In Tennessee, hundreds of parents of undocumented children who have critical illnesses or physical disabilities received a letter this month that threatens to upend their medical treatment.

Families were told that the Department of Health would share information on their child’s immigration status with the state’s immigration enforcement office if they continued receiving care through a specialized public health care program.

“I read the letter. I read it many times to make sure I understood it properly,” said Brenda, a Honduran mother with a 12-year-old daughter living with cerebral palsy and epilepsy. She said she even asked her older daughter to take a look.

The letter let Brenda know that if she keeps her daughter enrolled in the Children’s Special Services program from the Tennessee Department of Health after June 30, the agency will be required to turn over the girl’s information to the Centralized Immigration Enforcement Division, a state office created last year to oversee collaboration with federal immigration authorities.

Considered “a payer of last resort,” Children’s Special Services is a publicly funded program that helps low-income families afford costly treatments such as surgeries, medications and rehabilitation services.

Brenda’s daughter Sofia is among an estimated 400 immigrant children who are now at risk of losing access to those services at the end of the month.

Tennessee lawmakers in May approved a law that requires local health departments to “report individuals and all identifying information about such individuals who are not lawfully present in the United States.”

Republican lawmakers in favor of the legislation — including state Rep. Dennis Powers, the lead sponsor of the bill — insist that it does not limit access to lifesaving care to children.

In a statement to WBIR, NBC’s affiliate in Knoxville, Powers said, “No child receiving lifesaving medical treatment is denied care because of this new law. Federal protections for emergency and lifesaving medical services remain fully in place regardless of immigration status, criminal status or insurance. It simply ensures taxpayer-funded public benefits are reserved for those who are legally eligible to receive them.”

Brenda said mothers like her are now facing an impossible dilemma. Removing their children from the program means they won’t be able to pay for the medical services they need.

“But if we stay, they’ll come knocking on our door asking about our children as if they were criminals,” Brenda said, her voice breaking. “We are waiting for a miracle to stop the new state law from going into effect next month.”

Brenda spoke to NBC News on condition that only her first name be used for fear of retribution.

Brenda said she left her native Honduras for the U.S. a decade ago and sought medical care for Sofia after the girl had her first seizure when she was 2. Once in the U.S., her daughter was diagnosed with cerebral palsy, epilepsy and a congenital heart disease.

A heart surgery that saved Sofia’s life when she was younger was covered by the Children’s Special Services, the mother said. The program now helps Brenda, who is a single working mother, afford her daughter’s anti-seizure medications and visits to medical specialists such as cardiologists and neurologists.

“She knows that she depends heavily on her medications,” Brenda said of her daughter. “Without it, I fear, she will have a seizure.”

Sofia also requires a wheelchair as well as physical therapy to treat her mobility issues, and occupational therapy to develop her speech. Without the program, Brenda said, one therapy session can cost over $1,000.

In 2024, the Children’s Special Services program spent $2.19 million in claims to support 4,640 children in Tennessee who received medical payment assistance along with essential care coordination services, according to the latest annual report from the state’s Department of Health. The program receives a mix of state funding and a federal block grant.

Dr. Jill Obremskey, a pediatrician and former Tennessee Department of Health official, said it’s imperative for taxpayers to “understand they’re saving a life by their little contribution. They’re truly saving a life, prolonging a life or improving the life of a child.”

Under the new law, the undocumented children participating in the program will undoubtedly experience interruptions to the critical care they require, Obremskey said. “Those interruptions will lead to worsening health, more emergency room visits, more hospitalizations, more suffering, and for some children, death.”

At a news conference Tuesday, families, physicians and immigrant rights advocates called on Republican Gov. Bill Lee to take steps to protect undocumented children receiving care through the program.

Lee signed the bill into law last month.

“We won’t know if they didn’t understand the bill or didn’t care that this would be the effect, but here we are with children, really vulnerable sick children, paying the price for politics,” said Lisa Sherman Luna, executive director of the Tennessee Immigrant and Refugee Rights Coalition, at the news conference.

The Tennessee Department of Health did not respond to multiple requests seeking comment.

The Tennessee Justice Center filed a lawsuit on behalf of three Nashville physicians seeking a temporary restraining order to block the new law from going into effect in July, the organization told NBC News in an email Wednesday. The physicians serving as plaintiffs have patients who rely on the program and they could lose their care as soon as next week, the group said.

“When doctors are warning that even brief interruptions in treatment could be harmful or even deadly, we believe the state has a responsibility to protect these children rather than place them at greater risk,” said Michele Johnson, executive director of the Tennessee Justice Center, in a statement.