Last updated 2026-07-25
TL;DR
Texas regulates assisted living under HHSC as Assisted Living Facilities (Type A, B, or C), governed by Texas Health and Safety Code Chapter 247 and 26 TAC Chapter 553. Medicare does not pay for assisted living room and board. Medicaid covers some personal care costs through STAR+PLUS waiver programs, but not rent. Starting one requires a license application, life safety inspection, staffing plan, and background checks before HHSC issues a permit.
What is assisted living, exactly?
Assisted living is a residential care arrangement where someone gets a private or shared room, meals, help with daily tasks like bathing and medication, and some level of supervision, but not the round-the-clock skilled nursing care you'd find in a nursing home. In Texas, this category has a legal name: Assisted Living Facility, or ALF. The Texas Health and Human Services Commission (HHSC) is the agency that licenses and inspects these facilities under Texas Health and Safety Code Chapter 247 [1]. The state defines it plainly. An assisted living facility is "an establishment that furnishes, in one or more facilities, food and shelter to four or more persons who are unrelated to the proprietor of the establishment and provides personal care services" [1]. That four-or-more threshold matters a lot, because smaller homes with three or fewer unrelated residents generally fall outside this license category and into other rules entirely (more on that below). People search for this concept under a dozen different phrasings: assisted living facility, ALF, residential care home, senior group home. They're mostly talking about the same regulatory box in Texas, just described differently depending on whether they're a family member searching for a placement or an operator filling out paperwork.
What is a group home, and how is it different from assisted living?
A group home is a broader term that covers any residential setting where a small number of unrelated people live together and get support services, whether that's for seniors, people with intellectual or developmental disabilities (IDD), people in mental health recovery, or people in substance use recovery. Assisted living is one specific type of group home, aimed mostly at older adults and people with age-related care needs. In Texas, IDD group homes are usually licensed as Home and Community-based Services (HCS) providers or intermediate care facilities (ICF/IID) under a completely different chapter of HHSC rules, not Chapter 247. Adult foster care, meanwhile, is a Medicaid-funded program where a caregiver houses a small number of adults in their own home, licensed under different standards again. So if you hear "group home" used generically, always ask which population and which license track the person actually means, because the paperwork, staffing rules, and inspection standards diverge fast. If you're comparing populations and license types side by side, our assisted living facility guide breaks down where ALF licensing sits relative to IDD and behavioral health group home models.
What is an assisted living facility under Texas law?
Under Texas Health and Safety Code Chapter 247, an assisted living facility is licensed in three types, and the type dictates what kind of resident the facility can legally serve. Type A facilities serve residents who are physically and mentally capable of evacuating the building without help in an emergency. Type B facilities can serve residents who need help evacuating, including some with mobility or cognitive limitations. Type C, sometimes called an adult foster care Medicaid contract facility, is a small home setting, typically serving three to four residents, contracted through Medicaid's adult foster care program [2]. HHSC rules for these facilities live in 26 Texas Administrative Code Chapter 553 [3]. That chapter spells out physical plant standards, staffing minimums, medication management rules, resident rights, and the inspection process. If you're building a license application, this is the document you'll live in for weeks. One detail that surprises new operators: facilities serving three or fewer unrelated residents are generally exempt from ALF licensing under Chapter 247, though local zoning, fire code, and other state rules can still apply. Don't assume "small" means "unregulated." Confirm with your state licensing agency whether your specific resident count and services trigger a license requirement before you sign a lease.
What does assisted living actually provide, day to day?
Assisted living covers a defined bundle of services: a private or semi-private room, three meals a day, help with activities of daily living (dressing, bathing, toileting, mobility), medication administration or reminders, housekeeping, laundry, and 24-hour staff availability for supervision and emergencies. What it does not include, by definition, is ongoing skilled nursing care for medically complex conditions. That's the dividing line between assisted living and a nursing home. Texas rule 26 TAC §553.261 requires facilities to have sufficient staff on duty to meet resident needs around the clock, with specific staffing ratios that vary by facility type and resident acuity [3]. Type B and Type C facilities, which serve residents needing evacuation assistance, generally carry higher staffing expectations than Type A. Medication management is one of the most heavily scrutinized service areas during HHSC inspections. Facilities must have a documented med administration policy, staff trained per state requirements, and accurate records for every dose given. If you're building your policy manual, get this section right first, because it's one of the top citation categories in HHSC survey reports.
