Tennessee’s new law, co-authored with the White House, requires state and local governments to report immigrants receiving state aid to ICE. Even for pediatric cancer patients.
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- Tennessee’s new law, drafted with President Trump’s policy adviser Stephen Miller, requires the state to report the immigration status of about 400 disabled and chronically ill children to ICE.
- Children receive lifesaving care for conditions such as cancer and cystic fibrosis through programs of last resort that receive both state and federal funding.
- Families were informed that if their children continued to participate in the program, their information would be shared with federal law enforcement. At least four children have already dropped out of the program.
- Immigrant advocacy groups and health officials have warned that this could leave children without vital medical care.
Approximately 400 disabled immigrant children receiving life-saving state-funded medical care will have their immigration status reported to ICE later this month under Tennessee’s new law, drafted with input from the White House.
The Tennessee Department of Health’s Children’s Special Services Program is a “payer of last resort” that ensures access to life-saving medical care for very low-income children who do not qualify for TennCare. The program is aimed at people 21 years of age and younger with disabilities and chronic illnesses such as cystic fibrosis, cancer, and spina bifida.
To participate in this program, a family of four must have an annual income of $66,000 or less.
On June 1, the Tennessee Department of Health mailed a notice to 400 families receiving care through CSS, warning that if a patient continues to participate in the program past June 30, officials will be required by new law to report the patient’s immigration status.
“Due to your child’s current immigration status (redacted), if the Children’s Special Services Program continues to pay for medical care after June 30, 2026, the Tennessee Department of Health will share your child’s information with the Tennessee Department of Safety,” Interim Health Secretary John Dunn wrote.
Metro Nashville Department of Public Health Director Sanmi Arreola told The Tennessean, part of the USA TODAY Network, on June 11 that up to 100 critically ill children up to age 17 could be affected, including cancer patients and those dependent on ventilators.
“I’m very worried,” Arreola said. “These are our most vulnerable children. I personally shudder to think about the impact this will have.”
A new law passed by Tennessee Republicans this spring requires all government agencies to report to the state’s Immigration and Customs Enforcement (ICE) liaison office if a person is in the U.S. illegally while receiving government benefits.
President Donald Trump’s deputy chief of staff, Stephen Miller, helped draft the bill. The White House did not respond to requests for comment on this story.
Tennessee lawmakers hailed the policy as a fiscal responsibility measure to ensure tax dollars aren’t being spent on people who don’t deserve them.
“There’s a $971 million problem with illegal aliens getting any benefits in Tennessee,” bill sponsor Rep. Dennis Powers said during House debate. “We have people coming here from all over the world, from Mexico to Guatemala to Honduras, and they have to come here legally.”
Republicans passed an immigration bill co-authored with the White House that required proof of immigration status for nearly all public benefits. Throughout debate over the package, Republican lawmakers cited reports on crimes committed by illegal immigrants. According to the Tennessee District Attorney General’s 2025 Immigration Report, the most common crime committed by illegal aliens in Tennessee is drunk driving.
“The moment they cross our border, they break the law. We live in a sovereign country with borders. The moment they walk across that border, they’re here illegally. They’re breaking Title 18 of the United States Code,” Powers said. “We are not an extended stay hotel for people from all over the world.”
Tennessee lawmaker says taxpayers expect legal residents to be prioritized
Special Children’s Services is funded by the federal government through the Maternal and Child Health Services Grant. This grant is the same grant that funds the WIC food assistance program for low-income mothers and children under age 5, regardless of immigration status. There is no federal requirement that grants be used only for U.S. citizens.
Republican Tennessee House Minority Leader Mark Cochran said taxpayers should be illegally prioritized over American citizens.
“Tennessee taxpayers expect and have a right to have their financial resources prioritized, putting our legal residents and citizens first,” Cochran said.
She said immigrant children will continue to have access to emergency medical care because federal law requires access to life-saving treatment regardless of immigration status, insurance or criminal history.
“The new law does not deport children receiving life-saving treatment or deny them emergency medical care,” Cochran said. “It simply ensures that Tennessee public benefits are reserved for those legally present in the United States and directs appropriate referrals to ICE, while fully complying with all federal obligations for emergency and life-saving care.”
Elizabeth Johnson, communications director for Tennessee Gov. Bill Lee, said the state “must 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 Tennessee Republican leaders did not respond to questions.
Immigrant rights advocates sound the alarm
The nonprofit Tennessee Justice Center sent a letter to state health department officials on June 3 urging them to reconsider the directive, saying it would “undoubtedly save or extend the lives of many chronically ill children.”
Brant Harrell, the center’s legal director, listed reasons why he believes the directives surrounding the CSS program stem from a misunderstanding of state and federal law. He also made an emotional appeal for children to continue to be cared for, saying that “interrupting their care could result in serious injury, suffering and death.”
Harrell said one center worker “encountered a family with a severely disabled child on a ventilator and faced denial of CSS benefits.”
“We have received reports that a supplier of durable medical equipment is preparing to take oxygen tanks from other children’s homes because they are no longer eligible for CSS due to citizenship issues.”
Michelle Johnson, the center’s executive director, said many of the program’s participants are children of undocumented immigrants who are uninsured and do not qualify for Medicaid or TennCare, so the CSS program is the only resource for their care.
“Hundreds of children with treatable diseases will die because of where they were born,” Johnson said.
Other states with comparable amounts of federal funding also offer the program to children with severe disabilities such as cerebral palsy, spina bifida, cystic fibrosis, sickle cell anemia, congenital heart disease, and seizure disorders.
“If we’re talking about a new law, how it’s interpreted and how it’s implemented, that’s a state decision,” Arreola said. “The health impacts for our residents and children are not expected to be positive, and we have clearly communicated that to the state.”
Arreola said his office is working with local families whose immigration status may have changed to update their documents, and some may be removed from the list reported to the state.
“I’m going to keep doing it,” he said.
For families whose immigration status is reported, “our goal is to make sure these children have access to the care they need and the medicine they need,” Arreola said. “We will continue to fight, explore all options we have and continue to work with countries, decision makers, partners and providers.”
The Tennessee Judicial Center sent a letter of demand to the state health department, threatening civil action, saying the state’s compliance could lead to more children becoming sick and dying.
Seriously ill children are often covered by either the Affordable Care Act or TennCare, but immigrant families often don’t have access to that coverage.
“The first wave to affect participants in the CSS program was between the ages of 18 and 21, and in May, six seriously ill youth in Nashville lost treatment after failing to show proof of citizenship,” Arreola said.
His office was able to connect these youth with other services.
“This is a huge success story for us,” Arreola said. “But dealing with such a large number is an even bigger challenge.”
Beth Warren covers healthcare and can be reached at bwarren@tennessean.com or @BethWarrenCJ on X.
Vivian Jones covers state politics and government for The Tennessean. please contact her vjones@tennessean.com Or @vivian_e_jones on X.
