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Following Tennessee's loss of Title X funds, undocumented women are denied care

Medicine and maternity can make for an uneasy mix, female physicians report.

Reproductive care options are limited for undocumented immigrants in Tennessee since the state lost its federal Title X funding.

In April, Tennessee lost $7.5 million in federal funds for failing to provide abortion counseling to patients, which violated the funding’s requirements. The state is suing the federal government, but in the meantime, health-care providers say Tennessee is excluding undocumented immigrants from receiving care.

“Since the changes, I think I could probably tell you right off the bat, I've at least spoken to 30 women that are like, what am I supposed to do,” said Celeste Paula, the health promoter with Knoxville nonprofit Centro Hispano. “Every time we host a health-related event, they're like are you going to have these services by chance? We have to unfortunately tell them no.”

As a health promoter, Paula works closely with Knoxville’s Hispanic population, connecting them with affordable health-care providers. Since April, Paula has struggled to find low-cost reproductive services for undocumented individuals.

“We had a list of six or seven options for clients, and now we're down to one,” Paula said. “It's always in the back of my mind when I am going to hear that they have a waitlist, that they're full, that they don't have the capacity right now.”

Knox County’s Women’s Health Clinic, previously funded by Title X, was a trusted provider before the funding changes, according to Paula. About 20 % of the clinic’s patients were undocumented.

“For a lot of people, Title X clinics are the only place that they can get contraception and be screened for health conditions that they can afford,” said Dr. Amy Ausplaugh, researcher of reproductive care at the University of Tennessee College of Nursing, who used to work at a Title X clinic. “It's a way to fill in gaps for really essential preventative services that we aren't providing to people for various reasons.”

Currently, Tennessee is the only state without Title X-funded clinics, which are especially needed among immigrants because the clinics historically would not refuse service based on immigration status or ability to pay.

Gov. Bill Lee’s replacement funding now means these clinics are no longer mandated to follow Title X universal care policy. Dena Mashburn, the director of nursing at the Knox County Health Clinic, confirmed that the State Department of Health instructed the clinic to request citizenship documentation.

The State Department of Health said via email that local clinics must comply with the Eligibility Verification for Entitlement Act, a state law that mandates local health departments verify the citizenship status of applicants over 18 years of age, “except where prohibited by federal law.”

Data from the U.S. Census shows that about 54,000 unauthorized immigrant women were living in Tennessee in 2019, and the number is likely growing. It’s estimated that 73% of all unauthorized Tennesseans are uninsured.

“I think absolutely Tennessee has a lot of negative impacts coming its way, “ Ausplaugh said. “I think it's going to overwhelm a lot of the places that are already caring for the most marginalized people that have limited services; it's going to impact the quality of care. And if people can't get health care for the things they need, it's going to impact all of us eventually.”

Research shows that immigrant women are less likely to access contraception, leaving them susceptible to unplanned pregnancies. Data projections suggest that Tennessee could save as much as 16.9 million dollars by offering free contraception in Title X clinics across the state, thereby reducing state-funded unplanned pregnancies.

In late September, the Department of Health and Human Services redirected over $7.8 million in funds to The Virginia League of Planned Parenthood and Converge, Inc. of Mississippi, aiming to expand care into Tennessee and bypass funding through the State Department of Health.

However, the legality of this workaround remains uncertain. Tennessee Attorney General Jonathan Skrmetti filed a lawsuit shortly after HHS announced the funding diversion, arguing that it violated Tennessee's First Amendment rights and accused them of “'playing politics’ with the health of Tennessee women."