Guaman v. Velez

23 A.3d 451, 421 N.J. Super. 239, 2011 N.J. Super. LEXIS 131
CourtNew Jersey Superior Court Appellate Division
DecidedJuly 12, 2011
StatusPublished
Cited by12 cases

This text of 23 A.3d 451 (Guaman v. Velez) is published on Counsel Stack Legal Research, covering New Jersey Superior Court Appellate Division primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Guaman v. Velez, 23 A.3d 451, 421 N.J. Super. 239, 2011 N.J. Super. LEXIS 131 (N.J. Ct. App. 2011).

Opinion

The opinion of the court was delivered by

MESSANO, J.A.D.

Plaintiffs are legal resident aliens who have resided in this country for less than five years. They seek emergent relief enjoining enforcement of Medicaid Communication 10-01 and N.J.A.C. 10:78-3.2, as amended and adopted on May 28, 2010, which authorized termination of their enrollment in the NJ FamilyCare Program (FamilyCare), a state-funded Medicaid program offering subsidized health insurance to qualifying low-income adults and children. Pursuant to the issuance of the communication by the Division of Medical Assistance and Health Services (the Division), and adoption of the regulation by the Department of Human Services (DHS, and collectively, defendants), several thousand legal resident aliens were terminated from FamilyCare, and several thousand more became ineligible to enroll, resulting in an estimated $29.8 million in savings for the State. See id. at 1405. Plaintiffs argue that the agency actions are ultra vires, violate the equal protection guarantees of the Federal and State Constitutions, and will cause them to suffer irreparable harm unless injunctive relief is ordered.

On January 11, 2011, we granted plaintiffs leave to file a motion for emergent relief on an expedited basis and ordered briefing of the issues presented. In the interim, plaintiffs moved: 1) to file a proposed class member’s certification under seal because disclosure of his identity would pose a risk to his safety from terrorist groups in his native country; and 2) to permit thirteen organizations to appear as amici curiae.1 We granted those motions and heard oral argument from the parties and amici on April 5, 2011.

“[A] party who seeks mandatory preliminary injunctive relief must satisfy a ‘particularly heavy’ burden.” Rinaldo v. RLR Inv., LLC, 387 N.J.Super. 387, 396, 904 A.2d 725 (App.Div.2006) (quoting Punnett v. Carter, 621 F.2d 578, 582 (3d Cir.1980)). A [248]*248successful applicant must demonstrate by clear and convincing evidence, Am. Emp’rs’ Ins. Co. v. Elf Atochem N. Am., 280 N.J.Super. 601, 610-611 n. 8 (App.Div.1995), that a stay is necessary to prevent irreparable harm, that the legal right underlying the claim is settled, that the material facts are substantially undisputed, that the applicant has a reasonable probability of success on the merits, and that a balancing of the equities and the hardships weighs in favor of granting relief. Crowe v. De Gioia, 90 N.J. 126, 132-34, 447 A.2d 173 (1982). Having considered the arguments raised in light of the record and these applicable legal standards, we deny plaintiffs’ motion for a preliminary injunction staying enforcement of Medicaid Communication 10-01 and N.J.A.C. 10:78-3.2.

I.

We review the relevant statutory framework and provide some factual and procedural background that is undisputed.

While each State has significant discretion in designing its own Medicaid programs, A.K. v. Div. of Med. Assistance & Health Servs., 350 N.J.Super. 175, 178-79, 794 A.2d 835 (App.Div.2002), they are subject to the approval of the United States Secretary of Health and Human Services, and each state must comply with the minimum requirements imposed by the Federal Medicaid Act in order to receive federal matching funds. Atkins v. Rivera, 477 U.S. 154, 157, 106 S.Ct. 2456, 2458, 91 L.Ed.2d 131, 137 (1986); 42 U.S.C.A. § 1396a.

In 1968, New Jersey elected to participate in the Medicaid program by enacting the “ ‘New Jersey Medical Assistance and Health Services Act,’ ” N.J.S.A. 30:4D-1 to-19.5, administered by DHS through the Division. N.J.S.A. 30:4D-3(c) and 30:4D-4. The program enables the State:

[T]o provide medical assistance, insofar as practicable, on behalf of persons whose resources are determined to be inadequate to enable them to secure quality medical care at their own expense, and to enable the State, within the limits of [249]*249funds available for any fiscal year for such purposes, to obtain all benefits for medical assistance provided by the Federal Social Security Act.
[N.J.S.A. 30:4D-2 (emphasis added).]

As originally enacted, our statute conformed to the broad federal eligibility guidelines which then mandated coverage for non-citizen lawful permanent residents regardless of their date of entry or length of residency in the United States. L. 1968, c. 413. See Monmouth Med. Ctr. v. Hau Kwok, 183 N.J.Super. 494, 497, 444 A.2d 610 (App.Div.1982); 45 C.F.R. § 233.50 (1973); 42 C.F.R. § 435.402(b) (1990). A “ ‘[qualified applicant’ ” was initially defined as “a resident of this State ... determined to need medical care and services as provided under this act[.]” L. 1968, c. 413. See Monmouth Med. Ctr., supra, 183 N.J.Super. at 496, 444 A.2d 610 (quoting N.J.A.C. 10:94-3.2 (supp.12-8-76)(repealed 2010)). (an “ ‘applicant must be a resident of the United States who is either a citizen or an alien lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law’ ”).

In 1996, Congress enacted the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), 8 U.S.C.A. §§ 1601 to 46, and significantly limited a non-citizen’s access to federally-subsidized medical benefits. A.B. v. Div. of Med. Assistance & Health Servs., 407 N.J.Super. 330, 343, 971 A.2d 403 (App.Div.), certif. denied, 200 N.J. 210, 976 A.2d 386 (2009). PRWORA’s self-declared purpose was “to remove the incentive for illegal immigration provided by the availability of public benefits.” 8 U.S.C.A. § 1601(6).

To that end, PRWORA divided aliens into two categories— qualified and unqualified — and limited Medicaid eligibility to “qualified aliens,” which it narrowly defined as lawful permanent residents, designated refugees, aliens granted asylum, and other specified categories of lawfully-present aliens. 8 U.S.C.A. §§ 1612(b), 1641(b). Only qualified aliens who entered the country prior to August 22, 1996, or otherwise lived in the country for five years from the date of lawful permanent resident designation (the five-year bar), however, were eligible for non-emergency [250]*250federal Medicaid benefits. 8 U.S.C.A. §§ 1612(b)(2)(B), 1613(a). For all intents and purposes, federally-funded Medicaid is largely unavailable for people arriving in the United States after August 22, 1996 unless they have resided in this country for at least five years. 8 U.S.C.A. § 1613(a). Further, PRWORA provided:

With respect to the State authority to make determinations concerning the eligibility of qualified aliens for public benefits ..., a State that chooses to follow the Federal classification in determining the eligibility of such aliens for public assistance shall be considered to have chosen the least restrictive means available for achieving the compelling governmental interest of assuring that aliens be self-reliant in accordance with national immigration policy.
[8 U.S.C.A. § 1601(7) (emphasis added).]

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Bluebook (online)
23 A.3d 451, 421 N.J. Super. 239, 2011 N.J. Super. LEXIS 131, Counsel Stack Legal Research, https://law.counselstack.com/opinion/guaman-v-velez-njsuperctappdiv-2011.