NASHVILLE, Tenn. (AP) — Tennessee Republican leaders are escalating their calls to reject millions of federal dollars rather than comply with requirements over LGBTQ+ rights, abortion access and other hot-button issues.

Already this year, the Volunteer State has rebuffed federal funding designed to prevent and treat HIV and money that would help clinics serving low-income women. Now, GOP lawmakers are talking about cutting off nearly $1.8 billion in federal education dollars — much of it targeted to serve low-income students, English learners and students with disabilities.

“I think this trend in declining federal funds really is alarming,” said state Sen. Raumesh Akbari, a Democrat from Memphis. “A big portion of our government and our budget... rely on federal funds. They are there to level the playing field with other states.”

States declining to accept federal funding isn’t new. Tennessee is currently among 10 states that have long refused to expand Medicaid to thousands of low-income residents, many of whom can’t afford health coverage. And several years ago, many Republican-led states declined to keep accepting federal money for extra unemployment insurance payouts later in the COVID-19 pandemic.

But the new willingness from GOP state leaders to walk away from federal dollars over disagreements on LGBTQ+ rights, abortion and other hot-button issues should be cause for concern, said Thomas Kahn, a professor at American University.

“Typically, there’s a fight for federal funding and states are more than eager to accept money,” Kahn said. “Now, you’re seeing a much more conservative trend in this country where there’s more hostility toward the federal funding on anything it proposes. It’s a trend that’s getting worse.”

A recent example includes the dozen state or county agencies that have parted ways with tens of thousands of dollars in federal grants that help monitor teenagers’ sexual behaviors and try to lower rates of teen pregnancy and sexually transmitted diseases. The withdrawals come as many Republican-led states have looked to remove LGBTQ+ content from classrooms and school libraries, often touting that the effort is needed to fortify parental rights.

In Tennessee, where a GOP supermajority allows state legislators to even override the Republican governor, supporters of cutting off federal dollars argue that the state is in a strong financial position. The state’s revenues have come in higher than projected over the years, largely thanks to the money collected through sales taxes.

That assurance could be tested, however, in replacing federal education funds, which currently make up about 20% of Tennessee’s $8.3 billion education budget.

House Speaker Cameron Sexton has pointed to the state approving $3.2 billion in new spending in this year’s latest budget as evidence the state could make up the federal government’s spending portion. So far, he has not advocated cutting services to cover the difference.

“We should do everything that we can to be whole and autonomous and independent from the federal government,” Sexton, a Republican, told reporters last week. “When you take federal government money, their philosophies and what they want you to do is different than probably what the state wants to do.”

It’s unclear how and if Tennessee would actually rebuff federal education funding. While a legislative committee has been formed to study the issue, to date no state has successfully rejected federal education funds. Even states that threaten to reject federal money often stop short when it comes to education, because such funding is limited and many schools rely on that money for special education, students with disabilities and English learners.

The U.S. Department of Education criticized the idea earlier this year as “political posturing” as Tennessee has emerged as a leader in enacting the most anti-LGBTQ laws in the United States. Many of those laws have targeted schools and placed limits on what cannot be taught inside classrooms.

“I think the real issue has to do with restrictions around sexual orientation and gender,” Akbari said. “That’s something they do not want to have to comply with.”

Meanwhile, public school advocates note that Tennessee lawmakers have previously passed policies that carry a risk of funding loss should schools violate various restrictions. Currently, the state can withhold funding if schools do not properly lock doors, teach certain prohibited concepts on race and racism, implement COVID-19 mask mandates, and allow transgender athletes to participate in school athletics.

“The consideration of some lawmakers to reject critical federal funding at a time when Tennessee needs more great leaps in funding as quickly as possible is irresponsible,” said Tanya Coats, president of the Tennessee Education Association. “You don’t have to look hard to see where Tennessee elected officials have set up their own system of threatening districts with a loss of state funding through a series of arbitrary and often harmful legislation.”

Tennessee currently ranks among the lowest per-pupil spending in the United States and among the top 10 highest states in teen birth rates.

Outside of education funding, public health advocates say they were stunned when the state announced back in January that it was rebuffing roughly $9 million in federal funding designed to prevent and treat HIV.

Instead, health officials chose to fund the HIV-prevention program with state dollars. Doing so allowed Tennessee to bypass federal requirements and refuse to fund Planned Parenthood, long lambasted by Republicans for offering abortion and LGBTQ+ services.

Several months later, the state once again raised eyebrows when Tennessee was disqualified from receiving more than $7 million in federal funds under a family planning program known as Title X. The state lost the money after refusing to back down from a policy requiring that Title X clinics could only provide patients information on options that are “legal” in Tennessee, meaning they could not discuss abortion referrals because abortion has been banned in Tennessee ever since the U.S. Supreme Court overturned Roe v. Wade last year.

Similar to the HIV-prevent funds, Tennessee officials were quick to backfill the program with state funds — causing the same risks that it could withhold the resources from certain providers.

In both cases, the federal government eventually agreed to circumvent the state and chose to award federal funds directly to organizations like Planned Parenthood.

But for lawmakers like Akbari, the lingering fear of what funding source could next be on chopping block remains.

“We shouldn’t accept federal dollars because we don’t agree with certain policies? That’s taking things a little too far, it’s not fiscally responsible,” she said.

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Associated Press writer Jonathan Mattise contributed to this report.