Tennessee Argues Against Medicaid Benefits for Refugees

CINCINNATI (CN) – An attorney for the state of Tennessee argued before a Sixth Circuit panel Tuesday morning that a federal requirement to provide Medicaid benefits to refugees is unconstitutional.

The appeal stems from a federal lawsuit filed in 2017 by the Tennessee General Assembly, State Senator John Stevens and State Representative Terri Lynn Weaver, both Republicans, against the U.S. Department of State.

The lawsuit claimed the federal government’s threat to cut off Medicaid funding if it refused to provide benefits to refugees constitutes coercion in violation of the 10th Amendment.

U.S. District Judge S. Thomas Anderson disagreed, however, and ruled last year that the state and its representatives lack standing to bring their challenge, as they did not provide evidence of a concrete injury.

The lawmakers claimed a revocation of funding would “impede and interfere” with their ability to “fully discharge” their duties as elected officials, but Judge Anderson called their injuries “wholly abstract.”

Judge Anderson also agreed with the federal government that the claims brought by Tennessee are not yet ripe for review.

“Here,” he wrote, “Tennessee has not submitted a Medicaid plan amendment changing the provision of medical assistance to refugees. Nor have plaintiffs alleged that Tennessee is currently withholding medical assistance from refugees. … Additionally, there is nothing indicating that a finding of non-compliance would lead to the withholding of all of the state’s federal Medicaid funding.”

The state and its representatives also claimed the requirement to provide Medicaid benefits to refugees constitutes a new aspect of the Medicaid program, but Judge Anderson disagreed.

“None of the events described by plaintiffs represents a departure from the understanding pursuant to which Tennessee has accepted federal Medicaid funds for over forty years – that it must cover lawfully present aliens, including refugees, under its Medicaid program,” the judge wrote.

Attorney John Bursch argued on behalf of the state Legislature Tuesday, and called the potential revocation of funding a “catastrophic loss” that would represent 20 percent of the state’s annual budget.

“No state in their right mind would be able to walk away from 20 percent of their budget,” Bursch told the Sixth Circuit panel.

The attorney repeatedly cited the 2015 U.S. Supreme Court decision in Arizona State Legislature v. Arizona Independent Redistricting Commission, and noted that the Legislature in that case was given standing to sue on the basis of an “institutional injury.”

Bursch countered the district court’s ruling that the Legislature’s failure to submit an amendment to the current Medicaid plan renders the Arizona suit unripe as well, and told the panel the Supreme Court ruled in that case that the Arizona Legislature was not required to submit a redistricting plan it knew would be rejected by the commission.

Justice Department attorney Samantha Chaifetz argued on behalf of the federal government, and told the panel if it agreed with the Legislature’s position, it “would render all Medicaid requirements as commandeering state funds.”

She told the panel that while Medicaid does represent 20 percent of Tennessee’s annual budget, 65 percent of that comes from the federal government.

Chaifetz said the requirement to provide benefits to refugees has been a part of the Medicaid plan since its inception, and that in the last several years, the highest number of recipients in Tennessee was 2,000.

She rejected “this notion that refugees are obtaining preferential treatment.”

The attorney explained that if a refugee qualifies for Medicaid, there is a seven-year limit on the benefits he or she receives.

Chaifetz cited the landmark 2012 Supreme Court case National Federation of Independent Business (NFIB) v. Sebelius, in which the nation’s high court upheld the individual mandate of the Affordable Care Act, but ruled a Medicaid expansion was outside the realm of the government’s spending power.

The attorney called a comparison to NFIB “critical,” and said the current case differs because “the eligibility [for refugees] has not been expanded,” while NFIB involved the implementation of a new system of regulations.

In his rebuttal, Bursch said the number of refugees in Tennessee has “skyrocketed” in the past several years, but that his client is not opposed to providing Medicaid benefits, as long as they are not forced into doing it.

“The problem,” he concluded, “is when they do not give us an opportunity to opt out.”

The panel of judges included Chief U.S. Circuit Judge R. Guy Cole Jr., Senior U.S. Circuit Judge Danny Julian Boggs and U.S. Circuit Judge Julia Smith Gibbons.

No timetable has been set for the court’s decision.

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