Ehrlich v. Perez

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Robert L . Ehrlich, Jr., G overnor, e t al. v. Flor Pe rez, et al., No. 137, Sept. Term 2005. CONSTITUTIONAL LAW - MARYLAND DECLARATION OF RIGHTS - ARTICLE 24 - EQUAL PROTECTION - STRICT SCRUTINY - SUSPECT CLASSIFICATION CLASSIFICATION BASED ON ALIENAGE - PRELIMINARY INJUNCTION Appellan ts (Go vern or of Maryland, State T reasurer, and Secretar y of State Department of Health and Mental Hygiene) did not appropriate monies for the State Medical Assistance Program to resident alien children and pregnant women who immigrated to the United States on or after 22 August 1996 (a group not otherwise covered under analogous federal law Medicaid) for Fiscal Year ( FY ) 2006 when it funded the same benefits to citizens and resident aliens in Maryland who arrived before 22 Augus t 1996. A federal law , enacted in 1996 by the Federal Government under its national immigration policy, withheld federal funds for similarly situated aliens and expressly provided states with complete discretion to provid e who lly State-fu nded m edical b enefits to this cla ss of leg al reside nts. The Circuit Co urt for M ontgom ery County gran ted a prelimin ary injunction in favor of Appellees (minors, by next friends, who ca me within the class den ied benef its) based, in pa rt, on the conclusion that the failure of the State of Maryland to appropriate funds for FY 2006 for medical benefits, as provided under Maryland Code (1982), Repl. Vol. 2005), HealthGeneral Article, § 15-301(a)(2)(viii), violated Article 24 of the Maryland Declaration of Rights. The Circuit Court ordered on 12 January 2006 that the benefits payable under § 15301(a)(2)(v iii) previously denied to App ellees be reimbursed fo r past and current costs of Appellees medical coverage incurred between 1 July 2005 and 26 October 2005 (the date the original Complaint and Motion for Preliminary Injunction were filed), and be reinstated prospectively until final disposition of the case. The Court of Appea ls determine d that it was a ppropriate g enerally for the Circuit Court judge to grant the preliminary injunction because Appellees likely will succeed on the merits of the Article 24 claim . The failure to appropriate monies for medical assistance benefits on the basis of alienage violated the equal protection guarantees of Article 24 of the Declaration of Rights because the State s reason for the alienage classification (cost savings) was not tailored suitably to serve a compelling state interest. The strict judicial scru tiny standard is appropriate to apply to the State s action here because Congress did not prescribe a single, uniform policy to which states are required to adhere in exe rcising discre tion wheth er to fund, w ith State monie s only, suc h med ical assis tance. The Circuit Court s order for relief thro ugh a pre liminary injunctio n retrospec tive to the date of filing the Complaint and Motion for Preliminary Injunction, 26 October 2005, was not appropriate, however, because it was, in effect, an award of past damages to Appellees without either a final dispos ition on the m erits or a determ ination of a ctual dam ages, if any, suffered by App ellees. That portio n of the C ircuit Court s ord er that enjoins affirmative ly and prospectively Appellants to provide benefits under the Medical Assistance Program was appropriate because it was designed to preserve the status quo as of the initiation of the suit so as not to undermine the final disposition of the case on the merits. Circuit Co urt for Mo ntgomery C ounty Case # 265850 IN THE COURT OF APPEALS OF MARYLAND No. 137 September Term, 2005 ROB ERT L. EH RLIC H, JR., GOV ERN OR, et al. v. FLOR PERE Z, et al. Bell, C.J. Raker Wilner Cathell Harrell Battaglia Greene, JJ. Opinion by Harrell, J. Wiln er an d Ca thell , JJ., join in jud gme nt on ly. Filed: October 12, 2006 Pursuant to Maryland Code (1973, Repl. Vo l. 2002), Courts and Judicial Proceedings Article, § 12-303(3)(i), 1 Appellants (Defendants below), the Honorable Robert L. Ehrlich, Jr., the Honorable S. Anthony McCann, and the Honorable Nancy Kopp, each sued in his or her official capacity as Governor of Maryland, Secretary of the Maryland Department of Health and Mental H ygiene ( DH MH ), and State Treasurer , respectively, sou ght appella te review of a preliminary injunction issued by the Circuit Court for Montgomery County. The injunction essentially ordered the payment of medical assistance benefits to Appellees (Plaintiffs in the Circuit Court), comprised of Flo r Perez and Ana Pe rez (minors , by their father and next friend, Fidel Perez); Brayan Herrera, Osvaldo Herrera, and Leslie Herrera (minors, by their mother and next friend, Martha Herrera); and Gabriel Ntitebem, Henry Anu, and Vita lis A tema fac ( minors, b y their mother and nex t friend, Ajong Pam ela Nkahinjo), 2 1 Maryland Code (1973, Repl. Vol. 2002), Courts and Judicial Proceedings Article, § 12-303(3)(i) prov ides that a party may a ppeal fro m an inter locu tory order ente red b y a circuit court that [g]rant[s] or dissolv[es] an injunction, but if the appeal is from an order granting an injunction, then the order may be appealed only if the appellant has first filed his answer in the caus e[.] 2 A First Amended Complaint filed in the Circuit Court on 21 December 2005 (the day of the scheduled hearing for the request for a preliminary injunction) sought to add several new plaintiffs, including Jh onny Franc is Guerrel, Y oharis Fran cis Tama yo, and Yd alis Francis Tamayo (minors, by their father and next friend, Yohara Tamayo Ruiz), and Eelaaf Zahid and Muhammad Loulak Zahid (minors, by their father and next friend, Muhammad Zahid Iqbal). In its 12 January 2006 memorandum opinion and order granting the preliminary injunction, the Circuit Court stated that, in deciding whether to issue a preliminary injunction, it v iewed the case in light o f the facts as set forth in the original Com plaint. under the Medical A ssistance Program, M aryland Code (1982, Repl. Vol. 2005), HealthGeneral Article, § 15-103.3 Appellees, all residents of Maryland, are lawful permanent resident aliens of the United States who immigrated from their respective foreign countries on or after 4 August 2003. Section 15-103(a)(2)(viii) provides that the State [s]hall provide, subject to the limitation s of the State budget and any other requirements imposed by the State, comprehensive medical care and other health care services for all legal immigrant children under the age of 18 years and pregnant women who meet Program eligibility standards and who arrived in the United States on or after August 22, 1996, the effective date of the federal Person al Responsibility and Work Opportu nity Reconciliation Act [8 U.S.C . § 1601 , et. seq. (1996) (hereinafter PRW ORA ).] The Circuit Court gra nted the pre liminary injunctio n based, in part, upon its conclusion that Appellees likely would p revail on the ir claim that the failure of th e State of Ma ryland to appropriate funds for Fiscal Year ( FY ) 2006 (1 July 2005 through 30 June 2006) for medical benefits, as p rovided u nder § 15 -103(a)(2)(v iii), to resident alien children and resident alien pregnant women in Maryland who immigrated to the United States on or after 22 Aug ust 1996, w hile fundin g similar ben efits to citizens and resident aliens in Maryland who immigrated lawfully before 22 August 1996, violated Article 24 of the Maryland 3 Maryland Code (1982, Repl. Vol. 2005), Health-General Article, § 15-103 outlines the administration of the Medical Assistance Program. All statutory references in this opinion are to the Health-General Article unless otherwise specified. 2 Declaration of Rights.4 Appellants filed a timely appeal with the Court of Special Appeals. We issue d, on our in itiative, a writ of certiora ri to the C ourt of Specia l Appe als, Ehrlich v. Perez, 391 Md. 5 77, 894 A .2d 545 (2 006), befo re our collea gues on th e intermed iate appellate court could dec ide the merits of the case, in orde r to consider: 5 1. Whether Appellan ts violated A rticle 24 of the Maryland Declaration of Rights by not appropriating monies for the Statefunded Medical Assistance Program to resident alien children and pregnant women who immigrated to the United States on or after 22 August 1996 (a group not otherwise covered under federal analogous law Medicaid) where federal law, enacted under the authority held by the Federal Government over national immigration policy, expressly pro vides the S tates with comple te discretion to provide wholly State-funded medical benef its to this c lass of le gal resid ent alien s. 2. Whether the Circuit Court was authorized to order, through a preliminary injunction, A ppellants to reinstate medical b enefits to Appellees, as prescribed under the Medical Assistance Program, both retrospectively from 26 October 200 5, the date the original Co mplaint an d Motio n for Prelim inary Injunction were filed, back to 1 July 2005 and prospectively from 26 October 2005 until final disposition of the case. 4 Article 24 o f the Ma ryland Decla ration of R ights provid es [t]hat no man oug ht to be taken or imprisoned or disseized of his freehold, liberties or privileges, or outlawed, or exiled, or, in any manner, destroyed, or deprived of his life, liberty or property, but by the judgm ent of h is peers, o r by the L aw of the land . 5 We h ave r e-w ritten the q uestions for o ur co nsid erati on for clarity. 3 I. In its written memorandum opinion explaining w hy it issued the preliminary injunction, the Circuit Court summarized the relevant factual and legislative background as follows, in p ertinent part: *** FACTUAL BACKGROUND Based solely on the original Complaint filed on October 26, 2005, the Plaintiffs are comprised of Flor Perez and Ana Perez (by their father and next friend, F idel Perez); Brayan Herrera, Osyaldo Herrera, and Leslie Herrera (by their mother and next friend, Martha Herrera); and Gabriel Ntitebem, Henry Anu, and Vitalis Aternafac (by their mother and next friend, Ajong Pame la Nka hinjo). T hey have filed their original Complaint against the Defendants, who are comprised of the Governor (Robert L. Ehrlich, Jr.), the Secretary of the Department of Health and Mental Hygiene (S. Anthony McCan n), and the Treasurer (Nancy Kopp) for one count of Violation of M aryland D eclaratio n of R ights. On the day of the scheduled hearing for the Request for a Preliminary Injunction, the Plaintiffs filed an Amended Complaint, identifying five additional Plaintif fs. However, for purposes of this Preliminary Injunction, the Court viewed the case in light of the facts as set forth in the o riginal Com plaint. Gen erall y, the Plaintiffs Comp laint alleges tha t the State of Maryland, thr ough Go vern or Ehrlic h s b udgetary authority, discriminated and otherwise unc onstitutionally den ied certain persons living in the S tate access to health care [under § 15-103, called the Medical Assistance Program]. The Plaintiffs[] further contend that the State relied upon the classification of alienage in making their decision to deny health care coverage of these individuals. 4 On April 7, 2005, the General Assembly enacted the fiscal year 2006 B udget. In m id-June, the D epartmen t of Health and Mental Hygiene mailed a notice to all resident alien recipients, including the Plaintiffs named herein, to inform them that their current b enefits wo uld end starting June 30, 2005 as a result of the Governor s decision to eliminate such funding. The notice provided for a right to appeal the termination of coverage to the Office of Administrative Hearings (OAH). [6] The notice also informed the recipients that there were alternative options for publicly subsidized health care coverage. Specifically, the recipients were adv ised to apply to their local health department for Maryland Childre n s Health Program (MCH P) covera ge if they are under 19 years of age. The Department also notified the local health departments in each jurisdiction that funding for this coverage group had been eliminated from the fiscal year 2006 Budge t and thereb y instructed the lo cal departments to assist persons in this group with finding similar care wherever possible. 