Last updated 2026-07-25
TL;DR
In Texas, group homes for adults with IDD, mental illness, or aging needs are licensed by the Health and Human Services Commission (HHSC) under Texas Health and Safety Code Chapter 247 (assisted living) or through HCS/ICF programs for IDD. Requirements cover staffing, fire safety, background checks, and site inspections. There is no single "group home license"; the category depends on who you serve.
What is a group home, exactly?
A group home is a residential setting where a small number of unrelated people, usually people with disabilities, mental illness, or aging-related needs, live together and get support from paid staff. It's not a hospital and it's not a family home in the legal sense, even though it's often a house on a regular street. In Texas, the term "group home" isn't a formal license category by itself. The state licenses these homes under different labels depending on population and level of care: assisted living facilities under Texas Health and Safety Code Chapter 247 [1], Home and Community-based Services (HCS) or Intermediate Care Facilities (ICF/IID) for people with intellectual and developmental disabilities through HHSC [2], and various behavioral health residential settings for mental health and recovery populations. If you hear someone say "I'm opening a group home in Texas," ask them which population they mean. The paperwork, staffing ratios, and inspection standards are different for a four-bed IDD group home versus a 16-bed assisted living facility for seniors. Confusing the two costs people months of wasted application time. For a broader look at how this category works across states, see our guide to assisted living and assisted living facilities.
What is assisted living, and what is an assisted living facility?
Assisted living is a housing model that combines a private or semi-private living space with help for daily activities like bathing, dressing, medication reminders, and meals. It sits between fully independent senior living and a nursing home. An assisted living facility (ALF) is the licensed building or program that provides this care. Texas defines an assisted living facility in Health and Safety Code Section 247.002 as an establishment that furnishes food, shelter, and personal care services to four or more people unrelated to the proprietor, for periods longer than 24 hours [1]. HHSC issues two types of ALF licenses in Texas: Type A, for residents who are physically and mentally capable of evacuating a building without help, and Type B, for residents who need help evacuating, including some people with dementia [1]. There's also a Type C designation and small ALF options in some rules; confirm current subtypes with your state licensing agency since categories get updated. A facility that only houses three or fewer unrelated residents generally falls outside the Chapter 247 ALF licensing requirement, which is why some small operators intentionally cap capacity, though local zoning and other statutes can still apply. See our deeper explainer on assisted living facility licensing and the related facility assisted living requirements page.
What does assisted living provide day to day?
Assisted living provides a mix of housing and personal support, not medical treatment. Under Texas rules, licensed ALFs must offer three meals a day, help with activities of daily living (bathing, grooming, mobility, toileting), housekeeping, laundry, social and recreational activities, and 24-hour supervision by staff [1]. Medication administration is allowed but regulated closely. Unlicensed staff can generally only assist with self-administration (reminding, opening bottles, reading labels) unless they're delegated tasks by a registered nurse under Texas Board of Nursing delegation rules, or the facility employs licensed nurses directly. What assisted living does not typically provide is ongoing skilled nursing care, like IV therapy, wound vacs, or ventilator management. Residents who need that level of medical care usually need to move to a nursing facility or bring in outside home health or hospice services layered on top of the ALF's custodial care. HHSC's minimum standards rules (26 Texas Administrative Code Chapter 553) spell out required staffing, staff training hours, food service sanitation, and physical plant standards for these facilities [3].
What is assisted living vs nursing home? What's the difference?
