Last updated 2026-07-25
TL;DR
A Texas group home is a licensed residential setting (assisted living, adult foster care, or HCS/ICF for people with IDD) regulated by the Health and Human Services Commission. Licensing takes months, needs a fire marshal sign-off, staffing plan, and background checks. Confirm current fees and timelines directly with HHSC Long Term Care Regulation.
What is a group home, exactly?
A group home is a residential setting where a small number of people who need support with daily living share a house or facility with paid staff, instead of living alone or in a large institution. In Texas, the term gets used loosely, but the state's actual regulatory categories are more specific: assisted living facilities, adult foster care homes, and residential settings for people with intellectual or developmental disabilities (IDD) licensed under Home and Community-based Services (HCS) or Intermediate Care Facilities (ICF/IID). Which license you need depends entirely on who you're serving and what kind of care you provide. A house for four adults with IDD who need help with medication and daily routines is a very different license than a 16-bed assisted living facility for seniors who need help bathing and dressing. Texas Health and Human Services Commission (HHSC) regulates all of these, but under different chapters of the Texas Administrative Code [1]. If you're just starting to research this, it helps to first nail down your population: seniors needing personal care, adults with mental illness, people in recovery, or people with IDD. That single decision drives your license type, your staffing ratios, your physical plant rules, and your inspection checklist. Don't skip this step to save time. Picking the wrong license type early is the single most common reason applications stall for months.
What is assisted living, and what is an assisted living facility?
Assisted living is a category of long-term care for people who need help with daily activities like bathing, dressing, medication management, and mobility, but who don't need the level of skilled nursing care you'd get in a nursing home. An assisted living facility (ALF) is the licensed building or program that provides that care, typically as a residential arrangement with meals, supervision, and personal care staff on site. In Texas, assisted living facilities are licensed by HHSC under Texas Health and Safety Code Chapter 247 and the associated administrative rules [2]. The state defines an assisted living facility as an establishment that furnishes food, shelter, and personal care services to four or more residents unrelated to the operator, in exchange for compensation. Texas also licenses facilities that provide services to three or fewer people under certain rules, but four residents is the general threshold that triggers full ALF licensure. Texas assigns ALFs to different types based on the level of care and supervision offered. Type A facilities generally serve residents who are physically and cognitively capable of following instructions in an emergency (self-preservation). Type B facilities serve residents who need more help evacuating or who have greater cognitive impairment, which means more staff and stricter physical plant rules. There's also a Type C designation for adult foster care-like small settings. Confirm the current type definitions and staffing requirements with HHSC before you plan your build-out, because these categories affect everything from door widths to overnight staffing counts.
What does assisted living provide, day to day?
Assisted living typically provides help with what's called activities of daily living (ADLs): bathing, dressing, toileting, transferring, and eating, plus medication reminders or administration, meals, housekeeping, laundry, and social activities. It is not the same as skilled nursing care. Assisted living residents generally don't need 24-hour licensed nursing supervision for complex medical needs like ventilators, wound vacs, or IV therapy, though some Texas facilities do offer a higher tier of service for residents with more complex needs, under specific licensing add-ons. Medicaid.gov describes assisted living and similar residential care as part of the continuum of long-term services and supports that helps people live in the least restrictive setting appropriate to their needs [3]. In Texas, if a resident's needs progress to require ongoing skilled nursing care, the facility either has to bring in appropriate licensed staff and update its service agreement, or the resident may need to transition to a nursing facility. A well-run group home or ALF should have a written policy manual that spells out exactly what services are and aren't included, how care needs are reassessed, and what triggers a discharge or transfer plan. This isn't optional paperwork. HHSC surveyors ask for it during inspection, and residents' families rely on it to know what they're paying for.
