Last updated 2026-07-25
TL;DR
A Texas group home for adults with disabilities or seniors is licensed by HHSC, usually as an Assisted Living Facility or a HCSSA-related program. Expect a license application, a facility inspection, staffing and fire-safety requirements, and a wait of several months. Medicare does not pay for room and board; Medicaid may cover services through HCS or STAR+PLUS waivers.
What is a group home, exactly?
A group home is a residential setting, usually a house or small facility, where a handful of unrelated people who need support live together with paid staff on site or on call. In Texas, the term gets used loosely, but the state regulates these settings under specific license types depending on who lives there and what care they get. For adults with intellectual or developmental disabilities (IDD), Texas Health and Human Services Commission (HHSC) licenses many group homes under Home and Community-based Services (HCS) provider enrollment plus facility standards, or under the broader "Assisted Living Facility" category if the setting meets that definition. For seniors needing help with daily activities, the relevant license is almost always Assisted Living Facility (ALF), regulated under Texas Health and Safety Code Chapter 247 [1]. For mental health or recovery-focused housing, licensing depends heavily on whether personal care services are provided on site; sober living homes that don't provide care often aren't licensed at all, while those offering assistance with medication or ADLs usually need an ALF license. The practical upshot: before you buy a house or sign a lease, you need to know which HHSC license category your population and service model fall into. Get that wrong and you'll redo your whole application. Confirm the correct category with your state licensing agency before doing anything else.
What is assisted living?
Assisted living is a licensed residential care model for people, most often older adults, who need help with daily activities like bathing, dressing, medication management, or meal prep, but don't need the round-the-clock skilled nursing care a nursing home provides. Texas defines and licenses this as an Assisted Living Facility (ALF) under Health and Safety Code Chapter 247 [1]. ALFs in Texas fall into license types based on the level of care and the number of residents who need evacuation assistance: Type A (residents can evacuate independently in an emergency), Type B (residents need help evacuating or have certain cognitive or mobility limitations), and Type C (small, specific programs, less common). Each type carries different staffing ratios, physical plant requirements, and fire code obligations under HHSC rules found in 26 Texas Administrative Code Chapter 553 [2]. A small group home serving four to eight seniors who need overnight supervision, for example, is very likely to fall under Type B, which requires an awake staff member on site at all times [2].
What is an assisted living facility?
An assisted living facility is the specific licensed entity, whether it's a single house or a larger campus, that Texas HHSC certifies to provide personal care services and supervision to residents in a residential (non-medical) setting. The legal definition sits in Texas Health and Safety Code Section 247.002, which describes an ALF as an establishment that furnishes food, shelter, and personal care services for four or more people unrelated to the proprietor [1]. That "four or more residents" threshold matters a lot for small operators. If you're caring for three or fewer unrelated residents in a home, you may fall outside ALF licensing entirely, though this varies by exact services provided and you should confirm the threshold and any service-related exceptions directly with HHSC before assuming you're exempt. Many aspiring group home owners get tripped up here: they assume a small house is automatically unlicensed, then get a cease-and-desist letter once a neighbor complains. An ALF license is issued to a specific physical address and operator, not a person in the abstract. That means if you want to run two homes, you need two separate licenses, two separate inspections, and two separate sets of policies tailored to each site's floor plan and evacuation capacity [2].
What does assisted living provide, day to day?
Assisted living provides supervised housing plus help with what's often called activities of daily living (ADLs): bathing, dressing, toileting, transferring, and eating, along with medication administration or reminders, meals, housekeping, laundry, and some level of social or recreational programming. It does not typically provide ongoing skilled nursing care, IV therapy, or complex wound care, though Texas rules allow limited nursing tasks depending on facility type and the resident's needs [2]. Under 26 TAC Chapter 553, Type B facilities must have staff capable of providing assistance with evacuation and must maintain a resident's individual service plan that documents the specific help each person needs [2]. That plan isn't paperwork for paperwork's sake; inspectors will ask to see it and compare it against what staff actually do on shift. A well-run group home in Texas typically documents: medication administration records (MARs), incident reports, staffing schedules matched to resident acuity, and a current fire drill log. If you're building these systems from scratch, a policies and procedures framework built around the actual TAC chapter saves you from reinventing forms that inspectors already expect to see in a specific format.