| Care level | Custodial / personal care | Skilled nursing, physician-ordered | |
|---|---|---|---|
| Licensed nurse required 24/7 | No (varies by facility) | Yes | |
| Typical resident | Needs help with ADLs | Needs medical monitoring/treatment | |
| Medicaid pathway | HCBS waivers (STAR+PLUS) | Medicaid nursing facility benefit | |
| Governing statute | Tex. Health & Safety Code Ch. 247 | Tex. Health & Safety Code Ch. 242 | A lot of families pick assisted living first because it costs less and feels less institutional, then move to a nursing facility later if medical needs increase. Operators sometimes get this backwards when planning a business, thinking they can just "add nursing" to an ALF license. You can't; skilled nursing services require a different license entirely. |
The core difference is the level of medical care and the licensing category. Assisted living is custodial: help with daily living tasks in a home-like setting. A nursing home (called a nursing facility in Texas law) provides 24-hour skilled nursing care ordered by a physician, for people recovering from illness or managing complex chronic conditions. Nursing facilities in Texas are licensed under Texas Health and Safety Code Chapter 242 [4], a completely different chapter from the Chapter 247 assisted living rules. Nursing facilities must have licensed nurses on duty around the clock and are subject to federal Medicare/Medicaid Conditions of Participation if they accept those payers, per 42 CFR Part 483 [5]. | Feature | Assisted living (Ch. 247) | Nursing facility (Ch. 242) |
Does Medicare cover assisted living facilities?
No. Medicare does not cover the room and board cost of assisted living, and it generally does not cover personal care or custodial services provided in an ALF. CMS is explicit about this: Medicare Part A and Part B cover medically necessary skilled care, not long-term custodial care in a residential setting [6]. Medicare may still pay for medical services a resident gets while living in assisted living, like doctor visits, physical therapy ordered by a physician, or short-term home health visits, but it will not pay the facility's monthly rent-like fee for housing and personal care. Medicaid is a different story. Texas Medicaid can help cover some assisted living costs through Home and Community-Based Services (HCBS) waivers, most notably STAR+PLUS, which can pay for personal assistance services and other supports for eligible low-income adults who are elderly or have disabilities, though it typically does not pay full room and board [7]. Eligibility rules, waiver waitlists, and covered services change, so anyone counting on Medicaid revenue for a Texas group home needs to confirm current STAR+PLUS provider requirements with HHSC before building a business plan around it. This is one of the biggest points of confusion for new operators: assuming "Medicaid will pay for everything" without confirming which specific waiver applies to which population, and what the reimbursement actually covers.
How do I start a group home in Texas? (Step by step)
Starting a group home in Texas means choosing your population and license category first, because everything downstream, forms, fees, inspections, depends on that choice. 1. Pick your population and license type. Seniors and adults needing custodial care generally point toward an ALF license under Chapter 247 [1]. Adults with intellectual or developmental disabilities generally point toward HCS or ICF/IID enrollment through HHSC [2]. Mental health and recovery residences may fall under different licensing or, in some cases, operate as unlicensed sober living with local registration only; confirm classification with your state licensing agency before assuming you're exempt. 2. Check zoning and property compatibility. Group homes for people with disabilities are protected under the federal Fair Housing Act, and Texas Local Government Code Section 214.212 restricts how cities can regulate "community homes" for people with disabilities in single-family zones, treating qualifying small homes (typically 6 or fewer residents plus staff) similarly to a family residence [8]. Bigger facilities may need commercial zoning, fire marshal sign-off, and a certificate of occupancy. 3. Line up your building and life safety compliance. Expect a fire marshal inspection, ADA-relevant accessibility features, and compliance with life safety code requirements referenced in HHSC minimum standards rules [3]. 4. Write your policy and procedure manuals. HHSC will ask for admission and discharge policies, medication management procedures, resident rights disclosures, emergency preparedness plans, staff training plans, and abuse/neglect reporting procedures before it issues a license. 5. Build your staffing plan. You'll need documented staff-to-resident ratios (Texas doesn't set one flat number for all ALF types; it varies by facility type and resident needs under 26 TAC Chapter 553 [3]), background checks through the Texas DPS/FBI fingerprint process, and required orientation and continuing training hours for direct care staff. 6. Submit your license application and pay fees. HHSC posts current ALF license application forms and instructions on its Long Term Care Regulation licensing pages [9]. Fee amounts change periodically, so confirm current application and renewal fees directly with HHSC rather than relying on older published numbers. 7. Pass your pre-licensing inspection. HHSC surveyors will do an on-site inspection of the physical plant, fire safety, resident records, and staff files before issuing the initial license. 8. Get your license and start operating within its terms. ALF licenses in Texas are typically issued for a set period and require renewal; check current renewal timelines with HHSC. Building this stack of documents from scratch is genuinely the slowest part for most first-time operators. Some pull together a state-specific document set (policy manuals, staffing templates, inspection checklists) instead of drafting from zero. GroupHomePath's $299 State Group Home Licensing Kit is built around this exact document stack for operators who want a starting template rather than a blank page.
