Plaintiffs, twelve aliens residing lawfully in New York State, were denied Medicaid coverage for treatment of potentially life-threatening illnesses. Plaintiffs included lawfully admitted permanent residents and individuals permanently residing in the United States under color of law (PRUCOLs), who suffered from life-threatening illnesses. Plaintiffs brought a class action on behalf of "'[a]ll Lawful Permanent Residents who entered the United States on or after September 22, 1996 and all [PRUCOLs] who, but for the operation of New York Social Services Law " 122, would be eligible for Medicaid coverage in New York State.'" The Supreme Court granted in part Plaintiffs' motion for summary judgment, declaring that " 122 violates article XVII, " 1 of the New York State Constitution and the Equal Protection Clauses of the United States (U.S. Const. amend. XIV, " 1) and New York (NY Const. art. I, " 11) Constitutions.

Three days later, the Appellate Division decided Alvarino v. Wing, 690 N.Y.S.2d 262, holding that a state statute denying food assistance to aliens should be evaluated under the rational basis standard. The state statute had been enacted in direct response to federal legislation. Therefore, the Supreme Court granted reargument in Aliessa, vacating the portion of its decision that declared " 122 violative of the Equal Protection Clauses of the United States and New York Constitutions. The Appellate Division reversed in part and affirmed in part, holding that " 122 did not violate equal protection or article XVII, " 1. Plaintiffs appealed as of right. The Court of Appeals reversed and remitted the case to Supreme Court.

1. Whether Social Services Law " 122 violates article XVII of the New York State Constitution.

2. Whether Social Services Law " 122, enacted pursuant to Title IV of the Personal Responsibility and Work Opportunities Reconciliation Act of 1996, 8 U.S.C. " 1601-1622, (Title IV), violates the Equal Protection Clauses of the United States and New York Constitutions.

1. Yes. Social Services Law " 122 imposes upon Plaintiffs an overly burdensome eligibility condition having nothing to do with need, depriving them of an entire category of otherwise available basic necessity benefits.

2. Yes. Social Services Law " 122 is unconstitutional because it is enacted pursuant to Title IV, which authorizes states to adopt divergent and discriminatory laws regarding citizenship requirements for a federally supported welfare program.

State of the Law Before Aliessa

In 1996, Congress passed the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), Pub. L. No. 104-193, 110 Stat. 2105, to revise the US welfare system. Title IV, 8 U.S.C. " 1601 et seq, of the Act addresses the eligibility of legal and illegal immigrants to receive state and federal benefits. Before 1996, legal immigrants, such as permanent residents, were eligible for a variety of state and federal benefits. For example, permanent residents and PRUCOLs were eligible for Medicaid. With the passing of Title IV, Congress denied legal immigrants most forms of federal assistance and authorized states to deny state assistance.

Title IV divides aliens into two categories: qualified, including permanent residents, and unqualified, including PRUCOLs. Qualified aliens are divided into two further classes: those who were residing in the United States before August 22, 1996, and those who entered the country on or after that date. Qualified aliens in the first category are ineligible for the Security Income (SSI) and Food Stamp programs. Furthermore, states have the option to deny them Temporary Assistance for Needy Families ("TANF"), non-emergency Medicaid, and Social Services Block Grant benefits. However, Title IV (8 U.S.C. " 1612(b)(2)) requires that states provide Federal Medicaid to some but not all qualified aliens in the first subcategory, such as certain asylees, armed forces personnel or veterans, and aliens currently receiving services. Nevertheless, Title IV (8 U.S.C. " 1613(a)) imposes a five-year waiting period for qualified aliens in the second category, with some exceptions. Qualified aliens in the second category are eligible for emergency medical assistance. The Act grants states the power to determine eligibility criteria for qualified aliens for state and local benefits. Lastly, under Title IV (8 U.S.C. " 1611), unqualified aliens are not eligible for Federal benefit programs and states have the authority to deny them state and local benefits. Congress has modified the ban on SSI in the Balanced Budget Act of 1997, Pub. L. No. 105-33, "§ 5301-5308, 111 Stat. 251, 597-601, but other provisions such as Medicaid, have remained the same.

In response to Title IV, New York State passed Social Services Law " 122, terminating state-funded Medicaid and other benefits for unqualified aliens and instituting a five-year wait period for qualified aliens entering the United States after August 22, 1996. However, New York maintained Medicaid benefits for unqualified aliens diagnosed with AIDS or those that resided in certain licensed residential health care facilities. Social Services Law § 122 provides that all qualified and unqualified aliens may receive emergency medical assistance and safety net assistance.

In Graham v. Richardson, 403 US 365 (1971), the Supreme Court invalidated two state welfare statutes that denied benefits based on alienage. The Court held that alienage classifications are subject to strict scrutiny. Therefore, state interests in preserving their fiscal resources were not sufficiently compelling to justify alienage classifications. In Graham, the Court did not address the constitutionality of federally authorized state alienage classifications. However, the Court stated that "Congress does not have the power to authorize the individual States to violate the Equal Protection Clause." Furthermore, the Naturalization clause (US Const. Art. I, " 8, cl. 4) authorizes Congress to "establish an uniform Rule of Naturalization." As such the Graham Court indicated that: "A congressional enactment construed as to permit state legislatures to adopt divergent laws on the subject of citizenship requirements for federally supported welfare programs would appear to contravene this explicit constitutional requirement of uniformity."