What is the difference between assisted living and a nursing home?
| Primary need | Help with ADLs, supervision | Skilled nursing, medical care | |
|---|---|---|---|
| Nursing staff | Not required 24/7 in most cases | RN/LVN coverage required by federal rule | |
| Regulator (Texas) | HHSC, Health & Safety Code Ch. 247 [2] | HHSC, Health & Safety Code Ch. 242 | |
| Typical setting | Home-like, apartment or shared room | Clinical, hospital-adjacent feel | |
| Medicare coverage | Generally not covered as room and board | Covers up to 100 days post-hospital under conditions [4] | Nursing homes are federally certified under Medicare and Medicaid rules and must meet requirements like having a registered nurse on duty at least eight consecutive hours a day, seven days a week, per federal nursing home regulations [5]. Assisted living facilities are licensed at the state level and don't carry that same federal certification framework, which is part of why costs, staffing, and inspection rules differ so much between the two. |
The core difference is medical acuity and staffing. Assisted living is for people who need help with daily living but not ongoing skilled nursing care. A nursing home (skilled nursing facility) is for people who need daily medical care, often including a licensed nurse on site around the clock, physician oversight, and rehabilitation services like physical or occupational therapy. | Feature | Assisted living | Nursing home |
Does Medicare cover assisted living facilities?
No. Medicare does not pay for the room and board costs of assisted living. Medicare.gov is direct about this: Medicare does not cover long-term care (also called custodial care) if that's the only care you need, which includes most of what assisted living provides [4]. Medicare may still cover medically necessary services a resident receives, like doctor visits, some therapy, or durable medical equipment, but it won't pay the facility's monthly rate for housing, meals, and personal care. Medicaid is different. Some states, including Texas, use Medicaid waiver programs (in Texas, primarily through STAR+PLUS and HCS/ICF waivers for people with IDD) to help cover home and community-based services, which can include some assisted living-type settings or in-home personal care, depending on eligibility and program design [6]. Coverage rules and waiver waitlists vary and change; confirm current Medicaid waiver options with HHSC and the Texas Medicaid managed care program directly, since waitlists for IDD waivers in Texas have historically run for years, not months [7]. If your business model assumes private pay only, be explicit about that with families up front. If you plan to accept Medicaid waiver clients, build that into your licensing and provider enrollment process from day one. Retrofitting Medicaid billing after you're already operating is a much harder, slower process.
How do I start a group home in Texas? (Step by step)
Here's the realistic sequence, not the marketing-brochure version. First, pick your population and license type. Decide whether you're serving seniors (ALF), adults with IDD (HCS/ICF), people with mental illness, or people in recovery, since Texas doesn't have one single 'group home license.' Each population has its own HHSC licensing chapter, staffing ratios, and training requirements [1]. Second, write your business and program plan. This includes your admission criteria, services offered, staffing plan (including required manager qualifications), emergency preparedness plan, and a policy and procedure manual covering medication management, resident rights, abuse/neglect reporting, and grievance procedures. HHSC will want to see this before issuing a license, not after. Third, secure your property and confirm zoning. Group homes for people with disabilities are generally protected under the federal Fair Housing Act's reasonable accommodation provisions, meaning cities can't categorically ban them the way they might ban a general boarding house, but local zoning, fire code, and building occupancy rules still apply and vary by city and county. Confirm zoning classification, occupancy limits, and any required variances with your local planning department before you sign a lease. A property that looks perfect can fail a fire marshal inspection over exit widths, sprinkler requirements, or bedroom square footage. Fourth, apply for your license through HHSC Long Term Care Regulation. This includes submitting your application, paying the applicable fee, passing a life safety code inspection from the state fire marshal's office or local authority, and completing criminal background checks for owners, administrators, and staff. HHSC publishes current application forms and fee schedules on its licensing pages; confirm current fee amounts and processing timelines directly with HHSC rather than relying on older figures, since fee schedules get updated [1]. Fifth, hire and train staff before you accept residents. Depending on license type, Texas requires specific staff-to-resident ratios, a qualified administrator or manager (some categories require a licensed administrator with continuing education hours), and documented training in first aid, CPR, medication administration, and abuse/neglect recognition. Sixth, pass your initial licensing inspection. HHSC surveyors will walk the physical plant, review resident files (if you have any admitted under a provisional license process), check staff files and training documentation, and verify your emergency plan. Expect a plan of correction process if they find deficiencies; this is normal and doesn't necessarily mean denial, but it does add time. If you want a structured way to organize all of this paperwork instead of reconstructing it from scratch across a dozen HHSC PDF forms, that's exactly the gap the licensing kit builder is meant to fill, a one-time $299 state-specific packet covering the policy manual, staffing plan templates, and application checklists. It doesn't replace your HHSC application or guarantee approval; it's a starting template you customize.
