A new Tennessee law, drafted with input from White House adviser Stephen Miller, would require state agencies to report the immigration status of about 400 disabled and chronically ill children receiving state-funded medical benefits to ICE. Health officials a
By late June. the Tennessee Department of Health plans to send a warning that has already unsettled hundreds of families: if their children stay enrolled in a state program for critically ill care after June 30. the state will report their immigration information to the government’s ICE liaison office.
The notice arrives with a blunt consequence. Children getting lifesaving treatment for conditions such as cancer and cystic fibrosis through the Children’s Special Services program—described by state officials as a “payer of last resort”—could see their immigration status sent to federal authorities solely because they remain in a program funded by both state and federal dollars.
A new Tennessee law passed by Republicans this spring. drafted with help from White House policy advisor Stephen Miller. would require state and local government agencies to report immigrants receiving any state-funded benefits to ICE. Under the law. the reporting would apply to the immigration status of about 400 disabled and chronically ill children who receive lifesaving care through the Tennessee Department of Health’s Children’s Special Services (CSS) program.
The program is aimed at very low-income children who are not eligible for TennCare. It is open to people aged 21 and younger with disabilities and chronic illnesses including cystic fibrosis, cancer and spina bifida. Families of four must have an annual income of $66,000 or less to participate.
On June 1, the Tennessee Department of Health mailed notices to 400 families receiving care through CSS. The letters warned that officials would be required by the new law to report the patients’ immigration status if they remained on in the program past June 30.
Interim Health Commissioner John Dunn wrote in the notices: “Due to the current immigration status of your child. [redacted]. if the Children’s Special Services 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.”.
The letters, sent to families of children facing severe medical conditions, have already changed behavior. At least 4 children have withdrawn from the program.
Sanmi Areola. director of Nashville’s Metro Public Health Department. said in an interview published June 11 that as many as 100 critically ill children up to age 17 could be impacted. 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.”.
Tennessee lawmakers argue the move is designed to protect taxpayer spending. During debate, bill sponsor Rep. Dennis Powers said on the House floor. “We have a $971 million problem with illegals getting some type of benefits in the state of Tennessee.” He added that lawmakers want people who “need to come here legally.”.
Republicans passed a broader package of immigration bills drafted with the White House. requiring proof of immigration status for nearly every public benefit. Throughout the debate, 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.
Powers also said, “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,” before concluding, “We are not an extended-stay hotel for the rest of the world.”.
Tennessee Republicans also say that emergency care will remain available for immigrant children. House Assistant Majority Leader Mark Cochran said that taxpayers should take priority over people in the U.S. unlawfully. Cochran stated, “Tennessee taxpayers expect and deserve to have their resources prioritized for legal residents and citizens first.”.
Cochran added, “The new law does not deport children receiving lifesaving care or deny emergency medical care. 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 in response that the state is “required to administer the Children’s Special Services Program in accordance with applicable federal requirements and state law.” State House Speaker Cameron Sexton. Lt. Gov. Randy McNally and other senior Tennessee Republican leadership did not respond to questions.
The dispute turns on what families fear will happen after June 30—whether a reporting requirement will lead to interruptions in care for children already teetering on medical risk.
Immigration advocates and health officials argue that the CSS program may be the only path to treatment for many children in immigrant families. The Tennessee Justice Center sent a letter June 3 to state health department officials asking them to reconsider the directive. warning: “If you do. you will no doubt save or prolong the lives of numerous chronically ill children.”.
Brant Harrell, the center’s legal director, said he believed the directive stems from a misinterpretation of state and federal laws. In the letter, he made an urgent case about the stakes for patients, writing that “interruption of their care can result in serious injury, suffering, and death.”
Harrell said a center staff member “encountered a family whose severely disabled child is on a ventilator and who faced the denial of CSS benefits.” He also said the center has received reports of durable medical equipment suppliers preparing to take oxygen tanks from other children’s homes because they no longer qualified for CSS due to their citizenship status.
Michele Johnson. the center’s executive director. said many participants are children of undocumented immigrants who are not insured or eligible for Medicaid or TennCare. leaving CSS as their only resource for care. “Hundreds of children who have illnesses that are treatable will die because of where they were born,” Johnson said.
Other states that provide a match to federal dollars also offer similar programs for children with severe disabilities, including cerebral palsy, spina bifida, cystic fibrosis, sickle cell anemia, congenital cardiac conditions and seizure disorders.
Areola framed the issue as a practical risk to health, not an abstract policy debate. “It’s the state’s decision. whether we’re talking about the new law or how it’s interpreted or how it’s implemented. ” he 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.”.
At the same time, Areola said his office is working with local families whose immigration status may have changed to update documentation, which could remove some from the list reported to the state. “I will continue to do that,” he said.
For families whose immigration status will be reported, Areola said the goal is to protect access to medicines and treatment. “Our goal has to be for these kids to have access to the care that they need and the medications that they need. ” he said. “We will just keep fighting and exploring all the options that we have. keep working with the state. with decision makers. our partners and providers.”.
The Tennessee Justice Center also sent a demand letter to the state health department threatening a civil lawsuit if the state follows through. The center argued the approach could lead to sicker kids and deaths.
Health coverage gaps remain at the center of the concern. Children with critical illnesses are often covered by the Affordable Care Act or TennCare, but that coverage is often not available for immigrant families.
Areola said the “first wave” that impacted participants in the CSS program were 18 to 21 years old. He said six seriously ill young adults in Nashville lost care in May when they couldn’t provide proof of citizenship. His office was able to link those young adults to other services. calling it a “huge success story.” Dealing with the larger number of children scheduled for reporting after June 30. he said. is a bigger challenge.
The White House did not respond to a request for comment for this story.
Tennessee law ICE reporting immigrant children Children’s Special Services Stephen Miller John Dunn Nashville Metro Public Health TennCare WIC grant civil lawsuit