However, in Mathews v. Diaz, 426 US 67 (1976), the Supreme Court upheld Congressional alienage classifications for Medicaid benefits under a rational basis analysis. The Court reasoned that the Federal Government has broad power over immigration and naturalization. Therefore, the Federal Government can impose a five-year waiting period for Medicaid and can discriminate among aliens residing in the United States. The Court stated that "Congress may decide that as the alien's tie grows stronger, so does the strength of his claim to an equal share of that munificence." In Mathews, the Court distinguished Graham, reasoning it dealt with regulation by states and equal protection.

Effect of Aliessa on Current Law

In Aliessa, the Court of Appeals held that Social Services Law " 122's denial of state-funded Medicaid is unconstitutional because it violates article XVII of the New York State Constitution and the equal protection clauses of the United States and New York Constitutions. Basically, the Court has held that New York's compliance with the PRWORA directly violates its constitutional mandate to aid the needy. Furthermore, the decision may have important implications on immigrants' rights nationwide because the Court, in effect, found that it is unconstitutional for Congress to authorize states to regulate immigration.

First, the Court emphasized that article XVII of the New York Constitution mandates care for the needy. In addition, Tucker v. Toia, 43 N.Y.2d 1, 8 (1971), established that once the Legislature classifies a group of persons as needy, it cannot refuse to aid that group. The Court rejected Defendants' argument that Social Services Law " 122 merely sets levels of benefits for the needy; a matter within the Legislature's discretion. Instead, the Court found that " 122 denies otherwise needy persons ongoing medical care, which is distinct from emergency medical assistance and safety net assistance. Therefore, need played no part in " 122 classifications, making them "overly burdensome."

Secondly, the Court adopted strict scrutiny as the appropriate standard of review, rejecting the use of rational basis by the Appellate Division in Alvarino v. Wing, 690 N.Y.S.2d 262. In Alvarino, the Appellate Division reasoned that rational basis was the appropriate standard because Social Services Law " 95 was enacted in direct response to the PRWORA. The Court of Appeals reasoned that strict scrutiny applies because aliens are a discrete and insular minority and Congress cannot authorize states to determine the degree to which they will discriminate against legal aliens.

Furthermore, the Court reasoned that Title IV violates the Naturalization Clause because it "does not impose a uniform immigration rule for States to follow." Title IV expressly authorizes states to enact divergent laws and choose to what extent they will discriminate against aliens. Additionally, 8 U.S.C. " 1622 "authorizes each State to decide whether to disqualify many otherwise eligible aliens from State Medicaid." Since Title IV does not set a uniform rule of law, it cannot insulate Social Services Law " 122 from strict scrutiny review under Graham. " 122, when evaluated under strict scrutiny as a "State statute that classifies based on alienage," is unconstitutional under Graham and its progeny. The Court, nevertheless, limited the application of its opinion to New York State's denial of State Medicaid as authorized by Title IV.

Unanswered Questions

The Court of Appeals limited its decision to Social Services Law " 122's denial of state-funded Medicaid. However, the law denies legal aliens arriving after August 22, 1996 other benefits, including Family Health Plus, a "health insurance program for the working poor." The question remains whether this denial violates article XVII of the New York State Constitution and Equal Protection.

Furthermore, the Court did not address the issue of whether Congress can authorize the states to regulate immigration. If Congress can delegate to states such authority, it remains unclear whether a state law enacted pursuant to federal legislation should be evaluated under rational basis or strict scrutiny.

Survey of the Law in Other Jurisdictions

Although many states have enacted laws to comply with the PRWORA, few jurisdictions have addressed the constitutionality of such laws. Furthermore, several courts have held that federal discrimination in the allocation of welfare benefits among qualified aliens is constitutional since Congress has exclusive federal authority to regulate immigration and naturalization. See City of Chicago v. Shalala, 169 F.3d 598 (7th Cir. 1999); Rodriguez v. United States, 169 F.3d 1342 (11th Cir. 1999); Kiev v. Glickman, 991 F.Supp. 1090 (D. Minn. 1998). In addition, in Lewis v. Thompson, No. 00-6104, 2001 U.S. App. LEXIS 13264, (2d Cir. 2001), PRWORA's denial of prenatal care to unqualified alien mothers was upheld as constitutional under the rational basis test.

In Cid v. South Dakota Dep't of Soc. Servs., 598 N.W.2d 887 (S.D. 1999), the South Dakota Supreme Court upheld the constitutionality of state administrative regulations that implemented PRWORA's restrictions using rational review. The court found that "the State has a compelling interest in implementing the national immigration policy and in implementing uniform rules regarding alien eligibility for certain welfare benefits."

The Superior Court of Massachusetts, at Suffolk, upheld the constitutionality of a state cash assistance program which denied benefits to legal immigrants that had not resided in the state for six months, in Doe v. McIntire, No. 00-3014-F, 2001 Mass. Super. LEXIS 153. Massachusetts enacted the cash assistance program, funded entirely with state monies, to provide cash assistance to needy, qualified aliens arriving in the United States after August 22, 1996. This statute was authorized by 8 U.S.C. " 1624, as was the ability to restrict eligibility. The court first found that the residency requirement did not conflict with the federal law. Secondly, the court found that the law should be upheld as constitutional under rational basis, because it "benignly benefits only aliens and does not in any way put citizens in a superior position to similarly situated aliens."