How do I start a group home if I'm serving people with IDD specifically?
If your population is people with intellectual or developmental disabilities, Texas routes you through a different door than standard assisted living. Most IDD residential providers operate under the HCS (Home and Community-based Services) waiver program or ICF/IID licensure, both regulated by HHSC. HCS providers must be enrolled with HHSC as a Medicaid provider and meet program-specific standards under Texas Administrative Code Title 26 rules governing HCS providers, including person-centered planning requirements, staff qualifications, and individual service plans [8]. ICF/IID facilities are certified under federal Medicaid rules for intermediate care facilities and follow a more institutional, medically-oriented standard. Both pathways require far more documentation upfront than a private-pay assisted living startup: provider enrollment applications, a contract with HHSC, background check clearances through the Employee Misconduct Registry and Nurse Aide Registry, and program-specific training (like Texas's required Human Rights training). Budget significantly more lead time, often many months, for HCS/ICF enrollment compared to a straightforward ALF license, because you're dealing with both licensing and Medicaid provider enrollment simultaneously.
What staffing and training does Texas require?
Staffing requirements vary by license type, but a few things are consistent across most Texas residential care settings. Owners, administrators, and direct care staff must pass criminal background checks, generally checked against the Texas Department of Public Safety and, for certain populations, national fingerprint-based checks [1]. Assisted living facilities need a designated administrator who meets HHSC qualification requirements (education, experience, or a state administrator license depending on facility type and size). Direct care staff need documented training in areas like resident rights, infection control, medication assistance (if applicable), and emergency procedures, before or shortly after hire. Staff-to-resident ratios aren't a single fixed number across Texas; they depend on facility type, resident acuity, and time of day (day shift ratios are typically lower than overnight). Type B facilities, which serve residents needing more help evacuating, generally require higher staffing ratios than Type A. Confirm the exact ratio requirements for your specific license type and shift pattern with HHSC's current administrative rules rather than assuming a number, since these get revised. Don't understaff to save money in year one. Understaffing is one of the fastest routes to a serious deficiency citation, and in a small group home, a single citation for inadequate supervision can jeopardize your entire license.
What zoning and property rules apply to a Texas group home?
Zoning is where a lot of otherwise well-prepared operators get stuck. Cities and counties in Texas control zoning locally, so there's no single statewide answer. Some jurisdictions treat small group homes (typically six or fewer unrelated residents with disabilities) as a residential use permitted by right, following the federal Fair Housing Act's reasonable accommodation framework, which generally prevents cities from treating a small group home for people with disabilities differently than a regular family home. Larger facilities or those serving more residents may fall under commercial or institutional zoning categories requiring a special use permit. Beyond zoning, you'll need to clear the local fire marshal or the State Fire Marshal's Office for life safety code compliance, which covers things like fire alarm systems, sprinklers (depending on occupancy classification and resident mobility), exit signage, and emergency lighting. Building and health department approvals for kitchen facilities, water supply, and septic or sewer connections (especially in rural areas) also apply. Before signing any lease or purchase agreement, get written confirmation from your local zoning office and fire marshal that your intended use, resident count, and building type are acceptable. Verbal assurances from a landlord or realtor are not a substitute. If you're comparing this against other paths, it can help to first review general background on assisted living facilities before you get deep into a specific city's zoning code.
