## Facts

- Congress enacted the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), restricting many noncitizens’ eligibility for federally funded Medicaid and other public benefits.
- In 1997, Maine created a state-only medical assistance program, funded solely by the state, to cover certain lawfully present noncitizens made ineligible for Medicaid under PRWORA.
- In 2011, Maine enacted legislation terminating this state-funded medical assistance for the affected noncitizens.
- After the termination, otherwise eligible U.S. citizens continued to receive comparable state-funded assistance while similarly situated lawfully present noncitizens did not.
- Lawfully present noncitizen residents who lost coverage sued the Maine Department of Health and Human Services Commissioner, alleging an Equal Protection Clause violation based on alienage discrimination.

## Issues

1. Whether Maine’s termination of a state-funded medical assistance program for certain lawfully present noncitizens, while continuing comparable benefits for citizens, likely violated the Equal Protection Clause.
2. Whether plaintiffs satisfied the requirements for a preliminary injunction, particularly likelihood of success on the merits.

## Decision

- The First Circuit affirmed the district court’s denial of a preliminary injunction.
- The court concluded plaintiffs were not likely to succeed on the merits of their equal-protection claim.
- The court remanded with instructions that the equal-protection claim be dismissed.

## Legal Principles

- A preliminary injunction requires satisfaction of a multi-factor test, with likelihood of success on the merits as the decisive factor.
- Although state classifications based on alienage are generally suspect, a state is not constitutionally required to create or continue a discretionary, state-funded benefits program for lawfully present noncitizens.
- When federal law restricts noncitizens’ eligibility for federally funded benefits and leaves states discretion to supplement with state funds, equal protection does not require a state to maintain or “equalize” an optional, state-only supplement after deciding to end it.

## Conclusion

The First Circuit held that Maine’s decision to terminate a voluntary, state-funded medical assistance program for certain lawfully present noncitizens did not violate equal protection, and because plaintiffs lacked a likelihood of success on the merits, preliminary injunctive relief was properly denied and the claim was ordered dismissed.


Bruns v. Mayhew, 750 F.3d 61 (1st Cir. 2014)