Last updated 2026-07-25
TL;DR
To start a group home for adults in Texas, you generally need to pick a license type through the Texas Health and Human Services Commission (HHSC), such as an Assisted Living Facility license or an HCS/ICF provider contract, meet facility and staffing rules, pass a fire and life-safety inspection, and complete a pre-licensing survey. Expect several months from application to open license.[1]
What is a group home, exactly?
A group home is a small residential setting where a handful of adults, often people with intellectual or developmental disabilities (IDD), mental illness, or age-related care needs, live together and get support with daily activities. It's not one specific license type. In Texas, what most people call a "group home" could actually be licensed as an Assisted Living Facility, a Home and Community-based Services (HCS) provider setting, an Intermediate Care Facility for Individuals with an Intellectual Disability (ICF/IID), or a personal care home, depending on who lives there and what care they need.[1] This matters because the license you need drives almost everything else: your staffing ratios, your building code requirements, your inspection checklist, and your funding sources. A lot of new operators pick the wrong license category first and waste months redoing paperwork. Before you sign a lease or make an offer on a house, figure out which population you're serving and which HHSC program regulates that population. Texas HHSC regulates these settings under its Long-term Care Regulation division, and the specific chapter of the Texas Administrative Code that applies depends on your license type. Assisted Living Facilities fall under 26 TAC Chapter 553, for example.[2]
What is assisted living?
Assisted living is a licensed residential care model for adults, usually older adults, who need help with daily activities like bathing, dressing, medication management, and meals, but who don't need the round-the-clock skilled nursing care a nursing home provides. In Texas, assisted living facilities are licensed by HHSC under Texas Administrative Code Title 26, Chapter 553, which sets rules for staffing, physical plant, resident rights, and services.[2] Assisted living residents typically live in private or semi-private rooms or apartments, and the facility provides some level of supervision, help with activities of daily living (ADLs), and often social and recreational programming. It sits between fully independent senior living and a nursing home on the care spectrum. If your group home model is aimed at older adults who need support but not medical-level nursing care, an assisted living license is probably your path. If you're serving adults with IDD or serious mental illness instead, you're likely looking at a different HHSC program (HCS, ICF/IID, or a mental health community setting) rather than assisted living. Check assisted living for a broader look at how the license category works across settings.
What is an assisted living facility (and how is it different from a personal care home)?
An assisted living facility, under Texas rules, is a licensed facility that provides food, shelter, and personal care services for four or more residents unrelated to the facility owner.[2] The word "facility" here is doing legal work. Once you're housing four or more unrelated adults and providing personal care, you generally cross into facility licensing territory rather than being treated as an informal boarding arrangement. Texas categorizes assisted living facilities into different types (sometimes called Type A, Type B, and Type C historically, though HHSC has moved toward a more unified licensing framework in recent code updates) based on the mobility and care needs of residents. A facility serving residents who can evacuate independently in an emergency has different physical plant and staffing rules than one serving residents who need staff assistance to evacuate.[2] Confirm the current facility type structure with your state licensing agency, since Texas has updated Chapter 553 rules over time and the categories used in casual conversation don't always match the current regulatory text. See assisted living facility and assisted living facilities for related detail on how facility type affects licensing requirements.
What is assisted living vs nursing home?
| Level of care | Help with ADLs, some medication support | Skilled nursing, rehab, medical monitoring | |
|---|---|---|---|
| Staffing | Personal care aides, limited nursing | RNs, LVNs, CNAs required | |
| Typical resident | Needs supervision, not medical care | Needs daily nursing or post-hospital care | |
| Texas regulation | 26 TAC Chapter 553 | Separate nursing facility licensing rules | |
| Medicare coverage | Not covered as room and board | Covered for limited post-hospital stays | If you're deciding which model to build, be honest about the acuity of the residents you want to serve. Trying to run a nursing-home-level population under an assisted living license is a compliance problem waiting to happen, and HHSC surveyors will catch it. |
Assisted living and nursing homes both provide residential care, but they serve different acuity levels and are regulated differently. Assisted living is for people who need help with daily living tasks but not ongoing skilled nursing or medical treatment. A nursing home (called a skilled nursing facility, or SNF, for Medicare and Medicaid purposes) is for people who need daily nursing care, rehabilitation after a hospital stay, or medical monitoring that goes beyond personal care.[3] In Texas, nursing homes are licensed separately from assisted living facilities and are subject to federal certification requirements if they accept Medicare or Medicaid payment, on top of state licensing.[3] Staffing requirements are heavier in a nursing home: registered nurses and licensed vocational nurses are part of the required staffing model, whereas an assisted living facility's staffing plan is built more around personal care attendants and a smaller nursing presence (or none at all, in lower-acuity facility types). | Feature | Assisted Living | Nursing Home |
What does assisted living provide?
