The new Tennessee law requires government agencies to report those unlawfully in the United States to ICE if they are receiving government benefits.
NASHVILLE – About 400 disabled immigrant children who are receiving lifesaving state-paid medical care will have their immigration status reported to ICE at the end of June because of a new Tennessee law drafted with input from the White House.
The state has a program called Children’s Special Services, a ‘payer of last resort’ that ensures access to lifesaving medical care for very low-income children who are not eligible for TennCare, the state’s Medicaid program. The program is open to people age 21 and younger with disabilities and chronic illnesses like cystic fibrosis, cancer and spina bifida.
To participate, families of four must have an annual income of $66,000 or less. Children with critical illnesses frequently are covered by either the Affordable Care Act or the state’s Medicaid program, but that coverage is often not available for immigrant families.
On June 1, the Tennessee Department of Health mailed notices to 400 families receiving care through CSS, warning that officials will be required by a new law to report the patients’ immigration status if they remain in the program past June 30.
‘Due to the current immigration status of your child, [redacted], if the CSS program keeps paying for healthcare after June 30, 2026, the Tennessee Department of Health will share your child’s information to the Tennessee Department of Safety,’ wrote interim Health Commissioner John Dunn.
The program is federally funded through the Maternal and Child Health Services grant – the same grant that funds WIC, the Special Supplemental Nutrition Program for Women, Infants, and Children for low-income mothers and children younger than 5 regardless of immigration status. There is no federal requirement that the grant funding be used for U.S. citizens only.
Nashville’s Metro Public Health Department Director Sanmi Areola told the Nashville Tennessean, part of the USA TODAY Network, on June 11 that as many as 100 critically ill children up to age 17 could be affected, including some with cancer and others reliant on ventilators.
‘I am very worried,’ Areola said. ‘These are some of our most vulnerable children. I personally shudder to think about the consequences of this.’
A new law passed by Tennessee Republicans requires all government agencies to report people to the Immigration and Customs Enforcement liaison office in the state if they are receiving government benefits but are unlawfully present in the United States.
President Donald Trump’s Deputy Chief of Staff Stephen Miller helped draft the legislation. The White House did not respond to a request for comment.
Republicans passed a package of immigration bills drafted with the White House, to require proof of immigration status for nearly every public benefit. Throughout debate on the package, Republican lawmakers cited a report on crimes committed by undocumented immigrants. The most common crime committed by undocumented people in Tennessee is DUI, according to the Tennessee District Attorneys General Conference’s 2025 Immigration Report.
‘They have broken the law as soon as they crossed our border. We live in a sovereign country with borders. As soon as they walk across that border, they are here illegally: They have broken Title 18 of the U.S. Code,’ said state Rep. Dennis Powers, who sponsored the bill that passed this spring.
Republican Tennessee House Assistant Majority Leader Mark Cochran said taxpayers should take priority over people in the United States unlawfully. He indicated that emergency care will remain available for immigrant children because federal law requires lifesaving treatment be available regardless of immigration status, insurance or criminal history.
‘The new law does not deport children receiving lifesaving care or deny emergency medical care,’ Cochran said. ‘It simply ensures Tennessee public benefits are reserved for those legally present in the U.S. and directs appropriate referrals to ICE, while fully upholding all federal mandates for emergency and lifesaving care.’
Tennessee Gov. Bill Lee’s communications director, Elizabeth Johnson, said that the state is ‘required to administer the Children’s Special Services Program in accordance with applicable federal requirements and state law.’
Other senior Tennessee Republicans did not respond to questions.
The nonprofit Tennessee Justice Center sent a letter June 3 to state Health Department officials, asking them to reconsider the directive, saying, ‘If you do, you will no doubt save or prolong the lives of numerous chronically ill children.’
Brant Harrell, the center’s legal director, enumerated ways he believed the directive involving the CSS program stems from a misinterpretation of state and federal laws. He also included emotional pleas to continue care for the children, saying, ‘interruption of their care can result in serious injury, suffering, and death.’
A center staff member ‘encountered a family whose severely disabled child is on a ventilator and who faced the denial of CSS benefits,’ Harrell said.
‘We have received reports of durable medical equipment suppliers preparing to take oxygen tanks from other childrens’ homes because they no longer qualified for CSS due to their citizenship status.’
Michele Johnson, the center’s executive director, said the program is the only resource for many children of undocumented immigrants who aren’t insured or eligible for Medicaid or TennCare.
‘Hundreds of children who have illnesses that are treatable will die because of where they were born,’ Johnson said.
‘It’s the state’s decision, whether we’re talking about the new law or how it’s interpreted or how it’s implemented,’ Areola said. ‘The consequences to the health of our residents, our children, are not expected to be good, and we’ve communicated that very clearly to the state.’
For the families whose immigration status will be reported, ‘our goal has to be for these kids to have access to the care that they need and the medications that they need,’ Areola said.
The Tennessee Justice Center sent a letter to the state Health Department threatening a civil lawsuit if the state follows through, arguing it could lead to sicker kids and deaths.
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