Assisted living requirements in Texas: the full 2026 guide

Last updated 2026-07-24

What is assisted living?

Assisted living is a licensed residential setting where adults get help with daily activities like bathing, dressing, medication reminders, and meals, while still living in something closer to a home or apartment than a hospital. It sits between fully independent senior housing and skilled nursing care. In Texas, the state calls these places "assisted living facilities" (ALFs) and regulates them under Texas Health and Safety Code Chapter 247, administered by the Health and Human Services Commission (HHSC) ^[1]. The statute defines an assisted living facility as an establishment that furnishes food, shelter, and personal care services to four or more people who are not related to the owner, on a 24-hour basis ^[1]. That "four or more residents" line matters a lot for anyone reading this because it's the trigger point for licensure. Care three unrelated adults in a home and you may fall under a different regulatory bucket entirely (or none), depending on services provided. Cross into four or more and Chapter 247 applies, full stop. If you're comparing this to the broader category of assisted living facilities across states, Texas is fairly typical in structure but has its own fee schedule, inspection cadence, and staffing math, all covered below.

What is a group home?

"Group home" is a term people use loosely, and that looseness causes real licensing confusion. In plain usage, a group home is a residential setting for a small number of unrelated people who share staff support, often organized around a specific population: intellectual and developmental disabilities (IDD), mental health recovery, substance use recovery, or seniors needing personal care. Texas doesn't have one single "group home license." Instead, the state licenses different program types depending on who lives there and what care is given. A home for seniors needing help with ADLs is licensed as an assisted living facility under Chapter 247. A home serving people with IDD may fall under HHSC's Home and Community-based Services (HCS) program rules or ICF/IID rules. Recovery housing for substance use has its own certification track through the Texas Health and Human Services recovery housing certification program. So when someone searches "how to start a group home" in Texas, the honest first answer is: figure out which population you intend to serve, because that decision determines which license application, which inspection checklist, and which staffing rule book applies. Get that wrong and you'll fill out the wrong forms and waste months. For readers weighing a senior-focused model specifically, the assisted living overview is a good next stop before you commit to Chapter 247 licensure.

What is an assisted living facility?

Type A	Residents who are mentally and physically capable of evacuating without staff physical assistance and don't need routine attendant care during nighttime hours	Self-evacuation, no nighttime attendant care needs
Type B	Residents who need staff assistance to evacuate, or who need overnight attendant care, or who have mild cognitive limitations	Staff-assisted evacuation
Type C (four-bed)	Small, four-bed homes, sometimes called "adult foster care"-style settings	Varies, smaller scale	HHSC's licensing rules for these categories live in 26 Texas Administrative Code Chapter 553 [2]. That chapter is the operational rulebook: it covers physical plant standards, staffing ratios, resident rights, medication management, admission and discharge criteria, and required policies. One detail operators miss: the license type isn't a one-time choice you're stuck with forever, but changing it later means a new application, a new inspection, and possibly new construction to meet fire and evacuation standards for the new type. Decide early which population (ambulatory vs. non-ambulatory, cognitively intact vs. dementia-involved) you're actually going to serve, and license for that.

An assisted living facility, under Texas law, is a licensed establishment providing food, shelter, and personal care or general supervision to four or more unrelated adults, plus routine health monitoring below the intensity of a nursing facility ^[1]. Texas licenses three types, and the type dictates who can live there and how staff must respond to emergencies. | License Type | Who it serves | Mobility/evacuation requirement |

What is assisted living facility care actually like day to day?

