Maryland Court of Appeals Reports
EHRLICH v. PEREZ, 137 (Md. 10-12-2006) ROBERT L. EHRLICH,
JR., GOVERNOR, et al. v. FLOR PEREZ, et al. No. 137,
September Term, 2005. Court of Appeals of Maryland. Filed:
October 12, 2006.
Circuit Court for Montgomery County, Case #265850, Durke G.
Thompson, Judge.
Argued by Margaret Ann Nolan, Assistant Attorney General
(J. Joseph Curran, Jr., Attorney General of Maryland, and
Steven M. Sullivan and Joel L. Tornari, Assistant Attorneys
General, on brief) all of Baltimore, MD, for Appellants.
Argued by Hannah Lieberman (Regan Bailey of Legal Aid
Bureau, Inc. of Riverdale, MD) on brief
Argued by: Douglea M. Bregman (Heather Libman Kafetz and
Catherine Harrington of Bregman, Berbert, Schwartz &
Gilday, LLC of Bethesda, MD; Dan Friedman of Saul Ewing LLP
of Baltimore, MD) all on brief for Appellees.
Bell, C.J., Raker, Wilner, Cathell, Harrell, Battaglia,
Greene, JJ.
Opinion by HARRELL, J.
Wilner and Cathell, JJ., join in judgment only.
Pursuant to Maryland Code (1973, Repl. Vol. 2002), Courts
and Judicial Proceedings Article, §
12-303(3)(i),[fn1] Appellants (Defendants below), the
Honorable Robert L. Ehrlich, Jr., the Honorable S. Anthony
McCann, and the Honorable Nancy Kopp, each sued in his or
her official capacity as Governor of Maryland, Secretary of
the Maryland Department of Health and Mental Hygiene
(“DHMH”), and State Treasurer, respectively, sought
appellate review of a preliminary injunction issued by the
Circuit Court for Montgomery County. The injunction
essentially ordered the payment of medical assistance
benefits to Appellees (Plaintiffs in the Circuit Court),
comprised of Flor Perez and Ana Perez (minors, by their
father and next friend, Fidel Perez); Brayan Herrera,
Osvaldo Herrera, and Leslie Herrera (minors, by their
mother and next friend, Martha Herrera); and Gabriel
Ntitebem, Henry Anu, and Vitalis Atemafac (minors, by their
mother and next friend, Ajong Pamela Nkahinjo),[fn2] under
the Medical Assistance Program, Maryland Code (1982, Repl.
Vol. 2005), Health-General Article, § 15-103.[fn3]
Appellees, all residents of Maryland, are lawful permanent
resident aliens of the United States who immigrated from
their respective foreign countries on or after 4 August
2003. Section 15-103(a)(2)(viii) provides that the State
[s]hall provide, subject to the limitations of the State
budget and any other requirements imposed by the State,
comprehensive medical care and other health care services
for all legal immigrant children under the age of 18 years
and pregnant women who meet Program eligibility standards
and who arrived in the United States on or after August
22, 1996, the effective date of the federal Personal
Responsibility and Work Opportunity Reconciliation Act
[8 U.S.C. § 1601, et. seq. (1996) (hereinafter”
PRWORA”).]
The Circuit Court granted the preliminary injunction based,
in part, upon its conclusion that Appellees likely would
prevail on their claim that the failure of the State of
Maryland to appropriate funds for Fiscal Year (“FY”) 2006
(1 July 2005 through 30 June 2006) for medical benefits, as
provided under § 15-103(a)(2)(viii), to resident
alien children and resident alien pregnant women in
Maryland who immigrated to the United States on or after 22
August 1996, while funding similar benefits to citizens and
resident aliens in Maryland who immigrated lawfully before
22 August 1996, violated Article 24 of the Maryland
Declaration of Rights.[fn4] Appellants filed a timely
appeal with the Court of Special Appeals. We issued, on our
initiative, a writ of certiorari to the Court of Special
Appeals, Ehrlich v. Perez, 391 Md. 577, 894 A.2d 545
(2006), before our colleagues on the intermediate appellate
court could decide the merits of the case, in order to
consider:[fn5]
1. Whether Appellants violated Article 24 of the Maryland
Declaration of Rights by not appropriating monies for the
State-funded Medical Assistance Program to resident alien
children and pregnant women who immigrated to the United
States on or after 22 August 1996 (a group not otherwise
covered under federal analogous law – Medicaid)
where federal law, enacted under the authority held by the
Federal Government over national immigration policy,
expressly provides the States with complete discretion to
provide wholly State-funded medical benefits to this class
of legal resident aliens.
