Immigrant healthcare: Must states cover cost?

Should states pay for healthcare for legal immigrants who cannot afford it themselves?

Congress thought it had settled that question in 1996, as part of welfare reform: It's up to each state to decide.

Now, however, the New York Supreme Court has come up with a different answer. In a move that could ripple across the states, the court said last week that New York's practice of barring legal immigrants from receiving Medicaid, the health-insurance program for the poor, violates not only the state constitution, but also the equal-protection clause of the US Constitution.

"The case could increase pressure for others to sue" in other states, says Leighton Ku, a health-policy expert at the Center on Budget and Policy Priorities. "Many states would worry about violating the federal Constitution." Ten states provide Medicaid coverage for legal immigrants who arrived after 1996, he says.

One of the first states to be affected by the New York ruling may be Connecticut. Although it provides benefits for most legal immigrants, that funding expires July 1 and has not been included in the next budget, says Sheldon Toubman, an attorney with the New Haven Legal Assistance Association. If such healthcare coverage is not included, he says, a lawsuit would likely be brought against the state on behalf of legal immigrants - and it would rely in part on the reasoning from the New York ruling.

Of course, the decision in New York does not legally bind other states to pick up millions of dollars in medical costs for their legal immigrants.

"This case was successful [in part] because of a provision in the state constitution" that requires New York to provide aid to its poor, says Mara Youdelman, an attorney at the National Health Law Program.

A flood of lawsuits?

Still, in citing the US Constitution, the New York tribunal may yet open the floodgates of litigation elsewhere.

Under welfare reform, Congress allowed states to choose which immigrants would get which benefits. The New York ruling, however, says Congress cannot permit states to discriminate against subgroups of legal immigrants in state-funded Medicaid programs, says Tanya Broder, a lawyer with the National Immigration Law Center. The decision, she adds, will have the biggest impact on states that currently don't serve certain immigrant groups.

The New York ruling may also help force change in federal law, if Congress begins to feel political pressure. Governors and members of Congress from states with large numbers of immigrants may complain of the financial burden, says Julie Hudman of the Kaiser Commission on Medicaid and the Uninsured.

The cost of care

In New York, Gov. George Pataki (R) pledged to comply with the order to provide healthcare services to legal immigrants, says Robert Kenny, spokesman for the state's Health Department. But he says the governor is urging the US government to help states shoulder the cost. Restoring Medicaid for thousands of low-income immigrants now eligible to receive it will cost New York $2.5 million a year, according to a recent report by the Commonwealth Fund. Other estimates are much higher.

Several immigrant-rich states - including California and New Jersey - already provide Medicaid to post-1996 immigrants. Many others offer partial Medicaid coverage, such as only for low-income immigrant children or for pregnant women.

Cherilyn Scism of the National Governors Association says the NGA backs states that want the US government to do more to care for new immigrants. "States have no control over federal immigration policies," she says, "so it is unfair to require the states to shoulder all the costs."

Experts say the welfare reforms that began in 1996 have lowered the percentage of immigrants enrolled in Medicaid programs, says Ms. Hudman. Even immigrants who are eligible have shied away from enrolling, often because they don't understand the laws or the language, and worry about becoming public charges, she says.

(c) Copyright 2001. The Christian Science Monitor