Assisted living typically provides three bundled things: a place to live, help with daily activities, and some level of supervision or safety monitoring. Texas rule requires assisted living facilities to provide food, shelter, and personal care services, plus supervision appropriate to the resident's needs.[2] In practice, this usually breaks down into: housing (a private or shared room), three meals a day plus snacks, help with bathing, dressing, grooming, and toileting, medication reminders or administration depending on staff licensure, housekeeping and laundry, and some activities or social programming. Some facilities also provide transportation to medical appointments, though this varies by operator and is not universally required by rule. What assisted living does not typically provide is skilled nursing care, IV therapy, wound care beyond basic first aid, or 24-hour medical supervision by a nurse. If a resident's needs escalate past what your license type allows, Texas rule generally requires a plan for transferring that resident to a higher level of care, and your admission agreement should spell out what happens in that situation.
How do I start a group home in Texas? (step-by-step)
Starting a group home in Texas is a licensing process, not a single form. Here's the general sequence, though you should confirm each requirement with HHSC directly since program-specific rules vary: 1. Decide your population and license type. Older adults needing personal care usually means an assisted living license. Adults with IDD usually means an HCS provider enrollment or ICF/IID license. Adults with serious mental illness or recovery needs may fall under a different HHSC behavioral health program. This decision drives every other step. 2. Check zoning before you commit to a property. Group homes for people with disabilities are protected under the federal Fair Housing Act, and many Texas cities have specific rules about how group homes are treated in single-family zones.[4] Don't sign a lease until you've confirmed with local planning or zoning staff that your intended use is allowed at that address. 3. Form your business entity and get an EIN. Most operators set up an LLC or corporation in Texas through the Secretary of State before applying for licensure, since HHSC licenses are typically issued to a legal entity, not an individual. 4. Submit your license application to HHSC. This includes the facility's physical plant plans, staffing plan, policies and procedures manual, background check documentation for owners and staff, and applicable fees. Fee amounts and specific form numbers change, so confirm current figures with HHSC's Long-term Care Regulation division rather than relying on a number you saw somewhere else. 5. Pass a fire marshal and life-safety inspection. Most residential care licenses require sign-off from the local fire authority or the State Fire Marshal's Office confirming the building meets life-safety code for the number and mobility level of residents you intend to serve. 6. Pass HHSC's pre-licensing survey (inspection). A surveyor visits the facility before your license is issued to confirm the physical plant, staffing, and policies match what you submitted. See inspections content on the site for what surveyors typically check. 7. Get your license and register for Medicaid/HCS enrollment if applicable. If you intend to serve Medicaid-funded residents, this is often a separate enrollment process from the facility license itself. Timelines vary a lot by license type and how complete your initial application is, but plan for this to take several months from a clean application to an open license, not weeks.
What license type do I actually need for my group home?
This is the single most common point of confusion for new Texas operators, and getting it wrong early costs real time and money. Here's a rough map, though you should confirm the current program name and rule chapter with HHSC because Texas periodically reorganizes its long-term care programs: - Older adults needing personal care and supervision: Assisted Living Facility license, 26 TAC Chapter 553.[2]
- Adults with intellectual or developmental disabilities in a small home setting: Home and Community-based Services (HCS) program, which is a Medicaid waiver enrollment through HHSC rather than a standalone facility license in the traditional sense.[5]
- Adults with intellectual disabilities needing more intensive, campus-style care: Intermediate Care Facility for Individuals with an Intellectual Disability (ICF/IID) license.
