Last updated 2026-07-25
TL;DR
Texas doesn't have one single 'group home license.' Depending on who you serve, you'll apply through Texas HHSC for an Assisted Living Facility license, a Home and Community Support Services Agency license, or an HCS/ICF-IID provider enrollment for intellectual and developmental disability services. Each path has its own fees, staffing rules, and inspection cycle.
What is a group home, and how does Texas define it legally?
A group home is a residential setting where a small number of unrelated people live together and get some level of paid support, whether that's help with meals and medication or full personal care. It's a plain-English term, not a legal one. Texas doesn't issue a license called "group home license." Instead, the state licenses specific program types depending on who lives there and what care they need. If your home serves adults who need help with daily living activities (bathing, dressing, medication reminders) but not skilled nursing, you're probably looking at an Assisted Living Facility (ALF) license through the Texas Health and Human Services Commission (HHSC). Texas Health and Safety Code Chapter 247 is the statute that governs this, and it defines an assisted living facility as an establishment that furnishes food, shelter, and personal care services to four or more persons unrelated to the proprietor [1]. If your home serves people with intellectual or developmental disabilities (IDD), you're in a different lane entirely: HHSC's Home and Community-based Services (HCS) program or Intermediate Care Facilities for Individuals with an Intellectual Disability (ICF/IID) licensure, both governed under Texas Administrative Code Title 40 [2]. If you're providing skilled home health type services on top of residential care, you may also need a Home and Community Support Services Agency (HCSSA) license. So the first real step in "how do I start a group home" in Texas isn't filling out a form. It's figuring out which of these three (or more) regulatory buckets your intended population and services fall into. Get this wrong and you'll spend months on the wrong application.
What is assisted living, and what is an assisted living facility under Texas law?
Assisted living is a residential care model built for people who need daily help with things like bathing, dressing, medication management, and meals, but who don't need round-the-clock skilled nursing care. It sits between fully independent living and a nursing home. Under Texas Health and Safety Code Chapter 247, an assisted living facility is defined as an establishment that provides personal care services, meals, and a room to four or more people who aren't related to the owner, along with some degree of supervision [1]. HHSC further breaks ALFs into Type A and Type B licenses. Type A facilities serve residents who are mobile and don't need routine attendant care during nighttime hours. Type B facilities serve residents who need staff awake and available overnight, or who need help evacuating in an emergency [3]. There's also a Type C designation for smaller adult foster care type settings and a separate certification track for facilities that want to serve people with Alzheimer's disease or related dementia, which requires additional staff training under Texas Administrative Code §553.263 [4]. If your home will house four or more unrelated adults who need this kind of personal care support, you almost certainly need an ALF license, not a general business license alone. Related reading on this site: assisted living facility and assisted living facilities breaks down the license types state by state.
What does assisted living provide, day to day?
Assisted living provides help with what regulators call activities of daily living (ADLs): bathing, dressing, toileting, mobility, and eating, plus medication reminders or administration depending on staff licensure. It also typically includes housekeeping, laundry, three meals a day, and some level of social or recreational programming. What it does not provide, by design, is ongoing skilled nursing care. Texas ALF rules require a facility to have a plan for how residents' needs are assessed at admission and reassessed periodically, so that people whose needs exceed what the facility can safely provide get transferred to a higher level of care [3]. This assessment requirement is one of the most commonly cited deficiencies in state inspections, so build your admission and reassessment policy carefully before you ever open the door. Our assisted living at home guide covers how smaller residential settings handle this same requirement. Staffing rules follow from this scope of care. Type B facilities, which serve residents needing overnight supervision or help evacuating, must have an awake, on-duty attendant at all times [3]. Type A facilities have lighter overnight staffing requirements because residents are expected to be able to evacuate independently.
What is the difference between assisted living and a nursing home?
The core difference is the level of medical care. Assisted living is personal care and supervision; a nursing home (called a skilled nursing facility or SNF) provides 24-hour skilled nursing care, physician oversight, and rehabilitation services for people recovering from illness, surgery, or managing complex chronic conditions. In Texas, nursing facilities are licensed under a completely different chapter, Texas Health and Safety Code Chapter 242, and regulated separately from ALFs under Chapter 247 [5]. Nursing facilities must have licensed nurses on duty and are subject to federal Medicare/Medicaid Conditions of Participation if they accept those payers, on top of state licensure. Cost and staffing intensity track this difference closely. Nursing homes have RN and LVN staffing mandates tied to resident acuity. Assisted living facilities in Texas are not required to have a nurse on staff at all unless residents' care plans call for delegated nursing tasks under the Texas Board of Nursing's delegation rules [6]. The practical upshot for an operator: if you're picturing a home where residents mostly need reminders, meals, and a hand getting dressed, you want an ALF license. If you're picturing ventilators, wound care, and post-hospital rehab, you're in nursing home territory and need Chapter 242 licensure, a much heavier lift.