Day to day, assisted living in Texas centers on personal care support layered onto a home-like environment, not medical treatment. Staff help with bathing, dressing, grooming, mobility, and medication reminders or administration (depending on staff credentials), while residents keep as much routine and choice as possible. 26 TAC Chapter 553 requires facilities to have a written plan of care for each resident, updated based on functional and health assessments, and to provide three meals a day plus snacks, housekeeping, laundry, and 24-hour supervision appropriate to the license type ^[2]. Type B and Type C facilities generally serve residents who need more hands-on help, including some who cannot self-evacuate in an emergency, which drives stricter fire safety and staff awake-overnight requirements. Medication handling is a frequent audit target. Rules distinguish between residents who self-administer medication, staff who assist with self-administration, and staff who administer medication directly, with different training and documentation requirements attached to each ^[2]. If your policy manual doesn't clearly separate these three categories, that's often the first thing an HHSC surveyor flags. Activities, dietary accommodation, and resident council participation also show up in the regulatory text, more than as nice-to-haves. Chapter 247 gives residents specific rights, including the right to manage their own financial affairs and the right to receive visitors, and facilities have to have written policies protecting those rights ^[1].

What is the difference between assisted living and nursing home care?

The core difference is medical intensity. Assisted living provides personal care and supervision in a residential setting; a nursing home (called a skilled nursing facility or SNF) provides 24-hour skilled nursing care ordered and supervised by physicians, for people with more complex medical needs. Texas licenses nursing facilities separately under Texas Health and Safety Code Chapter 242, with its own HHSC survey process, distinct from Chapter 247 assisted living rules ^[3]. Staffing in a nursing facility includes licensed nurses around the clock in a way assisted living does not require. Assisted living Type A and B facilities are not required to have a registered nurse on-site continuously; they need designated staff trained to the resident population's needs, per 26 TAC 553 staffing rules ^[2]. Cost structure differs too, though Texas doesn't publish a single statewide rate; private pay assisted living rates and nursing home rates both vary widely by region and acuity. What's consistent is payer mix: nursing facilities have a much larger share of Medicaid-funded residents nationally, because Medicaid covers nursing facility care as a mandatory benefit under federal law, while assisted living/room-and-board is not a mandatory Medicaid benefit ^[4]. For operators, this distinction also drives your entire compliance path. If you want to serve residents with heavier medical needs (ventilators, wound care, IV therapy), you're likely looking at nursing facility licensure, not Chapter 247 assisted living, and that's a substantially heavier regulatory lift.

What does assisted living provide, specifically, under Texas rules?

Under Texas rules, assisted living facilities must provide, at minimum: three meals daily plus snacks, help with activities of daily living appropriate to the resident's assessed needs, housekeeping and laundry, 24-hour supervision, social and recreational activities, and a system for medication management ^[2]. Beyond those baseline services, Chapter 553 requires an initial assessment before or at admission, and periodic reassessment, to make sure the resident's needs still match the facility's license type and staffing capacity ^[2]. A resident whose needs escalate past what a Type A facility can safely provide (say, they can no longer self-evacuate) has to either be reassessed into appropriate services or discharged to a more appropriate setting, with required notice. Facilities also must maintain an emergency preparedness plan covering evacuation, sheltering in place, and continuity of care during disasters, a rule that got real teeth in Texas after Hurricane Harvey and winter storm Uri exposed gaps in several licensed facilities' emergency planning. Staff training requirements attach to all of this. HHSC requires facility staff to complete orientation and ongoing training hours covering resident rights, abuse/neglect reporting, infection control, and emergency procedures, with specifics laid out in 26 TAC 553 ^[2]. If you're building your policy manual from scratch, start with these categories, because they're what a surveyor checks first.