- Adults in recovery or with mental illness in a supportive housing model: This can fall under different HHSC behavioral health licensing depending on the level of clinical service provided, or may not require a residential facility license at all if it's a true sober-living/peer-support model without hands-on personal care. This is a gray area, and Texas doesn't have one clean license for every recovery housing model, so get a direct read from HHSC on your specific service model before assuming you're exempt from licensing. Don't guess on this step. Call HHSC's Long-term Care Regulation intake line and describe your intended population and services before you file anything. It's a free phone call that can save you months.
What does a Texas group home license application actually require?
Beyond the basic form, HHSC generally wants to see documented proof that you can run the facility safely on day one, more than good intentions. Core components typically include: - A policies and procedures manual covering admission and discharge criteria, medication management, emergency preparedness, resident rights, abuse/neglect reporting, and staff training.
- A staffing plan showing sufficient staff-to-resident ratios for the shifts and acuity level you're licensed for, plus documentation of required background checks (Texas requires criminal history checks for facility staff who have contact with residents).[2]
- Physical plant documentation, including floor plans, fire alarm and sprinkler system details (if required for your facility type), and evidence the building meets applicable life-safety code.
- Financial disclosure and ownership information for the licensed entity.
- Emergency preparedness plan, since Texas requires facilities to have a plan for things like extended power outages, severe weather, and evacuation, particularly relevant given Texas's exposure to hurricanes and winter storms. A weak policies manual is one of the most common reasons applications bounce back for revision. Surveyors want specifics: who does what, in what order, documented how. "Staff will handle emergencies appropriately" is not a policy; it's a wish.
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.[6] Medicare is a federal health insurance program, and it pays for medically necessary services like doctor visits, hospital stays, and short-term skilled nursing care after a qualifying hospital stay, but it does not pay for the custodial, non-medical care that makes up most of what assisted living provides. Medicare's own coverage rules describe skilled nursing facility care as covered only after a qualifying hospital stay and only for medically necessary skilled care, not custodial personal care of the kind assisted living provides day to day.[6] Medicare may still cover specific medical services a resident receives while living in an assisted living facility, such as doctor visits or physical therapy, the same way it would for anyone else, but it does not cover the facility's room, board, or personal care charges. Medicaid is a different story, and this matters a lot for operators building a business model. Some states, including Texas, offer home and community-based services waivers that can help cover certain services for eligible low-income residents, but this is not the same as Medicaid paying assisted living "room and board" directly in most cases. If your business model depends on Medicaid revenue, research the specific Texas HCS waiver rules and reimbursement structure directly through HHSC and Medicaid.gov before finalizing your financial projections.[5][7]
What are the staffing requirements for a Texas group home?
Staffing requirements depend heavily on your license type and the acuity of residents you're licensed to serve, but a few things are consistent across most Texas residential care licenses: you need enough staff awake and present to meet residents' supervision and care needs at all times, documented staff training before residents are admitted, and criminal background checks for anyone with resident contact.[2] For assisted living facilities, Texas rule under Chapter 553 ties staffing levels to the facility type and the mobility/evacuation capability of residents. A facility housing residents who need help evacuating in an emergency needs more staff on duty overnight than one housing fully independent residents who can self-evacuate. There is no single statewide number like "one staff per eight residents" that applies to every Texas assisted living facility; it's need-based and tied to your specific license type, so confirm the exact ratio requirement for your facility type with HHSC before finalizing your staffing plan and payroll budget. Don't understaff to save money in your first six months. Understaffing is one of the fastest ways to trigger a serious deficiency finding during a survey, and repeat deficiencies can put your license at risk.
How does zoning affect where I can open a Texas group home?
Zoning is one of the most underestimated hurdles in starting a group home, and it can kill a project faster than a licensing delay. Group homes serving people with disabilities are protected under the federal Fair Housing Act, which generally prohibits cities from treating a group home for people with disabilities worse than they'd treat a similarly sized group of unrelated people living together (like a group of roommates) in the same zoning district.[4] The Fair Housing Act itself, at 42 U.S.C. Section 3604(f), makes it unlawful to discriminate in the sale or rental of a dwelling, or to make a dwelling unavailable, because of a disability, and courts have applied this to zoning decisions that single out group homes for extra restrictions.[4] That said, cities can still apply reasonable, generally applicable rules: occupancy limits based on square footage, parking requirements, noise ordinances, and building and fire code. Some Texas municipalities have specific ordinances addressing group homes, spacing requirements between facilities (sometimes called "dispersal" rules meant to prevent clustering), or permit requirements distinct from your state HHSC license. Before you sign a lease or buy a property, call the city or county planning department and ask directly: is a licensed [insert your specific license type] group home an allowed use at this address, and is any local permit or variance required? Get the answer in writing if you can. See assisted living at home for related notes on smaller residential-scale models and how they interact with single-family zoning.
