How to start a group home in Texas: licensing, costs, and rules

Last updated 2026-07-25

What is a group home and how does it differ from assisted living in Texas?

A group home in Texas is a residential facility licensed to serve three or more unrelated adults who need supervision, personal care, or support services. Most Texas group homes serve people with intellectual and developmental disabilities (IDD), mental illness, or co-occurring disorders ^[1]. Assisted living, by contrast, is regulated under a completely different framework. Texas calls them Assisted Living Facilities (ALFs), and they primarily serve elderly residents who need help with activities of daily living like bathing, dressing, or medication reminders ^[2]. ALFs operate under stricter square-footage rules, different staffing ratios, and a separate licensure process through the same agency. The practical differences matter. Group homes can be single-family houses in residential neighborhoods, typically 3-8 beds, and staff focus on skills training, community integration, and behavioral support. Assisted living facilities look more institutional, require private or semi-private rooms with bathrooms, and emphasize medical oversight and aging-in-place services. Medicare does not cover either model; Medicaid waivers pay for most group home care. Texas also distinguishes nursing homes (skilled nursing facilities) from both. Nursing homes provide 24-hour licensed nursing care, IV medications, wound care, and post-hospital rehab. They're the highest level of care and cost $5,000-$8,000 per month out-of-pocket ^[3]. Group homes and assisted living sit below that threshold. If your future residents need a feeding tube or daily injections, you're looking at nursing home licensure, not a group home.

Which Texas agency licenses group homes and what are the main license types?

The Texas Health and Human Services Commission (HHSC) licenses all group homes through its Regulatory Services division ^[1]. You apply to the regional office that covers your county; Texas has 11 regions, and each processes applications independently. Texas issues group home licenses for six populations, each with its own chapter of administrative code: • Group Homes for Adults with Intellectual Disabilities or Related Conditions (26 TAC Chapter 555): serves adults with IDD, autism, or related conditions. This is the most common group home license in Texas ^[1]. • Group Homes for Persons with Mental Illness (26 TAC Chapter 555, Subchapter J): serves adults with schizophrenia, bipolar disorder, or other serious mental illness. • Halfway Houses (26 TAC Chapter 566): residential facilities for adults transitioning from psychiatric hospitals or criminal justice settings. • Chemical Dependency Treatment Facilities (26 TAC Chapter 448): residential substance use treatment, short-term or long-term. • ICF/IID (Intermediate Care Facilities for Individuals with Intellectual Disabilities, 26 TAC Chapter 553): Medicaid-certified group homes, more intensive staffing and documentation than standard group homes ^[4]. • Assisted Living Facilities (26 TAC Chapter 92): not technically a group home, but the closest aging-services parallel ^[2]. Most startup operators pursue the Chapter 555 IDD group home license or the mental illness license. Both allow 3-16 residents per home, though most run 6 beds to balance revenue and staffing cost. The application process is identical in structure; the difference is in the care plan documentation and staff training hours you'll need to demonstrate.

What does the Texas group home license application require?

Texas uses a paper application mailed or hand-delivered to your regional HHSC office ^[1]. There is no online portal for initial group home applications. You'll submit: • Initial Application for a License (Form 3736): basic operator information, proposed address, capacity, population served. • Ownership and Management Information (Form 3737): every owner with 5% or more equity, every manager, and their backgrounds. • Criminal Background Checks: fingerprint-based FBI and Texas DPS checks for all owners, directors, and staff who will have direct contact with residents. Texas disqualifies anyone with felony convictions for abuse, neglect, exploitation, or violent crimes ^[5]. • Financial Statement: proof you can operate at least three months without revenue. No set dollar amount is published, but regional surveyors expect $15,000-$30,000 in liquid reserves for a 6-bed home. • Fire Marshal Approval: a letter from your local fire marshal stating the property meets residential occupancy rules. You need smoke detectors, fire extinguishers, and an evacuation plan posted. • Zoning Verification: a letter from your city or county planning department confirming the address is zoned for group residential use or that you have a conditional use permit. • Lease or Deed: proof you control the property. • Policies and Procedures Manual: written protocols for admission, discharge, emergency response, medication management, behavior support, infection control, and resident rights. HHSC doesn't provide a template; you write your own or adapt industry samples ^[1]. • Staffing Plan: names, qualifications, and schedules showing you meet minimum ratios (discussed below). • Menu and Activity Schedule: a sample week demonstrating balanced meals and meaningful daily activities. The application fee is $100 for 3-6 residents, $225 for 7-12 residents, or $340 for 13-16 residents ^[1]. You pay at submission; it is non-refundable even if you withdraw. Texas adds a $50-per-bed annual renewal fee after your first year.