What is the difference between assisted living and a nursing home?
| Texas statute | Health & Safety Code Ch. 247 [1] | Health & Safety Code Ch. 242 | |
|---|---|---|---|
| Care level | Help with ADLs, supervision | Skilled nursing, medical care | |
| Staffing | Direct care staff, medication aides | Licensed nurses 24/7 | |
| Medicare coverage | Not covered for room/board [3] | Short-term skilled stays may be covered [3] | |
| Typical resident | Needs daily living support | Needs ongoing medical/nursing care | Families often move a loved one from assisted living to a nursing home when medical needs outpace what direct care staff can safely manage, not because the person "failed" assisted living, but because the care model genuinely changed. |
The core difference is the level of medical care and the license type. Assisted living (ALF) is a residential, non-medical model focused on daily living support; nursing homes are licensed as skilled nursing facilities that provide 24-hour nursing care, rehabilitation, and medical treatment for people with more complex health needs. Texas licenses nursing facilities separately under Health and Safety Code Chapter 242, not Chapter 247 [1]. Cost and staffing reflect that gap. Nursing homes must have licensed nurses on duty around the clock and typically serve residents recovering from surgery, managing chronic illness, or needing rehabilitation. Assisted living facilities are staffed by direct care workers and, in Texas, are not required to have a registered nurse on site at all times, though medication aides and certain trained staff handle medication tasks under specific rules [2]. | Feature | Assisted Living (ALF) | Nursing Home (SNF) |
Does Medicare cover assisted living facilities?
No. Medicare does not cover the cost of room and board in an assisted living facility, and it never has. Medicare.gov states plainly that Medicare "doesn't cover . . . long-term care (also called custodial care)" including help with daily activities like bathing and dressing when that's the only care needed [3]. Medicare will pay for specific medical services a resident receives, like doctor visits, some home health services, or a short skilled nursing stay after a qualifying hospitalization, but it will not pay the facility's monthly rate for housing, meals, or personal care assistance [3]. Medicaid is a different story, and it's where most funding conversations for group homes actually happen. Texas Medicaid doesn't pay ALF room and board directly either, but home and community-based waiver programs like STAR+PLUS and the HCS (Home and Community-based Services) waiver can pay for the care services delivered in a residential setting, and some programs combine with Supplemental Security Income (SSI) to help residents afford room and board [4][5]. If you're building a business model around Medicaid-funded residents, get familiar early with assisted living facility requirements and how HHSC's waiver enrollment process works, because provider enrollment is a separate track from facility licensing.
How do I start a group home in Texas?
Starting a group home in Texas means securing the right property, choosing your license category, submitting an application to HHSC, passing a life-safety and health inspection, and hiring staff who meet training requirements, roughly in that order, though some steps run in parallel. Here's the realistic sequence. 1. Confirm your license category (ALF Type A/B, HCS group home, or another HHSC program) based on your target population, following the definitions in Health and Safety Code Chapter 247 or the HCS provider rules [1][6]. 2. Secure a property that meets zoning requirements for a group home use, and check local fire marshal and building code requirements alongside the HHSC physical plant standards in 26 TAC Chapter 553 [2]. Zoning fights are one of the most common reasons projects stall; confirm allowed use with your city or county planning department before signing a lease. 3. Submit your license application to HHSC's Long Term Care Regulation division, including facility floor plans, ownership disclosure, and your policies and procedures manual [6]. 4. Pass a pre-licensing inspection covering fire safety, food handling, and physical plant standards. Expect the state fire marshal or local authority to be involved for life-safety sign-off [2]. 5. Hire and train staff to meet HHSC's minimum qualifications, including required orientation hours, and complete required background checks through the Texas Department of Public Safety and HHSC's Employee Misconduct Registry [6]. 6. Once licensed, maintain compliance with ongoing inspections, which HHSC conducts on a routine and complaint-driven basis [2]. Timelines vary a lot depending on how complete your application is and how backed up your local HHSC region is; some operators report a few months from application to license, others longer, especially if the first inspection finds deficiencies that need correcting and re-inspection. Confirm current processing times with your HHSC regional office, since these shift with staffing and application volume.
How do I actually build the paperwork HHSC wants to see?
