The introduction of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) led to considerable litigation on the rights of immigrants to welfare benefits and access to health care. There was considerable divergence between the approaches adopted by the different courts (both federal and State) based, in part, on the different statutory schemes involved but also on different approaches to equal protection. However, none of the cases reached the Supreme Court so the ‘correct’ approach remained unclarified. Perhaps inspired by the fiscal crisis of 2008, several States have again excluded certain legal immigrants from the scope of State health care or welfare schemes and these decisions are currently under challenge in the courts. At the time of writing, there are at least six recent or ongoing challenges in Connecticut, Hawaii, Massachusetts, New Jersey and Washington. Again, courts have come to very different conclusions as to the issues involved. On the one hand, the Massachusetts Supreme Judicial Court has held that strict scrutiny applies to the exclusion of immigrants from a State health care scheme (with federal funding) and that the law under challenge did not satisfy that requirement (Finch v. Commonwealth Health Insurance Connector Authority). On the other, the Connecticut Supreme Court has held that a decision to abolish a State health scheme for immigrants not entitled under the State-federal Medicaid scheme did not involve any discrimination (as no comparable citizen was being provided with State benefits) (Hong Pham v. Starkowski). This note discusses the recent cases and considers how the issues should be analyzed consistent with equal protection law.