6 Neither the trial court nor the parties explicated the origin of this apparent opportunity to litigate an administrative appeal of Appellants' action. See Furnitureland v. Comptroller, 364 Md. 126, 132, 771 A.2d 1061, 1065 (2001) (noting that any court may raise sua sponte the issue of invocation and exhaustion of administrative remedies). While Appellees note in a footnote of their brief that one of the persons who sought to join the case as a Plaintiff in the First Amended Complaint filed in the Circuit Court did pursue an administrative appeal, we could find nothing else in the record transmitted in the present litigation to suggest such an administrative appeal was pursued by any of the Appellees named in the original complaint. Even if an opportunity for an administrative remedy existed, judicial consideration of the present action would not be barred by the doctrine of exhaustion of administrative remedies because the "constitutional exception" to the general rule applies in the present case. See Montgomery County v. Broadcast, 360 Md. 438, 45560, 758 A.2d 995, 1004-07 (2000) (outlining the development and contours of the "constitutional exception"). This "constitutional exception" permits an aggrieved litigant to proceed immediately to court to seek a declaratory judgment or equitable remedy, regardless of the existence of an available administrative appeal, where the sole contention raised in the court action is based on a facial attack on the constitutionality of the governmental action. See, e.g., PSC v. Wilson, 389 Md. 27, 91, 882 A.2d 849, 887 (2005). 5 Despite the Department s efforts, Plaintiffs, and others similarly situated, have been precluded as a result of their own indigence. Coup led with their ina bility to pay, m ost of these programs are unable to provide such necessary services that were previously covered under the Medical Assistance Program. Often times these alternative programs are simply closed to new patients. LEGISLATIVE BACKGROUND In order to thoroughly understand the issues at hand, it is imperative that this Court outline the Federal and State statutory programs upon which the Plaintiffs previo usly relied for the ir health care services. A. FEDERAL PROGRAMS i. Medicaid Medica id is a federal program estab lished by Title XIX of the Social Security Act. See 42 U.S.C. §§ 1396-1396v. Congress has authorized grants to states for the purpose of enabling each state, as far as practicable under the conditions in such state, to furnish medical assistance to persons who are eligible thereof. 8 1 C.J.S. So cial Security and Public Welfare § 247. Eligible individuals include certain indigent persons, such as the aged, blind and disabled. Medicaid also provides coverage for pregnant w omen an d children w ho fall below a certain income threshold, in addition to covering medically needy persons, such as elderly persons w ho are confined to nursing homes and whose medical expenses have exhausted their other assets. If a state chooses to take part in the federal Medicaid program, it must comply with the requiremen ts set forth in Title XIX and its implementing regulations in order to receive federal matching funds. In Maryland, the federal matching fund is about 5 0% o f the tota l expen ditures. See Federal Matching Shares for Medicaid, 68 Fed. Reg. 67676 (Dec. 3, 2003). ii. Federal Welfare Reform Act 6 On August 22, 1996, Congress enacted legislation that significantly impacted Medica id coverage for select ind ividuals residing in the U.S. The Perso nal Responsibility and Wo rk Opportu nity Reconciliation Act of 1996, generally know as the Welfare Reform Act, was a program designed to further the national immig ration p olicy of s elf-suf ficienc y. 8 U.S .C. § 1601(1). The statement of national policy concerning welfare and immigration reads, in part: It is a compelling government interest to remove the incentive for illegal immigration provided by the availability of public benefits. 8 U.S.C. § 1 601(6). The Act ultimately rendered non-qualified aliens ineligible for Fede ral Medic aid benefits, while also creating two categories for qualified aliens. Alissa v. No vello, 96 N.Y.2d 418, 426, 745 N.E.2d 1 085 (200 1); see also 8 U.S.C. § 1613. The language states: An alien who is a qualified alien (as defined in section 1641 of this title) and who enters the United States on or after August 22, 1996, is not eligible for any Federal means-tested public benefit for a period of 5 years beginning on the date of the alien s entry into the United States with a status within the meaning of the term qualified alien. 8 U.S.C. 1613(a). Among the provisions of the W elfare Reform Act was the elimination of all benefits for illegal immigrants and other non-qualified aliens, with a few limited exceptions such as emergency medical care. 8 U.S.C. § 1613. In doing so, Congress divided the two qualified alien categories into two subcategories: (1) qualified aliens who have resided in the U.S. since a time p rior to A ugust 2 2, 1996 . Id. Some states were required to provide funding to the first subcategory of qualified aliens. Id. How ever, a period of f ive years residen cy in the U.S. was require d for th e secon d subc ategory. Id. Congress then authorized the States to enact any law after August 22, 1996, should they choose to compen sate this newly designated class of ineligible aliens, provided they use only State funds. B. MARYLAND STATE PROGRAMS i. Maryland s Welfare Innovation Act 7 State participation in Medicaid is voluntary, but if a state participates, it must comply with the federal statutes and regulations governin g the prog rams. Ho wever, the re is no legal prohibition preventing a state legislature from awarding medical assistance benefits on its own, independent of federal reimbu rsemen t. 81 C.J.S. S ocial Secu rity and Public Welfare § 247; see also San Lazaro Ass n, Inc. v. Con nell, 286 F.3d 1088 (9 th Cir. 2002), cert. denied, 537 U .S. 878, 123 S.Ct. 78 (20 02); Westside Mothers v. Haveman, 289 F.3d 852, 2002 FED App. 0172P (6 th Cir. 2002), cert. denied, 537 U.S. 1045, 123 S.Ct. 618 (2002). In 1997, th e Maryland General A ssembly enacted Chapter 593, the Welfare Innovation Act, adding HealthGeneral Article § 15-103(a)(2)(viii) to the Maryland Annotated Code. This addition thereby authorized the state to provide: [s]ubject to the limitations in the State budget and any other requirements imposed by the State, comprehensive medical care and other health care services for all legal immigrant children under the age of 18 years and pregnant women who meet Program eligibility standards and who arriv ed in the U.S. on or after August 22, 1996, the effective date of the federal Personal Responsibility and Work Oppo rtunity Re concilia tion Ac t. Md. Ann. Code , Health-General A rticle § 15-103(a)(2)(viii). The [statutory provision] provides for medical assistance to this newly excluded class of alien, pregnant women and children deemed ineligible for non-emergency, Fede ral Medic aid benefits. Although the Maryland State Medicaid program, along with federal matching funds, provides the same medical services as available under the Welfare Innovation Act to both citizens and resident aliens who meet the five-year residency requireme nt, this new provision is limited to those aliens for whom federal Medicaid eligibility was eliminated by the Welfare Reform Act. Therefore, it is funded entirely with state funds. Here, the State used the authority granted by Congress under the Welfare Reform Act. [The benefits established by the adoption of § 15-103] became known as the Medical Assistance Progra m. 8 C. THE MARYLAND STATE BUDGET *** Every year in Maryland, the Governor submits a proposed budget bill to the General Assembly containing the proposed budgetary measures for the State government for the following fiscal year. Unlike a give and take relationship between the Legislative and Execu tive bran ches . . ., the Gene ral Assem bly is free to reduce the Governor s budgetary proposals, but it may not increas e or am end. See MD C onst., Art. 3, § 52(6). Except as expressly mandated by the Constitution or statutes, the Governor has complete discretion over the inclusion of appropriations in the Budget and the amount for the executive branch. The constitutional mandates relate to funding the public schoo ls, redemption of the State debt, the payment of certain sa laries. With the consent of the General Assembly, the Governor can amend or supplement the Budge t Bill prior to its passage. Subject to certain exceptions and limitations, the General Assembly has express po wer only to strike or reduce ap propriations in the Bud get Bill. Howeve r, this express power includes the implied pow er to conditio n or q ualif y. Richard E. Israel, Archives of Maryland Online, Maryland s Budget Proces s, []www.mdarchives.state.md.us/megafile/msa/ speccol/sc2900/sc2908/html/budget.html (last visited December 29, 2005). Despite its ability to condition or qualify the revisions in the pro pose d Bu dget, the Gen eral A ssem bly is precluded from deciding that a particular appropriation is under funded. Maryland s Legislative branch is powerless to realign the Gove rnor s p ropose d spen ding lik e[, for example,] the legislatures in New York and Virginia. iv. The Fiscal Year 2006 Maryland Budget: The CarveOut Provision 9 Rec ently, the fiscal year 2006 Budget as proposed by the Governor eliminated funding f or the Medical Assistance Program. This budget cut essentially carved the aforementioned category of legal, resident aliens out of the State s final Budget Bill. There are currently no funds available in the budget for the women, who were not pregn ant, and childre n, both w ho were in this program at the beginn ing of the current fiscal year however, [§ 15-10 3] remain s in force. Despite their ability to condition or qualify certain budgetary m easures, the M aryland General Assembly never had the option to res tore fundin g to the program, as this wou ld have resu lted in the G eneral As sembly overste pping i ts Con stitutiona l bound aries[.] [7] On 12 January 2006, the Circuit Court issued a written memorandum opinion and order granting Appellees' Motion for Preliminary Injunction. In its opinion, the Circuit Court explained its view that Appellees satisfied the four requisite elements for issuance of a preliminary injunction. Specifically, the trial court determined that: the balance of convenience clearly favored Appellees because they suffered great harm as a result of the State's budget cut; Appellees were irreparably injured as a result of the State's action because they were unable to afford health care without the unfunded State assistance; the public interest "is best served if the [State is] required to provide benefits to [Appellees] for which they are currently entitled [under § 15-103(a)(2)(viii)];" and, finally, Appellees demonstrated that they likely would succeed on the merits of their Article 24 equal protection claim. It is this latter determination to which most of the parties attentions are directed on appeal. 7 We note that it appears tha t the Gene ral Assem bly, had it chose n to do so, could have restored funding to the program by adopting a Supplemental Appropriation Bill for that purpo se. See Constitution of M aryland, Article III, § 52(8). 