In response to the U.S. Supreme Court ruling that preserves birthright citizenship, Texas officials are wielding their authority to clamp down on birth tourism, primarily through investigating or suing health providers.

The Texas Health and Human Services Commission has requested the Attorney General’s Office to investigate whether two Rio Grande Valley hospitals — Mission Regional Medical Center in Mission and Knapp Medical Center in Weslaco — had violated state or federal laws by purchasing a billboard that Gov. Greg Abbott says targets foreign nationals traveling to Texas to give birth.

“Regardless of what the Supreme Court of the United States may have said, U.S. citizenship is not for sale in Texas. Texas will not tolerate the exploitation of our healthcare system as a pathway to skirt federal immigration laws,” Abbott said in a news release on Tuesday.

Abbott requested HHSC to look into the hospitals last week, accusing the hospitals of profiting off illegal birth tourism, a practice where expecting mothers travel to the U.S. to give birth so their children become citizens.

According to a social media post cited in the HHSC referral letter, the billboard was found in Latin American countries and showed in Spanish the cost of birth packages and listed Mission Regional Medical Center’s name and its social media channels. It also listed a phone number with the RGV’s area code and a website — havemybabyinTexas.com — both of which are no longer in service. HHSC also suggested that the hospital had been advertising to foreigners since 2023.

The hospital confirmed its use of the billboard and said it’s no longer in use to “prevent any misunderstandings,” Kathleen Avila, spokesperson for Mission Regional Medical Center told The Texas Tribune.

None of the efforts to crack down on birth tourism in Texas have involved investigating foreign national women who have given birth in the state for the purpose of securing citizenship for their child. Instead, officials have gone after care providers who they accuse of encouraging or aiding foreigners to give birth in Texas, possibly through illegal means.

Giving birth on U.S. soil as a foreign national is not illegal but cases of illegal birth tourism usually involve prosecutors determining businesses have facilitated fraud, such as visa fraud, according to the U.S. Department of Justice.

In April, Attorney General Ken Paxton sued a Houston postpartum care center, accusing the operators of coaching Chinese nationals on how to mislead or deceive federal immigration officials so they can travel to Texas to give birth. The operators denied the allegations in court documents, but did not provide any further reasons and their attorney did not return the Tribune’s request for comment. The next court hearing is scheduled for July 16.

Even before the Supreme Court upheld birthright citizenship last month, state Republicans have made calls in their latest platform to eliminate birth tourism in the upcoming legislative session. Abbott has called “foreign travelers (coming) to the United States under false pretenses to give birth and secure citizenship for their children” an illegal practice that exploits Texas’ hospitality. The Justice Department has also directed federal prosecutors to “bring illegal birth tourism to an end.”

Austin immigration attorney Kate Lincoln-Goldfinch said birth tourism is rare, largely because many noticeably pregnant women are turned away upon arrival at a port of entry. “Crossing through security as an obviously very pregnant woman is difficult,” she said.

Lincoln-Goldfinch worries that as Republicans continue to punish birth tourism, immigrants will not want to seek out care at hospitals. Immigration advocates have already warned that Texas has chilled immigrants from visiting hospitals after Abbott in 2024 started requiring hospitals to ask for patients’ immigration status, though patients can opt to not answer and hospitals still must provide care to all regardless of citizenship.

“I do think that immigrants will avoid necessary care,” said Lincoln-Goldfinch.

Here’s what to know about birth tourism.

How many U.S. births come from birth tourism?

There is no official count of babies who are born in the U.S. for the purposes of becoming citizens.

The Migration Policy Institute estimates that of the 3.6 million births that occur in the U.S. annually, between 9,600 and 26,000 of them are from birth tourism, according to Centers for Disease Control and Prevention data. Colleen Putzel-Kavanaugh, an associate policy analyst at the Migration Policy Institute, told the Tribune that her organization bases the low end of the range on the number of births to mothers with foreign addresses and they base the high end count on the number of births to a foreign-born mothers, who could be living in the U.S. and on a longer-term visa, such as a student visa or work visa.

“While rare, birth tourism has become a central but contested justification in the Trump administration's push to end the guarantee of birthright citizenship,” she and a fellow author said in a recent report.

Is birth tourism illegal?

Giving birth on U.S. soil as a foreign national is not illegal, but visa fraud is.

There is no visa specifically dedicated to foreigners who want to give birth in the U.S. but expecting mothers can enter on temporary travel visas.

While giving birth in the U.S. on a temporary travel visa is legal, obtaining that visa under false pretenses — such as intending to secure citizenship for a child — can constitute fraud, said Chuck DeVore, chief national initiatives officer of conservative think tank Texas Public Policy Foundation.