What is the difference between assisted living and a nursing home?
| Licensing chapter (TX) | Health & Safety Code Ch. 247 | Health & Safety Code Ch. 242 |
|---|---|---|
| Care level | Custodial, ADL support | Skilled nursing, medical |
| Nursing staff required | Not RN-intensive | RN/LVN coverage required |
| Typical Medicare coverage | Room/board: no | Short-term rehab stay: yes, with conditions |
The core difference is medical acuity and staffing. Nursing homes (called skilled nursing facilities or SNFs) are licensed to provide 24-hour skilled nursing care from licensed nurses, for residents recovering from surgery, managing complex chronic conditions, or needing rehabilitation therapy. Assisted living facilities are licensed for custodial care: help with daily living tasks, not medical treatment. Nursing homes in Texas are licensed separately under Texas Health and Safety Code Chapter 242 and regulated by HHSC's Long Term Care Regulation division, with a distinct inspection and staffing framework from Chapter 247 assisted living rules [4]. Nursing homes must have a registered nurse on duty and licensed nursing staff coverage that assisted living facilities are not required to maintain at the same intensity. Cost and payer mix also diverge sharply. Nursing home stays are far more likely to be covered, at least short-term, by Medicare Part A for skilled rehabilitation following a qualifying hospital stay [5]. Assisted living almost never qualifies for that Medicare pathway, which brings us to the next question people always ask. | Feature | Assisted Living Facility | Nursing Home (SNF) |
Does Medicare cover assisted living facilities?
No. Medicare does not pay for the room and board costs of assisted living, and it never has. Medicare.gov states plainly that "Medicare doesn't cover . . . Long-term care (also called custodial care)" including the kind of help provided in assisted living settings [5]. Medicare Part A can cover a short skilled nursing facility stay after a qualifying hospitalization, and Medicare Part B can cover doctor visits and some therapies wherever someone lives, but the rent-and-care package itself is not a Medicare benefit. Medicaid is a different story, though it's often misunderstood too. Texas Medicaid does not pay for the room and board portion of assisted living either, but it can cover personal care services for eligible low-income residents through home and community-based services (HCBS) waiver programs, including STAR+PLUS, administered by HHSC [6]. Adult foster care, the Type C category mentioned earlier, is a Medicaid-funded arrangement specifically because it's structured as a home care contract rather than a straight room-and-board lease. CMS's own guidance on HCBS waivers confirms that states can use these programs to fund "services and supports to individuals in the community" as an alternative to institutional care, but funding for the residential housing cost itself typically flows through Supplemental Security Income (SSI) or the resident's private funds, not the Medicaid medical benefit [7]. If you're building financial projections for prospective residents or their families, get this distinction very clear early, because it's the single most common source of confused phone calls to any operator's front desk.
How do I start a group home in Texas?
Starting a licensed assisted living facility in Texas runs through several concrete steps, and skipping any one of them stalls your application. Here's the sequence HHSC generally expects. First, confirm which license category fits your planned resident population and count: Type A, B, or C under Chapter 247, or a different license entirely if you're serving IDD, mental health, or recovery populations rather than seniors needing custodial care [1][2]. Second, secure a physical location that meets zoning requirements for group residential use and can pass a life safety code inspection, since HHSC coordinates with the State Fire Marshal's Office on life safety compliance for ALFs [3]. Third, submit your license application to HHSC along with required fees, floor plans, and an operating policy manual covering admission criteria, medication management, staffing plans, emergency procedures, and resident rights. Fourth, complete required background checks for the administrator and staff, since Chapter 247 requires criminal history checks before anyone works in a resident-facing role [1]. Fifth, HHSC will schedule a pre-licensing inspection to confirm the physical plant, staffing plan, and policies match what's on paper before an initial license is issued. Sixth, once licensed, expect the facility to be subject to unannounced HHSC surveys on a regular cycle plus any complaint-driven inspections. Building this paperwork stack from scratch, especially the policy manual and staffing plan documents, is the part that eats the most time for first-time operators. Our $299 State Group Home Licensing Kit is built around exactly this gap: state-specific policy templates, staffing plan frameworks, and application checklists so you're not reinventing every document HHSC expects to see. It doesn't replace legal review or guarantee approval; nothing can promise that. But it gets you to a complete draft faster than starting from a blank page.
How do I actually get a license application approved?