What are the staffing ratios and training requirements for Texas group homes?

Texas sets minimum direct-care staff ratios by population and time of day. For IDD group homes under Chapter 555, you must maintain ^[1]: • Waking hours: at least one staff for every six residents (1:6). • Sleeping hours: at least one awake staff for every eight residents (1:8), or one staff for every 16 residents if all residents can self-evacuate in an emergency. If any resident has complex medical needs, behavioral plans, or requires line-of-sight supervision, HHSC will tighten the ratio in your license conditions. Mental health group homes and halfway houses often require 1:4 or 1:3 during waking hours. Every direct-care employee must complete these training requirements before independent shifts: • Orientation: 8 hours covering fire safety, emergency procedures, resident rights, abuse/neglect reporting, and infection control ^[1]. • First Aid and CPR: current certification from the American Red Cross, American Heart Association, or equivalent. • Medication Administration: if staff will give meds, they need Texas's formal Medication Aide training (total 24 classroom hours plus skills demonstration) or supervision by an LVN/RN ^[6]. • Annual In-Service: 12 hours per year of continuing education on topics like behavior support, person-centered planning, or health monitoring. You must designate a Director who is on-site or on-call 24/7. The director needs a high school diploma or GED and at least one year of experience in human services or healthcare. If your home serves people with IDD, the director should also understand Medicaid waiver documentation, though Texas does not mandate that in the license standard. Record every training hour in each employee's personnel file. Inspectors audit training logs in every survey. Missing or expired certifications trigger immediate citations and can delay your license by months.

What property and physical plant standards must a Texas group home meet?

Texas group homes can operate in single-family houses, duplexes, or small multi-unit buildings, provided they meet these minimum standards ^[1]: • Bedrooms: 80 square feet per resident in shared rooms, 100 square feet for private rooms. No more than four residents per bedroom. • Bathrooms: at least one toilet, sink, and bathtub or shower for every eight residents. Bathrooms must have privacy locks (that staff can override) and grab bars in showers. • Common Areas: a living room and dining area large enough for all residents to gather at once. Total common space should be at least 35 square feet per resident. • Kitchen: functional stove, oven, refrigerator, and sink. Most operators use domestic appliances; commercial equipment is not required unless you serve more than 12 residents. • Exits: two independent means of egress. If the home is multi-story, residents' bedrooms should be on the ground floor or you need a fire-rated stairwell and an evacuation plan the fire marshal approves. • Accessibility: handrails on stairs, ramps for wheelchair users if any resident needs one. Full ADA compliance is not mandatory for group homes under 16 beds, but you must accommodate your actual residents. • Climate Control: heating and air conditioning that maintains 65-85°F year-round. Texas summers make this non-negotiable. You do not need a commercial kitchen license unless you plan to prepare meals for other facilities. You do need a fire safety inspection by your local fire marshal before you apply, and a follow-up inspection after you're licensed. The marshal checks smoke detectors (one per bedroom and in hallways), fire extinguishers (one per floor, inspected annually), and your posted evacuation map. Zoning is often the hardest hurdle. Many Texas cities limit group homes to commercial zones or require conditional use permits (CUPs) in residential areas. The Fair Housing Act protects group homes from outright bans, but you still need local approval ^[7]. Expect 4-12 weeks and a public hearing for a CUP. Some neighborhoods resist; prepare to explain how your home will operate and that state-licensed facilities carry liability insurance and background-checked staff.