What does the HHSC inspection process actually look like?
HHSC conducts an initial licensing survey before you can operate, and then periodic unannounced inspections after you're licensed, plus complaint-triggered investigations if someone reports a concern. Surveyors check the physical plant against life safety and building requirements, review resident records and care plans, verify staff training files and background check documentation, and observe medication administration and care practices in real time. Common deficiency areas in residential care inspections nationally, and consistent with what state licensing agencies report, include incomplete medication administration records, inadequate staff training documentation, missing or outdated care plans, and physical plant issues like blocked exits or missing fire extinguisher inspections. If HHSC finds deficiencies, you'll typically get a plan of correction with a deadline to fix each item, followed by a revisit. Repeated or severe deficiencies, especially anything touching resident safety or abuse/neglect, can lead to enforcement actions up to license revocation. The single best preparation is keeping your policy and procedure manual as a living document, not a binder you wrote once and never opened again. Surveyors can tell the difference between a facility that follows its own written policies and one that just has policies sitten on a shelf.
How much does it cost to license and open a group home in Texas?
Costs vary widely depending on license type, facility size, whether you're leasing or buying property, and whether you need renovation to meet fire and building code. There isn't one honest single figure to give you, and anyone quoting you an exact all-in number without knowing your specifics is guessing. What you can plan for: HHSC licensing application fees (confirm current amounts directly with HHSC, since fee schedules are updated periodically and vary by facility type and bed count) [1], background check fees per staff member, fire and building code compliance costs (which can range from minor upgrades to major renovation depending on your building's existing condition), liability insurance, and staffing costs before you have paying residents (since you need trained staff in place before your licensing inspection, not after). Medicaid provider enrollment, if you're pursuing HCS or ICF/IID licensure, adds its own administrative costs and timeline on top of standard licensing. Build a cash reserve that covers at least several months of staffing and overhead before you expect steady occupancy, because licensing timelines and initial fill rates are both slower than most first-time operators expect.
Where do I go for the official Texas rules and forms?
HHSC's Long Term Care Regulation division is the primary regulator for assisted living facilities, adult foster care, and most residential care license types in Texas, and its site hosts current applications, fee schedules, and the Texas Administrative Code sections governing each license type [1][2]. For HCS and IDD-specific programs, HHSC's IDD services pages carry the relevant provider enrollment and program rule documents [8]. For Medicare and Medicaid coverage questions specifically, Medicare.gov's long-term care coverage page [4] and Medicaid.gov's home and community-based services overview [3] are the right primary sources, not a facility's marketing page. If you want a working start point for your own policy manual, staffing plan, and application checklist rather than building every document from a blank page, the licensing kit builder is built around this exact process, a one-time $299 packet you customize to your state and population. It's a template, not a filing service, and it doesn't shortcut HHSC's review. You should also compare how other states handle similar licensing, which is covered in our assisted living facility overview and our page on assisted living at home arrangements, since some operators start smaller before scaling to a licensed facility.
Frequently asked questions
What is assisted living?
Assisted living is long-term care for people who need help with daily activities like bathing, dressing, and medication management, but who don't need the round-the-clock skilled nursing care provided in a nursing home. It's typically delivered in a residential, home-like setting with meals, supervision, and personal care staff, licensed at the state level rather than certified as a Medicare skilled nursing provider.
What is a group home?
A group home is a residential setting where a small number of people needing daily support, whether seniors, people with IDD, or people with mental illness, live together with paid staff. In Texas there's no single 'group home license'; the actual license depends on the population served, falling under assisted living, adult foster care, or HCS/ICF rules through HHSC.
What is an assisted living facility?
An assisted living facility is the licensed building or program providing food, shelter, and personal care services to residents in exchange for payment. In Texas, HHSC licenses these under Texas Health and Safety Code Chapter 247, with different facility types (A, B, C) based on residents' evacuation and care needs.
What is the difference between assisted living and a nursing home?