There's no shortcut that skips HHSC's review, and anyone who tells you otherwise is selling something. What you can control is completeness. Applications get delayed or denied most often because of missing background check documentation, an incomplete staffing plan that doesn't match the facility's licensed capacity, or a physical plant that doesn't yet meet fire and life safety code. HHSC posts specific application forms and instructions for assisted living licensure, and following that checklist exactly, rather than approximating from a different state's rules, saves real time [1][3]. If you've operated in another state before, resist the urge to reuse that state's policy manual wholesale. Texas has its own resident rights language, staffing ratio math, and reporting requirements, and reviewers will catch a manual that's clearly copied from Florida or California. Budget real time for this. Initial licensing review timelines vary and HHSC does not publish a guaranteed turnaround, so confirm current processing times with your state licensing agency rather than assuming a fixed number of weeks.
What do HHSC inspections actually look at?
HHSC conducts both routine (unannounced, cyclical) surveys and complaint investigations at licensed assisted living facilities under 26 TAC Chapter 553 [3]. Inspectors typically review medication administration records, staffing logs against the approved staffing plan, resident care plans, fire and life safety compliance, food service sanitation, and resident rights documentation like grievance procedures and admission agreements. Citations (called deficiencies) get documented with a required plan of correction and a follow-up timeline. Repeated or serious deficiencies, particularly around resident safety or unqualified staff providing care, can lead to enforcement actions ranging from a corrective action plan up to license revocation in the most severe cases. HHSC publishes facility inspection and complaint history that families and prospective operators can search, which is worth reviewing if you're buying an existing facility rather than building from scratch. Staffing documentation is consistently one of the top-cited problem areas nationally in assisted living inspections, which tracks with why HHSC's staffing rule under §553.261 is so specific about ratios and shift coverage [3]. If your staffing plan is aspirational rather than what's actually on the schedule, that gap will surface during an inspection.
What are the staffing and training requirements?
Texas requires assisted living facilities to have an administrator who meets HHSC's licensing and training requirements, plus enough direct care staff on every shift to meet resident needs based on the facility's type and resident acuity level [3]. Type A facilities, serving more independent residents, generally require lighter staffing than Type B or C facilities serving residents who need evacuation assistance or more hands-on care. Staff providing personal care or medication assistance must complete required training documented in the facility's personnel files, and HHSC checks this during inspections. Administrators typically need to complete HHSC-approved training and pass a competency exam before they can be listed as the facility's licensed administrator of record; confirm current administrator qualification requirements with HHSC directly since training program approvals and hour requirements can change. Don't understaff to save money in the early months. It's the single fastest way to draw a serious deficiency, and in a worst case, it's how residents get hurt and how a new operator loses a license before the business even gets going.
What about zoning and the physical building?
Local zoning rules for group residential facilities vary heavily by city and county in Texas, and HHSC licensing does not override local zoning; the two are separate approval tracks that both have to clear before you can operate. Some municipalities treat small assisted living homes as permitted residential uses, others require a conditional use permit or special exception, and some restrict them entirely from certain residential zones. Confirm with your local planning or zoning department early, before you sign a lease or purchase a property, because a building that's otherwise perfect for an ALF can be a dead end if the zoning doesn't allow group residential use at that address. Layer on the state's physical plant and life safety code requirements administered alongside the State Fire Marshal's Office, and you have two separate approval processes that both need to check out. For operators comparing building requirements across facility types, our facility assisted living overview walks through common physical plant standards that show up across state licensing rules.
How is Texas assisted living different from other states?
Every state licenses assisted living under its own statute, its own terminology, and its own staffing math, and Texas is no exception. Some states use "residential care facility" or "personal care home" instead of "assisted living facility." Some states have a single license tier; Texas has three (Type A, B, C) tied directly to resident evacuation capability and Medicaid contract status. If you're planning to operate in more than one state, don't assume any single state's rules, forms, or staffing ratios transfer over. Each state's health or aging agency publishes its own licensing statute and administrative code, and Texas's HHSC-administered Chapter 247 and 26 TAC Chapter 553 framework is specific to Texas [1][3]. Building a multi-state operation means building (or licensing) separate policy manuals for each state. For a broader look at how assisted living licensing compares across categories and populations, see our assisted living facilities and senior assisted living facilities near me guides.
Frequently asked questions
What is assisted living?
Assisted living is a residential care setting for people who need help with daily activities like bathing, dressing, and medication, but not full-time skilled nursing care. In Texas, it's a licensed category (Assisted Living Facility) regulated by HHSC under Health and Safety Code Chapter 247, covering room, meals, personal care, and 24-hour staff availability.
