American Journal of Law & Medicine

Denying Lawful Immigrants Access to State Healthcare Subsidies Violates the Equal Protection Provision of the Massachusetts Constitution - Finch V. Commonwealth Health Insurance Connector Authority

Denying Lawful Immigrants Access to State Healthcare Subsidies Violates the Equal Protection Provision of the Massachusetts Constitution--Finch v. Commonwealth Health Insurance Connector Authority (1)--The Supreme Judicial Court of Massachusetts held that a legislative appropriation denying state subsidies for the purchase of healthcare to lawfully-residing non-citizen immigrants fails strict scrutiny and thus, violates the equal protection provision of the Massachusetts Constitution. (2)

Plaintiffs, a group of Massachusetts non-resident aliens whose benefits were terminated by the appropriation, sued the Commonwealth Health Insurance Connector Authority (CCA), which is an independent public entity that administers the state healthcare subsidies. (3)The plaintiffs alleged that CCA's denial of benefits was based solely on their alienage and thus, violated their rights under the Commonwealth's equal protection provision. (4)

CCA administers the Commonwealth Care Health Insurance Program ("Commonwealth Care"), an integral part of Massachusetts healthcare reform. (5) Commonwealth Care "reduc[es] uninsurance in the commonwealth" by providing subsidies to aid eligible individuals (6) in purchasing health insurance. (7) Federal and state funds both support these premium payment subsidies for eligible Massachusetts residents. (8) Under the aegis of a Medicaid "demonstration project," the federal government partially reimburses Commonwealth Care's expenditures on individuals who are eligible for federal benefits and does not offer reimbursement for federally ineligible individuals. (9)

Initially, the Commonwealth Care permitted all eligible residents to enroll in Commonwealth Care, including all "qualified aliens," which are defined as lawful permanent residents and other certain specific categories of noncitizens, such as refugees or asylum recipients, (10) "Qualified aliens" is defined broadly in the Federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA). (11) Without federal matching funds, Massachusetts assumed the entire cost of providing subsidies to its approximately 29,000 federally-ineligible aliens under its Commonwealth Care insurance scheme. (12)

Due to the 2008 financial crisis, the Commonwealth's projected tax revenue estimate decreased by over $1.5 billion in May 2009, (13) and the Massachusetts Senate Ways and Means Committee proposed limiting Commonwealth Care subsidies only to aliens eligible for federal benefits. (14) As a result, in February 2010, plaintiffs filed suit in the Supreme Judicial Court, Suffolk County ("Supreme Judicial Court") to challenge the appropriation that enacted the Committee's proposal. …

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