Last updated 2026-07-24
TL;DR
Starting a group home in Texas means picking the right license type (assisted living facility, HCSSA, or a DID/HCS provider agreement), meeting HHSC rules under Texas Health and Safety Code Chapter 247, passing a life safety inspection, and submitting your application with the required fee. Timelines usually run 3 to 9 months depending on population served.
What is a group home, exactly?
A group home is a residential setting where a small number of people, usually 3 to 16, live together and get some level of support with daily living, supervision, or care. In Texas, the term isn't one single license category. It covers several regulated programs depending on who lives there: seniors needing help with bathing and medication, adults with intellectual or developmental disabilities (IDD), people in recovery from substance use, or adults with serious mental illness. The Texas Health and Human Services Commission (HHSC) licenses most of these under different rules. A home for seniors or adults needing personal care typically falls under the Assisted Living Facility license (Texas Health and Safety Code Chapter 247) [1]. A home serving people with IDD often operates under a Home and Community-based Services (HCS) or Texas Home Living (TxHmL) Medicaid waiver provider agreement, plus a related facility license depending on size [2]. Recovery residences have a separate, lighter-touch registration path rather than a full facility license [3]. So before you file anything, the real first question isn't 'how do I get a group home license,' it's 'which population am I serving, and which HHSC program regulates that population.' Get that wrong and you'll fill out the wrong forms, pay the wrong fee, and lose months. See our related guide on assisted living facility licensing basics if you're leaning toward the senior care model.
What is assisted living (and what is an assisted living facility)?
Assisted living is a category of long-term care that provides housing plus help with activities of daily living (bathing, dressing, medication reminders, meals) for people who don't need the round-the-clock skilled nursing care a nursing home provides. An assisted living facility is the licensed building and program where that care is delivered. In Texas, an Assisted Living Facility (ALF) is defined and regulated under Texas Health and Safety Code Chapter 247 and Texas Administrative Code Title 26, Chapter 553 [1][4]. HHSC categorizes ALFs into types based on the level of care residents need and whether residents can evacuate a building without help (Type A) or need staff assistance to evacuate (Type B) [4]. A Type C designation (small group homes, sometimes called 'adult foster care' style settings) has additional variations depending on resident count and staffing. Here's the plain-English version: if your home is going to house older adults or adults with disabities who need help getting dressed, remembering pills, or getting around, and they don't need a nurse managing IVs or wound care around the clock, you're probably in ALF territory, not a nursing facility. For more on what separates the two, see the section below on assisted living vs nursing home. Our assisted living overview walks through the license categories in more detail if you want the deeper dive on Type A versus Type B.
What does assisted living provide, day to day?
Assisted living provides a private or shared room, meals, help with activities of daily living, medication management (not administration by a nurse in most cases, unless staffing includes licensed personnel), housekeeping, laundry, social activities, and 24-hour staff availability for emergencies. What it does not typically provide is skilled nursing care such as IV therapy, ventilator management, or complex wound care. Texas rule requires ALFs to have sufficient staff 'awake and on duty' based on resident needs and facility type, and requires a documented plan of care for each resident that's reviewed periodically [4]. Medication administration by unlicensed staff is restricted; Texas allows 'medication assistance' by unlicensed staff who complete required training, but actual administration of injectable medications generally requires a licensed nurse or the resident's own capability to self-administer [4]. Staffing ratios aren't set as a single fixed number across all homes. Instead, Texas rule requires staffing 'sufficient to meet the needs of the residents' with minimums that scale by facility type and resident acuity, confirmed in your facility's individual plan of care review with HHSC. Don't assume a specific ratio without checking the current version of 26 TAC Chapter 553 with your regional HHSC licensing office [4].
What is assisted living vs nursing home? What's actually different?