How long does the Texas licensing process take and what happens during the inspection?

Most Texas operators report 4-6 months from application submission to receiving a license. HHSC acknowledges your application within 10 business days, then assigns a surveyor to review your paperwork ^[1]. If anything is incomplete, they mail a deficiency letter; you have 30 days to correct it or your application closes. Once your paperwork passes, HHSC schedules an initial licensing survey. The surveyor visits your property unannounced during business hours. The survey takes 4-6 hours and covers: • Physical plant walkthrough: room measurements, exits, fire equipment, water temperature (no hotter than 120°F at fixtures), kitchen cleanliness, and general safety. • Policies and procedures review: the surveyor reads your manual, checks that it addresses every required topic, and asks scenario questions to test your understanding ("What would you do if a resident fell and hit their head?"). • Personnel files: the surveyor audits background checks, training logs, and job descriptions for every current employee. • Resident records: if you have any residents already (some operators pre-admit under provisional licenses, though this is rare), the surveyor reviews care plans, medication logs, and incident reports. • Medication storage: locked cabinet or cart, proper temperature, no expired drugs, and a log matching every dose given to the physician's order. If the surveyor finds deficiencies, you receive a written report within 10 business days. Type A violations (immediate danger to residents) require correction before you can open. Type B violations (paperwork or minor safety issues) give you 45 days to fix and document. You must submit a Plan of Correction describing exactly how you'll fix each finding. HHSC conducts a follow-up survey to verify corrections, either as a full revisit or a desk review of your submitted evidence. Once all deficiencies clear, the agency issues your license. The license is valid for one year initially, then two-year renewals thereafter ^[1]. If your home isn't ready when the surveyor arrives (construction unfinished, no staff present, no policies), the survey fails and you start over with a new application and fee. Do not schedule a survey until you're truly ready.

What are the realistic startup costs for a Texas group home?

Property (first month + deposit if leasing)	$2,500	$4,500
Renovations and ADA modifications	$3,000	$15,000
Furniture and household supplies	$4,000	$8,000
Licensing application and background checks	$600	$1,200
Fire and zoning inspections	$300	$800
Insurance (liability, property, workers' comp deposit)	$3,000	$6,000
Initial food and household stock	$800	$1,500
Policies, forms, and compliance documents	$300	$1,000
Marketing and pre-opening administrative	$500	$2,000
Three-month operating reserve	$18,000	$30,000
Total	$32,000	$70,000	The reserve is critical. Most Medicaid waiver programs in Texas take 60-90 days to process enrollment paperwork, so you may operate without revenue for two months. Staff payroll alone runs $4,000-$6,000 per month for a 6-bed home (two full-time and two part-time direct-care workers at $12-$15/hour, plus a part-time director). Add food, utilities, insurance, and maintenance, and monthly expenses hit $8,000-$10,000 before any residents arrive. If you're buying a property, add $150,000-$300,000 for a suitable house in most Texas metro areas, plus closing costs. Conventional mortgages often balk at group home businesses; you may need a commercial loan or cash purchase. Leasing is faster and cheaper up front, but landlords sometimes add "no group home" clauses. Read your lease carefully and disclose your intended use before signing. Brand mention: Some operators invest in compliance tools like the GroupHomePath Licensing Kit to organize policies, staff training checklists, and inspection prep in one place. The kit costs $299 and includes state-specific templates, though you can also build everything from scratch using HHSC's published standards [1].

Startup costs vary widely by capacity and whether you lease or buy, but here's a realistic breakdown for a 6-bed IDD group home in Texas: | Expense | Low | High |

How do Texas group homes get paid and does Medicare or Medicaid cover services?