Does Medicare cover assisted living facilities?
No. Medicare does not cover the cost of room and board or personal care services in an assisted living facility. Medicare.gov states plainly that Medicare "doesn't cover long-term care (also called custodial care)" if that's the only care needed, which is exactly the category assisted living falls into [7]. Medicare will still pay for medically necessary services a resident receives while living in an ALF, things like doctor visits, physical therapy ordered by a physician, or a short skilled nursing stay after a hospitalization, but it won't pay the facility's monthly rate for room, board, or custodial help with ADLs. Medicaid is a different story. Texas offers Medicaid waiver programs, notably STAR+PLUS and the HCS waiver for IDD populations, that can help cover home and community-based services, including some assisted living type services for eligible low-income residents [8]. Coverage and reimbursement rules are specific and change, so if your business model depends on Medicaid waiver residents, verify current reimbursement rates and eligibility rules directly with HHSC before you build a pro forma around them.
How do I start a group home in Texas, step by step?
Start by defining exactly who you'll serve and what services you'll provide, because that determines your license type before anything else happens. Here's the general sequence most Texas operators follow for an ALF license, which is the most common path for adult residential group homes: 1. Confirm your license category with HHSC. Call or check the HHSC Long Term Care Regulation division to confirm whether your model needs an ALF license, an HCSSA license, or IDD program certification [9]. 2. Check zoning and local requirements. Cities and counties in Texas can impose their own occupancy, fire code, and zoning rules on group homes, separate from state licensing. Confirm with your local planning or zoning department before signing a lease or purchase contract. 3. Secure and prepare the physical location. Your building must meet Texas Administrative Code Title 26 physical plant and life safety requirements for the facility type, including fire marshal inspection and, for larger facilities, an architectural review [3]. 4. Submit your license application to HHSC, including required policies, staffing plan, disclosure statements, and the application fee. Confirm the current fee schedule directly with HHSC's Long Term Care Regulation licensing fee page, since fees are set in state rule and change periodically . 5. Pass your pre-licensure inspection. HHSC surveyors will inspect the physical plant, review your policy manual, and check staff files before issuing an initial license. 6. Get your license and register for any Medicaid program participation if applicable, through HHSC and, separately, CMS provider enrollment if you'll bill Medicare-covered services. This is the skeleton. The real work is in steps 3 and 4, the physical plant standards and the policy manual, which is where most first-time applications get delayed.
What paperwork and policies does HHSC require in the application?
HHSC requires a written policy and procedure manual covering admission and discharge criteria, medication management, emergency preparedness, resident rights, staff training, and abuse/neglect reporting, submitted as part of your ALF license application under 26 TAC Chapter 553 [3]. You'll also need: a disclosure of ownership form identifying all controlling persons, proof of financial capacity to operate, your facility's floor plan and fire safety documentation, a staffing plan showing coverage by shift, and criminal history background check clearance for owners, administrators, and staff through the Texas HHSC Provider Investigations or the Texas DPS clearinghouse process, depending on program type [3]. Texas also requires an administrator to hold a specific license or certification depending on facility type. ALF administrators generally must complete HHSC-approved administrator training and pass a competency exam before they can run a licensed facility [3]. Building this policy manual from scratch is genuinely the slowest part of the process for most first-time operators, often slower than the physical renovation. This is the exact gap our State Group Home Licensing Kit is built to close: a $299 one-time set of policy manual templates, staffing plan worksheets, and application checklists mapped to how HHSC actually reviews applications, so you're not starting the manual from a blank page.
What are the staffing requirements for a Texas group home?