10 With regard to the likelihood of success on the merits, the Circuit Court explored the principles of equal protection under Article 24. While acknowledging that Appellees are "appropriately classified as 'aliens,'" the court determined that the allegations pertained to the denial of Appellees' equal protection right "based on their status as individuals who are legally entitled to State funding [under § 15-103(a)(2)(viii)] not as a suspect class."8 Thus, rather than focusing upon the "'alienage' classification" to determine the appropriate standard of review to apply to the State action, the court looked to the "Governor's decision to cut funding to a legally entitled group of individuals . . . ." Recognizing that, in considering equal protection challenges, a rational basis standard of review generally applies to examining State action with regard to economic and social welfare issues, the Circuit Court determined that the "impact on [Appellees] . . . is far too disparate to ignore 'alienage' as an underlying classification . . . ." Therefore, the court reviewed the constitutional claim as to the budget cut under a strict scrutiny standard. The court then concluded that the State failed to advance a sufficient basis "as to how [its] budgetary interest was compelling enough to overcome strict scrutiny." The court noted that "cutting welfare funds to legally entitled 8 Although the court expressed the view that "alienage is not a suspect class," it later relied upon Nyquist v. Mauclet, 432 U.S. 1, 7, 97 S.Ct. 2120, 2124, 53 L.Ed.2d 63, 69 (1977) (recognizing that "classifica tions by a State that are base d on aliena ge are 'inhere ntly suspect and subject to close judicial scrutiny'"), to conclude that "because the only individ uals affected were legal resident aliens, the State's actions are dee med 'su spect,' and according ly are subject to a higher standard of review." In a footnote, the trial court stated that "[t]he use of the word 'suspect' only refer s to th e Go vern men t's actions, and [is] not mea nt to designa te 'alien age' a s a ne w 'su spec t clas s.'" 11 individuals is certainly not narrowly tailored enough to overcome strict scrutiny." Consequently, the Circuit Court reasoned that the State failed to meet its burden and determined that Appellees likely would succeed on the merits of their equal protection claim. The Circuit Court ordered th at the benef its payable und er the Hea lth-Genera l Article § 15-301, et seq. previously de nied to [A ppellees] be . . . retroactively reinstated and further ordered that the benef its payable under t he He alth-G eneral A rticle § 1 5-301 , et seq. be . . . reinstated until final disposition of this action. Appellants filed with the C ircuit Court a Notice of Appeal to the Court of Special Appea ls, an Answer, and a Motion for Stay Pending Appeal on 19 January 2006. Appellees filed an opposition on 23 January 2006. That same day, the Circuit Court issued a separate order staying the part of the preliminary injunction that ordered payment of retrospective benefits, but denied a stay in all other respects. The Court of Special Appeals issued an order on 7 February 2006 staying the judgmen ts entered on the Circuit Court s orders, pending appeal, without prejudice to the right of any current Appellee, at that time, to seek from the Circuit Court appropriate limited relief from the s tay upon a fu ll and com plete showing that (1) in order to avoid a serious risk to his or her health, the Appellee must receiv e particularize d medica l treatment prio r to April 7, 2006, (2) the Appellee would have coverage for this treatmen t if the Orde rs of the circu it court had not be en stayed by this O rder, and (3) the App ellee will not b e provided with necess ary treatm ent unle ss the cir cuit cou rt grants approp riate relie f. 12 After Appellants brief on the me rits was filed in the intermediate appellate court, but before further action could be taken by that court, we issued a writ of certiorari to the Court of Spe cial Ap peals o n 9 M arch 20 06. Ehrlich, 391 Md. at 577, 894 A.2d at 545. II. General Standards Applicable to the Review of the Grant of Injunctive Relief "Our review o f a prelimin ary injunction is lim ited becaus e we do not now finally determine the merits of the parties' arguments." LeJeune v. Coin Acceptors, Inc., 381 Md. 288, 300, 849 A.2d 451, 458 (2004) (citing Department of Transportation v. Armacost, 299 Md. 392, 404, 474 A.2d 191, 197 (1984)) (Internal quo tations omitted ). We revie w only whether the trial court properly granted the preli minary in junction . Fogle v. H & G Restaura nt, 337 M d. 441, 456 , 654 A.2d 449, 455 (1995); see also State Dep't v. Baltimore County , 281 Md. 548, 550, 383 A.2d 51, 53 (1977) (stating that "it is a rare instance in which a trial court's discretionary decision to grant or to deny a preliminary injunction will be disturbed by this Court"). In reviewing a trial court's decision to issue a p reliminary injunction, we "determine whether the trial judge exercised sound discretion in examining the four factors that must be found. . . ." LeJeune, 381 Md. at 300, 849 A.2d at 458 (citing Lerner v. Lerner, 306 Md. 771, 776, 511 A.2d 501, 504 (1986)). The four factors that the trial judge examines when considering the appropriateness of granting a preliminary injunction in clude: 13 (1) the likelihood that the plaintiff will succeed on the merits; (2) the "balance of convenience" determined by whether greater injury would be done to the defendant by granting the injunction than would re sult from its re fusal; [ ] (3) whether the plaintiff w ill suffer irreparable injury unless the injunction is granted; and (4) the pub lic interes t. Armacost, 299 Md. at 404-05, 474 A.2d at 197 (citing State Dep t v. Baltimo re Coun ty, 281 Md. at 554-57, 383 A.2d at 55. The party seeking the preliminary injunction has the burden of adducing facts necessary to satisfy these factors. Fogle, 337 Md. at 456, 654 A.2d at 456. The failure to prove the existence of even one of the four factors precludes the grant of injunctive relief. Id. With regard to the factor of the likelihood of success on the merits, "the party seeking the interlocutory injunction m ust establish th at it has a real probability of prevailing on the merits, not merely a remote possibility of doing so." Id. Yet, even with respect to a discretionary matter, a trial court mus t exercise its discretion in accorda nce with correct legal standards. LeJeune, 381 Md. at 301, 849 A.2d at 459 (Citation omitted). We review de novo a trial judge s decision involving a purely legal question. Matthews v. Park & Planning, 368 M d. 71, 92 , 792 A .2d 288 , 301 (2 002). We apply the more deferential abuse of discretion standard to a trial judge s ruling involving a balancing of inter ests. Id. In the prese nt case, the C ircuit Court s determina tion of the likelihood of success on the m erits is a q uestion of law . See Davis v. Slater, 383 Md. 599, 604, 861 A.2d 78, 80 (2004) (noting that because interpretation of the Maryland Declaration of Rights and C onstitutio n . . . [is] appropriately classified as [a] question[] of law, we review the issue[] de novo ). Consequently, we apply the de novo standard to that factor, but the 14 more deferential abuse of discretion standard to the trial judge s determinations as to the remain ing thre e facto rs. III. The Partie s Main A rgumen ts A. Level of Judicial Scru tiny to be Acc orded to the App ellants Actio n in the Eq ual Protectio n Analysis Appellan ts asse rt tha t the C ircuit Co urt erred in grantin g the prelimin ary injunction because Appellees lacked a real probability o f prevailing on the merits of their Article 24 claim. Appellants contend that their failure to appropriate funds for medical benefits to a subcategory of legal aliens who, by virtue of congressional action under PRWORA, were ineligible to receive federal medical benefits is subject to rational basis review under the Supremacy Clause and withstands Appellees equal protection challenge under that standard. Under the Supremacy Clause, Appellants contend, consideration of Appellee s state constitutional claim requires judicial deference to Congress plenary power over naturalization and immigration policy. Relying on Mathews v. Diaz, 426 U .S. 67, 9 6 S.Ct. 1883, 48 L.Ed.2d 478 (1976), and Fiallo v. Be ll, 430 U.S. 787, 97 S.Ct. 1473, 52 L.Ed.2d 50 (1977), Appellants argue that C ongress power over the admission and naturalization of aliens is complete and broa d such tha t Congress actions are subject to narrow judicial scrutiny. 15 Although conceding that the State may not exercise independently a like power over aliens, Appellan ts maintain that, in adopting the Welfa re Reform Act, Congress prescribed a uniform rule for the treatment of an alien sub-class in regard to the provision of medical benefits, which M aryland could follow, citing as suppor t Plyler v. Doe, 457 U.S. 202, 219 n.19, 102 S.Ct. 2382, 2396 n.19, 72 L.Ed.2d 786, 800 n.19 (1982 ), Toll v. Moreno, 458 U.S. 1, 102 S .Ct. 297 7, 73 L .Ed.2d 563 (1 982), DeCanas v. Bica, 424 U.S. 351, 358 n.6, 96 S.Ct. 933, 47 L.Ed.2d 43 (1976), and Graham v. Richardson, 403 U.S. 365, 91 S.Ct. 1848, 29 L.Ed.2d 534 (1971). It is necessary to apply this relaxed standard of scrutiny to both federal and state laws that follow a federal classification because [i]t would make no sense to say that Congress has plenary power in the area of immigratio n and natu ralization and then hold that the Constitution compels the states to refrain from adhering to the federal guidelines [when a state denies state-funded welfare benefits to certain aliens], quoting Sudomir v. McMahon, 767 F.2d 145 6, 1466 (9th Cir. 1985) (applying rational basis review in rejecting equal protection c hallenge to the State s denial of State-funded welfare benefits to a sub-class of alien s). Appellan ts offer that th e reason fo r the Mar yland budge t cut was to achieve a cost savings of seven million dollars (equal to the amount of funds appropriated in the Medical Assistance Program in Fiscal Year ( FY ) 2005, inclusive of the estimated number of individuals of the legal alien sub-class to which Appellees belong) of the four billion dollar budget appropriated for me dical assistance health care costs generally. They maintain that 16 Congress provided a sufficien t showing of a facially legitimate and bona fid e reason to discriminate against the relevant alien sub-class in the provision of federal Medicaid benefits, by including legislative findings in the Welfare Reform Act. These legislative findings provide that the provisions of the Welfare Reform Act were necessary to achieve the national immigration policy of encouraging self-sufficiency and removing incentives for illegal immigration. The Act s findings also provide that a State choosing not to provide nonemergency medical benefits to aliens excluded from federal benefits by the Welfare R eform Act, as Maryland did in the FY 2006 Budget, shall be considered to have chosen the least restrictive means available for achieving the compelling governmental interest of assuring that aliens be self-reliant in ac cordance with national immigration policy, quoting 8 U.S.C. § 1601(7). Appellants argue that the Supremacy Clause restrains Maryland State courts from disrega rding C ongres s directio n in this a rea of im migratio n policy. Fina lly, as to the correct standard of review to be applied to the Article 24 challenge, Appellan ts assert that the W elfare Ref orm Ac t grants M aryland the ab ility to determine whether and to what extent it will use State funds to provide n on-emerg ency medica l benefits to resident aliens who do not meet the five-year residency requirement, see 8 U.S.C. §§ 1622(a), 1624(a), p rovided tha t any prohibition s, limitations, or restrictions imposed by 17 Maryland are not more restrictive than the prohibitions, limitations, or restrictions imposed under comparable federal programs, see 8 U.S.C § 16 24(b). 