Abbott Orders Birth Tourism Investigation

Estimated Time to Read: 9 minutes

Just one week after the U.S. Supreme Court reaffirmed birthright citizenship under the Fourteenth Amendment, Texas officials are shifting their focus toward another part of the immigration debate.

Tuesday, Gov. Greg Abbott (R) directed the Texas Health and Human Services Commission (HHSC) to immediately investigate allegations that Mission Regional Medical Center marketed maternity “birth packages” to foreign nationals seeking to give birth in the United States. The governor also announced he intends to work with the Texas Legislature during the next regular session to strengthen state law aimed at eliminating birth tourism in Texas.

The directive follows reports that the South Texas hospital advertised bundled maternity services in Mexico and through the website HaveMyBabyInTexas.com (now unlisted). Images show bilingual billboards promoting “Birth Packages in South Texas,” listing fixed prices for natural deliveries and cesarean sections while directing prospective patients to the hospital’s website and contact information. According to the governor’s office, the advertisements targeted foreign nationals seeking to obtain U.S. citizenship for their children by giving birth in Texas.

The announcement marks the latest development in Texas’ broader effort to address birth tourism through state regulatory authority rather than changes to federal immigration law.

Building on Recent Developments

Abbott’s announcement comes amid a series of significant developments surrounding birth tourism.

In May, Texas Attorney General Ken Paxton filed a lawsuit against a Houston-area operation accused of operating an organized birth tourism business that allegedly helped foreign nationals obtain U.S. citizenship for their children through fraudulent means. Texas Policy Research (TPR) previously examined the lawsuit, which alleged the defendants coordinated travel, housing, medical care, and immigration-related services for foreign nationals traveling to Texas to give birth.

Then, on June 30, the U.S. Supreme Court upheld birthright citizenship, leaving intact the longstanding interpretation that children born in the United States generally acquire citizenship at birth under the Fourteenth Amendment. While the decision resolved immediate questions surrounding President Donald Trump’s (R) executive order, it also reinforced that individual states cannot independently redefine birthright citizenship.

With the constitutional question largely unchanged, Texas officials are increasingly focusing on conduct that falls within existing state regulatory authority.

What Governor Abbott Ordered

In his July 7 letter to HHSC Executive Commissioner Stephanie Muth, Abbott directed the agency to conduct an immediate and thorough investigation into whether Mission Regional Medical Center violated state law or contractual obligations by allegedly advertising “Birth Packages in South Texas” to foreign nationals in an effort to profit from obtaining U.S. citizenship for their children.

The governor instructed HHSC to refer any violations to the Texas Attorney General for civil enforcement and to the appropriate district or county attorney for potential criminal prosecution. He also directed the agency to pursue any available administrative sanctions against the hospital.

Abbott further stated that he intends to work with the Texas Legislature next session to strengthen Texas law addressing birth tourism, declaring that “American citizenship is not for sale” and that Texas will not permit its healthcare system to be used as a magnet for birth tourism.

The investigation itself is significant because it relies on existing executive authority. Rather than waiting for new legislation, the governor is directing HHSC to determine whether a regulated healthcare provider violated laws or contractual obligations already within the agency’s oversight.

Legislative Pressure Builds

Abbott’s directive also follows growing calls from some lawmakers for Texas to take additional action after the Supreme Court’s June 30 ruling.

On July 1, State Rep. Brian Harrison (R-Midlothian) publicly called on Gov. Abbott to convene a special legislative session devoted to combating birth tourism. Harrison proposed creating a state felony for operating or participating in birth tourism, expanding criminal penalties related to illegal entry for the purpose of birth tourism, granting additional investigative authority to the Texas Attorney General, and pursuing several additional policy changes related to birthright citizenship and state enforcement.

Although Abbott has not called a special session on the issue, his July 7 directive signals that birth tourism has become an emerging policy priority. Rather than immediately seeking new legislation, the governor’s first step is to pursue enforcement using authorities already available under state law while signaling that additional legislative proposals may follow during the next regular session.

Why This Case Differs from the Houston Lawsuit

While both cases involve allegations related to birth tourism, they target different parts of the alleged system.

The Houston lawsuit centered on a private business accused of organizing travel, immigration assistance, housing, and medical arrangements for foreign nationals seeking to give birth in Texas. The Mission Regional Medical Center investigation instead focuses on whether a licensed healthcare provider improperly marketed maternity services to foreign nationals.

