J.S. v. Nebraska Dept. of Health & Human Servs.
944 N.W.2d 266
Neb.2020Background
- J.S., a citizen of El Salvador, was placed in Nebraska foster care as a minor and had a pending Special Immigrant Juvenile (SIJ) application when she turned 19 and entered Nebraska’s Bridge to Independence (B2I) program.
- DHHS accepted J.S. into B2I but denied Medicaid coverage after her 19th birthday; DHHS found she did not meet Medicaid’s citizenship/alien-status eligibility requirements.
- J.S. exhausted administrative review; a district court affirmed DHHS’s denial and she appealed to the Nebraska Supreme Court.
- Legal context: PRWORA generally bars non-lawfully present aliens from state/local public benefits unless a state law "affirmatively provides" eligibility under 8 U.S.C. § 1621(d); Nebraska enacted the Young Adult Bridge to Independence Act (YABI), which authorizes B2I and states that extended services include medical care under the medical assistance program for eligible participants.
- Question presented: whether federal statutes, Nebraska’s Medicaid state plan, DHHS regulations, or YABI/§ 43-4505(1) affirmatively authorized Medicaid to a non-lawfully present noncitizen B2I participant over age 18 (age 19).
Issues
| Issue | Plaintiff's Argument (J.S.) | Defendant's Argument (DHHS) | Held |
|---|---|---|---|
| Whether CHIP or the federal "lawfully residing" exception (CHIPRA §214/§1396b(v)(4)(A)) or the ACA former-foster-care category required Medicaid for J.S. after age 18 | CHIPRA and the former-foster-care rules permit lawfully residing noncitizen children/young adults up to 21; J.S. was lawfully residing (pending SIJ) and thus eligible | Nebraska elected the optional CHIPRA provision only up to the State’s chosen age limit; Nebraska’s State Plan did not extend federal Medicaid to pending SIJ applicants past age 18/19 | Denied — Nebraska did not elect to extend those federal options beyond the State’s age limit; CHIP/former-foster-care did not provide coverage to J.S. after 19 |
| Whether YABI/§43-4505(1) "affirmatively provide[]" Medicaid eligibility to non-lawfully present aliens in B2I (i.e., bypass PRWORA) | YABI’s provision that B2I includes "medical care under the medical assistance program" means all B2I participants (including non-lawfully present pending SIJ applicants) must get Medicaid; omission of "lawfully present" cannot bar benefits | PRWORA requires a positive/express legislative statement to permit benefits to non-lawfully present aliens; YABI contains no such affirmative language — omission is not enough | Denied — YABI does not affirmatively provide Medicaid to aliens not lawfully present; PRWORA/§4-108 control |
| Whether passage of §43-4505(1) was a "material change in State law" requiring DHHS to amend the Medicaid State Plan to cover non-lawfully present B2I participants | The Legislature’s directive that B2I include medical care was a material change obligating DHHS to amend the State Plan to provide Medicaid for B2I participants (including non-lawful aliens) | The State Plan already provided for former foster youth per federal law; §43-4505(1) did not change eligibility language or override PRWORA; no material-change amendment was required to broaden eligibility | Denied — §43-4505(1) was not a material change requiring a State Plan amendment to override PRWORA; it would conflict with existing federal categories |
| Whether DHHS’s denial violated Nebraska’s separation-of-powers clause | DHHS’s regulations/practices effectively amend legislative policy by excluding non-qualified aliens from B2I medical care | The Legislature enacted §4-108 barring public benefits to persons not lawfully present unless federal law exempts; Legislature could have expressly included noncitizens in YABI but did not; DHHS applied the law | Denied — no separation-of-powers violation; DHHS followed statutory/regulatory scheme and PRWORA; courts will not substitute policy judgment for the Legislature |
Key Cases Cited
- McManus Enters. v. Nebraska Liquor Control Comm., 303 Neb. 56 (2019) (administrative procedure act standard for judicial review)
- In re Application No. OP-0003, 303 Neb. 872 (2019) (statutory and regulatory interpretation reviewed de novo)
- In re Estate of Vollmann, 296 Neb. 659 (2017) (describing Medicaid as joint federal-state program with federal requirements)
- Holloway v. State, 293 Neb. 12 (2016) (interpretation of discretionary meaning of "may")
- Jama v. Immigration and Customs Enforcement, 543 U.S. 335 (2005) ("may" ordinarily connotes discretion in statutory interpretation)
- Nebraska Coalition for Ed. Equity v. Heineman, 273 Neb. 531 (2007) (role of judiciary vis-à-vis legislative policymaking under separation of powers)