“The misleading of your visa application is illegal. But if you figure out how to get here, the act of giving birth in America is not illegal. That's why this all goes back to enforcement," said DeVore.

According to the Justice Department, most of the illegal birth tourism cases involve businesses committing visa fraud, but can also include wire fraud, money laundering, aggravated identity theft and health fraud.

“The Department of Justice will zealously protect the sanctity of United States citizenship by investigating and prosecuting those who fraudulently exploit our immigration system. Together, we will bring illegal birth tourism to an end and those responsible for justice,” according to a June 30 memo from the agency.

What is birthright citizenship?

A child born on American soil is automatically considered a U.S. citizen under the Fourteenth Amendment, regardless of the parents’ citizenship or immigration status.

After a child is born in Texas, the parents provide their names, places of birth, and the name of the child to the hospital. The hospital enters the parents’ information and information about the birth into the state’s vital statistics system, and the county registrar issues a birth certificate. Birth certificates do not list if a parent is a noncitizen.

Since the child is automatically given citizenship, “there is no difference in the application process” for parents who are foreign nationals or American citizens, said Lara Anton, spokesperson for the Texas Department of State Health Services.

How are Texas officials cracking down on birth tourism?

Texas Republican leaders are cracking down on birth tourism by attempting to restrict healthcare providers that solicit foreigners to give birth here and by scrutinizing the practice of using Texas surrogates to carry children for foreigners.

Last week, the state Senate health committee heard from a surrogate and California-based anti-surrogacy organization, Center for Bioethics and Culture Network, who said foreign nationals were exploiting Texas surrogates through dishonest agreements and contracting with various surrogates at the same time. Last year, a Corpus Christi woman told the center that a California-based agency helped her become a surrogate for a Chinese couple in California who had many children by surrogacy and who were later arrested on child endangerment charges.

The exact number of surrogacy births for foreign national parents is unknown because surrogacy contracts are private. In 2025, there were 657 surrogacy births in total in Texas, according to the Texas Department of State Health Services.

Talks about surrogacy came on the heels of Texas Attorney General Ken Paxton’s lawsuit against De’ai Postpartum Care Center in Houston.

In the lawsuit, Paxton accuses the center of helping Chinese nationals come to Texas to give birth by coaching them to misrepresent their travel purpose on visa applications, hiding the true reason for their trip, and advertising services that the state says were misleading.

The center operated four residential properties across the Houston area capable of hosting multiple families at a time and they advertised their services and expertise on TikTok answering questions like, “Do I have to buy a return airline ticket? Will a one-way ticket be refused entry?” or, “If I give birth in a red state, can the baby get a US passport?” according to court documents.

The center’s website also lists services that include nurses who provide postpartum care for women and newborns and meals designed for postpartum mothers.

The lawsuit says the center violated Texas laws against deceptive trade practices, tampering with government records, unlawful concealment and harboring, and public nuisance.

The allegations appear similar to a few cases that have happened in other parts of the country such as a 2024 case involving a California couple that coached Chinese clients on how to hide their pregnancies from immigration authorities, customs entrance guidance, provided housing, and transportation in the U.S. They were sentenced to three and a half years in prison.

While Texas Health and Human Services officials said allegations against Mission Regional Hospital and Knapp Medical Center are not identical to birth tourism schemes that the Justice Department has identified, state officials said the allegations were troubling.

What are the potential laws that Texas could pass?

Lawmakers may push for increased scrutiny at ports of entry or during visa applications at consulates, DeVore said.

At last week’s Senate health committee hearing, lawmakers also signaled they would be open to a ban on foreign nationals using Texas surrogates.

"I don't doubt that there'll be legislation introduced that would be more narrowly targeted at foreign nationals using surrogacy services, but I have a strong suspicion that we're going to be seeing multiple bills that would cover the waterfront on this issue,” DeVore said about restricting birthright.

Abbott’s and Paxton’s cases against healthcare facilities could also test who can be held responsible for birth tourism and what kinds of restrictions the state can impose on hospitals that receive public funding. DeVore said Abbott and the Legislature could discourage birth tourism by making hospitals require foreign nationals to pay for maternal care in cash.

Ultimately, the Texas GOP aims to eliminate birth tourism by essentially changing the Fourteenth Amendment by granting citizenship only to babies with at least one biological parent who is a U.S. citizen, according to the party’s platform. DeVore said the amendment’s enforcement clause gives conservatives room to pursue new legislation.

Disclosure: Texas Public Policy Foundation has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in The Texas Tribune's journalism. Find a complete list of them here.

This article first appeared on The Texas Tribune.