What does the inspection process look like before I can open?
Before HHSC issues your license, a surveyor typically conducts an on-site inspection to confirm your facility matches what you submitted on paper. This is not a courtesy check; it's a pass/fail gate. Expect the surveyor to check physical plant details (exits, fire extinguishers, smoke detectors, accessible bathrooms), review your policies and procedures manual against what staff can actually describe when asked, verify staff files (background checks, training documentation, required certifications), and confirm your emergency preparedness plan is specific to your building and location, not a generic template. Common reasons initial inspections fail: incomplete staff background check documentation, a policies manual that doesn't match actual practice, missing fire extinguisher inspection tags, and emergency plans that don't account for the facility's specific evacuation needs. Fix these before the surveyor arrives, not after. A failed initial inspection usually means a delay of weeks to months while you correct deficiencies and request a re-inspection, and repeat failures can slow your opening even further.
How much does it cost to start a group home in Texas?
Costs vary enormously depending on whether you're leasing or buying a property, renovating for accessibility and life-safety code, and how many residents you're licensed to serve, so there's no single honest number to quote here. Your major cost categories will be: property acquisition or lease-up and any required renovation to meet fire/life-safety code, HHSC licensing application fees (confirm current fee schedule with HHSC directly, since fees are set by rule and change periodically), staff hiring and training costs before you have paying residents, liability insurance, and working capital to cover several months of operating costs before you're at full occupancy. A realistic budget also needs a buffer for the licensing timeline itself. If it takes four to six months (or longer) to get from application to open license, you're paying rent, insurance, and possibly some staff costs during that entire window with no resident revenue coming in. Underestimating this pre-revenue runway is one of the most common reasons new operators run into cash trouble in year one. This is also where having your policies manual, staffing plan, and application paperwork built correctly the first time saves real money, since every round of application corrections adds weeks to your pre-revenue period. A state-specific licensing kit built around your exact license type, like the $299 State Group Home Licensing Kit, can shortcut the drafting work on policies and staffing plans so you're not building every document from a blank page. It doesn't replace your own research into Texas-specific rules, but it gives you a working starting point.
What should I do first if I'm serious about opening a Texas group home?
Call HHSC's Long-term Care Regulation division before you do anything else. Describe your intended population, services, and the type of building you're considering, and get a clear answer on which license category applies to you.[1] Everything downstream, your zoning research, your staffing budget, your policies manual, depends on getting this first answer right. After that, confirm zoning with your local planning department, start drafting your policies and procedures manual around the specific rule chapter that applies to your license type, and build a real budget that accounts for a multi-month pre-revenue licensing period. If you want a structured starting point for the paperwork side of this, the licensing kit builder walks through state-specific document templates so you're not starting from a blank page on your policies manual and staffing plan. Starting a group home in Texas is absolutely doable, and plenty of small operators do it successfully every year. The ones who struggle are usually the ones who picked a property or a population before confirming the license path, not the ones who spent an extra two weeks on the front end getting the paperwork right.
Frequently asked questions
What is assisted living?
Assisted living is a licensed residential care model for adults who need help with daily activities like bathing, dressing, and medication management but don't need round-the-clock skilled nursing care. In Texas, it's licensed under 26 TAC Chapter 553 and regulated by HHSC's Long-term Care Regulation division.
What is a group home?
A group home is a residential setting where several unrelated adults live together and receive support services, often people with IDD, mental illness, or age-related care needs. It's a general term, not a specific license; in Texas, the actual license type depends on the population served (assisted living, HCS, ICF/IID, or other HHSC programs).
What is an assisted living facility?