Medicare does not pay for group home room and board or custodial care. Medicare covers skilled nursing, hospital stays, and home health visits for acute medical needs, but once a person no longer requires skilled care, Medicare stops. Assisted living and group homes fall outside Medicare's scope entirely. Texas group homes rely on three main payment sources: 1. Medicaid Home and Community-Based Services (HCS) Waiver: This is the primary funding stream for IDD group homes in Texas ^[8]. HCS pays for residential support, day habilitation, and behavioral services. Rates vary by county and level of need, but typical residential support pays $130-$250 per resident per day, covering room, board, and direct care. You must enroll as a Medicaid provider, which requires a separate application through the Texas Medicaid & Healthcare Partnership (TMHP) and takes 90-120 days ^[9]. 2. Texas Home Living (TxHmL) Waiver: Pays for supports in the resident's own home or a host-family setting, not traditional group homes. Some small group homes structure as "host homes" to access TxHmL, but this is a niche model ^[8]. 3. Private Pay: Some families pay out-of-pocket, typically $2,500-$5,000 per month depending on level of care. Private-pay residents give you cash flow while Medicaid paperwork processes, but most Texas families cannot sustain private-pay long-term. 4. Supplemental Security Income (SSI): Many residents receive federal SSI ($914/month in 2024 for an individual) ^[10]. Some group homes charge residents their SSI as a monthly fee, though this rarely covers full cost of care. Operators supplement with waiver funds or family contributions. You do not need Medicaid certification to open, but without it your revenue is limited to private pay. Plan to apply for Medicaid provider enrollment as soon as your HHSC license is issued. TMHP requires a site visit, background checks, and detailed service documentation. Once enrolled, you bill monthly through the state's EVV (electronic visit verification) portal, and payments arrive 30-45 days later.

What ongoing compliance and inspection obligations does Texas require?

Texas group homes face three layers of ongoing oversight: HHSC Surveys: HHSC conducts unannounced monitoring surveys at least once every 24 months for standard group homes, or annually for homes with a history of violations ^[1]. Surveys cover the same checklist as the initial license: staffing, training, resident records, medication logs, safety, and policies. Inspectors can arrive any day, any time. Most visits last 4-8 hours. If they find deficiencies, you get a written report and 45 days to submit a Plan of Correction. Repeated or serious violations trigger enforcement: provisional licenses, fines ($500-$5,000 per violation per day), or license revocation. Incident Reporting: You must report abuse, neglect, exploitation, serious injuries, hospitalizations, and deaths to HHSC within 24 hours by phone, then submit a written report within 5 business days ^[1]. Texas also requires you to report to Adult Protective Services (APS) if abuse or neglect is suspected. Failure to report is a criminal offense and grounds for immediate license suspension. Fire and Health Inspections: Your local fire marshal inspects annually. Some counties also require health department inspections for food service, though most small group homes are exempt. Keep copies of all inspection reports in a binder for HHSC surveyors to review. Medicaid Audits: If you're enrolled as a waiver provider, TMHP can audit your billing records at any time. Auditors check that every billed service matches a signed care plan and progress note. Overbilling or missing documentation triggers recoupment demands (you must pay money back) and can result in Medicaid termination ^[9]. Staff Turnover and Training: Every time you hire a new employee, you must complete background checks and orientation before that person works an independent shift. Every employee needs 12 hours of in-service training annually ^[1]. Maintaining these records is the single most common survey deficiency. Operators who stay compliant treat documentation like a daily habit: log every med pass, every incident, every training hour. Assign one staff member (often the director) to review files weekly. Many operators schedule an internal mock survey every six months, walking through the property with the HHSC checklist and fixing small issues before a real surveyor finds them.

What common mistakes delay or derail a Texas group home license application?