9 Appellees, on the othe r hand, ma intain (as A ppellants see m to conc ede) that the budget cut of State -funded medical as sistance to certain resident aliens was a classification based upon alienage, and is therefore a suspect classification, relying on Murphy v. Edmonds, 325 Md. 342, 601 A.2d 102 (1992), and Graham, supra, 403 U .S. 365, 9 1 S.Ct. 1848, 29 L.Ed.2d 534. Appellees argue that, because Appellants used a classification based on alienage in cutting State-funded medical assistance to the relevant sub-class of legal aliens depending on their length of residency in the United States, a court reviewing the State action must apply the strict scru tiny standa rd, see, e .g., Graham, 403 U.S. at 370-76, 91 S.Ct. at 1851- 54, 29 L .Ed.2d at 540- 44, Nyquist v. Mauclet, 432 U.S. 1, 8, 97 S.Ct. 2120, 2125, 53 L.Ed.2d 63, 70 (1977), and Takahashi v. Fish & Game C omm n ., 334 U.S. 410, 418-22, 68 S.Ct. 1138, 1142-44, 92 L.Ed. 1478, 1486-89 (1948 ). Appellees and Appellants agree that if Congress prescribed a truly uniform rule or standard s for the treatm ent of aliens and a State abided by that rule or applied properly those standards when it chose to discriminate against 9 Appellants supplem entally contend that Maryland courts recognize that the deference afforded to the State under rational basis analysis is especially appropriate in reviewing equal protection challen ges to p ublic w elfare p rogram s, citing United Wire, Metal and Machine Health and Welfare Fund v. State of Maryland Deposit Insurance Fund Corporation, 307 Md. 148, 159, 512 A.2d 1047, 1052-53 (1986), and Callahan v. Department of Health and Mental Hygiene, 69 Md . App. 316 , 517 A.2d 781 (198 6). We no te that United Wire and Callahan are distinguis hable from the present case because the alleged discrimination in the present case, as we shall hold, is directed at a suspect class. 18 or between resident alien s within its territory, a re viewing c ourt should apply a rational b asis scrutiny to determin e whethe r the State action v iolated e qual pr otection rights. The parties part ways thereafter. Appellees assert that PRWORA provides no uniform rule or evaluative standards with regard to decisions involving State-funded medical assistance programs because PRWORA leaves unbridled discretion to the individual States to decide how each will treat the class o f resident a liens that immigrated to the United States on or after 22 August 1996 and therefore have not resided in the United States for five years. Thus, Appellees argue that th e approp riate standard of review of the State action here is strict scru tiny. Furthermore, Appellees contend that Appellants reason for the budget cut (cost savings) is not a sufficiently compelling state interest to justify its discrimination against an alien sub-cla ss whe n fash ioning its medi cal assis tance p lan bud get, citing , e.g., Graham, 430 U.S. at 374, 91 S.Ct. at 1853-54, 29 L.Ed.2d at 543 ( [A] State s desire to preserve limited welfare benefits fo r its own citize ns is inadeq uate to justify . . . mak ing noncitiz ens ineligible for public assista nce bene fits . . . and restricting benefits to c itizens and longtime resident aliens. ), and Shapiro v. Thompson, 394 U .S. 618 , 89 S.C t. 1322, 2 2 L.Ed .2d 600 (1969 ). Appellees bring to our attention that a similar medical assistance funding restriction adopted in New York, based on alienage, was found to be unconstitutional, under state and federal equal protection guarantees, in Aliessa v. Novello, 754 N.Ed.2d 1 085 (N.Y. 200 1). The Court of Appeals of New York in Aliessa conclude d that, in contrast to the federal governm ent, States may only discriminate against immigrants in State-funded programs if 19 the federal government has prescribed by uniform rule what it believes to be appropriate standards for the treatment of an alien sub-class, citing language from footnote 19 in Plyler v. Doe. Aliessa, 754 N.E.2d at 1096 (discussing Graham). The court concluded that, by enacting PRW ORA , Congres s did not esta blish a unifo rm rule for S tates regardin g the provision of medical assistance to legal immigrants because Congress left to the States discretion the develo pment of their own individualize d policies regarding the provision of State-funded medical assistance to legal immig rants. Aliessa, 754 N.E.2d at 1098. Because New York s termination of State-funded benefits to resident aliens was not pursuant to a uniform federal rule or set of criteria, our sister high court reviewed the State action under the strict scrutiny test, concluded that it did not pass that review, and held that the State action violated the Equal Protection guarantees of the federal and New York constitutions. Id.. The legal reasoning applied by the court in Aliessa applies, it is submitted by Appellees, with eq ual forc e to the p resent c ase. B. Judicial Action Possibly Implicating State Budget Appropriations Limitations Appellan ts claim that the Circuit Co urt lacked th e authority to issue a preliminary injunction requiring expenditure of State funds to pay for medical benefits that were not appropriated in the F Y 200 6 Bud get. Appellants argument is based on the contention that Maryland law does not permit c onstitutional a nd statutory requ irements go verning p ublic expen ditures to be ove rborne by a viola tion of A rticle 24 of the D eclaratio n of R ights. 20 Appellan ts characterize the Circuit Cou rt s order as an illegal order for the expenditure of unapp ropriated funds, in contravention of Article III, § 32 of the Maryland Constitution (which provides that State funds must be appropriated through the comprehensive executive budge t procedure pursuant to Article III, § 52 ); see also M d. Act. for Foster Child. v. State, 279 M d. 133, 148 , 367 A.2d 491, 499 (1977); Judy v. Schaefer, 331 Md. 239, 250, 627 A.2d 1039, 1044-45 (1993); Dorsey v. Petrott, 178 Md. 230, 242, 13 A.2d 630, 636 (1940 ); Philip Morris v. Glendening, 349 Md. 660, 681, 709 A.2d 1230, 1240 (1998). Maryland Code (1985, Repl. Vol. 2006), State Finance and Procurement Article, §§ 7-205, 7-234(a) and (c) likewise prohibits the expenditure of State funds not appropriated properly by law and provides for the removal of any State officer or employee who violates that pro hibition . Appellan ts contend that the Circuit Court s departure from the requirements of the Constitution in granting the preliminary injunction is not justified by a likely equal protection violation under Article 24 b ecause the Maryland D eclaration of Rights would not trump the express demand s of the C onstitution. R ather, App ellants posit tha t if there exists a conflict between Article 24 and the specific provisions of the Maryland Constitution governing budget an d approp riations require ments, then the specific p rovisions pr evail, relying on Commission on Medical Discipline v. Stillman, 291 Md. 390, 410-11, 435 A.2d 747, 757-58 (1981), and Broadw ater v. State, 306 M d. 597, 6 02 n.2, 5 10 A.2 d 583, 5 85 n.2 (1986). By expressly providing that the prohibition against unappropriated expenditures 21 applies to any order, Article III, § 32 forecloses the possibility that the constitutional provisions establishing budget and appropriations requirements may be suspended or evaded by the expedient of a cou rt order. Characterizing the Circuit Court s preliminary injunction order as an appropriation of funds from the State Treasury, Appellants maintain that the constitutional prerequisites for a lawful expenditure of State funds are not satisfied here and that there has been no appropriation for the ben efits that the preliminary injunction orders be paid. Thus, Appellan ts argue, the payment of funds may not be o rdered or made f rom the State Treasu ry to satisfy the preliminary injunction. Appellees counter that the Circuit Court possessed the authority to fashion the preliminary injunction as it did. First, Appellees assert that the G overnor s budgetary auth ority, although far-reaching, is subject to fundamental constitutional limitations, including Article 24. This Court can give both Article 24 of the Declaration of Rights and Article III, §§ 52 and 32 of the Maryland Constitution full effect, as part of an integrated docume nt, by requiring the Executive not to violate the Declaration of Rights in the course of exer cisin g his budgeta ry authority, a reading th at Appelle es posit is required by both the history of the Budget Amendment and its subsequent interpretations by this Court. Appellees also contend that Article III, § 32 pertains to legislative orders, not judicial orders, relying on Dorsey, supra, 178 Md. at 237, 13 A.2d at 634, and P HILIP B. P ERLMAN D EBATES OF THE M ARYLAND C ONSTITU TIONAL C ONVENTION OF 1867. 22 The Circuit Court did not order the direct expenditure of specific funds; rather the injunctive order was designed to remedy a constitutional violation and protect [Appellees] from irreparable harm, while leaving the mechanism for rectifying the constitutional violation entirely up to Appellants. Appellees argue that because the Budget Bill provides for a lump sum appropriation, of which some small portion is restricted for specific purposes (for example, the FY 2005 budget provided for a total of approximately $4 billion for medical care provider costs, of which some portion is used for medical assistance), the general language of the app ropriation lea ves significa nt leeway to th e DHM H to move fu nds within broad categorical a ppropriation s in order to satisfy the court s order. Appellees also highlight that, in recent years, when the State s medical assistance expenditures exceeded budget projections, Appellants did not deny coverage to eligible recipients, but instead, routinely i nclu ded in the ann ual B udget Bi ll am ounts to c over the prior year s de ficie ncy. IV. We consider first whether the failure to fund as to Appellees (and the sub-c lass of legal aliens of which they are a part) the Medical Assistance Program for FY 2006, i.e., the budget cut, violates the principles of equal p rotection em bodied in Article 24 of the Maryland Declaration of Rights. Article 24 and th e Equal P rotection C lause of the Fourteen th Amendment are in pari mate ria, and we generally apply them in like manner and to the same extent. Hornbeck v. Somerset Co. Bd. of Educ., 295 Md. 597, 640, 458 A.2d 758, 781 (1983). Although the two are capable of divergent application, [w]e have, however, long 23 recognized that decisions of the [U.S.] Supreme Court interpreting the equal protection clause of the fed eral constitution are persua sive author ity in cases involving the equal treatment provisions of Article 24. Id. (citing Attorney Gene ral v. W aldron , 289 Md. 683, 704-05, 426 A.2d 929, 940-41 (1981), and Bureau of Mines v. George s Creek, 272 Md. 143, 156, 321 A.2d 7 48, 755 (1974 )). See also K irsch v. Princ e Georg e s Coun ty, 331 Md. 89, 96-97, 626 A.2d 372, 375 -76 (1993 ); Murphy v. Edmonds, 325 Md. 342, 354, 601 A.2d 102, 108 (1992). Consequently, even though Appellees ground their equal protection challenge solely on Article 24, we shall consider the argument in light of both cases interpreting and applying the Equal Protection Clause of the Fourteenth Amendment and Article 24 of the Maryland Declaration of Rights. Differing standards have evolved for reviewing classifications challenged under the equal protection guarantees: In most instances when a governmental classification is attacked on equal protection grounds, the classification is reviewed under the so-called rational ba sis test. G enerally u nder th at test, a court w ill no t ove rturn the classifi catio n u nless the varying treatment of different groups or persons is so unrelated to the achievement of any combination of legitimate purposes that [the court] can only conclude that the [governm ental] actions were irrational. Gregory v. Ashcroft, U.S. , , 111 S.Ct. 2395, 2406, 115 L.Ed.2d 410, 430 (1991), quoting Vance v. Bradley, 440 U.S. 93, 97, 99 S.C t. 939, 943, 59 L.Ed.2d 171, 176 (1979 ). See Pennell v. San Jose, 485 U.S. 1, 14, 108 S.Ct. 849, 859, 99 L.Ed.2d 1, 16 (1988). A statutory classification reviewed under the rational basis standard enjoys a strong presumption of constitutiona lity and will be invalidated only if the classification is clearly arbitrary. See, e.g., Briscoe v. P.G. H ealth Dep t, 323 Md. 439, 448 -449, 593 A.2d 11 09, 1113 -1114 (19 91); Hargrove 24 v. Board of Trustees, [ ] 310 Md. [406, 423, 529 A.2d 1372, 1380 (1987)]; State v. W yand, [ ] 304 Md. [721, 726-27, 501 A.2d 43, 46 (1985)]; Whiting-Turner Contract. Co. v. Coupard, 304 Md. 340, 352, 499 A .2d 178, 18 5 (1985); Department of Transportation v. Armacost, 299 Md. 392, 409, 474 A.2d 191, 199 (1984); State v. Good Samaritan Hospital, 299 Md . 