Opinion ID: 2554470
Heading Depth: 1
Heading Rank: 2

Heading: Federal Medicaid Program

Text: The federal government created the federal Medicaid program through the enactment of Title XIX of the Social Security Amendments of 1965, Pub.L. No. 89-97, § 121, 79 Stat. 286, 343-52, codified as amended at 42 U.S.C. § 1396 et seq. (2006 and Sup. III 2009). Federal Medicaid is an optional federal and state cooperative medical assistance program pursuant to which a state that elects to participate receives federal funding to assist it in providing publicly funded medical assistance to certain groups of indigent individuals who meet eligibility criteria and possess at least one of the categorical eligibility characteristics generally required for coverage. [10] The phrase categorical eligibility generally refers to those who are disabled, blind, pregnant, a parent of a dependent child, or an individual under twenty-one years of age or sixty-five years of age or older. See 42 U.S.C. §§ 1396a (a)(10) and 1396d (a) (2006 and Sup. III 2009); see also 42 C.F.R. § 435.100 et seq. (2010). The members of the class all meet the categorical eligibility requirements for federal Medicaid. Federal law governs the federal Medicaid program and determines the eligibility requirements for that program. See, e.g., K & A Radiologic Technology Services, Inc. v. Commissioner of the Dept. of Health, 189 F.3d 273, 277 (2d Cir.1999). States that adopt federal Medicaid agree to administer the program in accordance with federal law and regulations in order to receive a substantial reimbursement from the federal government to subsidize the cost of the program. See id.; see also 42 U.S.C. § 1396a (a) (2006). Federal Medicaid provides the states certain options for coverage, and each state is required to submit its own plan that outlines the terms of the state's participation in the federal Medicaid program. See 42 U.S.C. § 1396a (a) (2006). The federal government must approve that plan before the state may participate. See 42 U.S.C. §§ 1396 and 1396a (b) (2006 and Sup. III 2009). Although the amount of federal funding varies by state, Connecticut, which, in 1965, authorized the state to participate in the federal Medicaid program; see Public Acts 1965, No. 357, § 1; currently receives a reimbursement from the federal government at a rate of approximately 50 percent of the cost of Connecticut's federal Medicaid program. [11] Cf. 42 U.S.C. § 1396d (b) (2006). The General Assembly has charged the defendant with administering federal Medicaid, in accordance with federal laws and regulations. See General Statutes § 17b-260. Until 1996, federal Medicaid provided assistance to many indigent individuals meeting the categorical eligibility requirements without regard to citizenship status or durational residency requirements. On August 22, 1996, Congress enacted the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Welfare Reform Act), Pub.L. No. 104-193, 110 Stat. 2105, which, as President William J. Clinton put it, was designed to end welfare as we know it. . . . (Internal quotation marks omitted.) P. Kilborn & S. Verhovek, Clinton's Welfare Shift Ends Tortuous Journey, N.Y. Times, August 2, 1996, p. A1. Title IV of the Welfare Reform Act substantially impacted the provision of public welfare assistance to certain immigrants. See generally 8 U.S.C. § 1601 et seq. (2006 and Sup. III 2009). In enacting the Welfare Reform Act, Congress included several statements regarding national immigration policy indicating that Congress favored self-sufficiency by immigrants, immigrants were applying for and receiving public assistance at greater rates and, through the Welfare Reform Act, Congress intended to discourage immigrants from relying on publicly funded assistance. 8 U.S.C. § 1601 (2006). [12] Whether an alien is eligible for public assistance depends on a number of factors, including whether the alien entered the country lawfully, the particular legal status under which the alien entered, the date that the alien entered, and the amount of time that the alien has resided in the United States. See 8 U.S.C. §§ 1612, 1613, 1621, 1622 and 1641(b) (2006 and Sup. III 2009). The Welfare Reform Act divides aliens into two groups: qualified and nonqualified aliens. See 8 U.S.C. § 1641(b) (2006) (defining qualified alien). Qualified aliens are generally those aliens lawfully admitted to the United States for permanent residence and those admitted pursuant to certain statutes. 8 U.S.C. § 1641(b) (2006). Any alien not considered a qualified alien is a nonqualified alien, which includes illegal aliens. See 8 U.S.C. § 1641(b) (2006). All nonqualified aliens are ineligible for federal public assistance, including federal Medicaid, subject to certain exceptions. [13] 8 U.S.C. § 1611(a) and (b) (2006). The class members in the present case are all qualified aliens. The Welfare Reform Act further distinguishes qualified aliens depending on their length of residency in the United States. Any qualified alien who has resided in the United States for five or more years is eligible for federal public assistance. See 8 U.S.C. § 1613(a) (2006). Aliens who have resided in the United States for fewer than five years, however, generally are barred from receiving federal public assistance until they have resided in the United States for five years (five year rule). [14] See 8 U.S.C. § 1613(a) (2006). But see 8 U.S.C. § 1613(b) (2006) (providing exceptions to five year rule). Federal law thus requires states to deny federal Medicaid coverage to qualified aliens who are barred from participating by the five year rule. [15] Additionally, the Welfare Reform Act similarly authorizes states to deny state funded public assistance to certain qualified aliens. 8 U.S.C. §§ 1622(a) and 1624 (2006). The class members meet the categorical eligibility requirements for participation in federal Medicaid but are barred from receiving federal Medicaid assistance because they have resided in the United States for fewer than five years.