Incomplete background checks top the list. Texas requires fingerprint-based FBI and DPS checks for every owner, director, and direct-care employee ^[5]. Paper-based name checks are not accepted. Operators who use a third-party background service sometimes submit results that lack the FBI rap sheet; HHSC rejects these and sends the application back. Use IdentoGO or another state-approved vendor, and confirm you're ordering the "HHSC group home" package. Zoning problems come next. Many operators sign a lease, submit their application, then discover the city requires a conditional use permit or that the neighborhood is zoned single-family only. HHSC will not issue a license without zoning approval ^[1]. Solve zoning first, before you spend money on the application. Call the city planning department, explain you're opening a state-licensed group home, and ask what's required. Get written confirmation. Policies that copy-paste from another state fail. HHSC expects your manual to cite Texas statutes (like "26 TAC Chapter 555") and address Texas-specific requirements like EVV, person-centered planning, and the state's abuse reporting hotline. Generic templates from online vendors often miss this. If you adapt a template, rewrite every section to match Texas rules and your actual operating procedures. Unrealistic financial projections hurt credibility. HHSC wants to see that you can operate for three months. If your financial statement shows $5,000 in the bank and your staffing plan budgets $6,000/month in payroll, the surveyor knows the math doesn't work. Either reduce your planned capacity, show more reserves, or identify a line of credit. Property not ready at survey time is the final killer. HHSC schedules the survey after paperwork is approved, often with only 7-10 days' notice. If the house still has construction debris, no furniture, or no working smoke detectors, the survey fails automatically and you start over. Do not submit your application until the property is 100% move-in ready. Take photos of every room, the kitchen, the bathrooms, and the fire equipment before the survey so you can prove compliance if anything is questioned. Other common mistakes: expired CPR cards on file, medication logs that don't match physician orders, no posted evacuation map, water temperature over 120°F, or missing the $100 application fee. Each one delays your license by weeks or months. Use a checklist, have a peer review your packet, and triple-check the details.

What do Texas group home operators wish they'd known before starting?

Medicaid enrollment takes longer than the license. Most operators expect the HHSC license to be the bottleneck, but once you have it you still face 90-120 days for TMHP to approve you as a Medicaid provider ^[9]. You can accept private-pay residents during that gap, but if you're counting on waiver reimbursement to cover payroll, budget an extra two months of reserves. Neighbor relations matter more than you'd think. Even with legal zoning approval, a group home that doesn't communicate with the neighborhood can face constant code complaints, police calls over noise, and hostile city council members when you try to expand ^[7]. Knock on doors before you open, explain what you're doing, share your direct contact info, and emphasize that your residents are screened, supervised, and part of the community. Some operators host an open house for neighbors a week before move-in. It defuses a lot of tension. Staffing is the hardest operational challenge. Texas's $12-$15/hour direct-care wage makes recruiting difficult, and turnover averages 40-60% annually in residential care . Every time someone quits, you pay overtime to cover shifts, delay admissions because you lack staff, and spend hours interviewing. Successful operators invest in retention: small raises after six months, flexible schedules, and clear career paths (direct-care to lead to assistant director). They also maintain a pool of pre-approved part-time staff who can pick up emergency shifts. You need good relationships with case managers. Medicaid waiver slots are limited, and case managers from Local Intellectual and Developmental Disability Authorities (LIDDAs) control referrals ^[8]. If your home earns a reputation for strong documentation, clean surveys, and stable staffing, case managers send you referrals. If you miss service plan meetings, submit late reports, or cycle through staff, referrals dry up. Treat every case manager interaction as a job interview for future residents. Cash flow runs tight the first year. Most operators break even at 80-85% occupancy. A 6-bed home needs 5 occupied beds to cover costs. It takes 6-9 months to fill a new home even with Medicaid contracts, because families want to visit, meet staff, and review your track record. Many operators open with 2-3 private-pay residents, convert them to Medicaid once enrolled, then fill the remaining beds. Expect your first year to be breakeven or a small loss, and plan accordingly. Brand mention: Experienced operators recommend having your compliance infrastructure in place before Day 1. Tools like the GroupHomePath Licensing Kit compile checklists, policy templates, and staff training trackers for $299, helping new operators avoid the documentation mistakes that cause failed surveys. You can also join Texas-specific industry groups like the Texas Council of Community Centers for peer mentorship and regulatory updates.

Frequently asked questions

What is assisted living and how does it differ from a group home?