310, 328, 473 A.2d 892, 901, appeal dismissed, 469 U.S. 802, 105 S.Ct. 56, 83 L.Ed.2d 7 (1984); Montgomery Co. v. Fields Road, 282 Md. 57 5, 579-580, 386 A .2d 344, 347 (197 8). Where, however, a statutory classification burdens a suspect class or impinges upon a fundamental right, the classification is subject to strict scrutiny. Such statutes will be upheld under the equal prote ction guara ntees only if it is shown that they are suitably tailored to serve a com pelling state interest. Broadw ater v. State, 306 M d. 597, 603, 510 A.2d 583, 585 (1986), quoting Cleburne v. Cleburne Living Center, 473 U.S. 432, 440, 105 S.Ct. 3249, 3254, 87 L.Ed.2d 313, 320 (1985). See, e.g., Graham v. Richardson, 403 U.S. 365, 372, 91 S.Ct. 1848, 1852, 29 L.Ed.2d 534, 541-542 (1971) ( classifications based on alienage, like those based on nationality or race, are inherently suspect and subject to close judicial scrutiny ); Shapiro v. Thompson, 394 U.S. 618, 634, 89 S.Ct. 1322, 1331, 22 L.Ed.2d 600, 615 (1969) ( in moving from State to State . . . appe llees were e xercising a c onstitutional right, and any classification which serves to penalize the exercise of that right, un less show n to be necess ary to promo te a compelling governmental interest, is unconstitutional ); Kramer v. Union Free School District, 395 U .S. 621 , 627, 89 S.Ct. 1886, 1889-1890, 23 L.Ed.2d 583, 589 (1969) (classification impinging upon the righ t to vote) . See also O.C. Taxpayers v. Ocean City, 280 Md. 585, 594, 375 A.2d 541, 547 (1977) ( we a re . . . here dealing with the right to vote, and thus the classification is subject to . . . special scrutiny ). Fina lly, there are clas sifications which have been subjected to a higher degree of scrutiny than the traditional and deferential rational basis test, but which have not been deemed to involve suspect classes or fundamental rights and thus have not been subjected to the strict scrutiny test. Included among 25 these have been classifications b ased on gende r (Mississippi University For Women v. Hogan, 458 U.S . 718, 723, 1 02 S.Ct. 3331, 3335, 73 L.Ed.2d 1 090, 109 7 (1982); Craig v. Boren, 429 U.S. 190, 97 S.Ct. 451, 5 0 L.Ed.2d 397 (197 6); Reed v. Reed, 404 U.S. 71, 92 S.Ct. 251, 30 L.Ed.2d 225 (1971)),[10] discrimination against illegitimate children under some circumstances (Weber v . Aetna C asualty & Surety Company, 406 Md. U.S. 164, 92 S.Ct. 1400, 31 L.Ed .2d 768 (1 972); Levy v. Louisiana, 391 U.S. 68, 88 S.Ct. 1509, 20 L.Ed.2d 436 (1968)), a classification between children of legal residents and children of illegal aliens with re gard to a free public education (Plyler v. Doe, 457 U.S. 202, 217-218, 224, 102 S.Ct. 2382, 2395, 2398, 72 L.Ed.2d, 786, 799-800, 803 (1982)), and a classification under which c ertain persons were denied the right to practice for compensation the profession for w hich they were qualified and licensed (Attorney General v. Waldron, supra, 289 Md. at 716-728, 426 A .2d at 947-9 54). (Som e alterations in original). Murphy, 325 Md. at 355-57, 601 A.2d at 108- 09. See also Kane v. B oard of A ppeals, 390 Md. 145, 171 n.18, 887 A.2d 1 060, 1075 n.18 (2 005). Classifications based on alienage employed by a State are inherently suspect and are therefore subject to strict judicial scrutiny whether or not a funda menta l right is im paired. Graham, 403 U.S. at 376, 91 S.Ct. at 1854, 29 L.E d.2d at 5 44. See also Murphy, 325 Md. at 356, 601 A.2d at 109; Nyquist v. Mauclet, 432 U.S. 1, 97 S.Ct. 2120, 53 L.Ed.2d 63 (1977) (holding that a New Y ork statutory provision barring certain resident alie ns from S tate 10 We stated in a footnote that [i]n Maryland, because of the Equal R ights Amendment to the Maryland Constitution (Article 46 of the M aryland Declaration of R ights), classifications based on gender are suspect and subject to strict scru tiny. State v. Burning Tree Club, Inc., 315 M d. 254, 2 95, 554 A.2d 3 66, 386 , cert. denied, 493 U.S. 816, 110 S.C t. 66, 107 L.Ed.2d 33 (1989). Murphy, 325 Md. 342, 357 n.7, 601 A .2d 102, 109 n.7 (19 92). 26 financial assistance for higher education violated the Equal Protection Clause of the Fourteen th Amendment after applying strict judicial scrutiny and finding that New York failed to offer a c ompelling governm ental interest to ju stify the discrimin ation); Graham, 403 U.S. at 371-72, 91 S.Ct. at 1852, 29 L.Ed.2d at 54 1-42 ( [T]he [U .S. Supreme] Co urt s decisions have established that classifications based on alienage, like those based on nationality or race, are inherently suspect and subject to close judicial scrutiny. Aliens as a class are a prime exam ple of a discrete and insular minority for whom such heightened judicial solicitude is appropriate. ) (Footnotes and citations omitted); Takahashi, 334 U.S. 410, 420, 68 S .Ct. 1138, 114 3, 92 L.Ed . 1478, 148 8 (conclud ing that a C alifornia statute violated the equal protection guarantee of the Fourteenth Amendment when it used a federally created racial ineligibility for citizenship as a basis for barring Japanese resident aliens from ob taining com mercial fish ing licenses, sta ting that the p ower of a state to app ly its laws exclusively to its alien inhabitants as a class is confine d within narrow lim its ).11 Statutory discrimination within the larger class of legal resident aliens, providing benefits to some aliens, but not to others, is nonetheless a classification based on alienage. Nyquist, 432 U.S. at 7-9, 97 S.Ct. at 2124-25, 53 L.Ed.2d at 69-71 (reje cting a claim that a New York statutory provision barring certain resident aliens from State financial assistance 11 Legal resident aliens as a group, by sole virtue of their immigration status, are not to be imagined as dole bludgers. Rather, these individuals are contributing members of society in that "[a]liens like citizens pay taxes and may be called into the armed forces." Graham, 403 U.S. at 376, 91 S.Ct. at 1854, 29 L.Ed.2d at 544 (Internal quotations and citation omitted). 27 for higher education did not impos e a classificatio n based o n alienage) ; Graham, 403 U.S. at 371, 376, 91 S.Ct. at 1851-52, 1854, 29 L.Ed.2d at 541, 544 (stating that a State statutory classification where otherwise qualified citizens living in a State are entitled to assistance benefits without regard to length of national residency, but aliens must hav e lived in this country for a number of years in order to qualify for aid, is an inherently suspect classification and is subject to strict scrutiny). 12 Where a federal statute distinguishes between citizens and aliens (and sub-classes of aliens), the U.S. Supreme Court applies a more relaxed standard of review than the strict 12 Appellants look to Soskin v. Reinertson, 353 F.3d 1242 (10th Cir. 2004), and Doe v. Commissioner of Transitional Assistance, 773 N.E.2d 404 (M ass. 2002), to support the ir contention that we should apply a rational basis standard of review to the budget cut at issue in the present c ase throug h adoption of a unif orm rule doctrine that extends to the provision of State medical benefits. We note that thes e cases do not hold w hat App ellants claim. In Doe, the State sup reme cou rt found th at a Massachusetts statutory provision barring welfare benefits to certain aliens based on the dur ation of the ir State residen cy was not a classification based on alienage because it distinguished between subgroups of aliens. Doe, 773 N.E.2d at 533-34. Consequently, the court in Doe applied a rational basis standard of review and up held the validity of the State law. Applying a similar rationale, the U.S. Court of Appeals for the Te nth Circuit, in Soskin, determined that [a] state s exercise of the option to include fewer aliens in its aliensonly program [under the provisions of PRWORA ]. . . should not be treated as discrimination against aliens as comp ared to c itizens. R ather, w hat the State is doing is discriminating within the aliens-only program against one class of aliens as compared to other classes of aliens. Soskin, 353 F.3d at 1255-5 6. Thus, the court in Soskin follow[ed] the Massachusetts Supreme Judicial Court s Doe decision in a pplying rationa l-basis review to such distinctions. Soskin, 353 F.3d at 1256. Rather, Graham and Nyquist make clear that discrimination among sub-classes of resident aliens remains a suspect classification and thus a State s discriminatory action will be subjected to strict judicial scrutiny review. 28 scrutiny standard o f review a pplied to co mparable State statutes. In Mathews v. Diaz, supra, 426 U.S. at 84, 96 S.Ct. at 1889, 48 L.Ed.2d at 492, the Court upheld a federal statute that conditioned an alien s eligibility for participation in a federal medical insurance program on continuous residence in the United States for a five-year period and admission for permanent residence. The Court noted the broad power over naturalization and immigration pursuant to which Congress regularly enacts rules governing aliens. Mathews, 426 U.S. at 79-80, 96 S.Ct. at 1891, 48 L.Ed.2d at 489-90. The Court also acknowledged that decisions regarding the relationship between the United States and aliens may implicate our country s relations with foreign powers an arena more appropriately left to the federal legislative and executive branches of government than to the federal judiciary. Mathews, 426 U.S. at 81, 96 S.Ct. at 1892, 48 L.Ed.2d at 490-91. The Court therefore applied a relaxed standard of review to a federal law that distinguished between sub-classes of aliens by conditioning an alien s eligibility for participation in a federal medical in surance program on satisfying a five-year national residency requirement and gaining admission for permanent residence requireme nt. Id. Applying th is relaxed stan dard of rev iew (in eff ect, a rational b asis standard of review), the Court concluded that it was reasonable for Congress to make an alien s eligibility for federal medical benefits dependent upon both the character and the duration of his or her re sidenc e. Mathews, 426 U.S . at 83, 96 S.C t. at 1893, 48 L.Ed.2d at 492. 29 Moreover, in Mathews, the Court contrasted the federal gov ernment s power to enact laws governin g aliens to the States lack o f authority to do likewise. T he Cou rt noted that its decision in Graham supported its decision in Mathews, stating that it is the business of the political branches of the Federal Government, rather than that of either the states or the Federal Judi ciary, to regulate the conditions of entry and residence of aliens. Mathews, 426 U.S. at 84, 96 S.Ct. at 1893-94, 48 L.Ed.2d at 493. The Court noted also that the equal protection analysis involved in Graham had significantly different considerations from those in Mathews because in Graham the Court considered the relationship between aliens and States. Mathews, 426 U.S . at 84-85, 96 S.Ct. at 1894, 48 L.Ed.2d at 493. Insofar as state welfare policy is concerned, there is little, if any, basis for treating persons who are citizens of anothe r State diff eren tly fro m pe rson s wh o are citizens o f ano ther country. Both groups are noncitizens as far as the S tate s interests in administering its welfare prog rams are conce rned. Mathews, 426 U.S. at 85, 96 S.Ct. at 1894, 48 L.Ed.2d at 493 ( Footnote omitted). 