Nashville CARES has asked Davidson County Chancery Court to stop the Tennessee Department of Health from enforcing a policy that ties access to certain federally funded HIV services to proof of citizenship or legal residency.
The Middle Tennessee HIV care organization, represented by the Tennessee Justice Center, argues that the requirements violate state and federal law. The dispute concerns eligibility for services through the Ryan White program and Housing Opportunities for People with AIDS, along with new documentation duties for providers.
The policy preserves access to HIV testing, treatment and certain medical services. Nashville CARES contends, however, that withholding support services can undermine the treatment patients continue to receive.
According to the complaint, Robertson Nash, the health department’s director of HIV programs, notified local case managers of the change in an Aug. 18 email. The directive took effect immediately and said patients unable to establish citizenship or legal residency would no longer qualify for benefits under the two programs, “other than HIV testing, treatment and associated core medical services” through the HIV Drug Assistance Program.
The distinction matters: The directive is not a blanket prohibition on HIV care for noncitizens. The challenge centers on access to additional assistance and the requirement that providers verify and document patients’ status.
The complaint describes the two programs as “payers-of-last-resort,” providing services to patients who cannot afford them or obtain them elsewhere. That safety-net role is central to the organization’s challenge because the affected patients already depend on federally funded assistance for care and related needs.
The federal Ryan White HIV/AIDS Program was established in 1990 and named for the Indiana teenager who became a national advocate after facing discrimination because he had HIV. Administered by the Health Resources and Services Administration, the program supports medical care, medications and essential services for low-income people with HIV. It helps fill gaps for people who are uninsured or whose insurance does not cover all their needs.
Housing Opportunities for People with AIDS, commonly known as HOPWA, is administered by the U.S. Department of Housing and Urban Development. It supports housing assistance and related services for low-income people living with HIV/AIDS and their families. Its focus reflects the connection between stable housing and the ability to remain in medical care.
For Nashville residents facing high housing costs, housing assistance can be an important part of maintaining that stability. A reliable place to live helps patients store medication, keep appointments and stay connected with case managers. Transportation and other practical supports can also help bridge the gap between having a treatment plan and being able to follow it.
The lawsuit distinguishes between medical treatment and the support needed to help that treatment succeed. According to the complaint, Ryan White core medical services include medications, home health care, mental health services and outpatient substance abuse care, among other interventions. Support services are those approved by the U.S. secretary of health and human services as necessary to help people with HIV/AIDS achieve their medical outcomes.
Nashville CARES argues that patients receiving medical services but denied needed support are more likely to struggle with treatment, limiting the effectiveness of the care they still receive.
Consistent HIV treatment has benefits beyond an individual patient’s health. Antiretroviral medication can suppress the virus, prevent progression to AIDS and allow people with HIV to live long, healthy lives. People who achieve and maintain an undetectable viral load do not transmit HIV through sex. Interruptions in care can jeopardize those gains.
The challenge also addresses administrative obligations imposed on providers. Nashville CARES and other organizations must maintain “auditable records” of citizenship status for every new program enrollee, according to the complaint. The organization argues that the verification and recordkeeping requirements are intrusive and burdensome and expose it to arbitrary enforcement.
Before going to court, Nashville CARES sought relief directly from the health department. It filed a petition on Sept. 29 asking the agency for a declaratory order invalidating the policy, then amended that petition on Oct. 14.
According to the complaint, the department had not responded and was not required to act for 60 days after the petition’s filing. Nashville CARES cites that waiting period as the reason for seeking immediate court intervention while the requirements remain in effect.
The organization is asking the court to block continued enforcement. Patients with questions about their own eligibility can contact their case manager or Nashville CARES through nashvillecares.org. Information about state HIV programs is available through the Tennessee Department of Health at tn.gov/health. Because the directive retains exceptions for testing and medical care, patients should not assume that it ends their access to HIV treatment.