Tennessee health department warns parents their children will be reported to immigration officials

By Anita Wadhwani (Tennessee Lookout) Published: June 11, 2026

Pediatricians and public health care providers on Wednesday said they feared life-threatening consequences for children with critical illnesses who rely on a specialized public health care program as Tennessee moves forward with a directive to verify and report their immigration status.

Letters sent by the Tennessee Department of Health warn parents that children without legal status who opt to continue to receive care through the Children’s Special Services program after June 30 will be reported to the Tennessee Department of Safety’s Centralized Immigration Enforcement Division, which shares data with U.S. Immigration and Customs Enforcement, or ICE.

The program, accessed through local public health departments, serves as a last-resort public health insurance program for low-income kids with disabilities, kids on ventilators and kids with life-threatening illnesses, such as cancer, spina bifida, congestive heart disease and terminal illnesses. For decades, the program has served children in Tennessee regardless of immigration status.

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“This letter is to inform you that based on our records, due to the current immigration status of your child…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, as required by new law,” reads a template of the letter obtained by the Tennessee Lookout. The letter is signed by John Dunn, interim commissioner of the health department.

The letters will reach at least 90 families in Nashville who rely on the program for healthcare, wheelchairs, in-school support and medications for their child. More families could be affected in the weeks ahead as their files are reviewed, according to Dr. Sanmi Areola, director of the Metro Nashville Public Health Department.

Areola said he and his staff are “concerned and worried” about the impact of the state directive on the vulnerable children they serve.

“There is no way to look at this positively on the health of participants, and obviously broadly on the health of our residents,” Dr. Areola said Wednesday.

“These are some of the kids with the highest health needs, and if they don’t have access to care or if they don’t have access to medications, conceptually no good outcome will come from that.”

Statewide, 4,640 children participated in the program in the 2024 fiscal year at a cost of $2.9 million, according to a state annual report. The Tennessee Department of Health has not publicly disclosed how many of these children may be impacted by new immigration verification requirements.

The state health department has not responded to multiple requests from the Lookout for further details.

In its letter to parents — and in a separate letter sent to healthcare providers — Dunn cited a 2026 state law that requires immigration verification of those seeking public benefits in Tennessee.

2026.06.02_CSS Letter to Patient Parents

The legislation, signed into law by Gov. Bill Lee May 22, requires applicants for public benefits to provide proof of citizenship or legal immigration status only if they are at least 18 years old.

The law also includes language requiring local health departments to “report individuals and all identifying information about such individuals who are not lawfully present” who receive public benefits to the state’s Centralized Immigration Enforcement Bureau. Failure to report comes with criminal penalties for public employees under the new law.

Katie Richards, president and CEO of the faith-based primary healthcare provider, Siloam Health, said the directive forces parents to make an agonizing choice: keeping their children on the program risks making families an immigration enforcement target. Forgoing care to avoid a child’s information being shared with immigration enforcement officials could put their children’s lives at risk.

“You are putting parents in a position where they’re having to deal with unimaginable decisions,” Richards said. “They face the risk of deportation, or risk their children’s lifesaving care.”

Siloam Health, a nonprofit provider of primary healthcare that primarily serves immigrant families, refers between 20 and 50 children each year to the program, Richards said. The children Siloam have referred to the program have included those who require feeding tubes, oxygen, cancer treatments, complex seizure management and wheelchairs due to severe neuromuscular disease, she said.

“For some of these children, loss of life is not a hyperbolic outcome in this scenario,” she said.

Quotation

You are putting parents in a position where they’re having to deal with unimaginable decisions. They face the risk of deportation, or risk their children’s lifesaving care.

– Katie Richards, Siloam Health Care

Dr. Jill Obremsky, a pediatrician who formerly served as medical director for rural public health clinics at the state health department, said the impact of the Children’s Special Services program goes beyond life-saving medication therapies, hospital and doctor care.

“Over my 30 years of practicing in different arenas, the coordinated care like Children’s Special Services provides has really changed the trajectory of kids’ lives, allowing them to grow into adults that contribute to a community,” she said.

“This has been a big shock and surprise,” she said.

Staff at the Nashville public health department have been working frantically to find alternatives for families who might be impacted with little advance notice from the state about the new immigration-check directive, said Dr. Morgan McDonald, a pediatrician and internist who serves on the Nashville Board of Health. The options are limited, however. The Children’s Special Services program is a last-resort option for low-income families without Medicaid or private insurance coverage for their children’s healthcare needs.

“I was on the phone with a provider over the last couple days and they were looking for home ventilators for some of these families,” said McDonald, formerly a deputy commissioner at the state health department. “There has not been much of a runway but people have been scrambling to do what they can for these kids.”

McDonald also questioned the health department’s interpretation of new state law as applying to children.

“I don’t think anyone wants this,” she said. “I don’t think this was the intent of the legislature. I mean, the (legislation) clearly says it applies to ‘over 18,’” she said.

Efforts Wednesday to reach the Republican authors of the legislation about their intent were unsuccessful. The legislation’s sponors — Rep. Dennis Powers of Jacksboro and Sen. Ed Jackson of Jackson — did not respond to inquiries Wednesday. A spokesperson for Gov. Bill Lee did not respond to questions.

McDonald noted the program, which relies on a combination of state dollars and funding from the federal government’s Maternal and Child Health block grant, is also subject to federal rules that do not require children’s immigration status to be verified.

“Tennesseans don’t want this outcome,” she said.

“The state health department doesn’t want this outcome. The legislature, who thought they had exempted kids from this legislation, didn’t want this outcome. These are children, many with significant medical problems, who rely on a program that’s been really the emblem of the Volunteer State for a hundred years and this can be fixed. It needs to be fixed immediately.”

Tennessee Department of Health letter to healthcare providers

2026.06.02_CSS Letter to Providers

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