13 13 The Court stated further that [d]ivision by a State of the category of persons who are not citizens of that State into subcategories of U.S. citizens and aliens has no apparent justification, whereas, a comparable classification by the Federal Government is a routine and normally legitimate part of its business. Mathews, 426 U.S. at 85, 96 S.Ct. at 1894, 48 L.Ed.2d at 493. Regarding discrimination in the treatment of aliens by a State, the Court stated that whereas the Constitution inhibits every State s power to restrict travel across its own borders, Congre ss is explicitly empowered to exercise that type of control over travel across the borders of the United States. Mathews, 426 U.S. at 85, 96 S.Ct. at 1894, 48 L.Ed.2d at 493 (Footnote omitted). Quoting a portion of the Graham decision in a footnote, the Court noted that 30 Appellan ts insist that w e sho uld a pply a relaxed standard of scrutiny when deciding whether the budge t cut underta ken by Ap pellants viola ted Article 24 of the Maryland Declaration of Rights, pursuant to the theory of the uniform rule, because a federal law (PRWORA) expressly gran ts to States the discretion whether to provide wholly State-funded medical benefits to th e class of res ident aliens w ho immig rated to the U nited States on or after 22 August 1996. Appellees counter by asserting that, becaus e Cong ress left com plete discretion to the States, we should apply the strict scrutiny standard to the State s actio n because the federal statute did not provide a uniform rule to which the States are required to adhere in exercising that discretion. The uniform rule foundation for application of a relaxed scrutiny review of State action under equal protection attack has not been adopted previously in a reported Maryland case or U.S. Supreme Court decision. Analysis of the question of whether the State action here is shielded by the uniform rule theory from what otherwise should be a strict scrutiny standard of review does not yield a succinct or ready answer. The U.S. Supreme Court has noted that it has "long recognized the preeminent role of the Federal Government with respect to the regulation of State alien residen cy requireme nts that either deny welfare benefits to noncitizens or condition them on longtime resid ency, equate with the assertion of a right, inconsistent with federal policy, to deny entrance and abode. Since such laws encroach upon exclusive f ederal pow er, they are cons titutionally imperm issible. Graham v. Richardson, 403 U.S. 365, 380, 29 L.Ed.2d at 534, 91 S.Ct. at 1848. Mathews, 426 U.S. at 85 n.25, 96 S.Ct. at 1894 n.25, 48 L.Ed.2d at 493 n.25. 31 aliens within our borders." Toll v. Moreno, 458 U.S. 1, 10, 102 S.Ct. 2977, 2982, 73 L.Ed.2d 563, 571 (1982) (citing Mathews, 426 U.S. 67, 96 S.Ct. 1883, 48 L.Ed.2d 478, Graham, 403 U.S. 365, 91 S.Ct. 1848, 29 L.Ed.2d 534, Takahashi, 334 U.S. 410, 68 S.Ct. 1138, 92 L.Ed. 1478, Hines v. Davidowitz, 312 U.S. 52, 61 S.Ct. 399, 85 L.Ed. 581 (1941), and Truax v. Raich, 239 U.S. 33, 42, 36 S.Ct. 7, 11, 60 L.Ed. 131 (1915)). In Takahashi v. Fish & Game Commission, supra, 334 U.S. at 419, 68 S.Ct. at 1142, 92 L.Ed. at 1487, the Court stated that these broad constitutional powers of the federal government include "determining what aliens shall be admitted to the United States, the period they may remain, regulation of their conduct before naturalization, and the terms and conditions of their naturalization." (Citation omitted). See also DeCanas, 424 U.S. at 355, 96 S.Ct. at 936, 47 L.Ed.2d at 48-49 (stating that regulation of immigration is "essentially a determination of who should or should not be admitted into the country, and the conditions under which a legal entrant may remain"). "Federal authority to regulate the status of aliens derives from various sources, including the Federal Government's power 'to establish [a] uniform Rule of Naturalization,' U.S. Const., Art. I, § 8, cl. 4, its power '[t]o regulate Commerce with foreign Nations', id., cl. 3, and its broad authority over foreign affairs, see United States v. Curtiss-Wright Export Corp., 299 U.S. 304, 318, 57 S.Ct. 216, 220, 81 L.Ed. 255 (1936); Mathews v. Diaz, supra, 426 U.S. at 81, n.17, 96 S.Ct., at 1892, n.17; Harisiades v. Shaughnessy, 342 U.S. 580, 588-589, 72 S.Ct. 512, 518-519, 96 L.Ed. 586 (1952)." Toll, 458 U.S. at 10, 102 S.Ct. at 2982, 73 L.Ed.2d at 571 (Alterations in original). But see 32 DeCanas, 424 U.S. at 355, 96 S.Ct. at 936, 47 L.Ed.2d at 48 (noting that it has never held that every state enactment which in any way deals with aliens is a regulation of immigration"). As noted previously in this opinion, courts apply a relaxed standard of review when examining the validity of a federal statute that distinguishes between citizens and aliens (and sub-classes of aliens) in the distribution of federal medical benefits because Congress is said to possess plenary power to regulate aliens. While it is clear that the federal government possesses authority to regulate national immigration policy, the question of whether and, if so, under what conditions and terms, the federal government may delegate that authority (or any portion of that authority) to the States, such that courts reviewing a resultant State action will apply a relaxed standard of review, is less apparent. In conjunction with recognition of the exclusive power of the federal government to regulate aliens, the Supreme Court also expressed, on numerous occasions, reservations about Congress delegating that authority to the States. In 1889, the Supreme Court articulated generally those reservations: The power of exclusion of foreigners being an incident of sovereignty belonging to the Government of the United States, as a part of those sovereign powers delegated by the Constitution, the right to its exercise at any time when, in the judgment of the Government, the interests of the country require it, cannot be granted away or restrained on behalf of anyone. The powers of Government are delegated in trust to the United States, and are incapable of transfer to any other parties. Chae Chan Ping v. United States, 130 U.S. 581, 609, 9 S.Ct. 623, 631, 32 L.Ed. 1068, 1076 (1889). Later, in Shapiro v. Thompson, supra, 394 U.S. at 641, 89 S.Ct. at 1335, 22 L.Ed.2d 33 at 619, the Court articulated more specifically that "Congress may not authorize the States to violate the Equal Protection Clause." The Court noted additionally that [p]erhaps Congress could induce wider state participation in school construction if it authorized the use of joint funds for the building of segregated schools. But could it seriously be contended that Congress would be constitutionally justified in such authorization by the need to secure state cooperation? Congress is without power to enlist state cooperation in a joint federal-state program by legislation which authorizes the States to violate the Equal Protection Clause. Katzenbach v. Morgan, 384 U.S. 641, 651 n.10, 16 L.Ed.2d 828, 836 n.10, 86 S.Ct. 1717 (1966). Id. In Graham v. Richardson, supra, 403 U.S. at 382, 91 S.Ct. at 1857, 29 L.Ed.2d at 54748, citing Shapiro, supra, 394 U.S. at 641, 89 S.Ct. at 1335, 22 L.Ed.2d at 619, the Court re-emphasized this limitation on the ability of Congress to delegate its authority over regulation of aliens to the States: "Although the Federal Government admittedly has broad constitutional power to determine what aliens shall be admitted to the United States, the period they may remain, and the terms and conditions of their naturalization, Congress does not have the power to authorize the individual States to violate the Equal Protection Clause." See also Saenz v. Roe, 526 U.S. 489, 508, 119 S.Ct. 1518, 1529, 143 L.Ed.2d 689, 707 (1999) ("Congress has no affirmative power to authorize the States to violate the Fourteenth Amendment and is implicitly prohibited from passing legislation that purports to validate any such violation.").14 It is not disputed that the federal government may authorize States 14 No party in the present actio n suggests the uncon stitutionally of Congress (contin ued...) 34 to legislate concurrently in subject areas in which it has acted; yet, it is less evident to this Court that the federal government expressly may transfer its authority (and thus justify a relaxed level of scrutiny of the resultant State action) to the States in order to regulate in the area of immigration in a manner that would be permissible if done by the federal government, but unconstitutional if carried out independently by an individual State. Compare Mathews, 426 U.S. 67, 96 S.Ct. 1883, 48 L.Ed.2d 478, with Graham, 403 U.S. 365, 91 S.Ct. 1848, 29 L.Ed.2d 534. Assuming that the power over immigration and naturalization possessed by the federal government includes establishing a single, uniform, and articulated directive for treating aliens regarding State-only funded medical assistance benefits, such that we will employ a rational basis standard of review to a State s elimination of State-only funded benefits for certain resident aliens,15 we conclude that PRWORA prescribes no uniform rule (...continued) enactment of PRWO RA itself. Thus, we focu s our examination o n the State's action. In doing so, we nonetheless consider the authority of Congress to authorize the States to, at th eir discretion, discriminate against aliens in the distribution of State-funded medical assistance benefits. 15 We note that there is some basis for lim iting the fede ral governm ent's authority to effectuate national immigration policy to only certain areas, which basis does not include regulating the guidelines used by States when providing solely State-funded medical assistance benefits to aliens. In Plyler v. Doe, 457 U.S. 202, 219 n.19, 102 S.Ct. 2382, 2396 n. 19, 72 L.Ed.2d 786, 800 n.19 (1982), the Supreme Court identified three specific areas that are affecte d by alienage c lassifications m ade by the fed eral govern ment: With respect to the actions of the Federal Government, alienage classifications may be intima tely related to the conduct of (contin ued...) 35 in any event. Rather, Congress has provided discretion to the States with regard to their decisions whether to provide State-funded medical benefits, on the basis of alienage, to those resident aliens who do not meet the requirements for federal medical assistance. The grant of discretion, without more, is not a uniform rule for purposes of imposing only a rational basis test. The unbridled discretion afforded by Congress prevents us from characterizing the material provisions of PRWORA as uniform. In suggesting that a uniform rule principle exists, the U.S. Supreme Court unhelpfully declared only a one element requirement that the rule prescribed by Congress be uniform. In Plyler v. Doe, 457 U.S. 202, 219 n.19, 102 S.Ct. 2382, 2396 n. 19, 72 L.Ed.2d 786, 800 n.19 (1982), the (...continued) foreign policy, to the federal prerogative to control access to the United States, and to the plenary federal power to determine who has suffic iently manifested his allegiance to become a citizen of the Nation. In Mathews v. Diaz, 426 U.S. 67, 80, 96 S.Ct. 1883, 1891-92, 48 L.Ed.2d 478, 49 0 (1976), however, the Court, examining whether the federal governm ent could p lace cond itions on aliens' eligibility for federal medical b enefits, noted that [t]he decision to share that bou nty [welfare benefits] with our guests may take into account the character of the re lationship between the alien and this country: Congress may decide that as the alien's tie grows stro nger, so do es the streng th of his claim to an eq ual sha re of tha t munif icence . Also, in Graham v. Richardson, 403 U.S. 365, 377, 91 S.Ct. 1848, 1854, 29 L.Ed.2d 534 (1971), the Court stated that "Congress has not seen fit to impose any burden or restriction on aliens who become indigent after their entry into the United States." Th is seeming ly leaves the door ajar. 36 Court explained that although no State independently could exercise a power held by the federal government in the area of immigration, "if the Federal Government has by uniform rule prescribed what it believes to be appropriate standards for the treatment of an alien sub-class, the States may, of course, follow the federal direction." (Citing DeCanas, 424 U.S. 351, 96 S.Ct. 933, 47 L.Ed.2d 43) (Emphasis added). As the Court of Appeals of New York noted in Aliessa v. Novello, supra, 754 N.E.2d at 1098, in administering their own programs [under PRWORA], the States are free to discriminate in either direction producing not uniformity, but potentially wide variation based on localized or idiosyncratic concepts of largesse, economics and politics." See also Traux, 239 U.S. at 42, 36 S.Ct. at 11, 60 L.Ed. at 135. This laissez faire federal approach to granting discretionary authority to the States in deciding whether to continue State-funded medical benefits for resident aliens who do not meet the five-year residency duration requirement does not prescribe a single, uniform or comprehensive approach. "If the rule were uniform, each State would carry out the same policy under the mandate of Congress the only body with authority to set immigration policy." Aliessa, 754 N.E.2d at 1098.16 Thus, a State's decision to eliminate the funding of a State-only funded Medical Assistance Program to a sub-class of lawfully admitted resident aliens who are ineligible for federal 16 An example of the divergence among States acting on maintaining coverage of medical assistance benefits for aliens ineligible for federal Medicaid is seen by the treatment in New York s and M aryland s curren t covera ge. See Aliessa, 754 N.E.2d at 1092. 