Ryan White Immigration Status Checks Blocked in Tennessee

A Nashville judge has temporarily stopped Tennessee from imposing Ryan White immigration status checks on people who get HIV care through the federally funded safety-net program. The order from Davidson County Chancellor I’Ashea L. Myles, issued late on Oct. 21 in a suit brought by Nashville CARES, bars the state health department from making clinics verify patients’ citizenship or immigration status as a condition of their contracts, at least until a hearing set for Nov. 4, according to the Tennessee Lookout, the only outlet so far to report the order.

The fight matters beyond Tennessee because it tests a question several states and federal agencies have been pressing since 2025: whether HIV treatment paid for with federal money is a “public benefit” that noncitizens must prove eligibility for, or public health care that Congress deliberately left open to everyone.

What the Tennessee health department asked clinics to do

The dispute began with an Oct. 1 memo from the Tennessee Department of Health’s HIV program to organizations that deliver Ryan White Part B services. It told subrecipients that their contracts must make them “responsible for eligibility verification for each potential beneficiary/recipient” to the extent grant funds pay for a state, local or federal public benefit. The memo cites Tennessee’s Eligibility Verification for Entitlements Act and the 1996 federal welfare law, 8 U.S.C. 1601 and following.

According to the Nashville CARES complaint, the state law behind the memo was tightened by Chapter 1106 of the 2026 Public Acts, which Gov. Bill Lee signed on May 22. The complaint says the amendment requires state agencies and local health officials to verify status, report people who are in the country unlawfully to the Tennessee Department of Safety, and exposes employees who skip the checks to criminal penalties.

It is the second court fight over the law. In June, a Nashville judge temporarily barred the department from giving immigration authorities information about roughly 400 sick and disabled immigrant children in a state health program, the Associated Press reported.

The federal exception at the center of the case

The 1996 law bars most noncitizens who are not “qualified aliens” from federal public benefits, and it lets states impose similar limits on their own benefits. But both bans carry the same carve-out. Sections 1611(b)(1)(C) and 1621(b)(3) exempt public health assistance “for testing and treatment of symptoms of communicable diseases whether or not such symptoms are caused by a communicable disease.” HIV is a communicable disease, and Nashville CARES argues that the exemption puts Ryan White care outside any status requirement.

Tennessee’s own statute may cut the same way. The verification act applies “except where prohibited by federal law,” a phrase the complaint relies on. If a court reads the federal exemption as covering HIV medical care, the state law arguably never reached these patients. Support services such as insurance premium help and HOPWA housing aid look less like “treatment” on a plain reading, and are the likelier battleground.

The stakes are wider than unauthorized immigrants. The federal definition of “qualified alien” in 8 U.S.C. 1641 leaves out many people who are in the country lawfully, including temporary visa holders, DACA recipients and asylum applicants. If Ryan White services were treated as a restricted public benefit, those groups could be screened out too, and every patient, citizens included, would face a document check before care.

The complaint puts numbers on the risk. It says at least 129 Nashville CARES patients with HIV receive help paying insurance premiums, 150 to 160 get mental health and medication management services, and 80 to 100 are seen at clinics, all of whom could lose services. Its statewide insurance assistance program serves about 7,500 to 8,000 people a year, the complaint says. None of these figures has been tested in court.

The state sees a narrower case. Its lawyers told the court that Nashville CARES was “essentially (asking) the Court to intervene in a contract dispute” and objected to one provider challenging terms that apply to every participating organization, the Tennessee Lookout reported.

A federal reinterpretation already set aside

The complaint says 2025 Justice Department, HHS and HUD notices reinterpreting “federal public benefit” were vacated on Sept. 21, 2026, by a federal court in Rhode Island in New York v. Department of Justice. If that account holds, Tennessee is defending a state mandate without the federal reading that once supported tighter screening.

A restraining order decides nothing on the merits. On Nov. 4 the court will weigh a temporary injunction that would last through the litigation, a ruling HIV providers in other states with verification laws will study. It lands as noncitizens already face new limits on ACA premium subsidies for lawfully present immigrants, the IRS rules that enforce that cutoff and the public charge guidance for green card applicants.

This article is for general information and is not legal advice.

Sources

Vasanth Vaidyanathan, Esq.

Administrator

Vasanth Vaidyanathan is an immigration attorney with over 20 years of experience focused exclusively on U.S. immigration and nationality law. He holds a LL.M. from California Western School of Law, San Deigo and advises individuals and businesses on employment and family-based immigration matters, including H-1B, PERM, EB categories, and adjustment of status. He has also been a featured speaker at immigration seminars across the U.S. To reach Vasanth visit: https://www.vnathan.com/

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