## Facts

- Congress enacted the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), permitting states to restrict some public benefits, including Medicaid, for specified categories of lawfully present noncitizens.
- New York enacted Social Services Law § 122, denying state-funded Medicaid to (1) lawful permanent residents who entered on or after September 22, 1996, and (2) persons “permanently residing under color of law” (PRUCOLs), while leaving only emergency Medicaid.
- The plaintiffs were lawfully present New York residents who were concededly needy, suffered serious illnesses, and would have qualified for Medicaid but for § 122.
- Plaintiffs filed a class action alleging that § 122 violated N.Y. Const. art. XVII and the Equal Protection Clauses of the U.S. and New York Constitutions.
- The trial court initially granted partial summary judgment for plaintiffs, later vacating its equal protection ruling; the Appellate Division upheld § 122; the Court of Appeals reviewed on appeal as of right.

## Issues

1. Whether Social Services Law § 122 violates N.Y. Const. art. XVII, § 1 by denying otherwise-eligible needy persons ongoing Medicaid based on alienage and entry-related criteria unrelated to need.
2. Whether § 122 violates federal and state equal protection by discriminating against lawful noncitizens in access to Medicaid, and what level of scrutiny applies.

## Decision

- The Court of Appeals reversed and held Social Services Law § 122 unconstitutional and unenforceable.
- The court held § 122 violated N.Y. Const. art. XVII, § 1 because it imposed an eligibility condition unrelated to need and withheld an entire category of basic-necessity benefits (ongoing medical care) from a needy class.
- The court held § 122 violated the Equal Protection Clauses of the U.S. and New York Constitutions because it created an alienage-based classification subject to strict scrutiny that the State could not justify.
- The case was remitted for further proceedings consistent with the court’s ruling.

## Legal Principles

- N.Y. Const. art. XVII, § 1 imposes an affirmative state obligation to provide aid, care, and support to the needy; legislative discretion concerns the manner and means of providing aid, not exclusion of needy persons based on criteria unrelated to need.
- Ongoing medical care may constitute a basic necessity benefit within Article XVII’s protection; the State may not deny such benefits to concededly needy persons through non-need-based categorical exclusions.
- State alienage classifications disadvantaging lawful resident aliens are generally subject to strict scrutiny under equal protection.
- Congressional permission for states to differentiate among lawful noncitizens in benefit programs does not immunize state statutes from equal protection review; Congress cannot authorize states to violate equal protection.
- Fiscal savings and generalized budgetary concerns are insufficient to satisfy strict scrutiny for a suspect classification, and categorical denial of benefits to a vulnerable class is not narrowly tailored.

## Conclusion

New York could not deny ongoing Medicaid to otherwise-eligible, needy lawful noncitizens based on immigration status and entry-related criteria: the exclusion conflicted with the State’s constitutional duty to aid the needy and failed strict scrutiny under federal and state equal protection.


Aliessa v. Novello, 96 N.Y.2d 418 (2001)