| Governing Texas law | Health & Safety Code Ch. 247 [1] | Health & Safety Code Ch. 242 [5] | |
|---|---|---|---|
| Licensed nursing staff 24/7 | Not required in most cases | Required | |
| Typical resident need | Help with ADLs, supervision | Complex medical / rehab care | |
| Medicare coverage | Generally not covered [6] | Covered for short-term skilled stays post-hospitalization [6] | |
| Medicaid coverage | Via HCS/TxHmL waiver or state supplement, not standard Medicaid room & board [2] | Covered under Texas Medicaid nursing facility benefit | If you're deciding which model to build, this distinction should drive your whole business plan, your staffing budget, and your insurance costs. Nursing homes cost more to run and require nursing licensure oversight; ALFs are lighter but still heavily regulated. |
The core difference is medical intensity. A nursing home (skilled nursing facility) provides 24-hour licensed nursing care for people with significant medical needs, often after a hospital stay or with chronic conditions requiring constant monitoring. Assisted living provides supportive housing and help with daily tasks for people who are more independent medically. Nursing homes in Texas are licensed separately under Texas Health and Safety Code Chapter 242 and must meet federal Medicare/Medicaid Conditions of Participation if they accept those payers [5]. Assisted living facilities are licensed under Chapter 247 and generally are not required to meet the same federal nursing home Conditions of Participation, though ALFs that want to serve Medicaid HCS/TxHmL waiver clients have their own separate compliance layer [1][2]. Here's a quick comparison: | Feature | Assisted Living Facility | Nursing Home (Skilled Nursing) |
Does Medicare cover assisted living facilities?
No. Medicare does not pay for the room and board or personal care costs of assisted living. Medicare.gov states plainly that Medicare 'doesn't cover room and board when you get hospice care in your home or another facility (like a nursing home)' and doesn't cover long-term custodial care such as assisted living [6]. Medicare Part A may cover a short-term stay in a skilled nursing facility after a qualifying hospital stay, but that's a different setting and a different benefit than ongoing assisted living [6]. Medicaid is a different story, and this matters a lot for group home operators. Texas Medicaid doesn't pay ALF room and board directly either, but it can pay for the services delivered inside a residential setting through home and community-based services waivers like HCS and TxHmL for people with intellectual or developmental disabilities, and through STAR+PLUS for some seniors and people with disabilities [2][7]. Room and board is usually covered separately through the resident's own income (Social Security, SSI) rather than Medicaid. If your business model depends on Medicaid-funded residents, you need a Medicaid provider enrollment in addition to your HHSC facility license, and the application timeline for that runs separately (often 60 to 90 days on top of your facility licensing timeline). Check current provider enrollment requirements directly with HHSC and with Texas Medicaid & Healthcare Partnership (TMHP).
How to start a group home in Texas: the step-by-step process
Starting a group home in Texas generally follows this sequence, though the exact forms and fees depend on which license type applies to your population. 1. Decide your population and license type. Seniors and adults needing personal care: Assisted Living Facility license under Chapter 247 [1]. Adults with IDD: HCS or TxHmL Medicaid waiver enrollment plus applicable facility licensure [2]. Recovery residences: consider certification through a recognized Texas recovery residence certifying organization rather than a full ALF license [3]. Behavioral health group homes may fall under different HHSC or Texas Department of State Health Services program rules depending on services offered; confirm with your state licensing agency before choosing a path. 2. Check your local zoning. Texas state law (Human Resources Code and related fair housing provisions) generally protects small group homes for people with disabilities from being excluded by residential zoning the same way an unrelated boarding house would be, but local ordinances, HOA rules, and occupancy limits still apply and vary by city and county. Confirm zoning treatment with your local planning department before signing a lease or purchase contract. 3. Secure and prepare the physical property. Life safety code compliance (fire alarms, sprinklers if required, exits, ADA-type accessibility features) is inspected before licensure. Requirements differ by facility type and resident count under 26 TAC Chapter 553 [4]. 4. Write your policies and procedures manual. HHSC requires documented policies covering admission and discharge criteria, medication management, staffing plans, emergency preparedness, resident rights, and abuse/neglect reporting procedures before it will issue a license [4]. 5. Hire and train staff, including a qualified administrator. Texas requires ALF administrators to be licensed separately through the Texas Health and Human Services Commission's Assisted Living Facility Administrator licensing program, with required training hours and an exam [4]. 6. Submit your license application and fee to HHSC. Applications are submitted through HHSC's Provider Portal or applicable regional office, with a required license fee that varies by facility type and bed count. Confirm the current fee schedule directly with HHSC, since fees are adjusted periodically. 7. Pass your pre-licensure inspection. HHSC surveyors will inspect the physical plant, records, and staffing before granting the license. 8. Get your license and open. Some operators also pursue Medicaid provider enrollment simultaneously if they intend to accept waiver clients. For a structured way to organize this paperwork, our $299 State Group Home Licensing Kit at /licensing-kit-builder walks through the policy manual, staffing plan, and application checklist pieces so you're not building every document from scratch.
