Last updated 2026-07-24
TL;DR
Starting a group home in Texas means forming a legal entity, picking a license type through the Texas Health and Human Services Commission (assisted living, HCSSA, or a specific IDD/behavioral health license), meeting zoning and life-safety code, staffing to state ratios, and passing a pre-licensure inspection. Expect several months of paperwork before HHSC issues a license under Texas Health and Safety Code Chapter 247.
What is a group home?
A group home is a residential setting where a small number of unrelated people live together and get some level of support, supervision, or care from paid staff. The term gets used loosely, but in Texas it usually maps to one of a few regulated categories: assisted living facilities for seniors or adults with disabilities, host home or residential settings for people with intellectual and developmental disabilities (IDD), and licensed recovery or behavioral health residences. The legal definition matters because it determines which state agency licenses you and which rules apply. In Texas, an assisted living facility is defined under Texas Health and Safety Code Chapter 247 as "an establishment that furnishes, in one or more facilities, food and shelter to four or more persons who are unrelated to the proprietor of the establishment and provides personal care services" [1]. If you're housing fewer than four unrelated residents, you may fall outside that specific chapter, but you still need to confirm with your state licensing agency whether another category (like an HCSSA license or a Medicaid HCS provider agreement) applies to your setup. Group homes for people with IDD in Texas often operate under the Home and Community-based Services (HCS) or Texas Home Living (TxHmL) Medicaid waiver programs, administered by HHSC, rather than under the assisted living statute. That's a different application track with different rules, covered later in this article.
What is assisted living and what is an assisted living facility?
Assisted living is a residential care model that combines housing with help on daily activities like bathing, dressing, medication reminders, and meals, without the round-the-clock skilled nursing you'd get in a nursing home. An assisted living facility is the licensed building or program where that care is delivered. Texas divides assisted living facilities into Type A, Type B, and Type C designations based on resident mobility and evacuation ability. Type A residents must be able to evacuate on their own or with minor physical assistance and can't require attention during sleeping hours. Type B facilities can serve residents who need help evacuating and staff awake during night hours, or who have mild dementia-related conditions. Type C is the designation for small adult foster care homes serving three or fewer residents, licensed under a different subset of rules within the same chapter [1][2]. HHSC's own guidance describes assisted living facilities as places providing "personal care services, 24-hour supervision, and assistance" to residents who need help with activities of daily living but do not need continual nursing care [2]. If your model is closer to a nursing facility (skilled nursing, ventilator care, post-acute rehab), you're in a completely different license category under Texas Health and Safety Code Chapter 242, not Chapter 247.
What is assisted living vs nursing home, and what's the difference?
The short version: assisted living is for people who need help with daily tasks but not medical nursing care around the clock. Nursing homes (skilled nursing facilities) are for people who need ongoing medical monitoring, wound care, IV therapy, or rehab from a licensed nurse on-site at all hours. Assisted living staff can administer medications and help with mobility, hygiene, and meals, but Texas assisted living rules do not require a registered nurse on-site 24/7. Nursing facilities licensed under Chapter 242 must meet federal Medicare/Medicaid certification standards including licensed nursing coverage and mandated staffing levels tied to CMS Requirements of Participation [3]. Cost and payer mix differ too. Nursing home stays are more likely to be covered short-term by Medicare Part A after a qualifying hospital stay, while assisted living almost never gets Medicare coverage (more on that below). Families often move a resident from assisted living to a nursing home when care needs escalate past what personal care staff can safely provide, which is one reason your admission and discharge policies need clear criteria for when a resident's needs exceed your license type.
Does Medicare cover assisted living facilities?
No. Medicare does not pay for room and board or personal care in an assisted living facility. 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 kind of care needed [4]. Medicare Part A may cover a short-term stay in a skilled nursing facility after a qualifying hospital admission, and Medicare Part B may still cover a resident's doctor visits, physical therapy, or durable medical equipment while they live in an assisted living facility. But the facility's monthly rate itself, the rent-like charge for room, board, and personal care, is a private-pay or Medicaid waiver expense, not a Medicare-covered service. Medicaid is a different story. Texas Medicaid does not pay room and board in most assisted living settings either, but it can pay for personal care services delivered there through programs like STAR+PLUS Home and Community Based Services waiver, and it fully funds room, board, and habilitation services in HCS/TxHmL group homes for people with IDD under specific waiver rules [5]. If Medicaid reimbursement is central to your business model, get familiar with funding and Medicaid rules well before you sign a lease.
