The highest court in New Jersey recently backed the state’s decision to cut Medicaid benefits for low-income immigrants who didn’t meet the five-year residency requirement to the chagrin of immigrants’ rights advocates.
In 2013, advocacy groups sued the state after lawmakers repealed Medicaid coverage for nearly 12,000 adults in response to an impending budget crunch. However, their efforts haven’t been fruitful. Before the latest case, a lower court ruled that the decision didn’t violate federal or state constitutions.
But immigration rights’ groups show no sign of slowing down, with some parties mulling over an appeal to the U.S. Supreme Court.
“We argued that the state was violating the requirement of equal protection and, essentially, discriminating against immigrants solely because they are immigrants — treating them differently from citizens for the purpose of cost savings, which under longstanding precedent violates the guarantees of equal protection,” Jenny-Brooke Condon, director of Seton Hall Law School’s Equal Justice Clinic, told Newsworks, a Philadelphia-based news outlet, on Thursday.
Before New Jersey rescinded benefits, it counted among the few states that allowed immigrants with less than five years of residency to enroll in Medicaid. Nearly 30 other states, the District of Columbia, and the Commonwealth of the Northern Mariana Islands only provide exemptions for legally residing children and pregnant women. Nationally, immigrants designated as “qualified non-citizens” can receive coverage if they meet their state’s income eligible requirements. Qualified non-citizens include permanent residents who hold green cards, those under asylum, refugees, victims of trafficking, and Cuban and Haitian entrants.
The new developments out of the Garden State come amid increasing Medicaid enrollment across the United States, a trend that some speculate happened because of the Affordable Care Act. Groups that advocate for severely limiting immigration, like the Center for Immigration Studies released a report last November that blamed legal and illegal immigrants and their children accounted for the spike in Medicaid enrollment.
“The high rate and significant growth in Medicaid associated with immigrants is mainly the result of a legal immigration system that admits large numbers of immigrants with relatively low-levels of education, many of whom end up poor and uninsured,” the report argued. “This fact, coupled with the extensive supports we provide to low-income residents, unavoidably creates very significant costs for taxpayers.”
These sentiments echo that of those who support New Jersey’s move. Proponents say that rescinding the Medicaid benefits of immigrants who don’t meet the five-year eligibility requirements translate into a cost savings of nearly $50 million over two years. However, that may not account for the external costs of denying health care, such as emergency room visits and lost productivity due to lack of health care.
The financial costs of immigration — legal and illegal — has been the prevailing argument among oppose policies favoring members of the group. Even with the projected seven percent growth in federal Medicaid-related expenditures, costs for benefits have risen slower than that of private insurance premiums.
Low-income households also benefit from Medicaid in the long term. Those who meet the federal eligibility floor of 138 percent of the poverty level receive long-term services and supports that could help them avoid increasingly expensive hospital emergency room visits. Mandatory benefits under Medicaid include family planning services, nurse midwifery, tobacco cessation counseling, and federally qualified health center resources. These offerings help expectant mothers in the form of care related to pregnancy, labor, delivery and any complications that occur during pregnancy, depending on her state of residence.
Even if the law allowed immigrants to receive Medicaid benefits, barriers exist that complicate efforts to attain healthcare, one of them being the complex language in educational materials. That’s why Condon said that relinquishing Medicaid benefits further marginalized legal immigrants, a group that contributes nearly 15 percent of the American economy despite accounting for 13 percent of the population: “It’s a decision that’s unfair,” Condon said. “Lawful residents contribute to the state’s tax coffers … help fund the very benefits that they are being denied.”
The debate over Medicaid benefits is not endemic to New Jersey. Florida lawmakers’ refusal to expand Medicaid in the Sunshine State has started a budget battle that some say won’t subside by the scheduled end of the legislative session in May. In Alaska, Gov. Bill Walker and state legislators are butting heads over the issue, despite a new poll that shows strong support for Medicaid expansion among Alaskans. A July 2014 study also alluded the effects of not expanding Medicaid, with data showing that people in the Southern poverty belt have shorter, sicker life expectancies than other Americans.