This is where most first-time applicants lose weeks. HHSC doesn't just want a floor plan and a check; it wants an operational package that proves you can run the place safely on day one. That means a written policies and procedures manual covering medication management, emergency preparedness, resident rights, abuse/neglect reporting, staffing plans by shift, and admission/discharge criteria, all matched to your specific facility type under 26 TAC Chapter 553 [2]. A lot of applicants try to write this from a generic template found online, then get deficiency citations because the template doesn't match Texas-specific requirements like the Employee Misconduct Registry check or Texas's specific fire drill frequency rules. If you want a shortcut through that first draft, the $299 State Group Home Licensing Kit at /licensing-kit-builder builds a Texas-specific policy manual and staffing plan template so your first submission to HHSC isn't a rough draft; it still needs your facility's specific details filled in, and it doesn't replace working directly with HHSC or a licensing consultant on anything state-specific like fee amounts or your regional office's exact submission process. Whatever path you take, budget real time for a second draft. Inspectors flag manuals that read generically far more often than ones that reference specific room numbers, specific staff titles, and specific local emergency contacts.
What does inspection and ongoing compliance look like?
HHSC conducts both pre-licensing and ongoing inspections of assisted living facilities to verify compliance with 26 TAC Chapter 553, covering everything from medication storage to exit signage to staff-to-resident ratios during specific times of day [2]. Inspections can be scheduled (routine survey) or unannounced, and complaint-driven inspections can happen at any time if HHSC receives a report of neglect, abuse, or an unsafe condition. Common deficiency areas nationally, and Texas is no exception, include incomplete medication administration records, missing or expired staff training documentation, and fire drill logs that don't match the required frequency. Keep your logs current in real time, not reconstructed the week before a survey; surveyors can often tell the difference from ink patterns and staff interviews alone. If you receive a deficiency citation, HHSC generally requires a plan of correction with a defined timeline. Repeated or serious violations can lead to enforcement actions, up to and including license revocation, so treat the first citation as a serious signal to fix systemic gaps, more than the specific instance flagged.
How much does it cost to license a group home in Texas?
Exact license fees change periodically, so confirm current amounts directly with HHSC's Long Term Care Regulation licensing fee schedule before budgeting [6]. Beyond the state license fee itself, real costs include property acquisition or lease, renovations to meet fire and physical plant codes (fire-rated doors, sprinkler systems in some cases, accessible bathrooms), staff wages and required training hours, liability insurance, and background check fees per employee. Most underestimated cost: physical plant retrofits. A house that looks perfectly livable to a family often fails an ALF inspection on fire separation, exit width, or plumbing fixture counts specific to the resident capacity you're licensing for. Get a fire marshal walkthrough before you sign a lease, not after. Staffing costs run continuously and dwarf the one-time licensing fee over the life of the business. Texas requires specific staff-to-resident ratios and awake overnight staff for Type B facilities, and every hour of coverage is a real payroll cost you need modeled before you commit to a lease [2].
What's the difference between a group home for IDD, mental health, and seniors in Texas?
Texas doesn't use one license for all group homes; the population served determines the regulatory path. Group homes serving adults with intellectual or developmental disabilities are usually tied to HCS or Texas Home Living (TxHmL) Medicaid waiver enrollment through HHSC, with its own provider standards separate from general ALF rules [5][6]. Group homes serving seniors who need help with ADLs are licensed as Assisted Living Facilities under Chapter 247 [1]. Mental health and recovery residences occupy a gray zone: if the home only provides housing and peer support with no hands-on personal care, it may not need an HHSC license at all, but the moment staff start administering medication or assisting with ADLs, ALF licensing rules typically apply. This distinction changes almost everything about your application: which HHSC division you work with, which staffing credentials you need, what your policy manual must cover, and which population-specific training (like IDD behavioral support or mental health crisis response) your staff need. If you're not sure which category fits your model, HHSC's Long Term Care Regulation intake staff can point you to the right program before you file anything [6]. See also our overview on assisted living facilities for how population type shapes licensing category across states.
How does zoning affect where I can open a group home in Texas?
Zoning is a local (city or county) matter, separate from HHSC state licensing, and it can stop a project just as fast as a licensing denial. Many Texas cities allow small group homes (typically six or fewer residents) in residential zones under fair housing accommodations, since federal Fair Housing Act protections limit a city's ability to exclude group homes for people with disabilities from residential neighborhoods purely because of the use. Larger facilities or those serving more residents may need a special use permit or fall under commercial zoning depending on your municipality. Before signing a lease or purchase agreement, call your city or county planning department and ask directly whether the address is zoned for a group home / residential care use at your intended capacity. Get the answer in writing if you can. This step gets skipped constantly by first-time operators who assume state licensing is the only approval that matters, then discover a zoning objection six months into the process. For a wider look at how this plays out across different states, see our guide on assisted living at home models and how they intersect with residential zoning rules.
Frequently asked questions
What is assisted living?
