A Voice for Texas' Most Vulnerable Citizens

Join PTFK in standing up for medically fragile Texans. HHSC's proposed rule 26R040 would make it harder for kids to qualify for the Medically Dependent Children Program. Send your comment before Monday, September 21, 2026.

Action alert

Tell HHSC to fix Rule 26R040

Comments are due Monday, September 21, 2026. It takes two minutes.

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Send your comment

The comment period has closed. Thank you.

You can still contact your own lawmakers about Rule 26R040 below.

What's happening

HHSC wants to change how Texas decides which kids qualify for the Medically Dependent Children Program. As written, proposed rule 26R040 adds a new "medically fragile" definition and stacks barrier on barrier for families already in crisis. Your comment becomes part of the official record. HHSC has to read it before the rule is final.

Step 1

Send your official comment

This sends your comment to HHSC and to every member of the Senate and House committees that oversee it.

Personal stories carry the most weight. Before you hit send, add a sentence or two about your child, or paste in any of the points below.

Optional points to add

Copy any that apply.

Fix the language

Use "medically dependent," not "medically fragile." That is the term this program actually serves.

If a definition of "medically fragile" must exist, it should match the Texas Education Agency's existing definition (PEIMS element E0999), not a new one made up for this rule.

Fix the medical criteria

Add immunocompromised status as a qualifying condition.

Add autonomic storming as a qualifying condition.

Change "30 calendar days" to "most days."

Replace strict hours-based criteria with "requiring a high level of medical judgment."

Count ER evaluations, not just hospital admissions.

Address the tracheostomy definition: remove "functional" and replace "and" with "or."

Fix the process

Subsection (E)'s treating-physician input is a good idea, but the wording needs to give a treating physician's clinical judgment real weight.

Step 2

Contact your own lawmakers

Your own state senator and representative care most about hearing from voters in their district. Enter your address to email or call them.

What Does It Mean To Be Medically Fragile?

"Fragile Kids" are children with medical complexity that is defined as having multiple significant chronic health problems that affect multiple organ systems and result in functional limitations, high health care need or utilization, and often the need for or use of medical technology.

Since the STAR Kids program was established in 2016, children with medical complexity have been experiencing significant gaps in coverage, excessive waitlist times, limited providers, and issues accessing quality care, among other problems with STAR Kids, STAR+Plus, and Texas Medicaid.
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Join PTFK in standing up for the medically fragile by urging your legislator to take action by passing immediate patient protections, improving Medicaid provider rates, and implementing an alternative, more appropriate model of care for Texans with disabilities and complex medical needs.

Ways to Give

THE ISSUE

Texas Must Do Better To Protect Our Most Vulnerable Citizens

The STAR Kids program has failed to provide effective care and support for families with medically complex children who are struggling to keep their families together and children out of institutions. The program's execution has been poor, marked by denials of critical life-sustaining care, significant gaps in care, inadequate networks, lengthy waiting lists to access care, ineffectual support services, regional county-based service areas limiting access to care, and exponential increase in administrative burden.

Overwhelmed families have been left trying to piece together a way to keep their child alive and stable . There is a clear need for better healthcare policies and programs that prioritize the needs of the most vulnerable members of society, such as medically complex children.

Who does STAR Kids effect?

The STAR Kids Program is a Texas Medicaid managed care program that applies to disabled children and young adults aged 20 or below who have certain qualifications and meet certain criteria. Participation in the STAR Kids program is required for those who are 20 or younger, covered by Medicaid, and meet at least one of the following:

Receive Supplemental Security Income (SSI) for disabilities.
Receive Medicaid and Medicare for disabilities.
Live in a community-based intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID) or nursing facility.
Receive services through the Medically Dependent Children Program (MDCP) waiver.
Receive services through the Youth Empowerment Services (YES) waiver.
Receive services through any of the following intellectual and developmental disability (IDD) waiver programs:

Community Living Assistance and Support Services (CLASS)
Deaf Blind with Multiple Disabilities (DBMD)
Home and Community-based Services (HCS)
Texas Home Living (TxHmL)