Texas' Health and Human Services Commission has referred two Rio Grande Valley hospitals to Attorney General Ken Paxton's office over allegations they marketed maternity packages to foreign nationals seeking U.S. citizenship for their children.

The action escalates a state crackdown on what Texas Gov. Greg Abbott calls illegal birth tourism after the Supreme Court preserved birthright citizenship in June.

The referral names Mission Regional Medical Center in Mission and Knapp Medical Center in Weslaco, both affiliated with Prime Healthcare Foundation.

Abbott directed HHSC on July 7 to investigate Mission Regional after images circulated of a Spanish-language billboard advertising "Birth Packages in South Texas," and the agency broadened its review after finding that both hospitals linked to the now-defunct site, havemybabyinTEXAS.com, were involved.

Natural deliveries were advertised starting at $3,950 and cesarean sections at $5,525, along with a U.S. phone number displayed with the international dialing prefix for calls from Mexico.

Mission Regional confirmed the campaign and said the marketing has been pulled to "prevent any misunderstandings." A hospital spokesperson said Knapp had no involvement in the campaign after 2024.

"Regardless of what the Supreme Court of the United States may have said, U.S. citizenship is not for sale in Texas," Abbott said in a statement announcing the referral.

The move follows Paxton's April suit against De'ai Postpartum Care Center in Houston, which the state accuses of coaching Chinese nationals to misrepresent their travel purpose on visa applications, hiding their intent to give birth in the U.S.

The complaint alleges violations of Texas deceptive-trade-practices, government-records, and public-nuisance laws. The center's operators have denied the allegations. The next hearing is set for July 16, the Texas Tribune reported.

Federal prosecutors have targeted similar operations.

In 2024, a California couple was sentenced to more than three years in prison for coaching Chinese clients to conceal pregnancies from immigration officers.

The Justice Department has said most illegal birth tourism cases involve visa fraud and can extend to wire fraud, money laundering, and identity theft.

Giving birth in the U.S. as a foreign national is not, by itself, illegal, and there is no visa specifically for this purpose.

The Migration Policy Institute estimates 9,600 to 26,000 of the roughly 3.6 million annual U.S. births involve birth tourism, a fraction of the total.

Chuck DeVore of the Texas Public Policy Foundation told the Tribune he expects "multiple bills" next session, including proposals to bar foreign nationals from using Texas surrogates.

The state Department of State Health Services recorded 657 surrogacy births in Texas in 2025, though the share tied to foreign parents is unknown. The Texas GOP platform calls for restricting 14th Amendment citizenship to children with at least one U.S. citizen parent.