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Noncitizens Struggle After Losing Health Benefits

Advocates Hope Connecticut Decision Will Be Reversed

By WILLIAM WEIR

September 01, 2011

After undergoing eight cycles of chemotherapy for leukemia earlier this year, Claudia De Borhorquez was prescribed several medications, costing well over $1,000 each month. She purchased her regimen for July, but before she could get the next round of drugs, she received a letter from the state.

It began: "Effective July 1, 2011, state-funded medical assistance for most noncitizens will end."

De Borhorquez, 70, is one of about 4,700 people in Connecticut who are in the U.S. legally but have not yet obtained citizenship, and recently lost their health benefits.

Those benefits had been provided as part of the State Medical Assistance for Noncitizens Act, which the state legislature created in 1996. It was a reaction to the federal government's discontinuation of coverage for legal noncitizens whose income levels would qualify for Medicaid.

Like those in many states at the time, Connecticut's lawmakers decided to provide medical benefits for five years — approximately the time it takes to obtain citizenship — to legal noncitizens. Although a regular subject of debate during budget negotiations, the act managed to survive.

But in 2009, in an increasingly difficult economy, the state legislature voted to end state medical assistance for noncitizens for a projected savings of $19 million over two years. For the most recent budget vote, there was no discussion about reinstating the benefits.

"It was a cut we absolutely hated to make," said Derek Slap, spokesman for Senate Democrats. "When you have a $3.5 billion deficit, and you're looking for savings everywhere," options are limited, he said. It's possible that the benefits will be reinstated in the next legislative session, "but obviously, we have to see how the budget comes out."

Greater Hartford Legal Aid immediately filed an appeal, and in December of 2009, won in state Superior Court. The state appealed that decision, and in April the state Supreme Court ruled in favor of the legislature's decision.

Benefits for noncitizens who are legal residents continue only for those who live in a nursing home and for pregnant women and children under 21 who are eligible for Medicaid.

The notice, sent by the state Department of Social Services, encouraged noncitizens who didn't meet those exceptions to look into the Charter Oak assistance program, which costs $464 per month.

De Borhorquez moved to the U.S. from Colombia and was diagnosed with leukemia in October 2010, a little more than a year after she became a legal resident. She lives in Sandy Hook with her daughter and son-in-law. She'll have to wait until at least 2014 before receiving citizenship.

"I can't sleep, thinking about it," De Bohorquez said, with her daughter, Freya Lombardo, translating.

De Bohorquez filed an appeal of the decision; on Aug. 18, she received a letter from the state denying her appeal. De Bohorquez said she is feeling better now, but is worried about what will happen if she doesn't take the prescribed medications.

"We're only asking for help to continue her treatment," said Lombardo, who married a U.S. citizen and has lived in the U.S. for nine years. "I think a lot of people are in this situation."

Sheldon Toubman, an attorney with the New Haven Legal Assistance Association, said continuing the benefits is a matter of both fairness and practicality.

"It is unfair because they pay taxes like anyone else, they have the same obligation as any citizen," he said. Although the decision was made with budgetary concerns, he said, it will also backfire economically. Any chronic condition that goes untreated can land the patient in the emergency room, he said.

"That is an expense that we all bear," Toubman said. "As we move to universal health care, here we have 5,000 people who are here legally, playing by the rules, and we're dumping them back into the emergency room cycle, which is ultimately unproductive."

Postponed Surgery,An Unused Artificial Leg

Jim Haslam, a New London attorney representing Juan Jimenez, who moved to New London from the Dominican Republic, said the experience has been a frustrating one. Jimenez, 69, had a heart attack shortly after he scheduled cataract surgery in June and was preparing to get a new prosthetic leg to replace an ill-fitting one. Unaware of the July 1 change, he postponed the cataract surgery and waited to get the prosthesis while he recovered from the heart attack.

When it came time for the surgery, health providers told him he had no insurance and there was nothing they could do. The artificial leg was made, but with no money to pay for it, it sits in the shop.

Haslam said his client received a notice from the state, but it was written in English and it took him a while to have it translated. Had Jimenez appealed his case within 10 days of receiving the notice, Haslam said, he would have continued receiving benefits until a decision was reached; that could have bought him six to eight weeks' time. Almost surely his appeal would have been denied, Haslam said, and the state would have retroactively billed him. Even so, Haslam said, Jimenez would at least have had the eye surgery and a working prosthetic leg.

"Honestly, there's nothing I can do to help him get these things right now," Haslam said.

'Most Vulnerable'

Sue Garten of Greater Hartford Legal Aid said the state's noncitizens have few options.

"These are the most vulnerable people because they're older, blind, disabled or caretakers of children, and for them to be without any medical coverage whatsoever is really inhuman and un-American," she said. Garten said it's unconstitutional to deny them benefits since "all of our clients are legally in the U.S. and should be treated the same as citizens."

That argument was successful in state Superior Court, but state Supreme Court Justice Peter T. Zarella ruled that Connecticut had been performing an altruistic service for the noncitizens and was not legally obligated to continue doing so.

Garten said cases in other states offer some hope. Similar appeals have been filed in Washington, Hawaii and Massachusetts. So far, the lower courts have ruled on behalf of continuing benefits for noncitizens. If an appeal reaches the U.S. Supreme Court, she said, and the ruling favors noncitizens, that would reverse the situation for Connecticut's noncitizens.

More immediately, Toubman said, the best chance of changing the policy is not through the courts, but by persuading state lawmakers to reverse their 2009 decision.

"Right now, it's up to the legislature to fix this," he said. But that's a tall order, he said, since the state has even more pressing budgetary problems now than in 2009.

Ina Leff's family hopes that she won't need any health care until 2014. That's when the 82-year-old Leff will be eligible for citizenship. Leff lives in Branford with her daughter and son-in-law, who emigrated from Belarus to Israel in the 1990s and came to the U.S. in 2001. Leff came to the U.S. in January 2008, shortly after her husband died.

Because of errors in paperwork, Leff didn't receive her green card and Social Security number until this May, so her benefits came too late to pay for a weeklong stay in the hospital for a back problem. That left her family with a bill of about $50,000. They figured that at least they wouldn't incur any more health care costs once Leff began receiving benefits. But a few days later, said her son-in-law, Michael Dubrovsky, they received notice that those benefits would end.

"When she came here," he said, "we weren't expecting so many problems."