2. Whether the Circuit Court was authorized to order,
through a preliminary injunction, Appellants to reinstate
medical benefits to Appellees, as prescribed under the
Medical Assistance Program, both retrospectively from 26
October 2005, the date the original Complaint and Motion
for Preliminary Injunction were filed, back to 1 July 2005
and prospectively from 26 October 2005 until final
disposition of the case.
I.
In its written memorandum opinion explaining why it issued
the preliminary injunction, the Circuit Court summarized
the relevant factual and legislative background as follows,
in pertinent part:
* * *
FACTUAL BACKGROUND
Based solely on the original Complaint filed on October
26, 2005, the Plaintiffs are comprised of Flor Perez and
Ana Perez (by their father and next friend, Fidel Perez);
Brayan Herrera, Osyaldo Herrera, and Leslie Herrera (by
their mother and next friend, Martha Herrera); and Gabriel
Ntitebem, Henry Anu, and Vitalis Aternafac (by their
mother and next friend, Ajong Pamela Nkahinjo). They have
filed their original Complaint against the Defendants, who
are comprised of the Governor (Robert L. Ehrlich, Jr.),
the Secretary of the Department of Health and Mental
Hygiene (S. Anthony McCann), and the Treasurer (Nancy
Kopp) for one count of Violation of Maryland Declaration
of Rights. On the day of the scheduled hearing for the
Request for a Preliminary Injunction, the Plaintiffs filed
an Amended Complaint, identifying five additional
Plaintiffs. However, for purposes of this Preliminary
Injunction, the Court viewed the case in light of the
facts as set forth in the original Complaint.
Generally, the Plaintiffs’ Complaint alleges that the
State of Maryland, through Governor Ehrlich’s budgetary
authority, discriminated and otherwise unconstitutionally
denied certain persons living in the State access to
health care [under § 15-103, called the Medical
Assistance Program]. The Plaintiffs[] further contend that
the State relied upon the classification of” alienage” in
making their decision to deny health care coverage of
these individuals.
On April 7, 2005, the General Assembly enacted the fiscal
year 2006 Budget. In mid-June, the Department of Health
and Mental Hygiene mailed a notice to all resident alien
recipients, including the Plaintiffs named herein, to
inform them that their current benefits would end starting
June 30, 2005 as a result of the Governor’s decision to
eliminate such funding. The notice provided for a right to
appeal the termination of coverage to the Office of
Administrative Hearings (OAH).[fn6] The notice also
informed the recipients that there were alternative
options for publicly subsidized health care coverage.
Specifically, the recipients were advised to apply to
their local health department for Maryland Children’s
Health Program (MCHP) coverage if they are under 19 years
of age. The Department also notified the local health
departments in each jurisdiction that funding for this
coverage group had been eliminated from the fiscal year
2006 Budget and thereby instructed the local departments
to assist persons in this group with finding similar care
wherever possible.
Despite the Department’s efforts, Plaintiffs, and others
similarly situated, have been precluded as a result of
their own indigence. Coupled with their inability to pay,
most of these programs are unable to provide such
necessary services that were previously covered under the
Medical Assistance Program. Often times these alternative
programs are simply closed to new patients.
LEGISLATIVE BACKGROUND
In order to thoroughly understand the issues at hand, it
is imperative that this Court outline the Federal and
State statutory programs upon which the Plaintiffs
previously relied for their health care services.
A. FEDERAL PROGRAMS
i. Medicaid
Medicaid is a federal program established by Title XIX of
the Social Security Act. See 42 U.S.C. §§
1396-1396v. “Congress has authorized grants to states for
the purpose of enabling each state, as far as practicable
under the conditions in such state, to furnish medical
assistance to persons who are eligible thereof.” 81 C.J.S.
