Lewis v. Grinker: 2d Circuit Rules That States May Deny Prenatal Care to "Not Qualified" Immigrants

IMMIGRANTS & PUBLIC BENEFITS

Health Care

LEWIS V. GRINKER: 2D CIRCUIT RULES THAT STATES MAY DENY PRENATAL CARE TO "NOT QUALIFIED" IMMIGRANTS
Immigrants' Rights Update, Vol. 15, No. 4, June 29, 2001

The U.S. Court of Appeals for the Second Circuit has ruled that Congress acted constitutionally in banning states from using federal Medicaid to provide prenatal care to women who are not "qualified" immigrants as defined in the Personal Responsibility and Work Opportunity Act of 1996 (PRWORA). The decision reversed a U.S. district court's conclusion that denying prenatal care to "not qualified" immigrants under section 401(a) of the PRWORA violated their U.S.-born children's constitutional right to equal protection. See Immigrants' Rights Update, Feb. 11, 2000, p. 8. Nonetheless, the court of appeals clarified, U.S. citizen children born to "not qualified" immigrant mothers have an equal protection right to be automatically eligible for Medicaid on the same basis as children born to U.S. citizen mothers.

The court's ruling will have little practical effect on the availability of prenatal care for undocumented women. At the time the decision was announced, only New York was receiving federal Medicaid matching funds for prenatal care services to "not qualified" immigrants. Many states use other resources, including state or local funds, to provide prenatal care to these immigrants. These services, as well as labor and delivery services funded in all states by emergency Medicaid, were not affected by the court's decision. In New York, legislation that would make prenatal care available to all immigrants regardless of status is currently pending.

The Lewis litigation has spanned several generations of Medicaid eligibility standards since it was filed in 1979. The recent case was the latest in a series of challenges to a 1987 injunction that barred the New York Medicaid agency from denying Medicaid-funded prenatal care to women on the basis of their immigration status. The district court had found that the PRWORA required the denial of such care but concluded that withholding prenatal care from "not qualified" immigrant women violated the equal protection rights of their U.S.-born children.

The court of appeals declined to find a constitutional basis for providing prenatal care to undocumented women. The court first rebuffed the argument that the denial of prenatal care violated the women's constitutional rights. The judges reasoned that the denial was within the scope of Congress's broad power to regulate immigration and must therefore be evaluated under a highly deferential standard. The New York Medicaid agency argued that Congress had three objectives in adopting PRWORA's immigration provisions: a desire to deter illegal immigration, to encourage self-sufficiency, and to save on costs. The court acknowledged that it had no evidence that a person considers the availability of prenatal care when deciding to immigrate without documents but concluded nonetheless that deterring illegal immigration provided a sufficient rational basis for denying prenatal care. The court declined to discuss the other two rationales presented, despite the evidence described in its opinion that providing prenatal care is more cost effective than treating the conditions that result from its absence.

The court also rejected the district court's finding that the denial of prenatal care violated the U.S. citizen children's right to equal protection. This claim, brought by the mothers on behalf of the newly born children, related to the physical and mental challenges the children were likely to experience after birth because their mothers were denied prenatal care. The court held that the claim was precluded by the U.S. Supreme Court's decision in Roe v. Wade. "If," the court explained, "as Roe v Wade instructs, a fetus lacks constitutional protection to assure it an opportunity to be born, we see no basis for according it constitutional protection to assure it good prospects after birth."

The court ruled, however, that children born to "not qualified" immigrant mothers are automatically eligible for one year of Medicaid coverage on the same basis as children born to U.S. citizen mothers. Finding that requiring applications from such children after birth disadvantaged them (compared to children who receive immediate coverage under their mother's Medicaid number), the court concluded that this disadvantage represented a denial of equal protection. The court of appeals remanded the case to the district court with instructions to revise the injunction. Until this process is completed, prenatal care remains available to New York women regardless of immigration status.

The body of the opinion closes with the court's observation that the New York Medicaid agency would likely need to adopt a procedure permitting the "not qualified" immigrant mother, during her pregnancy, to apply for and obtain a Medicaid number that would become effective upon the birth of her child. This would present an opportunity for New York to issue emergency Medicaid cards that women could use for their labor and delivery.

Lewis v. Grinker, __ F.3d __ (2d Cir. 2001) (decided May 22, 2001).