Health Law Advocates, Inc.
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Boston, MA 02108

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Priority Areas

Legal Immigrant Access to Health Care


HLA Wins Landmark Case, Gains Health Care Access for Low-Income Legal Immigrants

On January 5, 2012, in a case filed by Health Law Advocates (HLA), the Massachusetts Supreme Judicial Court (SJC) ruled unanimously that a state law barring 40,000 low-income legal immigrants from the state’s Commonwealth Care program is unconstitutional and must be struck down.  Read the full decision here.

The suit, Finch v. Connector Authority, filed by HLA on behalf of tens of thousands of low-income Massachusetts legal immigrants in February 2010, challenged the constitutionality of a state law passed in 2009 eliminating access to Commonwealth Care for legal immigrants who had been in the U.S. for less than five years.   Massachusetts’ historic health reform law passed in 2006 allowed legal immigrants who met eligibility requirements to obtain health insurance through the Commonwealth Care program.

In its unanimous and historic January ruling, the SJC asserted that legal immigrants are entitled to equal protection under the state constitution.  Wendy Parmet, a member of HLA’s Board of Directors and a Northeastern University School of Law professor argued the case for HLA.  As a result of the ruling, Massachusetts’ state legislature allocated the additional budgetary resources to the state’s Commonwealth Care program to meet its constitutional obligations. 

“Fiscal considerations alone cannot justify a State's invidious discrimination against aliens,” notes the ruling.  “The discrimination against legal immigrants that its limiting language embodies violates their rights to equal protection under the Massachusetts constitution.”

In this case, the Supreme Judicial Court took the unusual step of permitting the plaintiffs to file their lawsuit directly in the high court as opposed to requiring them to begin the litigation in a lower court.  HLA’s attorneys successfully argued to the Justices that the issues in the case met the Court’s standard permitting the direct filing of cases of “broad public importance.”  As a result, HLA won invalidation of the Commonwealth’s discriminatory policy sooner than if the Court had declined their request for direct review. 

In May, 2011, the Court made an initial ruling in the case that the Massachusetts Constitution virtually prohibits the Commonwealth from adopting policies that discriminate against legal immigrants by limiting their access to public benefits compared to citizens. The Commonwealth cannot use financial reasons to defend discrimination against legal immigrants, the Court said.  In January’s ruling, the Court affirmed that the State must allow legal immigrants back into Commonwealth Care because there was no justification for the discriminatory policy.

The federal Affordable Care Act requires that as of 2014, federal subsidies to obtain private health insurance are to be made available for low-income, uninsured U.S residents including legal immigrants. Massachusetts had been providing a state subsidy to this population for this purpose as of 2006, as part of its implementation of Health Care Reform.  The SJC’s ruling requires the full resumption of those subsidies to low-income legal immigrants. The Massachusetts case may serve as a precedent as other states prepare to implement expanded health coverage in compliance with the Affordable Care Act and as many State’s implement and weigh additional policies that discriminate against immigrants.

Case History

On March 23, 2010, the Defendants answered Plaintiffs’ complaint and removed the case to the United States District Court for the District of Massachusetts. The Plaintiffs responded with a motion to remand to State court, which was opposed by the defendants. Federal District Judge William Young held a hearing on May 18, 2010 and remanded the case to the SJC.

On June 8, 2010, Plaintiffs filed an Updated Motion to Reserve and Report This Matter to the Full Court (SJC). Although the initial complaint contained a federal claim, once Plaintiffs removed that claim, the case only presented a state law claim: whether the equal protection clauses of the Massachusetts Declaration of Rights permit the Commonwealth to discriminate against residents in the provision of state-subsidized health insurance solely on the basis of their citizenship status. The Plaintiffs’ motion was argued by Lorianne Sainsbury-Wong, Senior Staff Attorney at HLA, and Justice Cordy of the SJC ultimately agreed [click to read] that the resolution of the matter depended on novel interpretations of state constitutional law, not the adjudication of contested facts, and therefore was appropriate for reservation and report to the SJC. In his order for Reservation and Report, Justice Cordy set forth four questions of law to be resolved on the basis of the then-assembled record as supplemented by the parties’ agreed statement of facts. The parties then jointly filed a Stipulation of the Parties to Accompany Reservation and Report of Questions and Stipulation Exhibits A-J.

On July 23, 2010, the Commonwealth (Attorney General Martha Coakley) filed a Motion to Intervene as Defendant.

The first phase of the case was heard on November 1, 2010 by the SJC.  The oral arguments can be viewed here.

HLA attorneys filed a motion and supporting legal memo in the SJC on May 23, 2011 asking the Court to formally declare the State law barring low-income legal immigrants from Commonwealth Care unconstitutional to pave the way for 40,000 low-income legal immigrants to enroll in the Commonwealth Care program. 

The SJC heard oral arguments in the final phase of the case on October 6, 2011.  The oral arguments can be viewed here.