What paperwork and policies does HHSC actually require?
HHSC's minimum standards for ALFs, found in 26 Texas Administrative Code Chapter 553, require a defined set of written policies before a license is issued [3]. At minimum, expect to submit or maintain: an admission agreement template disclosing services and fees, a resident rights policy consistent with state and federal disability rights protections, a medication management and administration policy, an emergency preparedness and evacuation plan (including how Type B facilities handle residents who can't self-evacuate), an abuse, neglect, and exploitation reporting policy tied to mandatory reporting law, infection control procedures, and a staff training plan covering required orientation hours. HHSC also requires background checks. Direct care staff and certain other employees must clear criminal history checks through the Texas Department of Public Health/HHSC Provider Investigations process before working unsupervised with residents. Facilities that fail to properly screen staff face licensing action, and this is one of the most common citation categories in state survey reports. Don't treat these policies as boilerplate to satisfy a checklist. Surveyors will ask staff about the actual procedures during inspection interviews, and a policy manual that doesn't match real practice creates a citation, sometimes a serious one.
What are the staffing and background check requirements?
Staffing requirements in Texas ALFs scale with facility type and resident acuity rather than one fixed number. Type A facilities (residents who can self-evacuate) generally require less intensive staffing than Type B facilities (residents needing evacuation assistance, including many dementia care residents), per HHSC minimum standards [3]. All facilities must have an awake staff member on duty overnight if any resident needs help evacuating or has needs that require overnight monitoring. Administrators of ALFs must meet specific qualification and, in many cases, licensing or certification requirements set by HHSC; confirm the current administrator licensure rule with the agency since training hour requirements are periodically updated. Every direct care employee needs a criminal background check before starting unsupervised work, and HHSC maintains an employee misconduct registry that facilities are required to check before hire. Facilities that skip this step, or hire before results come back, risk both a licensing citation and, in a worst case, a resident safety incident that triggers an immediate jeopardy finding. Staff training isn't a one-time event either. HHSC rules require ongoing in-service training hours annually, covering topics like resident rights, infection control, and emergency procedures. Build this into your annual budget and calendar from day one instead of scrambling before a renewal survey.
What zoning rules apply to a Texas group home?
Zoning is where a lot of otherwise well-prepared operators get stuck, because it's local, more than state-level. Texas state law gives some protection to small group homes, but cities still control a lot of the details. Texas Local Government Code Section 214.212 addresses "community homes" for people with disabilities, generally requiring cities to treat qualifying small homes (the statute references homes serving a limited number of residents, commonly cited around six, plus necessary staff) the same as other single-family residential uses, meaning a city generally can't use zoning alone to exclude a small, appropriately licensed group home from a residential neighborhood [8]. This tracks the intent of the federal Fair Housing Act, which prohibits zoning that discriminates against housing for people with disabilities. But this protection has limits. It typically applies to smaller homes serving people with disabilities specifically, not necessarily to larger assisted living facilities, and it doesn't override legitimate health and safety codes, fire codes, or occupancy limits tied to building size. A 16-bed ALF in a single-family zoned neighborhood is a very different zoning conversation than a 6-bed IDD group home. Before signing a lease or buying property, call your city or county planning/zoning department and ask directly: is this specific use, at this specific bed count, allowed at this address under current zoning, and does it need a special use permit, variance, or separate certificate of occupancy? Get the answer in writing if you can. Zoning denials after a lease is signed are one of the most expensive mistakes in this business, and they're avoidable with one phone call before you commit to a property.
What happens during a Texas group home inspection?