Staffing requirements depend entirely on your license type and facility designation. For Type A ALFs, Texas requires enough staff on duty to meet residents' scheduled needs, but doesn't mandate an awake overnight attendant if all residents are assessed as able to evacuate without physical assistance [3]. For Type B ALFs, an attendant must be awake and on duty at all times, because residents may need help evacuating or overnight physical assistance [3]. Facilities certified to serve residents with Alzheimer's disease or related dementia have additional staff training hour requirements under 26 TAC §553.263, covering topics like communication techniques and managing behavioral symptoms [4]. For IDD group homes licensed under the HCS program, staffing ratios are typically driven by each resident's individual service plan and level of need determination rather than a flat facility-wide ratio, so your staffing plan has to map to the specific residents you're licensed to serve [2]. Across all program types, HHSC requires documented staff training records, current CPR/first aid certification for direct care staff, and background checks cleared before an employee has unsupervised contact with residents. Build your staffing plan with realistic shift coverage for call-outs and turnover; understaffing is one of the fastest ways to trigger a complaint investigation.
What does the Texas inspection and survey process look like?
Texas ALFs get an initial licensing survey before the license is issued, then recurring unannounced inspections, typically annually, plus inspections triggered by complaints. HHSC surveyors check the physical plant, resident records, medication administration records, staff files, and policy compliance against 26 TAC Chapter 553 standards [3]. If surveyors find deficiencies, HHSC issues a statement of deficiencies and the facility must submit a plan of correction with a timeline. Serious violations, especially those involving resident health and safety, can result in enforcement actions ranging from administrative penalties to license revocation, depending on severity and whether the facility is a repeat offender [3]. Complaint investigations can happen at any time and don't require advance notice. Anyone, a family member, a staff member, an ombudsman, can file a complaint with HHSC, and investigators will show up to look into it specifically. The practical lesson here: your inspection readiness isn't a one-time event before opening, it's an ongoing operating discipline. Facilities that treat their policy manual as a living document, updated whenever a procedure changes, do much better on repeat surveys than facilities that wrote it once and filed it away.
What zoning and property rules apply to Texas group homes?
Zoning for group homes in Texas is a patchwork of state protections and local rules, and it trips up more new operators than the state license itself does. Under the federal Fair Housing Act, group homes for people with disabilities are generally protected from zoning ordinances that treat them differently than other single-family residences, and Texas courts and HHSC generally recognize small group homes (six or fewer residents) as a residential use, not a commercial one, in many jurisdictions. But "generally" is doing a lot of work in that sentence. Cities can still impose neutral requirements like parking, occupancy limits tied to square footage, fire code compliance, and separation distances between similar facilities in some cases. These vary block by block and city by city. Before signing a lease, confirm with your local zoning or planning department, and get it in writing, that your intended use is permitted at that address. This is a mistake worth avoiding twice: sign a lease first, discover a zoning problem second.
What is the difference between an IDD group home and an ALF in Texas?
An IDD group home in Texas is licensed and funded through entirely separate rules than an ALF. IDD group homes typically operate under the HCS (Home and Community-based Services) Medicaid waiver or as an ICF/IID, both regulated under Texas Administrative Code Title 40, and serve people with intellectual or developmental disabilities who need individualized supports mapped to a person-centered service plan [2]. An ALF, by contrast, is licensed under Texas Health and Safety Code Chapter 247 and serves adults, often seniors, who need personal care assistance but not IDD-specific programming [1]. Funding streams differ sharply too. HCS group homes are almost entirely Medicaid-waiver funded and enrollment is capped by waiver slots, meaning there's often a waitlist for new residents to access services, a well-documented issue with Texas's IDD waiver system [2]. ALFs are funded through private pay, long-term care insurance, and in some cases Medicaid through STAR+PLUS, but they aren't capped the same way HCS waiver slots are. If you're not sure which population you want to serve, this is the decision to make before you touch a lease or an application. The staffing models, funding streams, and even physical plant requirements diverge from here.
Frequently asked questions
What is assisted living?
Assisted living is residential care for adults who need help with daily activities like bathing, dressing, and medication management, but don't need 24-hour skilled nursing. In Texas, it's licensed as an Assisted Living Facility under Texas Health and Safety Code Chapter 247, distinct from nursing home licensure under Chapter 242 [1][5].
What is a group home?
A group home is a plain-language term for a residential setting where a small number of unrelated people live together and receive paid support. Texas doesn't license anything called a "group home"; instead it licenses specific categories like Assisted Living Facilities, HCSSA agencies, or IDD-specific HCS/ICF programs depending on the population served.
