["Medical Anthropology Quarterly, EarlyView. ", "\nAbstract\nDrawing from ethnographic work with women utilizing publicly funded prenatal care in El Paso, Texas, this paper considers how bureaucratic mechanisms lead to systematic exclusion of US citizens and legal permanent residents from health services for which they would appear to qualify under Texas's Medicaid for Pregnant Women. This bureaucratic exclusion contributes to cross‐border utilization of health services, with the Mexican health sector functioning as a safety net for an inadequate public health system in the United States. This article considers how immigration and health care bureaucracy intersect to exclude pregnant people from publicly funded health services, even when a person appears to be legally entitled to benefits. This exclusion contributes to the normalization of cross‐border utilization of health services among those with a certain degree of transnational cultural capital. Attending to transnational cultural capital is revealing of the ways individuals exert agency in the context of constrained access.\n"]