Social Security and Public Welfare § 247. Eligible
individuals include certain indigent persons, such as the
“aged,” “blind” and “disabled.” Medicaid also provides
coverage for pregnant women and children who fall below a
certain income threshold, in addition to covering
medically needy persons, such as elderly persons who are
confined to nursing homes and whose medical expenses have
exhausted their other assets. If a state chooses to take
part in the federal Medicaid program, it must comply with
the requirements set forth in Title XIX and its
implementing regulations in order to receive federal
matching funds. In Maryland, the federal matching fund is
about 50% of the total expenditures. See Federal Matching
Shares for Medicaid, 68 Fed. Reg. 67676 (Dec. 3, 2003).
ii. Federal Welfare Reform Act
On August 22, 1996, Congress enacted legislation that
significantly impacted Medicaid coverage for select
individuals residing in the U.S. The Personal
Responsibility and Work Opportunity Reconciliation Act of
1996, generally know as the “Welfare Reform Act,” was a
program designed to further the national immigration
policy of “self-sufficiency.” 8 U.S.C. § 1601(1).
The statement of national policy concerning welfare and
immigration reads, in part: “It is a compelling government
interest to remove the incentive for illegal immigration
provided by the availability of public benefits.” 8 U.S.C.
§ 1601(6).
The Act ultimately rendered non-qualified aliens
ineligible for Federal Medicaid benefits, while also
creating two categories for qualified aliens. Alissa v.
Novello, 96 N.Y.2d 418, 426, 745 N.E.2d 1085 (2001); see
also 8 U.S.C. § 1613. The language states: “An
alien who is a qualified alien (as defined in section 1641
of this title) and who enters the United States on or
after August 22, 1996, is not eligible for any Federal
means-tested public benefit for a period of 5 years
beginning on the date of the alien’s entry into the United
States with a status within the meaning of the term
`qualified alien.'” 8 U.S.C. 1613(a). Among the provisions
of the Welfare Reform Act was the elimination of all
benefits for illegal immigrants and other “non-qualified
aliens,” with a few limited exceptions such as emergency
medical care. 8 U.S.C. § 1613. In doing so, Congress
divided the two qualified alien categories into two
subcategories: (1) qualified aliens who have resided in
the U.S. since a time prior to August 22, 1996. Id. Some
states were required to provide funding to the first
subcategory of qualified aliens. Id. However, a period of
five years residency in the U.S. was required for the
second subcategory. Id. Congress then authorized the
States to enact any law after August 22, 1996, should they
choose to compensate this newly designated class of
ineligible aliens, provided they use only State funds.
B. MARYLAND STATE PROGRAMS
i. Maryland’s Welfare Innovation Act
“State participation in Medicaid is voluntary, but if a
state participates, it must comply with the federal
statutes and regulations governing the programs. However,
there is no legal prohibition preventing a state
legislature from awarding medical assistance benefits on
its own, independent of federal reimbursement.” 81 C.J.S.
Social Security and Public Welfare § 247; see also
San Lazaro Ass’n, Inc. v. Connell, 286 F.3d 1088 (9th Cir.
2002), cert. denied, 537 U.S. 878, 123 S.Ct. 78 (2002);
Westside Mothers v. Haveman, 289 F.3d 852, 2002 FED App.
0172P (6th Cir. 2002), cert. denied, 537 U.S. 1045, 123
S.Ct. 618 (2002). In 1997, the Maryland General Assembly
enacted Chapter 593, the “Welfare Innovation Act,” adding
Health-General Article § 15-103(a)(2)(viii) to the
Maryland Annotated Code. This addition thereby authorized
the state to provide:
“[s]ubject to the limitations in the State budget and any
other requirements imposed by the State, comprehensive
medical care and other health care services for all legal
immigrant children under the age of 18 years and pregnant
women who meet Program eligibility standards and who
arrived in the U.S. on or after August 22, 1996, the
effective date of the federal Personal Responsibility and
Work Opportunity Reconciliation Act.”
Md. Ann. Code, Health-General Article §
15-103(a)(2)(viii). The [statutory provision] provides for
medical assistance to this newly excluded class of alien,
pregnant women and children deemed ineligible for
non-emergency, Federal Medicaid benefits. Although the
Maryland State Medicaid program, along with federal
matching funds, provides the same medical services as
available under the Welfare Innovation Act to both
citizens and resident aliens who meet the five-year
residency requirement, this new provision is limited to
those aliens for whom federal Medicaid eligibility was
eliminated by the Welfare Reform Act. Therefore, it is
funded entirely with state funds. Here, the State used
the authority granted by Congress under the Welfare
Reform Act. [The benefits established by the adoption of
§ 15-103] became known as the Medical Assistance
Program.