How to start a group home in Texas: the licensing steps

Starting a licensed assisted living facility in Texas runs through several concrete steps, and skipping ahead (say, signing a lease before confirming zoning) is the single most common expensive mistake new operators make. 1. Choose your population and license type. Decide between Type A, Type B, or the four-bed Type C model, based on the mobility and care needs of who you intend to serve. 2. Confirm zoning and property compliance. Local zoning ordinances vary by city and county in Texas; confirm with your local planning/zoning department before signing a lease or purchase agreement, and separately confirm fire marshal and building code sign-off requirements with your state licensing agency and local fire authority. 3. Submit the license application to HHSC. Applications, along with required fees, go through HHSC's Long Term Care Regulation division. Confirm current application forms and fee amounts with HHSC directly, since fee schedules change ^[1][2]. 4. Pass life safety and health inspections. Before licensure, HHSC (often coordinating with the State Fire Marshal's Office) inspects the physical plant for compliance with fire code, evacuation capability matched to your license type, and sanitation standards. 5. Build your staffing plan and policy manual. You'll need written policies covering admission/discharge criteria, medication management, abuse/neglect reporting, emergency preparedness, resident rights, and staff training documentation, all required under 26 TAC 553 ^[2]. 6. Background checks and staff qualifications. Texas requires criminal history checks for facility staff and owners/controlling persons, run through HHSC's background check unit. 7. Initial licensing survey. After application approval and pre-opening steps, HHSC conducts an initial survey before issuing the license; ongoing facilities are then subject to periodic unannounced inspections. This is also where a lot of first-time operators get overwhelmed by paperwork volume rather than the actual care model, which is exactly the gap a Group Home Licensing Kit is built to close: a $299 one-time set of policy templates and application checklists mapped to state requirements, so you're not drafting a medication management policy from a blank page at 11 p.m.

Does Medicare cover assisted living facilities?

No. Medicare does not cover the room-and-board or personal care costs of assisted living. Medicare.gov states plainly that Medicare does not pay for "custodial care" (help with daily activities like bathing and dressing) when that's the only kind of care needed, and it does not cover long-term residence in an assisted living facility ^[5]. Medicare Part A can cover a short skilled nursing facility stay after a qualifying hospital stay, and Medicare Part B can cover doctor visits, therapy, and some medical equipment for someone living in assisted living, but the facility's monthly rate itself (rent, meals, personal care staff) is a private-pay or Medicaid-waiver cost, not a Medicare-covered service ^[5]. Medicaid is a different story, though still limited. Texas Medicaid does not pay for assisted living room and board directly, but the STAR+PLUS Home and Community Based Services (HCBS) waiver program can help cover personal assistance services and other supports for eligible low-income Texans, in some cases including assisted living settings that participate in the program ^[6]. Eligibility is need-based and income-based, and slots are limited, so waiting lists are common; confirm current STAR+PLUS eligibility rules and provider availability with HHSC. Anyone budgeting for a family member, or building a facility's payer-mix plan as an operator, needs to plan around this reality: assisted living in Texas is overwhelmingly private-pay, with Medicaid HCBS waivers as a partial, capacity-limited supplement, not a guarantee.

How do I start a group home serving IDD or mental health populations instead of seniors?

If your population is intellectual/developmental disabilities or mental health recovery rather than seniors needing personal care, you're not licensing under Chapter 247 assisted living rules at all; you're in a different regulatory lane with its own agency contacts and forms. For IDD group homes, Texas typically routes through HHSC's Home and Community-based Services (HCS) program or, for higher-acuity settings, Intermediate Care Facilities for Individuals with an Intellectual Disability (ICF/IID) licensure. Both have distinct staffing ratio rules, service plan requirements, and provider enrollment steps through HHSC, separate from the assisted living survey process. For mental health and substance use recovery housing, Texas HHSC runs a recovery housing certification program rather than a facility license in the assisted living sense; certification confirms the home meets recognized recovery housing standards (often aligned with National Alliance for Recovery Residences principles), which matters for referral sources and, in some cases, funding eligibility. The practical takeaway: "group home" as a search term covers several genuinely different regulatory paths in Texas. Confirm with HHSC which program area governs your specific population before you draft policies or sign a property lease, because the physical plant standards (bedroom square footage, bathroom ratios, evacuation capability) differ meaningfully between an assisted living Type A home and an IDD HCS group home.

What are the staffing and inspection requirements once you're licensed?