Assisted living in Texas (called Assisted Living Facilities or ALFs) serves elderly residents who need help with daily activities like bathing, dressing, and medication reminders. ALFs require private or semi-private rooms, operate under 26 TAC Chapter 92, and focus on aging services. Group homes serve adults with intellectual disabilities, mental illness, or other conditions, can use shared bedrooms, and emphasize skills training and community integration rather than medical oversight.

What is a group home in Texas?

A group home is a state-licensed residential facility that provides supervision, personal care, and support services to three or more unrelated adults. Texas licenses group homes primarily for people with intellectual and developmental disabilities, mental illness, or substance use disorders. They operate in single-family houses or small multi-unit buildings and are regulated by the Texas Health and Human Services Commission under 26 TAC Chapter 555 and related chapters.

How do I start a group home in Texas?

Submit a paper application (Form 3736) to your regional HHSC office with background checks, financial statements, fire marshal and zoning approvals, a policies manual, and a staffing plan. Pay the $100-$340 application fee, pass an on-site inspection, and correct any deficiencies. Most operators spend 4-6 months and $32,000-$70,000 from application to opening. Enroll as a Medicaid provider separately through TMHP to receive waiver reimbursement for residents.

What is the difference between assisted living and a nursing home?

Assisted living provides room, board, and help with daily activities like bathing and dressing but no skilled nursing care. Nursing homes (skilled nursing facilities) offer 24-hour licensed nurses, IV medications, wound care, and post-hospital rehabilitation. Nursing homes serve people who need medical oversight; assisted living serves people who need personal care support. Nursing homes cost $5,000-$8,000/month in Texas; assisted living averages $3,000-$5,000/month.

Does Medicare cover assisted living facilities or group homes?

No. Medicare pays only for skilled medical care: hospital stays, skilled nursing facility rehab, and home health for acute conditions. It does not cover room and board, custodial care, or supervision in assisted living or group homes. Texas group homes rely on Medicaid Home and Community-Based Services waivers, private pay, or SSI contributions. Assisted living is typically private-pay, though some Texas Medicaid waiver programs cover personal care services in ALFs.

What does assisted living provide that group homes don't?

Assisted living facilities in Texas emphasize aging-in-place services: private or semi-private apartments, medication management by licensed nurses, restaurant-style dining, housekeeping, transportation, and on-site activities. They're designed for elderly residents with chronic conditions. Group homes provide skills training, community integration, behavioral support, and employment coaching for younger adults with IDD or mental illness. The care philosophies and physical environments are distinct, though both offer 24-hour staffing.

How much does it cost to start a group home in Texas?

Expect $32,000-$70,000 for a 6-bed home, including first month's rent, renovations, furniture, licensing fees, insurance, and a three-month operating reserve. The reserve is critical because Medicaid waiver enrollment takes 90-120 days and you'll run expenses (payroll, food, utilities) before revenue starts. Buying a property adds $150,000-$300,000 in metro areas. Private-pay residents or family contributions can bridge the gap while Medicaid paperwork processes.

What staff-to-resident ratio does Texas require for group homes?

Texas IDD group homes (26 TAC Chapter 555) require at least 1:6 staff-to-resident during waking hours and 1:8 during sleeping hours, or 1:16 asleep if all residents can self-evacuate. Mental health group homes often require 1:4 or 1:3 depending on acuity. If any resident has complex needs or behavioral plans, HHSC may impose stricter ratios in your license conditions. At least one awake staff must be on-site 24/7.

Can I run a group home out of a single-family house in Texas?

Yes, provided the house meets HHSC's physical plant standards: 80 square feet per resident in shared bedrooms, one bathroom per eight residents, two exits, and fire safety equipment. You also need local zoning approval. Many Texas cities allow group homes in residential zones under the Fair Housing Act, but some require conditional use permits or limit homes to commercial zones. Verify zoning with your city planning department before signing a lease or buying.

How long does a Texas group home license last?