C. THE MARYLAND STATE BUDGET
* * *
Every year in Maryland, the Governor submits a proposed
budget bill to the General Assembly containing the
proposed budgetary measures for the State government for
the following fiscal year. Unlike a “give and take”
relationship between the Legislative and Executive
branches . . ., the General Assembly is free to reduce the
Governor’s budgetary proposals, but it may not increase or
amend. See MD Const., Art. 3, § 52(6).
Except as expressly mandated by the Constitution or
statutes, the Governor has complete discretion over the
inclusion of appropriations in the Budget and the amount
for the executive branch. The constitutional mandates
relate to funding the public schools, redemption of the
State debt, the payment of certain salaries. With the
consent of the General Assembly, the Governor can amend or
supplement the Budget Bill prior to its passage. Subject
to certain exceptions and limitations, the General
Assembly has express power only to strike or reduce
appropriations in the Budget Bill. However, this express
power includes the implied power to condition or qualify.
Richard E. Israel, Archives of Maryland Online,
“Maryland’s Budget Process,”
[]www.mdarchives.state.md.us/megafile/msa/speccol/
sc2900/sc2908/html/budget.html (last visited December 29,
2005). Despite its ability to “condition” or” qualify” the
revisions in the proposed Budget, the General Assembly is
precluded from deciding that a particular appropriation is
under funded. Maryland’s Legislative branch is powerless
to realign the Governor’s proposed spending like[, for
example,] the legislatures in New York and Virginia.
iv. The Fiscal Year 2006 Maryland Budget: The “Carve-Out”
Provision
Recently, the fiscal year 2006 Budget as proposed by the
Governor eliminated funding for the Medical Assistance
Program. This budget cut essentially carved the
aforementioned category of legal, resident aliens out of
the State’s final Budget Bill. There are currently no
funds available in the budget for the women, who were not
pregnant, and children, both who were in this program at
the beginning of the current fiscal year — however,
[§ 15-103] remains in force. Despite their ability
to condition or qualify certain budgetary measures, the
Maryland General Assembly never had the option to restore
funding to the program, as this would have resulted in
the General Assembly overstepping its Constitutional
boundaries[.][fn7]
On 12 January 2006, the Circuit Court issued a written
memorandum opinion and order granting Appellees’ Motion for
Preliminary Injunction. In its opinion, the Circuit Court
explained its view that Appellees satisfied the four
requisite elements for issuance of a preliminary
injunction. Specifically, the trial court determined that:
the balance of convenience clearly favored Appellees
because they suffered great harm as a result of the State’s
budget cut; Appellees were irreparably injured as a result
of the State’s action because they were unable to afford
health care without the unfunded State assistance; the
public interest “is best served if the [State is] required
to provide benefits to [Appellees] for which they are
currently entitled [under § 15-103(a)(2)(viii)];”
and, finally, Appellees demonstrated that they likely would
succeed on the merits of their Article 24 equal protection
claim. It is this latter determination to which most of the
parties’ attentions are directed on appeal.
With regard to the likelihood of success on the merits,
the Circuit Court explored the principles of equal
protection under Article 24. While acknowledging that
Appellees are “appropriately classified as `aliens,'” the
court determined that the allegations pertained to the
denial of Appellees’ equal protection right “based on their
status as individuals who are legally entitled to State
funding [under § 15-103(a)(2)(viii)] — not as
a suspect class.”[fn8] Thus, rather than focusing upon the
“`alienage’ classification” to determine the appropriate
standard of review to apply to the State action, the court
looked to the “Governor’s decision to cut funding to a
legally entitled group of individuals. . . .” Recognizing
that, in considering equal protection challenges, a
rational basis standard of review generally applies to
examining State action with regard to economic and social
welfare issues, the Circuit Court determined that the
“impact on [Appellees] . . . is far too disparate to ignore
`alienage’ as an underlying classification. . . .”
Therefore, the court reviewed the constitutional claim as to
the budget cut under a strict scrutiny standard. The court
then concluded that the State failed to advance a
sufficient basis “as to how [its] budgetary interest was
compelling enough to overcome strict scrutiny.” The court
noted that “cutting welfare funds to legally entitled
individuals is certainly not narrowly tailored enough to
overcome strict scrutiny.” Consequently, the Circuit Court
reasoned that the State failed to meet its burden and
determined that Appellees likely would succeed on the merits
of their equal protection claim.
