Refugees, asylum seekers to lose TennCare, while state weighs ending immigrant prenatal care

Tennessee officials are considering a policy to end access to a prenatal care program for pregnant immigrants without legal status . (Photo: Getty Images)

Thousands of legal immigrants will lose access to TennCare beginning in October as a result of new Trump administration policy, while Tennessee officials separately consider barring pregnant women without legal immigration status from accessing publicly-funded prenatal care.

TennCare Director Stephen Smith told lawmakers this week that, beginning Oct. 1, about 8,500 refugees and asylum seekers would be cut from TennCare, Tennessee’s Medicaid program. The cuts are a result of policy changes contained within the Trump Administration’s One Big Beautiful Bill Act, signed into law earlier this year. Refugees and asylum seekers are legal immigrants.

State officials are currently examining whether a separate but related program in Tennessee, the Child Health Insurance Program, or CHIP, could begin to exclude pregnant immigrant women without legal status from prenatal care. Like TennCare, the CHIP program is a joint federal-state program; it provides low-cost health coverage for children and pregnant women whose families earn too much money to qualify for TennCare. 

“We’re looking into whether, if for example you all decided, or we decided internally that we no longer wanted to cover services related to the unborn child, whether we could do that,” Smith told lawmakers on the House Insurance Committee Tuesday. 

Smith’s remarks came in response to questions by Republican lawmakers about whether immigrants without legal status qualified for TennCare benefits. Immigrants unlawfully present in the United States are not eligible for TennCare, Smith said. 

In 2024, the cost of TennCare benefits for asylum seekers and refugees was about $20 million annually with the state government picking up about $7 million of the tab while the federal government paid the rest, Smith said.  

TennCare officials did not respond to questions about plans to eliminate pregnant immigrant women from prenatal care under the CHIP program.

Tennessee has offered prenatal services regardless of immigration status through the CHIP program for more than 20 years as part of a policy introduced by former President George W. Bush. States were given the option to provide prenatal care to immigrants without legal status,  which Tennessee did under the administration of former Republican Gov. Don Sundquist, according to Michele Johnson, executive director of the Tennessee Justice Center. 

The program, Johnson said, has resulted in more healthy babies. Cutting off access to prenatal services for pregnant women without legal status would signal that “we think these babies don’t matter,” she said. 

Emergency physician Dr. Katrina Green, who has advocated for access to reproductive care in Tennessee, said she was disheartened by the discussion she observed during Tuesday’s legislative hearing.

Green noted some Republican lawmakers have long advocated for “fetal personhood” legislation defining life as beginning at fertilization. 

“If you are a fertilized egg in Tennessee and considered a person, you are a Tennessean and entitled to healthcare,” Green said. Green noted that was not her own opinion. “If that’s what the Republicans are saying, they should be on board for prenatal care. I’m really concerned they would consider cutting off care for these women that would harm future citizens as a result.”