How do I start a group home in Texas? (the step-by-step process)
Here's the realistic order of operations, based on how HHSC structures Chapter 247 licensing. 1. Decide your population and license type. Seniors and adults needing personal care point you toward an assisted living facility license (Type A, B, or C). Adults with IDD point you toward HCS/TxHmL provider enrollment. Mental health or recovery residences may need a different state or voluntary certification depending on the services offered. This decision drives everything else, so don't skip it. 2. Form your business entity. Most operators set up an LLC or corporation with the Texas Secretary of State before applying. You'll need this entity name and EIN for the license application. 3. Secure and vet your property. Confirm zoning allows a residential care use (see the zoning section below), and make sure the building can meet the physical plant, fire safety, and space-per-resident standards in the Texas Administrative Code before you sign a long lease or close on a purchase. 4. Submit the license application to HHSC. Assisted living applications go through HHSC's Long Term Care Regulation division. Expect to submit an application form, floor plans, proof of ownership or lease, staffing plan, policies and procedures manual, and the application fee. HHSC's fee schedule for assisted living licenses varies by facility size and license type, so confirm current fee amounts with HHSC's Long Term Care Regulation licensing fee page before budgeting [6]. 5. Pass your life safety and health inspections. HHSC and, for some facilities, the State Fire Marshal's Office will inspect the physical building before a license is issued. 6. Hire and train staff to meet minimum ratios. You need a qualified administrator (Texas requires assisted living facility administrators to hold a state license or be actively working toward one under Texas Occupations Code Chapter 247, distinct from the facility license chapter, so check current administrator licensure rules with the Texas Department of Licensing and Regulation) and enough direct care staff to meet resident needs at all times. 7. Get your license, then keep your policy and procedure manual current. Chapter 247 requires written policies covering admission, discharge, medication management, abuse/neglect reporting, and emergency preparedness, and HHSC surveyors will ask to see them at every inspection. If you want a structured way to organize the paperwork across these steps, the State Group Home Licensing Kit bundles application checklists and policy templates built around HHSC's requirements, though it doesn't replace HHSC's own forms or guarantee approval.
What are the licensing requirements and who is the licensing agency?
The Texas Health and Human Services Commission (HHSC), specifically its Long Term Care Regulation division, licenses assisted living facilities under Texas Health and Safety Code Chapter 247 and its implementing rules in Title 26 of the Texas Administrative Code [1][7]. Core requirements include: a completed license application, disclosure of ownership and any prior license revocations, a fire safety inspection (often coordinated with the State Fire Marshal or local fire authority), compliance with physical plant rules on bedroom size and occupancy limits, a criminal background check for the applicant and staff through the Texas Department of Public Safety, and written policies on the topics listed above. HHSC's statute directs the agency to "protect the health and safety" of facility residents and gives it authority to inspect facilities "at least annually" and in response to complaints [1]. That annual inspection cadence is worth planning around: your policies and procedures manual should be treated as a living document you review before every survey cycle, not a one-time binder you file away. If your group home will serve people with IDD through a Medicaid waiver instead of private-pay assisted living, you'll go through HHSC's HCS or TxHmL provider enrollment process instead, which has its own contract, background check, and provider qualification requirements separate from Chapter 247.
What zoning and property rules apply to a Texas group home?
Zoning is one of the most underestimated hurdles in this business. Texas cities and counties control land use locally, and a residential care use isn't automatically allowed just because your building is in a residential zone. Many Texas municipalities treat small group homes (six or fewer residents) as a "family" for zoning purposes in single-family districts, consistent with how many states interpret the Fair Housing Act's protections against discriminatory zoning toward people with disabilities. The federal Fair Housing Act, enforced by HUD, prohibits zoning rules that treat group homes for people with disabilities less favorably than other residential uses of similar size . But local interpretation varies by city, and larger facilities (Type B assisted living with more residents, or IDD group homes above a certain occupancy) may trigger a conditional use permit or a separate commercial zoning classification. Before you lease or buy, call your city or county planning department directly and ask, in writing if you can get it, whether a licensed residential care facility of your intended size is a permitted use at that address. Get that answer before you spend money on a lease. Also confirm fire code occupancy classification with your local fire marshal, since Texas often requires an institutional or residential board-and-care occupancy classification under the adopted fire code, which affects sprinkler and egress requirements separately from HHSC's own inspection. For more on this step, see assisted living facility zoning considerations and how they interact with state licensing timelines.
What staffing plan and ratios does Texas require?