Assisted living is a licensed residential care option for people who need help with daily activities like bathing, dressing, or medication management but don't need full-time skilled nursing care. In Texas, it's licensed as an Assisted Living Facility under Health and Safety Code Chapter 247, with rules on staffing and physical plant set out in 26 TAC Chapter 553.
What is a group home?
A group home is a residential setting, often a single house, where several unrelated residents who need support live together with paid caregiving staff. In Texas, depending on the population served, it's licensed as an Assisted Living Facility, enrolled as an HCS/TxHmL provider, or in limited cases operates without a state license if no personal care is provided.
What is an assisted living facility?
An assisted living facility is the specific licensed entity HHSC certifies to provide food, shelter, and personal care to four or more unrelated residents in a residential setting, as defined in Texas Health and Safety Code Section 247.002. It must meet staffing, physical plant, and fire safety standards under 26 TAC Chapter 553.
What is assisted living facility, in plain terms?
It's a licensed home or building where people who need help with daily tasks like bathing, meals, or medication get that support while living in a residential, non-hospital setting. Texas assigns license types (A, B, C) based on how much help residents need to evacuate safely in an emergency, which drives staffing rules.
What is the difference between assisted living and nursing home?
Assisted living provides help with daily activities in a residential, non-medical setting; nursing homes provide 24-hour skilled nursing care for people with complex medical needs. Texas licenses them under separate chapters of the Health and Safety Code (247 for ALFs, 242 for nursing facilities), with very different staffing and licensing requirements.
What does assisted living provide?
Assisted living provides housing, meals, help with bathing/dressing/toileting, medication administration or reminders, housekeeping, and social activities. It generally does not provide ongoing skilled nursing, IV therapy, or complex medical treatment, which falls under nursing home or home health care instead.
How do I start a group home in Texas?
Confirm your license category with HHSC based on the population you'll serve, secure a property that meets zoning and fire code requirements, submit a license application with floor plans and a policies manual, pass a pre-licensing inspection, and hire staff who meet training and background check requirements. Expect the process to take several months.
How do I start a group home if I have no healthcare background?
You don't need a clinical license to open most group homes, but you do need an administrator or manager who meets HHSC's qualification requirements for your facility type, plus trained direct care staff. Many first-time operators partner with or hire an experienced administrator to meet these requirements while they handle the business side.
Does Medicare cover assisted living facilities?
No. Medicare does not cover room and board or custodial care in assisted living facilities. It may cover specific medical services a resident receives there, like doctor visits or limited home health care, but not the facility's monthly housing and personal care charges.
Does Medicaid pay for group homes in Texas?
Texas Medicaid doesn't pay ALF room and board directly, but waiver programs like STAR+PLUS and the HCS waiver can cover the personal care and support services delivered in a residential setting. Room and board is often covered separately through the resident's own income, including SSI, depending on the program.
How many residents can live in a Texas group home before it needs an ALF license?
Texas Health and Safety Code Section 247.002 generally defines an assisted living facility as serving four or more unrelated residents, but the exact threshold and any exceptions depend on the specific services provided. Confirm your specific situation directly with HHSC before assuming a smaller home is exempt.
What's the difference between Type A and Type B assisted living licenses in Texas?
Type A facilities serve residents who can evacuate a building on their own in an emergency with minimal staff assistance. Type B facilities serve residents who need staff help to evacuate or who have certain cognitive or mobility limitations, which triggers stricter staffing requirements, including awake overnight staff.
How long does it take to get a group home license in Texas?
Timelines vary widely based on application completeness, property readiness, and regional HHSC workload; some operators report a few months from application submission to licensure, others longer if inspections find deficiencies that require correction and re-inspection. Confirm current expected timelines with your HHSC regional office.
Sources
- Texas Statutes, Health and Safety Code Chapter 247: Legal definition of an assisted living facility and the four-or-more-residents threshold
- Texas Administrative Code, Title 26, Chapter 553: Assisted living facility staffing, physical plant, license type (A/B/C), and inspection requirements
- Medicare.gov, Nursing Home Care coverage page: Medicare does not cover long-term custodial care or assisted living room and board
- Texas HHSC, STAR+PLUS program page: STAR+PLUS Medicaid managed care can cover long-term services and supports in community settings
- Texas HHSC, Home and Community-based Services (HCS) Program page: HCS waiver enrollment and provider standards for group homes serving people with IDD
- Texas HHSC, Assisted Living Facilities licensing overview: HHSC Long Term Care Regulation licensing process, application requirements, and staff background check obligations