Protection and Affordable Care Act, Pub.L. No. 111-148, § 2001(a)(4)(A), supra, 124 Stat. at 274; Public Acts 2010, No. 10-3, § 23; Public Acts, Spec. Sess., June, 2010, No. 10-1, §§ 23 and 24 (Spec.Sess.P.A.10-1). Although the full impact of these changes is not clear, we note the statutory language in § 55 of Spec. Sess. P.A. 09-5 governing SAGA-medical has remained undisturbed notwithstanding the recent changes to SAGA-medical, and state law requires the defendant to operate the Medicaid-LIA program in accordance with the eligibility requirements for SAGA-medical, to the extent possible. See Spec. Sess. P.A. 10-1, § 24.
First, to the extent that this statement implies that state classifications that harm a subclass of aliens necessarily discriminate on the basis of alienage, we reject this conclusion for the same reasons that we enumerated in footnote 23 of this opinion. As we previously stated, a state discriminates on the basis of alienage when it favors citizens over aliens because of citizenship status and not merely because the state takes an action that harms a group of aliens within a program that benefits only aliens.
Second, we further disagree with the court's reading of Nyquist and Graham. Although the court in Ehrlich appears to read these cases to mean that discriminating between groups of aliens is necessarily a classification based on alienage, this reading is not supported by those cases. Nyquist and Graham addressed claims of discrimination in programs that generally provided benefits to both citizens and aliens but that denied benefits to certain aliens on the basis of their status as noncitizens. See Nyquist v. Mauclet, supra, 432 U.S. at 3-4, 8-9, 97 S.Ct. 2120 (state benefit provided to citizens and aliens who had applied for citizenship but denied to those aliens who had not applied for citizenship); Graham v. Richardson, supra, 403 U.S. at 376, 91 S.Ct. 1848 (invalidating state law that provided benefits to citizens and some aliens but denied benefits to other aliens). In those cases, the court concluded that the state had classified on the basis of alienage in denying benefits to certain aliens because the challenged statutes "imposed a . . . requirement for welfare benefits on aliens but not on citizens." Nyquist v. Mauclet, supra, at 8, 97 S.Ct. 2120; see also Graham v. Richardson, supra, at 376, 91 S.Ct. 1848. Unlike the programs at issue in Nyquist and Graham, however, the program that we address in the present case, like that in Ehrlich, provides benefits to aliens only and not to citizens because citizens cannot participate. Therefore, the state, in reducing the scope of SMANC, an alien-only program, is not imposing any restrictions on aliens that it is not imposing on citizens. Moreover, unlike in Nyquist and Graham, in the present case, the state is not providing any benefit to citizens through a program administered and funded exclusively by the state that it is denying to certain aliens. Because Nyquist and Graham did not address discrimination between aliens in a program that serves only aliens, these cases do not affect our analysis of the programs at issue in the present case. To the extent that the court in Ehrlich determined otherwise, we disagree.
We further disagree with the District Court's conclusion insofar as it rejects the holding in Soskin that the elimination of an alien-only program does not discriminate on the basis of alienage. In rejecting the holding of Soskin, the District Court relied exclusively on a single sentence in Nyquist v. Mauclet, supra, 432 U.S. at 7-9, 97 S.Ct. 2120, in which the United States Supreme Court stated that "the important points are that [the challenged statute] is directed at aliens and that only aliens are harmed by it." Id., at 9, 97 S.Ct. 2120. We respectfully disagree with the District Court's reliance on Nyquist for the same reasons that we disagree with the apparent reliance by the court in Ehrlich on that case insofar as those courts apply language in Nyquist in a manner that goes beyond the factual circumstances addressed in Nyquist. Nyquist does not affect our analysis in the present case, and we disagree with the District Court's reliance on a single sentence in that decision to reach a contrary conclusion.
The defendant apparently understood the plaintiff's challenge to be based on a different theory. In his brief, the defendant noted that the "[p]laintiff also does not claim that Connecticut was under any constitutional obligation to step forward and fill the gap deliberately left by Congress, but claims instead that having voluntarily stepped forward and having established a special alien-only benefit program only for those qualified aliens made ineligible by [the Welfare Reform Act], Connecticut is forever constitutionally barred from subsequently eliminating or curtailing the program."
In her brief, the plaintiff did not specifically respond to this statement by the defendant but, instead, repeated her claims that "Spec. Sess. P.A. 09-5 . . . violates the guarantees of the federal equal protection clause by utilizing alienage, a suspect classification subject to strict scrutiny, to eliminate . . . medical assistance benefits under the SMANC program, and bar [the class members] from accessing the SAGA-medical program, while similarly situated citizens continue to receive undiminished medical benefits [under federal Medicaid]."
At oral argument before this court, the plaintiff's appellate counsel acknowledged, however, that the nature of the plaintiff's challenge is based on the premise that, following the passage of the federal Welfare Reform Act, the equal protection clause required the state to fill the gap left by the federal government by providing to the class members a level of assistance equivalent to that received by citizens under federal Medicaid. In light of this clarification by the plaintiff's appellate counsel, we view this as the correct understanding of the plaintiff's equal protection challenge.
Second, the plaintiff's argument would contradict Congress' stated intent to reduce the eligibility of certain aliens to receive public assistance in order to avoid providing an incentive for immigration by individuals who will depend on public assistance rather than remaining self-sufficient. Under the plaintiff's interpretation, the states would be required to provide those aliens displaced by the Welfare Reform Act a level of assistance equivalent to that which citizens receive under federal Medicaid. The plaintiff's argument would not reduce the eligibility of such aliens to receive public assistance but would only shift the provision of such assistance from the federal Medicaid program to the states alone. Congress explicitly stated, however, that it adopted the Welfare Reform Act "to enact new rules for eligibility and sponsorship agreements in order to assure that aliens be self-reliant in accordance with national immigration policy"; 8 U.S.C. § 1601(5) (2006); such that "aliens within the Nation's borders not depend on public resources to meet their needs, but rather rely on their own capabilities and the resources of their families, their sponsors, and private organizations.. . ." 8 U.S.C. § 1601(2)(A) (2006).