That distinction matters because Texas exercises broad regulatory authority over hospitals through HHSC. While immigration policy and citizenship remain primarily federal responsibilities, the state has clear authority over hospital licensing, healthcare regulation, contractual compliance, and professional standards.

As a result, this investigation is not about changing immigration law. Instead, it seeks to determine whether a regulated healthcare provider violated laws or regulations governing its operations.

What Could the Legislature Do?

Gov. Abbott’s letter indicates he intends to work with lawmakers to strengthen state law during the next legislative session, but it does not specify what legislation he intends to pursue.

Several policy options have already begun emerging publicly.

Harrison’s proposals would create new criminal offenses and expand state enforcement authority over birth tourism.

Other lawmakers could instead pursue narrower reforms directed at entities regulated by the state. Those proposals could include prohibiting healthcare providers from marketing maternity services abroad for the purpose of facilitating birth tourism, increasing administrative penalties for licensed facilities that knowingly participate in unlawful schemes, or strengthening reporting and compliance requirements for hospitals serving international patients.

Which approach gains traction will likely depend in part on the findings of HHSC’s investigation.

Why the Investigation Matters

The investigation highlights how Texas is approaching birth tourism following the Supreme Court’s recent decision reaffirming birthright citizenship.

While Texas cannot independently redefine who receives U.S. citizenship, it does possess broad authority to regulate hospitals, professional licensing, consumer protection, fraud, and other areas of state law. Abbott’s directive reflects a strategy of using those existing authorities to investigate businesses and institutions alleged to have facilitated birth tourism rather than attempting to alter citizenship itself.

The investigation also illustrates a broader shift in Texas’s response to birth tourism. Earlier this year, the Attorney General pursued an alleged consulting business accused of organizing birth tourism in the Houston area. Now, the state is examining whether a licensed healthcare provider improperly marketed services that encouraged the practice. Together, those actions suggest Texas is increasingly focused on the organizations and businesses that allegedly make birth tourism possible.

It is also important to distinguish between lawful international medical travel and the allegations at issue here. Foreign nationals routinely travel to the United States for medical care, including maternity services. The question in this investigation is whether a regulated healthcare provider knowingly participated in an organized effort to facilitate birth tourism in violation of state law or contractual obligations.

Senate Hearing Adds Legislative Focus

The issue is also receiving attention from the Texas Legislature.

On July 8, the Senate Committee on Health & Human Services is scheduled to hold an interim hearing examining “the unethical and foreign interests exploiting the surrogacy and fertility industries in Texas” and to develop recommendations aimed at ending those practices and protecting patients and children.

Although the hearing is broader than birth tourism alone, the committee’s charge reflects growing legislative interest in how Texas regulates fertility-related services involving foreign nationals and whether additional safeguards are needed.

Combined with Abbott’s directive to HHSC and Attorney General Ken Paxton’s ongoing lawsuit against an alleged Houston-area birth tourism operation, the hearing suggests the issue is receiving coordinated attention from both the executive and legislative branches of state government.

Looking Ahead

The HHSC investigation does not establish that Mission Regional Medical Center violated any law. Instead, it begins the fact-finding process that will determine whether civil, criminal, or administrative enforcement is warranted.

Regardless of the investigation’s outcome, Texas’s response to birth tourism continues to evolve. Over the past several months, Attorney General Ken Paxton has pursued civil litigation against an alleged Houston-area birth tourism operation, the U.S. Supreme Court reaffirmed birthright citizenship under existing constitutional interpretation, and Gov. Greg Abbott has directed HHSC to investigate whether a licensed Texas hospital violated state law or contractual obligations by allegedly marketing birth tourism services to foreign nationals.

The issue is also receiving attention from the Texas Legislature. On July 8, the Senate Health & Human Services Committee is scheduled to examine “the unethical and foreign interests exploiting the surrogacy and fertility industries in Texas” as part of an interim hearing, with lawmakers expected to develop recommendations to address related harms. While the hearing is broader than birth tourism alone, it reflects growing legislative interest in how Texas regulates fertility-related services involving foreign nationals.

Taken together, these developments suggest the debate is moving beyond the constitutional question of birthright citizenship and toward what actions Texas can take under existing state authority to regulate businesses, healthcare providers, and other entities alleged to facilitate birth tourism. The findings of HHSC’s investigation, the Senate committee’s recommendations, and legislation filed ahead of the 90th Legislature will likely shape the next phase of Texas’ response to the issue.

---