Texas doesn't publish one universal numeric staff-to-resident ratio for all assisted living facilities the way some states do; instead, the rules require staffing "sufficient" to meet resident needs based on the facility's licensed type and the acuity of residents on-site, with more specific requirements for medication aides, night supervision, and administrator qualifications spelled out in Title 26 of the Texas Administrative Code [7]. That flexibility cuts both ways: you have room to build a plan around your actual resident mix, but a surveyor can also cite you if your staffing pattern doesn't match the needs of the people living there. At minimum, plan for these roles:
- A licensed administrator (or one working under supervision toward licensure) responsible for day-to-day operations
- Direct care staff awake and present 24 hours a day in Type B facilities, since those residents may need overnight assistance
- A medication aide or licensed nurse if your facility administers medications, since unlicensed staff generally cannot administer certain medications without state-approved medication aide training
- Backup and on-call staff, because a single call-out on a night shift is a licensing violation waiting to happen if you don't have coverage Build your staffing plan before you apply, not after. HHSC will ask to see it as part of the application, and your local labor market (rural vs. metro Texas) will affect how realistic your proposed ratios actually are once you're operating.
What inspections should I expect and how do I prepare?
Expect at least three distinct rounds of scrutiny: a pre-licensure inspection before HHSC issues your initial license, an annual licensing survey once you're operating, and complaint-driven inspections that can happen any time someone (a family member, a staff member, an ombudsman) reports a concern. HHSC's statutory authority requires the agency to inspect assisted living facilities on a regular basis and investigate complaints "as necessary to protect the health and safety of residents" [1]. Surveyors typically review: resident records and care plans, medication administration logs, staff training and background check files, the physical plant (exits, smoke detectors, food storage temperatures), and your written policies against what's actually happening on the floor. The single biggest preparation mistake operators make is having a policy manual that doesn't match practice. If your abuse-reporting policy says staff report to the administrator within 24 hours but your staff have never been trained on that policy, that's a citation. Walk through your own policies and procedures with staff on a schedule, more than when you're expecting a survey. For a broader look at what a first-year inspection cycle usually looks like, see inspections guidance built around common state survey findings.
How much does it cost and how long does it take to get licensed?
Cost and timeline both depend heavily on your license type, facility size, and whether you're renovating an existing building or starting from raw land, so treat any number here as a planning range, not a quote. HHSC charges an application fee for assisted living licenses that varies by facility bed count and license type; confirm the current fee schedule directly on HHSC's Long Term Care Regulation licensing fees page before budgeting, since fees are set in agency rule and can change [6]. Beyond the state fee, plan for local business licensing fees, fire marshal inspection fees, background check costs per staff member through DPS, and any zoning or building permit fees from your city or county. On timeline, HHSC's own process includes application review, scheduling a pre-licensure survey, and correcting any deficiencies found, which commonly stretches into several months from a complete application to license issuance. Renovation or new construction adds significant time on top of that for permitting and build-out. Rushing this part rarely helps: an incomplete application or a building that fails its first fire inspection resets your clock, often by weeks.
What is the difference between a group home and an assisted living facility, legally?
In everyday language, people use "group home" and "assisted living facility" almost interchangeably, but in Texas law they aren't always the same license. "Assisted living facility" is a specific defined term under Chapter 247, covering personal care for four or more unrelated residents (with Type C covering three or fewer in certain home-based settings) [1]. "Group home" more often refers colloquially to IDD residential settings funded through HCS or TxHmL Medicaid waivers, which are licensed and monitored by HHSC under separate waiver program rules, not Chapter 247's assisted living framework. There are also licensed recovery residences and behavioral health group settings that may fall under different voluntary certification or licensure tracks depending on the services offered. The practical takeaway: don't assume the word "group home" tells you which application to file. Call HHSC's Long Term Care Regulation division (or the relevant IDD services division) and describe your population, service model, and resident count before you pick a license path. Getting this wrong early means redoing your entire application later.
Frequently asked questions
What is assisted living?
Assisted living is a residential care model where adults live in a licensed facility and get help with daily activities like bathing, dressing, medication reminders, and meals, plus 24-hour supervision, without the round-the-clock skilled nursing care found in a nursing home. In Texas it's regulated under Health and Safety Code Chapter 247 [1].
What is a group home?
A group home is a residential setting where a small number of unrelated people live together and receive support or supervision from paid staff. In Texas, depending on the population served, that setting may be licensed as an assisted living facility under Chapter 247 or as an IDD residential provider under HCS/TxHmL Medicaid waiver rules.