HHSC conducts an initial licensing survey before your license is issued, then periodic renewal surveys, plus complaint-driven investigations if someone reports a concern. Surveyors from HHSC's Long Term Care Regulation division typically review resident records, staff files (including background check documentation), medication administration records, the physical building (fire exits, smoke detectors, sprinkler systems where required, kitchen sanitation), and interview staff and residents. Common citation areas in Texas ALF surveys include incomplete or late background checks, missing or outdated care plans, medication administration errors or documentation gaps, inadequate staffing during required hours, and fire/life safety deficiencies like blocked exits or expired fire extinguisher inspections. If a survey finds deficiencies, the facility gets a plan of correction requirement and a follow-up visit to confirm the fix. Serious deficiencies, especially anything HHSC classifies as an immediate threat to resident health or safety, can result in a directed plan of correction, admission holds, or in severe cases, license revocation. The best preparation isn't a last-minute cleanup before a scheduled survey (and Texas surveys are often unannounced anyway). It's running your documentation and staffing the way you'd want it to look if a surveyor walked in unannounced tomorrow, because that's exactly what happens.
How much does it cost and how long does it take to get licensed?
Costs and timelines vary by facility type, size, and how prepared your application is when submitted, so treat any number you see online, including here, as a planning range rather than a guarantee. Expect these general cost categories: HHSC application and licensing fees (confirm current amounts directly on HHSC's licensing fee schedule since these are adjusted periodically), fire marshal and building inspection fees charged locally, background check/fingerprinting fees per employee, and the cost of any physical plant upgrades needed to meet fire and life safety code. Timeline-wise, first-time applicants should expect the process, from initial application submission to license issuance, to take multiple months rather than weeks, largely because scheduling the initial survey and correcting any pre-licensing deficiencies takes time. Applicants who submit incomplete policy manuals or haven't finished required staff background checks before their scheduled survey are the ones who see the longest delays, sometimes pushing a projected two-month timeline into five or six months. There's no legitimate fast-track guarantee anyone can offer you here. HHSC's process moves at the pace of accurate paperwork and a compliant building; the fastest path is simply not giving surveyors anything to send back for correction.
How is IDD group home licensing different from assisted living?
If your residents have intellectual or developmental disabilities rather than aging-related care needs, you're generally not applying for a Chapter 247 ALF license at all. Instead, Texas serves this population mainly through HHSC's Home and Community-based Services (HCS) program and Intermediate Care Facilities for Individuals with an Intellectual Disability (ICF/IID), both administered through HHSC's IDD services division [2]. HCS group homes are typically smaller, Medicaid-waiver funded settings where providers contract with HHSC to deliver services under an approved provider enrollment process, rather than a standard building license like an ALF. ICF/IID facilities are licensed and certified separately and must meet federal Medicaid conditions of participation for intermediate care facilities under 42 CFR Part 483 Subpart I [5]. The enrollment and contracting process for HCS providers involves a provider application, a pre-enrollment review, home and record reviews, and ongoing HHSC monitoring, which is a meaningfully different administrative path than the ALF license process described above. If you're planning to serve the IDD population, don't reuse ALF paperwork or assume the same fee schedule and forms apply; go straight to HHSC's IDD provider enrollment pages and confirm the current process.
Frequently asked questions
What is assisted living?
Assisted living is a residential care model where people get help with daily activities like bathing, dressing, and medication reminders while living in a private or semi-private unit. It's less medically intensive than a nursing home. In Texas it's licensed under Health and Safety Code Chapter 247 as an assisted living facility, with Type A and Type B designations based on residents' evacuation ability [1].
What is a group home?
A group home is a residential setting where a small number of unrelated people with disabilities, mental illness, or aging needs live together and receive support from paid staff. In Texas, "group home" isn't a single license category; it's licensed differently depending on the population, usually as an assisted living facility, an HCS/ICF-IID provider for IDD residents, or under separate behavioral health rules.
What is an assisted living facility?
An assisted living facility (ALF) is a licensed establishment that provides food, shelter, and personal care services to four or more unrelated residents for more than 24 hours at a time. Texas Health and Safety Code Section 247.002 defines this and HHSC licenses ALFs as Type A or Type B based on residents' ability to evacuate independently [1].
What is the difference between assisted living and nursing home?
Assisted living provides custodial help with daily activities in a home-like setting, licensed under Texas Chapter 247. A nursing home (nursing facility) provides 24-hour skilled nursing care ordered by a physician, licensed under a different statute, Texas Chapter 242, and must have licensed nurses on duty around the clock [1][4].
