Local health services are primarily state and county functions. Any city in a county with an established health department may cooperate in the maintenance of that department and levy taxes to pay its proportionate share. T.C.A. § 68-2-605. Cities also may participate in a multi-county district.  T.C.A. § 68-2-701. T.C.A. § 68-9-201 requires city and other health officers involved in tuberculosis control to notify appropriate health authorities in other jurisdictions when an infected individual relocates from Tennessee.

Regulating local hospitals and other health care centers is a state function. T.C.A. §§ 68-11-501, et seq. A hospital built with private funds may be maintained with public funds for up to five years, provided the contract specifically states that the facility is for public use. Cities also may contribute land or money for public welfare hospitals. T.C.A. §§ 68-11-501–507.

Within the limits of state appropriations, the commissioner of mental health and mental retardation, with approval from the commissioner of finance and administration and the state comptroller’s office, is empowered to make grants to cities, counties, non-profit corporations, or combinations thereof for constructing, maintaining, or operating mental health or mental retardation facilities, programs, or services. T.C.A. § 33-1-302.