What is an assisted living facility?
An assisted living facility is Texas's specific legal term, defined in Health and Safety Code Chapter 247, for an establishment providing food, shelter, and personal care services to four or more unrelated residents [1]. Texas further classifies these as Type A, Type B, or Type C based on resident mobility and care needs.
What is the difference between assisted living and a nursing home?
Assisted living helps residents with daily activities like bathing and dressing but doesn't require 24/7 licensed nursing staff. A nursing home (skilled nursing facility) provides ongoing medical care, wound treatment, and rehab under licensed nursing staff at all hours, and is licensed in Texas under a separate statute, Chapter 242, with federal CMS certification standards attached [1][3].
Does Medicare cover assisted living facilities?
No. Medicare does not pay for room, board, or custodial personal care in assisted living. Medicare.gov confirms Medicare doesn't cover long-term custodial care [4]. Medicare Part B may still cover a resident's outside medical services, like doctor visits or therapy, while they live in an assisted living facility.
How do I start a group home in Texas?
Pick your population and license type, form a business entity, secure a property that clears zoning and fire code, apply to HHSC's Long Term Care Regulation division under Health and Safety Code Chapter 247 (or enroll as an HCS/TxHmL provider for IDD group homes), pass a pre-licensure inspection, hire qualified staff, and keep written policies current for annual surveys.
What license do I need to open a group home in Texas?
It depends on who you serve. Seniors or adults needing personal care require an assisted living facility license (Type A, B, or C) from HHSC under Chapter 247. Adults with intellectual or developmental disabilities are usually served through HCS or TxHmL Medicaid waiver provider enrollment, a separate process from Chapter 247 licensing.
How much does it cost to get a group home license in Texas?
HHSC charges an assisted living license application fee that varies by facility size and license type; confirm the current fee on HHSC's Long Term Care Regulation fee page before budgeting [6]. Add local business permit fees, background check costs, fire inspection fees, and any zoning or building permit costs on top of the state fee.
How long does it take to get a group home licensed in Texas?
There's no single guaranteed timeline. Once you submit a complete application, HHSC review, scheduling a pre-licensure inspection, and correcting any deficiencies commonly takes several months. Renovation or new construction adds significant time before you can even request that inspection.
Can I run a group home out of a house in a residential neighborhood?
Sometimes, but you must confirm this with your local zoning authority first. Many Texas cities treat small group homes (typically six or fewer residents) as a residential use similar to a family household, partly reflecting Fair Housing Act protections, but rules vary by city and by resident count, so get written confirmation before signing a lease [8].
What staffing do I need for a Texas assisted living facility?
Texas requires staffing sufficient to meet resident needs rather than one fixed statewide ratio, with specific rules for administrators, medication aides, and night coverage in Title 26 of the Texas Administrative Code [7]. At minimum, plan for a licensed administrator, awake direct care staff for Type B facilities, and reliable on-call backup coverage.
Does Texas Medicaid pay for group home care?
It depends on the setting. Texas Medicaid generally does not pay room and board in private-pay assisted living, but it does fund personal care services through waiver programs and fully funds room, board, and habilitation in HCS/TxHmL group homes for people with intellectual and developmental disabilities under specific waiver rules [5].
What inspections will my group home face in Texas?
Expect a pre-licensure inspection before your license is issued, an annual licensing survey after you're operating, and complaint-driven inspections triggered any time HHSC receives a report. HHSC has statutory authority to inspect facilities regularly and investigate complaints to protect resident health and safety [1].
Sources
- Texas Health and Safety Code, Chapter 247 (Assisted Living Facilities): Definition of assisted living facility, licensing and inspection authority for HHSC
- Texas HHSC, Assisted Living Facilities licensing overview: Description of Type A, B, C assisted living facility categories and personal care services
- CMS, Nursing Home Requirements of Participation: Federal staffing and certification standards for skilled nursing facilities
- Medicare.gov, Long-term care coverage: Medicare does not cover long-term custodial care such as assisted living room and board
- Texas HHSC, Home and Community-based Services (HCS) Program: HCS Medicaid waiver funds room, board, and habilitation for IDD group home residents
- Texas HHSC, Long Term Care Regulation licensing fees: Assisted living license application fees vary by facility size and are set by HHSC
- Texas Administrative Code, Title 26, Chapter 553 (Licensing Standards for Assisted Living Facilities): Staffing, administrator, and physical plant requirements for assisted living facilities