37 medicaid benefits was not carried out in compliance with a single, uniform policy prescribed by the federal government. 17 Recent decisions from state and federal courts lend support for this conclusion. In Aliessa, the Court of Appeals of New York adopted a similar position on the "uniform rule" principle. Aliessa, 754 N.E.2d at 1098. The court determined that a provision of the New York Medicaid statute, which denied State-only medical benefits coverage to otherwise eligible persons permanently residing in the United States under color of law and lawfully admitted permanent residents based on their status as aliens, violated the Equal Protection Clauses of both the U.S. and New York Constitutions. Aliessa, 754 N.E.2d at 1098-99. Under the equal protection challenge,18 the court first established that State actions based on alienage classifications should be strictly scrutinized. Aliessa, 754 N.E.2d at 1094. Noting that the State did not attempt to justify its action under the strict scrutiny standard of review, the court next addressed the State's contention that the State statute "implements [PRWORA's] Federal immigration policy and should therefore be evaluated under the less 17 It matters not to our analysis that Maryland chose to exercise the discretion purported ly accorded by PRWORA in 1996 to continue to extend m edical benefits to the relevant sub-class o f aliens not c overed b y federal med ical benefits u ntil FY 20 06 whe n it recanted those benefits. The State may not act independently in a discriminatory manner with regard to distributing S tate-funde d medica l benefits to lawful resident aliens unless it survives a strict scrutiny standard of review. The purported discretionary authorization of PRWORA does not reduce that standard of review of the State s action. 18 The Court of Appeals of New Y ork determined also that the relevant provision of the New Y ork Me dicaid statute also violated a separate article of its State constitution, which mandates care for the needy. Ma ryland does n ot have a sim ilar article in its State constitution. 38 stringent 'rational basis' standard[ ]" because, the State argued, PRWORA provided a uniform rule which States could choose to follow. Aliessa, 754 N.E.2d at 1095. The New York high court compared State and Congressional authority with regard to immigration and naturalization. Aliessa, 754 N.E.2d at 1095-96. Acknowledging the authority of the federal government, and the sources of that authority, with regard to immigration and naturalization issues, the Court stated that "over no conceivable subject is the legislative power of Congress more complete." Aliessa, 754 N.E.2d at 1096 (quoting Oceanic Steam Nav. Co. v. Stranahan, 214 U.S. 320, 339, 29 S.Ct. 671, 676, 53 L.Ed. 1013, ---- (1909)). Citing Mathews, the court noted Congress' ability to distinguish between aliens and citizens when allocating federal welfare benefits. Id. The court concluded that "when Federal welfare programs are jointly administered with the States, Congress may direct the States to implement national immigration objectives as long as the 'Federal Government has by uniform rule prescribed what it believes to be appropriate standards for the treatment of an alien sub-class.'" Id. (quoting Plyler, 457 U.S. at 219 n.19, 102 S.Ct. at 2396 n. 19, 72 L.Ed.2d at 800 n.19). With regard to "whether [PRWORA] can constitutionally authorize New York to determine for itself the extent to which it will discriminate against legal aliens for State Medicaid eligibility," Id., the Court determined it could not because "[PRWORA] 39 does not impose a uniform immigration rule for States to follow." Aliessa, 754 N.E.2d at 109819 ; see also Teytelman v. Wing, 773 N.Y.S. 2d 801 (N.Y. Sup. 2003). This uniformity requirement for applying a relaxed scrutiny standard of review to State action in a somewhat similar context also has been noted by the U.S. Court of Appeals for the Ninth Circuit. In Sudomir v. McMahon, 767 F.2d 1456 (9th Cir. 1985), the Ninth Circuit affirmed the lower court's denial of the plaintiffs' motion for a preliminary injunction. Sudomir, 767 F.2d at 1457. The court rejected the challenge that the State's decision not to provide welfare benefits to the plaintiffs, who were aliens that had applied for, but not yet received, political asylum, under a cooperative federal-state assistance program, violated the Equal Protection Clause of the Fourteenth Amendment. Sudomir, 767 F.2d at 1457. The court, however, determined that the State's action was constitutional because "Congress ha[d] enacted a uniform policy regarding the eligibility of asylum applicants for welfare benefits." Sudomir, 767 F.2d at 1466. The Court in Sudomir distinguished its material facts from those in Plyler on the basis that the "State [in Plyler] had employed the federal classification 'for its own discriminatory policy[.]'" Sudomir, 767 F.2d at 1466 (quoting Plyler, 457 U.S. at 226, 102 S.Ct. at 2399, 19 To support its conclusion of requiring unifor mity in the fede ral directive be fore it will apply relaxed scrutiny to a State action, the Court of Appeals of New York relied upon Graham, supra, 403 U.S. 365, 91 S.Ct. 1848, 29 L.Ed.2d 534, Plyler, supra, 457 U.S. at 219 n.19, 102 S.Ct. at 2396 n. 19, 72 L.Ed.2d at 800 n.19, Mathews, supra, 426 U.S . 67, 96 S.C t. 1883, 48 L.Ed.2d 478, and Hampton v. Mow Sun Wong, 426 U.S. 88, 96 S.Ct. 1895, 48 L.Ed.2d 495 (1 976). 40 72 L.Ed.2d at 805). The court noted also that the outcome in Plyler might have been different had "there been an articulable federal policy" and emphasized the following language from Plyler: "[b]ut if the Federal Government has by uniform rule prescribed what it believes to be appropriate standards for the treatment of an alien sub-class, the States may, of course, follow the federal direction." Sudomir, 767 F.2d at 1466 (quoting Plyler, 457 U.S. at 226, 219 n. 19, 102 S.Ct. at 2399, 2396 n. 19, 72 L.Ed.2d at 805, 800 n.19). Turning back to its own case, the court concluded that "the [S]tate employed both a federal classification and a uniform federal policy regarding the appropriate treatment of a particular sub-class of aliens." Sudomir, 767 F.2d at 1466. Specifically, with regard to the uniformity of the federal policy at issue in that case, the court noted that the federal law required the denial of benefits to the specified alien sub-class. Sudomir, 767 F.2d at 1466.20 The court, therefore, concluded that the lower court correctly applied the relaxed scrutiny standard to 20 Immediately following this analysis, the court stated that [i]t would make no sense to say that Congress has plenary power in the area of immigration and naturalization and then hold that the Constitution impels the states to refrain from adhering to the federal guidelines. Sudom ir v. McMahon, 767 F.2d 1456, 14 66 (9th Cir. 198 5). Appellants in the present case point to this language, in their brief, to support their position. As we hav e noted, howev er, the court in Sudom ir addressed the circumstance where the federal law required the exclus ion of th e alien su b-class i n ques tion. 41 the State law upholding the denial of benefits to asylum applicants. Sudomir, 767 F.2d at 1466.21 Because we conclude that PRWORA does not provide a "uniform rule" for subsequent State actions,22 we shall employ a strict scrutiny standard of review in our consideration of the State action here that, in effect, discriminated in the provision of Statefunded medical assistance benefits based on an alienage classification or sub-classification. See also Kurti v. Maricopa County, 33 P.3d 499 (Ariz. Ct. App. 2001) (Arizona statute attempting to remove qualified legal aliens from medicaid regardless of amount of time in U.S. is subject to strict scrutiny); Official Opinion No. 96-1, Op. Att y Gen. of Pa. (1996) (binding opinion held that Pennsylvania statute excluding legal aliens from State-funded medical assistance, after passage of PRWORA, was subject to strict scrutiny review and accordingly unconstitutional). As we noted, supra, a statutory classification that is subject 21 In further support of its conclu sion, the N inth Circuit relied on Monmouth Medical Center v. Hau Hwok, 444 A .2d 610 (N.J.Su per. 1982), which it noted "[ upheld a] s tate regulation excluding illegal aliens from coverage of joint federal/state Medicaid program, where pertinent federal regulations required such exclusion." Sudom ir, 767 F.2d at 1466 (Emp hasis ad ded). 22 The U.S. Court of Appeals for the Tenth Circuit has viewed more narrowly this uniformity requirement for applying a relaxed scrutiny standard. In Soskin v. Reinertson, 353 F.3d 1242, 1256 (10th Cir. 2004), the court stated in dicta, see supra n. 12 discussing the holding in Soskin, that "we reject the argument that the PRWORA's authorization to the states to provide or deny Medicaid benefits to certain aliens runs afoul of the uniformity requirement of the Constitution's Naturalization Clause." Examining Graham, the court in Soskin concluded that, because "Congressional power over aliens derives from more than just the Naturalization Clause," the "uniformity requirement is imposed only on a 'Rule of Naturalization.'" Soskin, 353 F.3d at 1256. We, however, do not view the requirement so narrowly. 42 to strict scrutiny must be tailored suitably to serve a compelling state interest. The sole reason advanced by Appellants for instituting the budget cut, other than those purportedly borrowed from PRWORA, was to create a cost savings. We conclude, under a strict scrutiny standard, that Appellants have failed to justify their decision to eliminate the funding.23 In Shapiro v. Thompson, supra, 394 U.S. at 622, 89 S.Ct. at 1324, 22 L.Ed.2d at 608, the Supreme Court held unconstitutional a State or District of Columbia statutory provision denying welfare assistance to residents of the State or District who had not resided within their jurisdictions for at least one year immediately preceding their applications for such assistance. The governmental appellants, in Shapiro, "justif[ied] the waiting-period requirement as a protective device to preserve the fiscal integrity of state public assistance programs." Shapiro, 394 U.S. at 627, 89 S.Ct. at 1328, 22 L.Ed.2d at 611. The Court rejected this funding justification, under strict scrutiny analysis, stating that [w]e recognize that a State has a valid interest in preserving the fiscal integrity of its programs. It may legitimately attempt to limit its expenditures, whether for public assistance, public education, or any other program. But a State may not accomplish such a purpose by invidious distinctions between classes of its citizens. It could not, for example, reduce expenditures for education by barring indigent children from its schools. Similarly, in the cases before us, appellants must do more than show that denying welfare benefits to new residents 23 Additionally, we do not find the reasons provided in PRWORA to justify denying eligibility for federal benefits (promoting self-sufficiency and discouraging illegal aliens) to meet the strict scrutiny standard of review applied to the State s action in the present case. 43 saves money. The savings of welfare costs cannot justify an otherwise invidious classification. Shapiro, 394 U.S. at 633, 89 S.Ct. at 1330, 22 L.Ed.2d at 614 (Footnote omitted). See also Graham, 403 U.S. at 