Families of medically fragile children in Tennessee are opening their mail to find a new kind of threat: keep using a state health program, and your child’s information could be sent to immigration enforcement officials.
Letters sent this week by the Tennessee Department of Health warn parents and providers that the state may begin verifying immigration status and sharing records on undocumented children enrolled in Children’s Special Services (CSS). The notices give families until June 30. If the program continues to pay for services after that date, the letters say, the child’s information could be forwarded to the state’s immigration enforcement office. Pediatric providers and advocacy groups say that puts some of the state’s sickest children in an impossible bind between medical care and personal safety.
Letters Say Records Could Go to Immigration Unit
Templates of the notices obtained by Tennessee Lookout show the Department of Health telling parents and clinic staff that information for sick or disabled children in the CSS program could be shared with the Tennessee Department of Safety’s Centralized Immigration Enforcement Division. The letters note that CSS relies on a mix of federal and state funding and warn that, after June 30, records will be shared “as required by law.”
Local health departments administer CSS and help coordinate care for a small number of high-need children across the state, often arranging specialist visits and therapies that families could not otherwise access.
Advocates Say Lifesaving Care Is on the Line
Advocates and some medical providers say tying the program to immigration checks risks disrupting treatment for children who are anything but routine patients.
“We're talking about cancer. We are talking about congenital heart defects. We are talking cystic fibrosis,” Gordo Bonnyman of the Tennessee Justice Center told FOX 17, arguing that CSS serves some of the most medically fragile children in Tennessee.
The Young Center for Immigrant Children's Rights has called the directive an entanglement of health care and immigration enforcement that will deter families from seeking help. In its public statements, the group has urged state leaders to reverse the policy, warning that even the threat of information sharing can be enough to keep children out of doctors’ offices.
State Officials Say They Are Protecting Public Funds
Republican lawmakers who backed the change say it is about guarding taxpayer dollars, not targeting disabled or sick children.
House Assistant Majority Leader Mark Cochran told FOX 17 that the measure “does not deport children receiving life-saving care or deny emergency medical care,” and he pointed to existing federal rules that require federally qualified health centers to provide emergent treatment to anyone who needs it.
State health officials have not yet publicly detailed how many families received the notices or exactly how the new verification system will work, leaving providers and parents to fill in the blanks on their own.
How Tennessee Built Its Immigration Enforcement Office
The Centralized Immigration Enforcement Division, often shortened to CIED, was created by the legislature last year and placed under the Department of Safety. According to a January report to the General Assembly, the office is charged with coordinating state and local engagement with federal immigration authorities.
The same report describes CIED’s work expanding participation in Immigration and Customs Enforcement’s 287(g) program and running an Immigration Enforcement Grant Program. Advocates say that context makes it clear why funneling health department data to CIED feels less like routine paperwork and more like a direct pipeline to an enforcement unit.
Immigration Law Already Facing a Court Fight
Civil-rights organizations moved quickly to challenge pieces of Tennessee’s broader immigration package in federal court. The American Civil Liberties Union and the National Immigration Law Center have filed a lawsuit arguing that states cannot step into what has traditionally been federal immigration authority. That legal challenge, reported by WKMS and other outlets, notes the larger law is scheduled to take effect July 1.
What Families and Providers Can Do Now
Families who received notices are being urged to loop in their child’s medical provider and to keep copies of all correspondence from the state. Advocacy groups say documentation could be important if care is interrupted or if families later seek legal help.
Parents can review the letters obtained by Tennessee Lookout to compare them with what arrived in their own mailbox, and can look to national organizations such as the Young Center for Immigrant Children's Rights for information and resources.
Families and providers who still have questions about what the policy means in practice may consider requesting formal guidance from the Department of Health or speaking with legal aid organizations that handle both immigration and public-benefits issues. For now, with a June 30 date hanging over the program, those conversations are likely to feel increasingly urgent.