Your initial license is valid for one year. After the first year, Texas issues two-year renewals if you pass monitoring surveys and pay the annual per-bed renewal fee ($50 per bed). HHSC conducts unannounced surveys at least every 24 months; homes with past violations get surveyed annually. You must submit a renewal application and updated background checks 90 days before expiration. Operating with an expired license is illegal and triggers immediate closure.

What training do Texas group home staff need?

Every direct-care employee must complete 8 hours of orientation (fire safety, abuse reporting, resident rights, infection control), current CPR and first aid certification, and 12 hours of annual in-service training. If staff administer medications, they need Texas's 24-hour Medication Aide course or LVN/RN supervision. The director needs a high school diploma and one year of human services experience. All training must be documented in personnel files; missing records are the most common survey deficiency.

What populations can a Texas group home serve?

Texas licenses group homes separately for adults with intellectual and developmental disabilities (26 TAC Chapter 555), adults with mental illness (Chapter 555 Subchapter J), halfway house residents (Chapter 566), people in substance use treatment (Chapter 448), and ICF/IID Medicaid-certified group homes (Chapter 553). Each license type has distinct care, staffing, and documentation standards. You choose your population when you apply; switching later requires a new application and survey.

Do I need a commercial kitchen to operate a Texas group home?

No. Group homes serving 16 or fewer residents use domestic kitchens with standard stoves, ovens, and refrigerators. You do not need a commercial food service permit unless you prepare meals for other facilities or serve the public. Your local fire marshal and HHSC surveyor will check that the kitchen is clean, appliances work, and food is stored safely, but residential equipment is fine for small homes.

How does Medicaid pay for Texas group home services?

Texas Medicaid Home and Community-Based Services (HCS) waivers pay $130-$250 per resident per day for residential support, covering room, board, and direct care. You enroll as a Medicaid provider through TMHP after your HHSC license is issued. Enrollment takes 90-120 days and requires a site visit, background checks, and service documentation. You bill monthly through the state's EVV portal; payments arrive 30-45 days later. Most IDD group homes depend on HCS waiver funding for 80-100% of revenue.

Sources

1. Texas Health and Human Services Commission, Regulatory Services: Group Homes: HHSC licenses group homes for IDD, mental illness, and other populations under 26 TAC Chapter 555; application process, fees ($100-$340), staffing ratios (1:6 waking, 1:8 sleeping), training (8-hour orientation, 12-hour annual in-service), and survey procedures
2. Texas Health and Human Services Commission, Assisted Living Facilities: Assisted Living Facilities operate under 26 TAC Chapter 92, serve elderly residents, and have distinct room, staffing, and licensure requirements from group homes
3. Genworth Cost of Care Survey 2023, Texas: Nursing home care in Texas averages $5,000-$8,000 per month for a semi-private room
4. Texas Health and Human Services Commission, ICF/IID Program: ICF/IID facilities are Medicaid-certified group homes with more intensive staffing and documentation than standard Chapter 555 group homes
5. Texas Health and Human Services Commission, Background Checks for Long-Term Care Providers: Fingerprint-based FBI and Texas DPS checks required for all owners, directors, and direct-care staff; felony convictions for abuse, neglect, exploitation, or violence disqualify applicants
6. Texas Department of Aging and Disability Services (archived), Medication Aide Training: Medication Aide training in Texas requires 24 classroom hours plus skills demonstration; staff who give medications need this training or LVN/RN supervision
7. U.S. Department of Housing and Urban Development, Fair Housing Act: The Fair Housing Act protects group homes from discriminatory zoning; cities cannot outright ban group homes in residential areas but may require conditional use permits
8. Texas Health and Human Services Commission, Home and Community-based Services (HCS) Waiver: HCS waiver funds residential support, day habilitation, and behavioral services for adults with IDD in group homes; rates vary by county and level of need
9. Social Security Administration, SSI Federal Payment Amounts: Federal SSI benefit for individuals is $914/month in 2024; many group home residents contribute SSI toward room and board
10. PHI National, Workforce Data Center: Direct Care Workers: Direct-care worker turnover in residential settings averages 40-60% annually; wages in Texas average $12-$15/hour for group home staff