Does Medicare cover assisted living facilities?
No. Medicare does not pay for the room, board, or custodial personal care costs of assisted living. CMS covers medically necessary skilled services, not long-term custodial residential care [6]. Medicare may still pay for a doctor visit or short-term therapy a resident gets while living in an ALF, but not the facility's monthly fee.
How do I start a group home in Texas?
Pick your population and correct license category first (ALF under Chapter 247, or HCS/ICF-IID for IDD residents), then confirm zoning, prepare required policies and staffing plans, complete staff background checks, submit your HHSC application with fees, and pass the pre-licensing inspection. Expect the full process to take several months, longer if paperwork is incomplete.
Does Texas Medicaid pay for assisted living or group homes?
Texas Medicaid can help cover some costs through Home and Community-Based Services waivers, notably STAR+PLUS, which can pay for personal assistance services for eligible low-income elderly or disabled adults, though it usually doesn't cover full room and board [7]. IDD group homes are often funded through the separate HCS waiver program administered by HHSC [2].
Can a Texas group home operate in a residential neighborhood?
Often yes, for small homes. Texas Local Government Code Section 214.212 generally requires cities to treat qualifying small "community homes" for people with disabilities the same as other single-family residential uses, limiting how much zoning alone can exclude them [8]. Larger facilities may still need commercial zoning or special permits; always confirm with your local planning department.
What background checks are required for group home staff in Texas?
Direct care staff must complete a criminal history background check before working unsupervised with residents, and facilities must check HHSC's employee misconduct registry before hiring. Requirements are set out in HHSC minimum standards rules and enforced during licensing surveys [3]. Skipping or delaying this check is one of the most common citation issues in Texas ALF inspections.
What staffing ratio does Texas require in assisted living facilities?
Texas doesn't set one flat statewide ratio; staffing requirements scale with facility type (Type A vs Type B) and resident needs under 26 Texas Administrative Code Chapter 553 [3]. Facilities with residents needing evacuation assistance or overnight monitoring generally need more awake staff on duty than Type A facilities serving independently mobile residents.
How long does it take to get a group home license in Texas?
There's no guaranteed timeline, and HHSC doesn't publish a fixed number. Realistically, expect several months from application submission to license issuance, since scheduling the pre-licensing survey and correcting any deficiencies takes time. Applicants with complete policy manuals and finished staff background checks before their scheduled survey generally move faster than those who don't.
Is a sober living or recovery residence the same as a licensed group home in Texas?
Not necessarily. Some recovery residences operate without a full facility license if they don't provide direct medical or personal care services, functioning more like shared housing with peer support. Others fall under different behavioral health licensing depending on services offered. Confirm classification with HHSC before assuming a sober living home is exempt from licensing.
Sources
- Texas Health and Safety Code, Chapter 247 (Assisted Living Facilities): Definition of assisted living facility, Type A/Type B designations, and licensing framework
- Texas HHSC, Intellectual and Developmental Disabilities Services: HCS program licensing/enrollment path for IDD group homes
- Texas Administrative Code, Title 26, Chapter 553 (Licensing Standards for Assisted Living Facilities): Minimum standards for staffing, training, policies, and physical plant in Texas ALFs
- Texas Health and Safety Code, Chapter 242 (Nursing Facility Licensing): Nursing facility licensing requirements distinct from assisted living
- Code of Federal Regulations, 42 CFR Part 483: Federal conditions of participation for nursing facilities and ICF/IID
- Medicare.gov, Long-term care coverage: Medicare does not cover long-term custodial care such as assisted living room and board
- Texas HHSC, STAR+PLUS Medicaid Managed Care: STAR+PLUS waiver can cover personal assistance services for eligible elderly/disabled adults
- Texas Local Government Code, Section 214.212: Cities must generally treat qualifying small community homes for people with disabilities as single-family residential use
- Texas HHSC, Long Term Care Regulation, Assisted Living Facility Licensing: HHSC licensing process, forms, and application requirements for ALFs