Once licensed, Texas assisted living facilities operate under ongoing staffing ratio rules tied to license type and resident acuity, plus a recurring inspection schedule run by HHSC's Long Term Care Regulation division. Staffing: 26 TAC 553 requires facilities to maintain sufficient staff, awake and on duty, to meet resident needs based on the facility's license type; Type B facilities generally need higher staff-to-resident ratios and overnight awake staff because residents may need evacuation assistance or overnight attendant care ^[2]. Exact numeric ratios depend on resident census and acuity mix, so confirm current ratio worksheets with HHSC rather than assuming a flat number. Inspections: HHSC conducts both routine, generally unannounced, inspections and complaint-triggered investigations. Facilities found out of compliance receive a statement of deficiencies and must submit a plan of correction; repeat or serious violations can lead to enforcement actions ranging from administrative penalties to license revocation, under the enforcement authority in Chapter 247 ^[1]. Record-keeping is where many facilities lose points during survey, not clinical care itself. Surveyors check resident files for current assessments, signed care plans, medication administration records, and incident reports, and they check personnel files for background check documentation and training completion. If you're setting up your compliance calendar, build in quarterly internal file audits well before HHSC's inspector shows up unannounced.

How much does it cost to license and operate an assisted living facility in Texas?

Costs break into three buckets: state licensing fees, physical plant/construction costs, and ongoing operating costs, and only the first is something HHSC publishes directly. HHSC charges application and licensing fees for assisted living facilities under its Long Term Care Regulation fee schedule; exact current amounts vary by facility size and license type and change periodically, so confirm current fee amounts directly with HHSC's Long Term Care Regulation division before budgeting ^[2]. Physical plant costs depend heavily on whether you're converting an existing residential property or building new. Converting a home to meet Type B fire and evacuation standards (wider doorways, sprinkler systems in some cases, ADA-compliant bathrooms) can cost far more than a Type A conversion, because the resident population's evacuation capability drives fire code requirements. Ongoing costs are the ones new operators consistently underestimate: staffing (the largest recurring cost in nearly every licensed residential care setting), liability insurance, food service, background check renewals, continuing education hours for staff, and required policy manual updates whenever HHSC amends 26 TAC 553. None of these numbers are ones we'll guess at, because they vary by region, facility size, and staffing model; build your own budget against current HHSC fee pages and at least two or three vendor quotes before committing to a lease.

What should I check before I sign a lease or start construction?

Before signing anything, confirm four things with the relevant local and state offices, because a facility that looks perfect on paper can fail on zoning or fire code before it ever opens. First, confirm local zoning allows a residential care facility use at that address; some municipalities treat assisted living as a permitted residential use, others require a conditional use permit or special exception, and rules vary by city and county across Texas. Second, confirm fire marshal and building code requirements for your intended license type (Type A vs. B) since evacuation capability standards differ. Third, confirm current HHSC application requirements and required supporting documents, since forms and required attachments do change. Fourth, confirm background check and staff credentialing requirements early, since hiring delays are a common reason facilities miss their planned opening date. For operators comparing Texas to other states before deciding where to build, the assisted living facility and facility assisted living guides walk through how requirements shift state to state, which matters if you're weighing a multi-state expansion rather than a single Texas location. Finally, if you're at the paperwork-assembly stage rather than the strategy stage, a state-specific licensing kit builder can save real time by giving you Texas-mapped policy templates instead of starting your admission agreement, medication policy, and emergency plan from a blank document.

Frequently asked questions

What is assisted living in simple terms?

Assisted living is a licensed residential setting where adults get help with daily tasks like bathing, dressing, and medication management while living in a home-like environment, not a hospital. In Texas, any place doing this for four or more unrelated residents needs an HHSC license under Texas Health and Safety Code Chapter 247.

What is a group home versus an assisted living facility?

"Group home" is a general term for shared residential care, often for IDD or mental health populations, while "assisted living facility" is Texas's specific legal term under Chapter 247 for licensed personal care homes serving four or more unrelated adults. Which license applies depends entirely on who you're serving.

