Tennessee has enacted new legislation that will severely restrict access to state-funded medical aid for critically ill and disabled undocumented children, requiring families to confront a stark choice: remain in the children’s assistance program and face potential reporting to immigration authorities, or forgo essential care. The change takes effect on July 1 and impacts families enrolled in the state’s Children’s Special Services, a program designed to assist low-income households in covering costs for life-sustaining treatments such as ventilators, wheelchairs, feeding tubes, and specialized medications.
The bill, passed in the spring, mandates that state and local agencies verify the immigration status of individuals receiving public benefits. If an applicant or beneficiary is found to be undocumented, agencies must report them to the Centralized Immigration Enforcement Division, a Tennessee state agency established in 2025 to coordinate immigration enforcement efforts in partnership with federal authorities. The legislation was one among several immigration-related measures enacted this year, backed by both Tennessee lawmakers and the White House as part of a broader strategy aimed at discouraging undocumented immigrants from residing in the state.
According to the Tennessee Department of Health, around 400 families currently relying on Children’s Special Services have recently received notifications warning them of the new requirements and potential consequences. Advocates for immigrant and healthcare rights have expressed alarm at how the policy affects vulnerable children. Michele Johnson, executive director of the Tennessee Justice Center, described the move as “life and death” for many of those affected.
This state-level action aligns with federal initiatives under the Trump administration, which has tightened restrictions on immigrants’ access to public benefits. These federal policies last year expanded the list of ineligible benefits for undocumented immigrants, introduced data-sharing agreements between Medicaid and immigration enforcement, and curtailed coverage for some lawful immigrants under programs like Medicaid and the Children’s Health Insurance Program. Experts note that Tennessee is among six states—along with Indiana, Louisiana, North Carolina, Wyoming, and Oklahoma—that now require agencies to report undocumented applicants for public benefits to immigration authorities.
At a legislative session in January, sponsors of the Tennessee bill acknowledged collaboration with the Trump administration and specifically mentioned Deputy Chief of Staff Stephen Miller, a key figure behind the administration’s immigration agenda. While the White House did not confirm Miller’s direct involvement in the state’s legislation, a spokesperson stated that the administration advises state lawmakers on implementing policies consistent with the president’s agenda to protect “the American people from fraud and abuse perpetrated by illegal aliens.”
In addition to limiting aid, Tennessee’s new immigration laws compel local law enforcement cooperation with federal immigration agencies and impose penalties on individuals who remain in the state for more than 90 days after receiving an order of final removal, a practice that has often gone unenforced due to logistical constraints.
The legislation’s human impact is illustrated by cases such as Gabriella, a Honduran asylum seeker caring for her 10-year-old son Daneri, who has spina bifida and multiple complex medical needs. Enrolled in Children’s Special Services, Gabriella said the program “literally saved my son’s life” by covering vital hospital costs, devices, medications, and specialist visits. Despite residing in Tennessee since 2019 and paying taxes, Gabriella and her husband are undocumented and were forced to withdraw from the program after receiving notice that her son’s information would be sent to immigration enforcement when the law takes effect. She expressed deep fear of separation and deportation.
Health professionals warn of significant risks posed by the policy to affected children, many of whom depend entirely on state aid for critical treatments. Pediatrician Morgan McDonald, a Nashville Metro Health board member, highlighted concerns about potential loss of life and deterioration in health outcomes absent the program’s support. Advocacy groups are exploring alternative funding sources, including hospital charities and private donors, but the resources remain uncertain.
The Tennessee Department of Health declined to comment for this report. Meanwhile, the Department of Homeland Security stated that Immigration and Customs Enforcement (ICE) does not separate families, but provided no assurance regarding enforcement actions involving Children’s Special Services recipients. Families affected by the policy live with heightened anxiety over possible detention and deportation, often fearing family separations despite official statements to the contrary.
As the July 1 implementation date approaches, families like Gabriella’s face an uncertain future, striving to secure care for critically ill children in the face of tightening immigration enforcement intertwined with public health policy. "I will not let him die," Gabriella said. "I will knock on doors, search for people, it doesn’t matter who I have to ask or where I have to travel. I will do anything."