Under Texas rule, an assisted living facility is a licensed facility providing food, shelter, and personal care services to four or more unrelated residents, regulated under 26 TAC Chapter 553. Facility type varies based on residents' mobility and evacuation ability, which affects staffing and physical plant requirements.
What is assisted living vs nursing home?
Assisted living serves people who need help with daily activities but not medical care; nursing homes serve people needing daily skilled nursing or rehab. Nursing homes require RN and LVN staffing and separate state and federal certification; assisted living staffing is built around personal care aides with lighter nursing involvement.
What does assisted living provide?
Assisted living typically provides housing, meals, help with bathing/dressing/toileting, medication reminders, housekeeping, laundry, and supervision. Texas rule requires facilities to provide food, shelter, personal care services, and supervision appropriate to resident needs, but not skilled nursing or 24-hour medical care.
How do I start a group home in Texas?
Decide your population and matching HHSC license type, confirm zoning at your intended address, form a business entity, submit a license application with policies, staffing plan, and physical plant documentation, pass a fire and life-safety inspection, and pass HHSC's pre-licensing survey before your license is issued.
Does Medicare cover assisted living facilities?
No. Medicare pays for medically necessary skilled care like hospital stays and short-term skilled nursing after a qualifying hospital stay, but it doesn't cover room, board, or personal care in assisted living. Medicare may still cover separate medical services a resident receives, like doctor visits, but not facility charges.
What license does a Texas group home for adults with IDD need?
Adults with intellectual or developmental disabilities in a small home setting are typically served through the Home and Community-based Services (HCS) Medicaid waiver program through HHSC, rather than a standalone assisted living license. More intensive care may require an ICF/IID license instead. Confirm your exact category with HHSC.
How long does it take to get a group home license in Texas?
There's no fixed statewide timeline, and it varies by license type and application completeness, but operators should realistically plan for several months from a complete application to an open license, accounting for review time, a required fire/life-safety inspection, and HHSC's pre-licensing survey.
Can a group home be denied for zoning reasons in Texas?
Cities can't treat a group home for people with disabilities worse than a similarly sized group of unrelated people under the federal Fair Housing Act, but reasonable, generally applicable rules like occupancy limits and fire code still apply. Some municipalities have specific group home ordinances, so confirm directly with local planning staff.
Do group home staff need background checks in Texas?
Yes. Texas requires criminal history background checks for staff who have contact with residents in licensed residential care settings. This documentation is part of what HHSC reviews during the licensing application and the pre-licensing survey, so get checks completed and filed before you submit your application.
What's the difference between assisted living and a personal care home in Texas?
In practice, Texas regulates both under the same Chapter 553 assisted living facility framework once a facility houses four or more unrelated residents and provides personal care services. Smaller, informal arrangements below that threshold may fall outside facility licensing, but this line should be confirmed directly with HHSC.
How much does it cost to start a group home in Texas?
Costs vary widely based on property, renovation needs, and license type, with no single honest number to quote. Major categories include property/renovation, HHSC application fees (confirm current amounts with HHSC), staffing and training, insurance, and several months of working capital during the pre-licensing and ramp-up period.
Sources
- Texas Health and Human Services, Long-term Care Regulation: HHSC regulates long-term care provider licensing including group home and residential care settings in Texas
- Texas Administrative Code, Title 26, Chapter 553 (Assisted Living Facilities): Texas assisted living facility licensing requirements including facility type, staffing, and services definitions
- Medicare.gov, Nursing Home Care: Nursing homes are certified separately and provide skilled nursing care distinct from assisted living
- 42 U.S.C. Section 3604, Fair Housing Act discrimination in sale or rental of housing: Group homes for people with disabilities are protected from discriminatory zoning treatment under the Fair Housing Act
- Texas Health and Human Services, Home and Community-based Services (HCS) Program: HCS is a Medicaid waiver program for adults with intellectual and developmental disabilities in Texas
- Medicare.gov, Skilled Nursing Facility Care coverage: Medicare covers skilled nursing facility care only after a qualifying hospital stay and does not cover custodial assisted living room, board, or personal care
- Medicaid.gov, Home & Community-Based Services: Medicaid HCBS waivers can help cover certain long-term care services for eligible individuals outside of institutional settings