What is the difference between assisted living and a nursing home in Texas?

Assisted living (Chapter 247) provides personal care and supervision; nursing homes (Chapter 242) provide 24-hour skilled nursing care ordered by physicians for higher medical acuity. Nursing facilities require continuous licensed nursing staff; assisted living does not, though Type B facilities need more overnight staff support than Type A.

Does Medicare pay for assisted living in Texas?

No. Medicare.gov confirms Medicare does not cover custodial care or long-term assisted living room and board. Medicare can cover related medical services like doctor visits or short-term skilled nursing after a hospital stay, but not the facility's monthly assisted living rate itself.

Does Medicaid pay for assisted living in Texas?

Texas Medicaid doesn't directly pay standard assisted living room and board, but the STAR+PLUS Home and Community Based Services waiver can help eligible low-income residents access personal care supports, sometimes within assisted living settings. Eligibility is income and need-based, and waiting lists are common; confirm current details with HHSC.

How do I start a group home in Texas?

Choose your population and license type, confirm zoning and fire code compliance for that property, submit your application to HHSC, build your staffing plan and required policy manual, complete background checks, and pass the initial licensing survey. Each step has its own forms and timelines, confirmed directly with HHSC.

What are the three types of assisted living licenses in Texas?

Texas licenses Type A (residents who can self-evacuate and don't need overnight attendant care), Type B (residents who need staff help evacuating or overnight care), and Type C (small four-bed homes). The type you choose determines fire safety standards, staffing ratios, and which residents you can legally admit.

What does an assisted living facility have to provide under Texas law?

At minimum: three daily meals plus snacks, help with activities of daily living, housekeeping and laundry, 24-hour supervision, social activities, and medication management systems, per 26 TAC Chapter 553. Facilities also need written care plans, periodic reassessments, and an emergency preparedness plan.

How much does it cost to get an assisted living license in Texas?

HHSC charges licensing and application fees that vary by facility size and license type, and these amounts change periodically, so confirm current fees directly with HHSC's Long Term Care Regulation division. Physical plant, staffing, and insurance costs add substantially more and vary widely by region and facility size.

Can I convert my house into a licensed assisted living facility?

Possibly, but you'll need to confirm local zoning allows residential care use at that address, meet fire marshal and building code requirements matched to your license type, and pass HHSC's pre-licensing inspection. Conversion costs vary widely depending on whether you're licensing as Type A or the more stringent Type B.

What's the difference between assisted living and independent living?

Independent living is unlicensed senior housing with minimal or no personal care support, essentially apartment living with some amenities. Assisted living is licensed under Texas Health and Safety Code Chapter 247 specifically because it provides personal care, supervision, and health-related services beyond housing alone.

Who inspects assisted living facilities in Texas?

HHSC's Long Term Care Regulation division conducts both routine, generally unannounced inspections and complaint-driven investigations. Facilities with deficiencies must submit a plan of correction, and serious or repeat violations can lead to administrative penalties or license revocation under Chapter 247.

Sources

1. Texas Health and Safety Code, Chapter 247 (Assisted Living Facilities): Definition of assisted living facility, resident rights, and enforcement authority
2. 26 Texas Administrative Code, Chapter 553 (Licensing Standards for Assisted Living Facilities): License types (A, B, C), staffing, services, medication management, and physical plant standards
3. Texas Health and Safety Code, Chapter 242 (Nursing Facility Licensing): Separate licensing structure for nursing facilities distinct from assisted living
4. Medicaid.gov, Nursing Facilities: Medicaid mandatory coverage of nursing facility care
5. Medicare.gov, Long-Term Care: Medicare does not cover custodial care or long-term assisted living costs
6. Texas HHSC, STAR+PLUS Home and Community Based Services: STAR+PLUS HCBS waiver can help cover personal assistance services for eligible Texans