Immigrant advocates are hopeful that a Massachusetts Supreme court ruling could help restore full subsidized health care to thousands of legal immigrants that have been denied coverage due to their immigration status.

The case stems from a decision by state legislature in 2009 to deny coverage to legal immigrants. The rollback was the first major reform to Massachusetts' landmark 2006 health care law, which was used in part as a blueprint for the national health care law signed by President Barack Obama.

A ruling Friday by the Supreme Judicial Court does not actually decide the case, but it answers key legal questions that will allow it to proceed.

The court ruled that while protections against discrimination in the Massachusetts Constitution don't explicitly protect individuals based on their immigration status, any attempt to deny benefits to "resident aliens" should be held to the strictest judicial scrutiny possible.

The court also appeared to reject a key cost-cutting argument that lawmakers used in 2009 when they decided to block legal immigrants from the Commonwealth Care health plan. The plan provides subsidized care for those earning up to three times the federal poverty level.

The cut was estimated to save the state about $130 million a year. Legislative leaders at the time said they had little choice, given the state's dire fiscal straits.

"While we are acutely aware of the financial difficulties presently facing the Commonwealth, the fiscal consequences of any subsequent judgment on the merits can't be permitted to intrude on consideration of the case before us," the court ruled.

The court also noted that during the first three years that the law was in effect, subsidized health care benefits were offered to qualified immigrants living in Massachusetts.

Given their "particularly vulnerable status," the court added, "it thus remains necessary to exercise heightened vigilance to ensure that the full panoply of constitutional protections are afforded to the Commonwealth's resident aliens."

Lawyers for the immigrants said the answers provided by Friday's ruling make it much harder for the state to argue that the 2009 decision to block legal immigrants from the program was constitutional.

"This is an important victory," said Wendy Parmet, the lead attorney for the plaintiffs in the class action lawsuit that was filed last year.

Parmet said the state will now have to prove under a "strict scrutiny" standard that there is a compelling reason to continue denying subsidized care for legal immigrants.

"Under strict scrutiny they will have to show that the discrimination was necessary for a compelling state interest," Parmet said. "It's very, very tough to prove."

Officials from the Commonwealth Health Insurance Connector Authority, which oversees the Commonwealth Care program, did not immediately respond to a request for comment.

Immigrant activists say the Legislature should take a cue from the court and once again allow some 40,000 legal immigrants to be covered under Commonwealth Care.

"In the long run this is going to help the state," said Eva Millona, executive director of The Massachusetts Immigrants and Refugee Advocacy Coalition. "It is fiscally responsible to have this population covered."

In 2009, Gov. Deval Patrick created a separate program to provide some health coverage to legal immigrants after they were denied access to Commonwealth Care.

The Massachusetts House voted last month to restore about half of the money for the Commonwealth Care Bridge program after the House Ways and Means Committee had previously voted to eliminate funding.

Patrick had pushed for the funding and said in a statement that he was grateful for the House action.

Health care activists also hailed Friday's ruling.

Amy Whitcomb Slemmer, executive director of the advocacy group Health Care For All, said the court's decision upholds the state's core values as a Commonwealth.

"All legal residents of Massachusetts deserve equal access to health care," Slemmer said. "These are our friends and neighbors who have a right to the same health benefits we have all enjoyed for the last five years under health reform."

The class action lawsuit now heads back to a single Supreme Judicial Court justice.

Based on reporting by the Associated Press.

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