What is a group home?
A group home is a residential setting where a small number of unrelated people live together and receive support services, whether for seniors, people with intellectual or developmental disabilities, or people in mental health or substance use recovery. Assisted living is one type of group home specifically for people needing custodial senior care.
What is an assisted living facility?
Under Texas Health and Safety Code Chapter 247, an assisted living facility furnishes food, shelter, and personal care services to four or more unrelated residents. It's licensed as Type A, B, or C depending on residents' evacuation ability and whether the facility contracts with Medicaid's adult foster care program.
What does assisted living provide?
Assisted living provides a room, meals, help with daily living tasks (bathing, dressing, mobility), medication administration or reminders, housekeeping, laundry, and 24-hour staff supervision. It does not provide ongoing skilled nursing or medical treatment; that level of care requires a licensed nursing home.
What is the difference between assisted living and a nursing home?
Assisted living provides custodial help with daily tasks; nursing homes provide 24-hour skilled nursing care for medical conditions and rehabilitation. In Texas, they're licensed under separate statutes (Chapter 247 for assisted living, Chapter 242 for nursing homes) with different staffing requirements, and nursing homes must maintain licensed nursing coverage that assisted living facilities don't.
Does Medicare cover assisted living facilities?
No. Medicare does not cover the room and board or custodial care costs of assisted living, according to Medicare.gov's official coverage guidance. Medicare can cover a short-term skilled nursing facility stay after a qualifying hospitalization, or doctor visits and therapy wherever someone lives, but not ongoing assisted living costs.
How do I start a group home in Texas?
Confirm the right license category for your population, secure a zoning-compliant location that can pass a life safety inspection, submit a license application with a complete policy manual and staffing plan to HHSC, complete required background checks, and pass a pre-licensing inspection before HHSC issues the license.
Does Medicaid pay for assisted living in Texas?
Texas Medicaid doesn't cover the room and board cost of assisted living, but it can cover personal care services for eligible residents through HCBS waiver programs like STAR+PLUS, administered by HHSC. Adult foster care (Type C facilities) is structured specifically as a Medicaid-funded home care contract.
What's the difference between Type A, Type B, and Type C assisted living facilities in Texas?
Type A serves residents who can evacuate without help in an emergency. Type B serves residents who need evacuation assistance, including some with cognitive or mobility limitations. Type C is a small adult foster care setting contracted through Medicaid, typically serving three to four residents in a home-like environment.
How many residents can live in an assisted living facility before it needs a Texas license?
Texas Health and Safety Code Chapter 247 generally applies to facilities serving four or more unrelated residents. Facilities with three or fewer unrelated residents typically fall outside this license requirement, though zoning, fire code, and other rules can still apply; confirm your specific situation with HHSC.
What agency licenses assisted living facilities in Texas?
The Texas Health and Human Services Commission (HHSC) licenses and inspects assisted living facilities under Texas Health and Safety Code Chapter 247 and administrative rules in 26 Texas Administrative Code Chapter 553.
How often does HHSC inspect assisted living facilities?
HHSC conducts routine unannounced surveys on a regular cycle plus complaint-driven investigations whenever a complaint is filed against a facility. Inspection findings and any deficiencies with required corrective action plans are documented and can be reviewed through HHSC's facility search tools.
Can I convert my house into an assisted living facility?
Potentially, but you need to clear local zoning approval for group residential use, meet fire and life safety code requirements often coordinated with the State Fire Marshal's Office, and satisfy HHSC's physical plant standards under 26 TAC Chapter 553, all before applying for a license.
Sources
- Texas Health and Safety Code, Chapter 247 (Assisted Living Facilities): Definition of assisted living facility and the four-or-more unrelated resident threshold
- Texas HHSC, Assisted Living Facilities program page: Type A, B, and C license category descriptions
- 26 Texas Administrative Code, Chapter 553 (Licensing Standards for Assisted Living Facilities): Staffing, medication management, and inspection standards for licensed facilities
- Texas Health and Safety Code, Chapter 242 (Convalescent and Nursing Homes): Separate licensing statute for nursing homes distinct from assisted living
- Medicare.gov, Long-Term Care coverage page: Medicare does not cover long-term custodial care such as assisted living room and board
- Texas HHSC, STAR+PLUS program page: STAR+PLUS Medicaid waiver can cover personal care services for eligible residents
- Medicaid.gov, Home & Community-Based Services page: HCBS waivers fund community-based services and supports as an alternative to institutional care