Assisted living serves people who need help with daily living tasks but not ongoing skilled medical care. Nursing homes serve people needing daily nursing care and are federally certified, generally requiring RN coverage at least eight hours a day per federal rule. Assisted living is state-licensed and doesn't carry that same federal nursing staffing mandate.
Does Medicare cover assisted living facilities?
No. Medicare.gov states Medicare does not cover long-term custodial care, which is most of what assisted living provides, including room, board, and personal care. Medicare may cover specific medical services a resident receives (like doctor visits or therapy), but not the facility's monthly housing and care charges.
How do I start a group home in Texas?
Pick your population and matching HHSC license type, write your program and policy manual, secure a property that clears local zoning and fire code, apply through HHSC Long Term Care Regulation with required fees and background checks, hire and train staff to meet ratio requirements, and pass your initial licensing inspection before accepting residents.
How do I start a group home for adults with IDD in Texas?
You'll generally go through HCS (Home and Community-based Services) provider enrollment or ICF/IID licensure, both regulated by HHSC, which requires Medicaid provider enrollment alongside licensing, person-centered service plans, and specific staff training like Human Rights training. This path typically takes longer than standard assisted living licensing because it combines two enrollment processes.
What license do I need to open a group home in Texas?
It depends on who you serve. Seniors needing help with daily living generally require an assisted living facility license under Health and Safety Code Chapter 247. Adults with IDD generally fall under HCS or ICF/IID programs. Confirm the exact license category with HHSC based on your resident population and level of care before applying.
How many residents can live in a Texas group home before it needs a license?
Texas generally requires an assisted living license once a facility serves four or more unrelated residents in exchange for compensation, though some smaller arrangements serving three or fewer residents may fall under different rules. Confirm the exact resident-count thresholds and any exceptions with HHSC, since definitions can vary by facility type.
How long does it take to get a group home license approved in Texas?
Timelines vary by license type, application completeness, and inspection scheduling, and HHSC does not guarantee a fixed approval window. Expect the process, from application submission through initial licensing inspection, to take several months at minimum, longer for HCS/ICF enrollment. Confirm current processing timelines directly with HHSC Long Term Care Regulation.
Can a group home operate without HHSC licensure in Texas?
No. Operating an assisted living facility, adult foster care home, or HCS/ICF residential setting without the required HHSC license is illegal and can result in enforcement action, fines, and forced closure. If you're unsure whether your planned setting requires a license, contact HHSC Long Term Care Regulation directly before accepting any residents.
What is the difference between adult foster care and assisted living in Texas?
Adult foster care in Texas typically involves smaller settings, often serving three or fewer residents in a family-style home, with a different regulatory pathway than a larger assisted living facility. Assisted living facilities generally serve four or more residents under Chapter 247 rules. Confirm the specific thresholds and requirements for each with HHSC.
Sources
- Texas Health and Human Services, Long Term Care Regulation: HHSC regulates assisted living, adult foster care, and IDD residential license types with distinct application requirements and fee schedules
- Texas Health and Safety Code, Chapter 247: Assisted living facilities are defined and licensed under Chapter 247, including facility type distinctions
- Medicaid.gov, Home & Community Based Services: Medicaid HCBS programs support long-term services and supports in the least restrictive appropriate setting
- Medicare.gov, Long-term care coverage: Medicare does not cover long-term custodial care, including most assisted living services
- eCFR, 42 CFR 483.35 Nursing services: Federal nursing home regulations require RN coverage at least eight consecutive hours a day, seven days a week
- Texas HHSC, STAR+PLUS program: Texas uses STAR+PLUS Medicaid managed care to help cover home and community-based long-term services
- Texas HHSC, IDD waiver interest lists: Texas IDD Medicaid waiver interest lists have historically involved multi-year waits
- Texas Administrative Code, Title 26, HCS Program rules: HCS providers must meet program-specific staffing, training, and service planning standards under Title 26 rules