The Circuit Court ordered “that the benefits payable under
the Health-General Article § 15-301, et seq.
previously denied to [Appellees] be . . . retroactively
reinstated” and further ordered “that the benefits payable
under the Health-General Article § 15-301, et seq.
be . . . reinstated until final disposition of this
action.” Appellants filed with the Circuit Court a Notice
of Appeal to the Court of Special Appeals, an Answer, and a
Motion for Stay Pending Appeal on 19 January 2006.
Appellees filed an opposition on 23 January 2006. That same
day, the Circuit Court issued a separate order staying the
part of the preliminary injunction that ordered payment of
retrospective benefits, but denied a stay in all other
respects.
The Court of Special Appeals issued an order on 7 February
2006 staying the judgments entered on the Circuit Court’s
orders, pending appeal, without prejudice to the right of
any current Appellee, at that time, to seek from the
Circuit Court “appropriate limited relief from the stay
upon a full and complete showing that (1) in order to avoid
a serious risk to his or her health, the Appellee must
receive particularized medical treatment prior to April 7,
2006, (2) the Appellee would have coverage for this
treatment if the Orders of the circuit court had not been
stayed by this Order, and (3) the Appellee will not be
provided with necessary treatment unless the circuit court
grants appropriate relief.”
After Appellants’ brief on the merits was filed in the
intermediate appellate court, but before further action
could be taken by that court, we issued a writ of
certiorari to the Court of Special Appeals on 9 March 2006.
Ehrlich, 391 Md. at 577, 894 A.2d at 545.
II.
General Standards Applicable to the Review of the Grant of
Injunctive Relief
“Our review of a preliminary injunction is limited because
we do not now finally determine the merits of the parties’
arguments.” LeJeune v. Coin Acceptors, Inc., 381 Md. 288,
300, 849 A.2d 451, 458 (2004) (citing Department of
Transportation v. Armacost, 299 Md. 392, 404, 474 A.2d 191,
197 (1984)) (Internal quotations omitted). We review only
whether the trial court properly granted the preliminary
injunction. Fogle v. H & G Restaurant, 337 Md. 441, 456,
654 A.2d 449, 455 (1995); see also State Dep’t v. Baltimore
County, 281 Md. 548, 550, 383 A.2d 51, 53 (1977) (stating
that “it is a rare instance in which a trial court’s
discretionary decision to grant or to deny a preliminary
injunction will be disturbed by this Court”). In reviewing
a trial court’s decision to issue a preliminary injunction,
we “determine whether the trial judge exercised sound
discretion in examining the four factors that must be
found. . . .” LeJeune, 381 Md. at 300, 849 A.2d at 458
(citing Lerner v. Lerner, 306 Md. 771, 776, 511 A.2d 501,
504 (1986)). The four factors that the trial judge examines
when considering the appropriateness of granting a
preliminary injunction include:
(1) the likelihood that the plaintiff will succeed on the
merits; (2) the “balance of convenience” determined by
whether greater injury would be done to the defendant by
granting the injunction than would result from its
refusal;[] (3) whether the plaintiff will suffer
irreparable injury unless the injunction is granted; and
(4) the public interest.
Armacost, 299 Md. at 404-05, 474 A.2d at 197 (citing State
Dep’t v. Baltimore County, 281 Md. at 554-57, 383 A.2d at
55. The party seeking the preliminary injunction has the
burden of adducing facts necessary to satisfy these
factors. Fogle, 337 Md. at 456, 654 A.2d at 456. The
“failure to prove the existence of even one of the four
factors” precludes the grant of injunctive relief. Id. With
regard to the factor of the likelihood of success on the
merits, “the party seeking the interlocutory injunction
must establish that it has a real probability of prevailing
on the merits, not merely a remote possibility of doing
so.” Id.
Yet, “even with respect to a discretionary matter, a trial
court must exercise its discretion in accordance with
correct legal standards.” LeJeune, 381 Md. at 301, 849 A.2d
at 459 (Citation omitted). We review de novo a trial
judge’s decision involving a purely legal question.
Matthews v. Park & Planning, 368 Md. 71, 92, 792 A.2d 288,
301 (2002). We apply the more deferential abuse of
discretion standard to a trial judge’s ruling involving a
balancing of interests. Id. In the present case, the
Circuit Court’s determination of the likelihood of success
on the merits is a question of law. See Davis v. Slater,
383 Md. 599, 604, 861 A.2d 78, 80 (2004) (noting that
because “interpretation of the Maryland Declaration of
Rights and Constitution . . . [is] appropriately classified
as [a] question[] of law, we review the issue[] de novo”).