What is an assisted living facility?
Under Texas law, an assisted living facility is an establishment that provides food, shelter, and personal care services to four or more unrelated people, along with supervision [1]. Texas licenses these as Type A, Type B, or Type C facilities depending on residents' mobility and overnight care needs [3].
What is assisted living vs nursing home?
Assisted living provides help with daily activities like bathing and medication reminders; a nursing home provides 24-hour skilled nursing care and physician oversight for people with complex medical needs. Texas licenses them under separate statutes: Chapter 247 for ALFs and Chapter 242 for nursing facilities [1][5].
What does assisted living provide?
Assisted living provides help with bathing, dressing, mobility, and medication management, plus meals, housekeeping, laundry, and social programming. It doesn't provide ongoing skilled nursing care; Texas rules require facilities to reassess residents periodically and transfer anyone whose needs exceed the facility's scope of care [3].
How do I start a group home in Texas?
Confirm which license category fits your population (ALF, HCSSA, or IDD program) with HHSC, check local zoning, secure a compliant building, write your required policy manual and staffing plan, submit your application with fees, and pass a pre-licensure inspection before HHSC issues your license [3][9].
Does Medicare cover assisted living facilities?
No. Medicare does not cover room, board, or custodial personal care in assisted living facilities. Medicare.gov states it "doesn't cover long-term care" when that's the only care needed [7]. Medicare may still cover medically necessary services a resident gets while living there, like physician visits or therapy.
What license does a Texas group home need?
It depends on who lives there. Adults needing personal care generally require an Assisted Living Facility license under Texas Health and Safety Code Chapter 247. People with intellectual or developmental disabilities are served under HCS or ICF/IID programs under Texas Administrative Code Title 40 [1][2].
How much does it cost to get a Texas ALF license?
Fees are set by HHSC rule and change periodically, so confirm the current amount directly on the HHSC Long Term Care Regulation licensing fee page before budgeting [10]. Costs beyond the license fee include building renovation, staff background checks, and administrator training and exam fees.
Do Texas group homes need a nurse on staff?
Not automatically. Texas ALFs aren't required to employ a nurse unless a resident's care plan involves delegated nursing tasks, which fall under Texas Board of Nursing delegation rules [6]. Nursing facilities, licensed under a separate chapter, do require licensed nursing staff on duty.
What's the difference between Type A and Type B assisted living in Texas?
Type A facilities serve residents who are mobile and can evacuate without physical help, with lighter overnight staffing. Type B facilities serve residents needing overnight physical assistance or evacuation help, and must have an awake attendant on duty at all times [3].
Can I open a group home in a residential neighborhood in Texas?
Often yes for small group homes, since federal fair housing protections generally treat them as a residential use, but cities can still apply neutral rules like occupancy limits, parking, and fire code. Confirm zoning status in writing with your local planning department before signing a lease.
Does Texas Medicaid pay for assisted living?
Texas Medicaid can help cover some assisted living type services for eligible low-income residents through waiver programs like STAR+PLUS, and IDD group home care through the HCS waiver, but eligibility and reimbursement rules are specific and change, so verify current terms directly with HHSC [8].
Sources
- Texas Health and Safety Code Chapter 247: Definition of an assisted living facility as serving four or more unrelated persons with personal care services
- Texas Administrative Code Title 40, HHSC IDD Program Rules: HCS and ICF/IID licensure and program rules for IDD group homes
- Texas Administrative Code Title 26, Chapter 553, Assisted Living Facilities: ALF licensing standards, staffing requirements, physical plant rules, and Type A/B/C designations
- 26 TAC §553.263, Alzheimer's certification staff training: Additional staff training hours required for facilities certified to serve residents with Alzheimer's disease
- Texas Health and Safety Code Chapter 242, Nursing Facilities: Nursing facilities are licensed under a separate statute from assisted living facilities
- Medicare.gov, Long-term care coverage: Medicare doesn't cover long-term custodial care when that's the only care needed
- Texas HHSC, STAR+PLUS Program: Texas Medicaid STAR+PLUS program can help cover home and community-based services for eligible residents
- Texas HHSC, Long Term Care Regulation: HHSC Long Term Care Regulation oversees licensing determinations for ALF, HCSSA, and IDD provider types
- Texas HHSC, Long Term Care Regulation License Fees: Current ALF licensing fee schedule is maintained and updated by HHSC