How do I start a group home if I'm serving people with IDD specifically?
If your group home will serve adults with intellectual or developmental disabilities, you're generally looking at becoming a Medicaid HCS (Home and Community-based Services) or TxHmL (Texas Home Living) provider, which is a different track than a standard ALF license, though some facility licensure requirements can overlap depending on size and structure [2]. The HCS program is Texas's primary IDD waiver for residential and community services, and it requires providers to enroll through HHSC, meet program-specific staffing and training standards, and undergo both licensure and program certification reviews. According to HHSC, HCS 'provides services and supports to people with an intellectual disability... who live in their own home, their family's home, or other community settings, such as small group homes' [2]. This path is more paperwork-heavy than a straightforward senior ALF because you're layering Medicaid provider enrollment on top of facility rules. Budget more time (many operators report 6 to 12 months total, though HHSC does not publish an official standard turnaround, so treat this as a planning range, not a guarantee) and expect a person-centered plan review for every resident placed.
What are the staffing and training requirements for a Texas group home?
Staffing requirements depend on your license type, but a few things are consistent across most Texas residential care licenses: you need a designated administrator or director, direct care staff trained in basic first aid and CPR, and documented in-service training on topics like abuse/neglect reporting, resident rights, and emergency procedures [4]. For Assisted Living Facilities, HHSC requires the administrator to hold an ALF Administrator license, which involves specific training hours and passing a competency exam through HHSC's licensing program [4]. Direct care staff typically need training hours documented before working unsupervised with residents, with topics including medication assistance (if applicable), infection control, and emergency response. Criminal background checks are required for all staff who have direct contact with residents, run through the Texas Department of Public Safety and, in many cases, the HHSC Long-term Care Regulation background check unit. Don't skip this step or try to shortcut it; a disqualifying criminal history finding after you've hired someone is one of the more common (and expensive) mistakes new operators make. Staff-to-resident ratios aren't published as a single statewide number; they scale with resident acuity and facility type under 26 TAC Chapter 553, and your facility's specific ratio gets worked out with your HHSC licensing surveyor based on the residents you actually serve [4].
What does the inspection process look like?
Before HHSC issues your license, a surveyor conducts an on-site inspection covering life safety (fire exits, smoke detectors, sprinkler systems where required), sanitation, food service if you're providing meals, medication storage, resident records, and staff files. After licensure, Texas ALFs are subject to periodic unannounced inspections, and HHSC investigates complaints as they come in. Deficiencies get documented on a statement of deficiencies, and you'll be required to submit a plan of correction with a timeline. Repeated or serious deficiencies (like inadequate supervision leading to resident harm) can result in enforcement actions ranging from a plan of correction requirement up to license revocation, depending on severity [4]. A practical tip: walk your building the week before any inspection with a printed copy of the current 26 TAC Chapter 553 checklist (or your regional HHSC office's published inspection guide, if one is available) and physically verify every fire extinguisher tag date, every exit sign bulb, and every medication log entry. Surveyors write up small stuff constantly, and small stuff adds up to a bad survey.
What does zoning and property setup actually require?
Group homes for people with disabilities generally get some protection from exclusionary zoning under fair housing law, but that protection isn't unlimited, and local rules still matter enormously in practice. The federal Fair Housing Act (as amended in 1988) prohibits municipalities from using zoning to exclude group homes for people with disabilities in ways that treat them differently from other residential uses, and HUD has published extensive guidance on 'reasonable accommodation' requests when local zoning would otherwise block a group home . That said, occupancy caps, fire code requirements, parking rules, and HOA covenants can still create real friction, and enforcement of fair housing protections often requires the operator to formally request a reasonable accommodation rather than assuming an automatic exemption. Before signing a lease or a purchase contract, call your city or county planning department and ask directly: 'Is a licensed [ALF/group home] use permitted in this zoning district, and if not, what's the reasonable accommodation process?' Get the answer in writing if you can. This single phone call saves operators more time and money than almost any other step in the process, because a property that looks perfect on paper can become a two-year zoning fight if nobody checked first.
What should the business and financial setup look like?