Consequently, we apply the de novo standard to that factor,
but the more deferential abuse of discretion standard to
the trial judge’s determinations as to the remaining three
factors. III.
The Parties’ Main Arguments
A.
Level of Judicial Scrutiny to be Accorded to the
Appellants’ Action in the Equal Protection Analysis
Appellants assert that the Circuit Court erred in granting
the preliminary injunction because Appellees lacked a real
probability of prevailing on the merits of their Article 24
claim. Appellants contend that their failure to appropriate
funds for medical benefits to a subcategory of legal aliens
who, by virtue of congressional action under PRWORA, were
ineligible to receive federal medical benefits is subject
to rational basis review under the Supremacy Clause and
withstands Appellees’ equal protection challenge under that
standard. Under the Supremacy Clause, Appellants contend,
consideration of Appellees’ state constitutional claim
requires judicial deference to Congress’ plenary power over
naturalization and immigration policy. Relying on Mathews
v. Diaz, 426 U.S. 67, 96 S.Ct. 1883, 48 L.Ed.2d 478 (1976),
and Fiallo v. Bell, 430 U.S. 787, 97 S.Ct. 1473, 52 L.Ed.2d
50 (1977), Appellants argue that Congress’ power over the
admission and naturalization of aliens is complete and broad
such that Congress’ actions are subject to narrow judicial
scrutiny.
Although conceding that the State may not exercise
independently a like power over aliens, Appellants maintain
that, in adopting the Welfare Reform Act, Congress
prescribed a uniform rule for the treatment of an alien
sub-class in regard to the provision of medical benefits,
which Maryland could follow, citing as support Plyler v.
Doe, 457 U.S. 202, 219 n. 19, 102 S.Ct. 2382, 2396 n. 19,
72 L.Ed.2d 786, 800 n. 19 (1982), Toll v. Moreno, 458 U.S.
1, 102 S.Ct. 2977, 73 L.Ed.2d 563 (1982), DeCanas v. Bica,
424 U.S. 351, 358 n. 6, 96 S.Ct. 933, 47 L.Ed.2d 43 (1976),
and Graham v. Richardson, 403 U.S. 365, 91 S.Ct. 1848, 29
L.Ed.2d 534 (1971). It is necessary to apply this relaxed
standard of scrutiny to both federal and state laws that
follow a federal classification because “[i]t would make no
sense to say that Congress has plenary power in the area of
immigration and naturalization and then hold that the
Constitution compels the states to refrain from adhering to
the federal guidelines [when a state denies state-funded
welfare benefits to certain aliens],” quoting Sudomir v.
McMahon, 767 F.2d 1456, 1466 (9th Cir. 1985) (applying
rational basis review in rejecting equal protection
challenge to the State’s denial of State-funded welfare
benefits to a sub-class of aliens).
Appellants offer that the reason for the Maryland budget
cut was to achieve a cost savings of seven million dollars
(equal to the amount of funds appropriated in the Medical
Assistance Program in Fiscal Year (“FY”) 2005, inclusive of
the estimated number of individuals of the legal alien
sub-class to which Appellees belong) of the four billion
dollar budget appropriated for medical assistance health
care costs generally. They maintain that Congress provided
a “sufficient showing of a facially legitimate and bona
fide reason” to discriminate against the relevant alien
sub-class in the provision of federal Medicaid benefits, by
including legislative findings in the Welfare Reform Act.
These legislative findings provide that the provisions of
the Welfare Reform Act were necessary to achieve the
national immigration policy of encouraging self-sufficiency
and removing incentives for illegal immigration. The Act’s
findings also provide that a State choosing not to provide
non-emergency medical benefits to aliens excluded from
federal benefits by the Welfare Reform Act, as Maryland did
in the FY 2006 Budget, “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,” quoting 8 U.S.C. § 1601(7). Appellants
argue that the Supremacy Clause restrains Maryland State
courts from disregarding Congress’ direction in this area
of immigration policy.