376, 91 S.Ct. at 1854, 29 L.Ed.2d at 544 (noting that "the justification of limiting expenses is particularly inappropriate and unreasonable when the discriminated class consists of aliens") (Citation omitted) (Internal quotations omitted). Although Shapiro was assessing the right to travel in its equal protection analysis, this distinction does not make less compelling for our analytical purposes the Court s conclusion that preserving the fiscal integrity of a State benefits program is not, by itself, a sufficient basis to satisfy strict scrutiny review . Accordingly, we agree with the Circuit Court that Appellees demonstrated a likelihood of succeeding on the merits of their equal protection challenge under Article 24. With respect to the remaining three factors to be considered in acting on a preliminary injunction request, we conclude that the Circuit C ourt did no t abuse its discretion in resolving them in favor of Appellees. First, considering Appellees personal interests and the burden to the State , the trial court determined that the relative cost to Appellees of searching for other medical coverage was substantial, but the cost to the State to maintain the cancelled program was relatively minimal. The balance of convenience, it was concluded, favored Appellees. Second, Appellees provided sufficient factual averments, if proven at trial, of their on-going medical needs and inability to obtain alternative h ealth care, w ithout State assistance, for the Circ uit Court to find reasonably that Appellees likely would suffer irreparable injury unless the requ ested p relimina ry injunctio n was issued. Third, in light of 44 the public policy goals of the Welfare Innovation Act, the Circuit C ourt did no t abuse its discretion in conclu ding that the public interes t was best se rved by requ iring the State to provide benefits to some of the most vu lnerable segmen ts of its populati on. Con sequ ently, the Circuit Court generally acted within the permissible range of its discretion in deciding to grant preliminary injunctive relief in favor of Appellees. V. We consider n ext wheth er the court p roperly ordered Appellan ts to reinstate medical benefits to Appellees, as prescribed under the Medical Assistance Program . The Circu it Cou rt's order of 12 January 2006 provided that the med ical benefits b e reinstated a s of 1 July 2005. Addition ally, the Circuit Co urt ordered that the med ical benefits b e reinstated prospectiv ely from 26 October 2005, the date the original Complaint and Motion for Prelimi nary Injun ction w ere filed , until fin al dispo sition of the case . As we have noted previously, "injunctive relief is a prev entiv e and protectiv e rem edy, aimed at future acts , and is not intended to redress past wrongs." El Bey v. M oorish Te mple, 362 Md. 339, 353, 765 A.2d 132, 139 (2001) (citing Colandrea v. Wilde Lake Comm unity Ass'n, Inc., 361 Md. 371, 394, 761 A.2d 899, 911 (2000), which quoted Carroll C ounty Ethics Comm'n v. Lennon, 119 Md.App. 49, 58, 703 A.2d 1338, 1342-43 (1998)) (Internal quotations omitted ). Moreo ver, a prelimin ary injunction is d esigned to preserve the court s ability to render a meaningful decision on the me rits by su staining the statu s quo. State Dep t v. B altimore C ounty, 281 Md. 548, 558-59, 383 A.2d. 51, 57 (1977) (quoting Canal 45 Authority v. Callaway, 489 F.2d 567, 576 (5th Cir. 1974), and Wieck v. Sterenbuch, 350 A.2d 384, 387-8 8 (D.C . 1976) ). See also Harford Co. Educ. Ass'n v. Board, 281 Md. 574, 585, 380 A.2d 1041, 1048 (1977) ("[I]t is fundamental that a preliminary injunction does not issue as a matter of right, but only where it is nece ssary in order to preserve the status quo.") (Internal quotation a nd citation o mitted); Maloof v. Dep t of Environment, 136 Md. App. 682, 693, 767 A.2d 372, 378 (2001 ).24 The status quo to be preserved by a preliminary injunction ordinarily has been described as the last, actual, peaceable, noncontested status 24 As we stated in State Dep artment v . Baltimore County , 281 Md. 548, 558, 383 A.2d. 51, 57 (1977): [I]t is quite clear from our cases that a preliminary injunction will lie when it is necessary to preserve the statu s quo. Tyler v. Secretary of State, 230 Md. 18, 20, 185 A.2d 385, 386 (1962); Dolan v. Motion Picture Etc. Union, 206 Md. 256, 258-260, 111 A.2d 462, 263 (1955) (in suit to enjoin union from expelling plaintiffs, alleging threa t of loss of jo bs and oth er property rights, chancellor should have issued a preliminary injunction pending a decision on his own jurisdiction in order to preserve status quo); Kahl v. Con. Gas, El. Lt. & Power Co., 189 Md. 655, 658, 57 A.2d 3 31, 332-33 (1948) (no abuse in refusing preliminary injunction in view of defendant s stipulation and agreement to maintain the status quo); Martin v. United States Wkrs. Ass n, 189 Md. 383, 388, 56 A.2d 28, 30 (1947) (order refusing to dissolve injunction reversed f or lack of indispensable party; effect of injunction was to change the status quo by assisting the plaintiff to gain possession of assets belonging not to defe ndants b ut to a par ty not before the court); 43 C.J.S. Injunctions § 2, at 406 (1945) (sole o bject of preliminary injunction is to preserve subject in controversy in its then existing condition a nd to prev ent any act w hereby right in contro versy ma y be mate rially injure d or end angere d). 46 which preceded the pendin g contr oversy. State Dep t v. Baltimor e Coun ty, 281 Md. at 556 n.9, 383 A.2d a t 56 n.9 ( Interna l quotati on and citation o mitted). We conclude that the Circu it Court s order for retrospective relief through a preliminary injunction was not appropriate. Here, the court s order for retrospective reinstatement of medical assistance benefits was not a p reservation of the status quo . Rather, it was, in eff ect, an aw ard of pas t damage s to Appe llees. Dam ages, if any, may be awarded only upon disposition of the case upon the merits, not through the grant of a preliminary injunction. In the prese nt case, the C ircuit Court e ffectively awarded damages to Appellees in the form of undetermined retrospective medical assistance benefits without either a final adjudication on the merits of liability or a determination of actual damages, if any, suffered by Appe llees. See Benson v. State, 389 Md. 615, 631, 887 A.2 d 525, 53 4 (2005). W e vacate that part of the C ircuit Court s order reinsta ting medic al benefits to Appellees, as prescribed under the Medical Assistance Program, retrospectively from 26 Octo ber 2005 (the date suit was filed) back to 1 July 2005. We affirm, however, that portion of the Circuit Court's order which compels medical benefits to Appellees, as prescribed under the Medical Assistance Program, prospectiv ely from 26 October 2005, the date the original Complaint and Motion for Preliminary Injunction were filed, u ntil final d ispositio n. As n oted, supra, Appellees satisfied the four requisite factors for issuance of a p reliminary injunc tion. Becau se this relief is designed to preserve the status quo from future acts so as not to undermine the final disposition of the case on the merits, the portion of the Circuit Court's order that enjoins 47 affirmative ly and prosp ectively App ellants to provide medic al assistance b enefits to Appe llees sha ll stand. Appellan ts contend that t he co urt la cks the au thority to order the executive and legislature branches prospectively to reinstate medical assistance benefits to Appellees. Appellan ts argumen ts are misplac ed. First, Appellan ts characterize the Circuit Court's order as an illegal appropriatio n of fun ds. While A ppellants no te correctly that Article III §§ 32 and 52 of the Maryland Co nstitution pro vide a com preh ensive ex ecut ive b udgetary procedure for appropriating monies, the order prospectively reinstating medical benefits to Appellees in the present case does no t operate as a n order dire cting the ap propriation o f specific funds. 25 Rather, the order serves as a judicial determination that Appellants' action warranted the issuance of a preliminary injunction because there is a likelihood that Appellants' action was u ncons titutiona l. 25 Maryla nd Action for Foster C hildren v. Sta te, 279 Md. 133 , 367 A.2d 491 (1977), is not helpful to Appellants cause. In Foster C hild, we concluded that a statute requiring equal funding levels to pare nts of foster children was not an appropriation because it did not purport to appropriate money out of the State Treasury or direct the Comptroller, Treasu rer, or anyone else to make payments of m one y." Foster Child., 279 Md. at 139, 367 A.2d at 494. We found that same statute did not require the Governor to fund payments to foster child parents at a p articular level b ecause to d o so wo uld frustrate Article III, § 52 where the funding level at issue was at the discretion of the Governor, and not bound by a constitutional duty. Foster Child., 279 Md. at 148-53 , 367 A.2d at 499 -502. In contrast, the o rder here is a judicial determination that a State action is likely a violation of Article 24 of the Constitution, and thus it is appropria te to order that the status quo of the controversy be reinstate d prosp ectively. 48 Second, Appellants argue that the Declaration of Rights does not overbear the express terms of the Constitution. If there were a conflict between Article 24 and the budget provisions of the Co nstitution, the more specific budget pr ovisions w ould prev ail. It is unclear to us why Appellants advance this argument when no issue has been presented that questions the validity of the budget a nd appropriations provisions of the Maryland Constitution. Assuming, as we do, that Appellants actually mean to argue that the equal protection guarantees of Article 24 do not apply to the budget appropriation process, we reject the argument because the executive and legislative budget authority is subject to the constitutional limitations of the Declaration of Rights . See, e.g., Judy, 331 Md. at 266, 627 A.2d at 1053 (ap plying a standa rd of revie w to a governor s reduction to a budget appropriation that examined whether the governor and an executive board acted within their legal boundaries). Indeed, to hold otherw ise would create a leg al means for State government to employ invidious classifications that violate the equal protection guarantees of the Maryland De claration of Rights (as well as other constitutional guarantees) by adopting budgets rather than by enacting laws, which w e have lon g recogn ized is subjec t to constitu tional co nstraints . Third, and related to their secon d argum ent, Appe llants contend that by providing expressly that the prohibition against unappropriated expenditures applies to any orde r, Article III, § 32 invalidates the Circuit Court s preliminary injunction. Article III, § 32, however, pertains to legislative orders for the appropriation of funds. Dorsey, 178 Md. at 49 237, 13 A.2d at 634 (stating that the effect of Article III, § 32 is to exclude a legislative order or resolution from the c ategory of an appropriatio n within the meaning of the provision ); Baltimore v. O Conor, 147 Md. 639, 644, 128 A. 759, 761 (1925) (stating the purpose of the Budget Amendments was to remedy the uncorrelated system in which the General Assembly caused deficits). Article III, § 32 does not pertain to a cou rt s preliminary injunction order that enjoins affirmatively and prospectively Appellants to provide medical assistance benefits to Appe llees until the d isposition of the merits of the case; no r would Article III, § 32 ap ply to a co urt orde r to rem edy a con stitutiona l violatio n. See Marbury v. Madison, 1 Cranch 137, 177 (1803) ( It is empha tically the province and duty of the judicial department to say wha t the law is. ). JUDGMENT OF TH E CIRCUIT COURT FOR MONTGOMERY COUN TY AF FIRME D IN PART AND VACATED IN PART; CASE REMANDED TO THAT COURT FO R FURTHER PROCEEDINGS. COSTS TO BE PAID BY APPELLANTS. Judg es W ilner and Cath ell jo in in the ju dgm ent o nly. 50

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