Finally, as to the correct standard of review to be applied
to the Article 24 challenge, Appellants assert that the
Welfare Reform Act grants Maryland the ability to determine
whether and to what extent it will use State funds to
provide non-emergency medical benefits to resident aliens
who do not meet the five-year residency requirement, see 8
U.S.C. §§ 1622(a), 1624(a), provided that any
prohibitions, limitations, or restrictions imposed by
Maryland are not more restrictive than the prohibitions,
limitations, or restrictions imposed under comparable
federal programs, see 8 U.S.C § 1624(b).[fn9]
Appellees, on the other hand, maintain (as Appellants seem
to concede) that the budget cut of State-funded medical
assistance to certain resident aliens was a classification
based upon alienage, and is therefore a suspect
classification, relying on Murphy v. Edmonds, 325 Md. 342,
601 A.2d 102 (1992), and Graham, supra, 403 U.S. 365, 91
S.Ct. 1848, 29 L.Ed.2d 534. Appellees argue that, because
Appellants used a classification based on alienage in
cutting State-funded medical assistance to the relevant
sub-class of legal aliens depending on their length of
residency in the United States, a court reviewing the State
action must apply the strict scrutiny standard, see, e.g.,
Graham, 403 U.S. at 370-76, 91 S.Ct. at 1851-54, 29 L.Ed.2d
at 540-44, Nyquist v. Mauclet, 432 U.S. 1, 8, 97 S.Ct. 2120,
2125, 53 L.Ed.2d 63, 70 (1977), and Takahashi v. Fish &
Game Comm’n., 334 U.S. 410, 418-22, 68 S.Ct. 1138, 1142-44,
92 L.Ed. 1478, 1486-89 (1948). Appellees and Appellants
agree that if Congress prescribed a truly uniform rule or
standards for the treatment of aliens and a State abided by
that rule or applied properly those standards when it chose
to discriminate against or between resident aliens within
its territory, a reviewing court should apply a rational
basis scrutiny to determine whether the State action
violated equal protection rights. The parties part ways
thereafter. Appellees assert that PRWORA provides no uniform
rule or evaluative standards with regard to decisions
involving State-funded medical assistance programs because
PRWORA leaves unbridled discretion to the individual States
to decide how each will treat the class of resident aliens
that immigrated to the United States on or after 22 August
1996 and therefore have not resided in the United States
for five years. Thus, Appellees argue that the appropriate
standard of review of the State action here is strict
scrutiny. Furthermore, Appellees contend that Appellants’
reason for the budget cut (cost savings) is not a
sufficiently compelling state interest to justify its
discrimination against an alien sub-class when fashioning
its medical assistance plan budget, citing, e.g., Graham,
430 U.S. at 374, 91 S.Ct. at 1853-54, 29 L.Ed.2d at 543
(“[A] State’s desire to preserve limited welfare benefits
for its own citizens is inadequate to justify . . . making
noncitizens ineligible for public assistance benefits . . .
and restricting benefits to citizens and longtime resident
aliens.”), and Shapiro v. Thompson, 394 U.S. 618, 89 S.Ct.
1322, 22 L.Ed.2d 600 (1969).
Appellees bring to our attention that a similar medical
assistance funding restriction adopted in New York, based
on alienage, was found to be unconstitutional, under state
and federal equal protection guarantees, in Aliessa v.
Novello, 754 N.Ed.2d 1085 (N.Y. 2001). The Court of Appeals
of New York in Aliessa concluded that, in contrast to the
federal government, States may only discriminate against
immigrants in State-funded programs if the federal
government has prescribed by uniform rule what it believes
to be appropriate standards for the treatment of an alien
sub-class, citing language from footnote 19 in Plyler v.
Doe. Aliessa, 754 N.E.2d at 1096 (discussing Graham). The
court concluded that, by enacting PRWORA, Congress did not
establish a uniform rule for States regarding the provision
of medical assistance to legal immigrants because Congress
left to the States’ discretion the development of their
own individualized policies regarding the provision of
State-funded medical assistance to legal immigrants.
Aliessa, 754 N.E.2d at 1098. Because New York’s termination
of State-funded benefits to resident aliens was not
pursuant to a uniform federal rule or set of criteria, our
sister high court reviewed the State action under the
strict scrutiny test, concluded that it did not pass that
review, and held that the State action violated the Equal
Protection guarantees of the federal and New York
constitutions. Id. The legal reasoning applied by the court
in Aliessa applies, it is submitted by Appellees, with
equal force to the present case.
[…]