Beyond licensing, you'll need a business entity (LLC is common for liability separation), general liability and professional liability insurance, workers' compensation coverage for staff, and a clear financial model that accounts for licensing fees, staff wages, food, utilities, insurance, and property costs before your first resident moves in. Most lenders and investors will want to see your HHSC license application status, your lease or property deed, your staffing plan, and a projected census (how many residents, at what payer mix) before funding anything. If you're planning to accept Medicaid waiver clients, factor in that reimbursement rates are set by HHSC and published in the Texas Medicaid fee schedules; these rates vary by service type and region, and operators should pull the current rate schedule directly from HHSC or TMHP rather than relying on secondhand numbers, since rates are updated periodically. Don't over-invest in a large facility before your license is approved. A common and costly mistake is buying or renovating a big property assuming licensure is a formality; it isn't. Get your license type confirmed with HHSC in writing before committing serious capital.
Frequently asked questions
What is assisted living?
Assisted living is housing plus support with daily living tasks like bathing, dressing, and medication reminders, for people who don't need the round-the-clock skilled nursing care a nursing home provides. In Texas it's licensed as an Assisted Living Facility under Health and Safety Code Chapter 247 and Texas Administrative Code Title 26, Chapter 553 [1][4].
What is a group home?
A group home is a residential setting where a small number of unrelated people live together and receive supervision or support, whether that's seniors, adults with IDD, people in mental health or substance use recovery, or another population. Texas regulates it through different license types (ALF, HCS/TxHmL waiver provider, recovery residence certification) depending on who lives there [1][2][3].
What is an assisted living facility?
An assisted living facility is the licensed building and program that provides housing and personal care assistance to residents who need help with daily activities but not full-time skilled nursing. Texas licenses these under Health and Safety Code Chapter 247, with facility types (like Type A and Type B) based on residents' evacuation ability and care needs [1][4].
What is an assisted living facility, in terms of daily operations?
Day to day, it's staff helping residents with bathing, dressing, medication reminders, meals, and housekeeping, plus 24-hour staff availability for emergencies. It is not a setting for IV therapy, ventilator care, or complex wound management; those needs generally require a licensed nursing facility instead [4][5].
What is the difference between assisted living and a nursing home?
Assisted living provides help with daily activities in a home-like setting; a nursing home provides 24-hour licensed skilled nursing care for people with significant medical needs. In Texas, ALFs are licensed under Chapter 247 and nursing homes under Chapter 242, with different staffing and clinical requirements for each [1][5].
Does Medicare cover assisted living facilities?
No. Medicare does not cover the room, board, or personal care costs of assisted living. It may cover a short-term stay in a skilled nursing facility after a qualifying hospital stay, but that's a different benefit and a different type of facility [6].
How do I start a group home in Texas?
Pick your resident population and matching license type (ALF, HCS/TxHmL waiver, or recovery residence certification), confirm zoning, prepare your property for life safety inspection, write your required policy manual, hire trained staff, submit your HHSC application and fee, and pass your pre-licensure inspection. Timelines commonly run 3 to 9+ months depending on complexity [1][2][4].
Does Medicaid pay for group homes in Texas?
Texas Medicaid generally doesn't pay assisted living room and board directly, but it can pay for services delivered in residential settings through waivers like HCS and TxHmL for people with IDD, and through STAR+PLUS for some seniors and people with disabilities. Room and board is typically paid from the resident's own income [2][7].
How long does it take to get a group home license in Texas?
There's no single official published timeline; it depends on license type, application completeness, and inspection scheduling. ALF licensure alone can take a few months once your property and staffing are ready; adding Medicaid waiver enrollment on top typically adds another 60 to 90 days or more. Confirm current processing expectations with your HHSC regional office.
Can a group home be denied by local zoning in Texas?
Federal fair housing law limits municipalities from excluding group homes for people with disabilities through discriminatory zoning, but local occupancy caps, fire codes, and HOA rules still apply, and protections often require a formal reasonable accommodation request rather than an automatic exemption [8]. Always confirm zoning treatment with your local planning department before committing to a property.
What's the difference between an ALF Type A and Type B in Texas?
Type A generally serves residents who can evacuate the building without physical assistance from staff during an emergency. Type B serves residents who need staff assistance to evacuate, which typically requires additional staffing and building safety features. The exact criteria are set in 26 TAC Chapter 553 [4].
Do I need a special administrator license to run a Texas assisted living facility?
Yes. Texas requires ALF administrators to hold a separate Assisted Living Facility Administrator license through HHSC, which involves completing required training hours and passing a competency exam before you can serve as the facility's administrator of record [4].
What background checks are required for group home staff in Texas?
All staff with direct resident contact need criminal background checks, typically run through the Texas Department of Public Safety and HHSC's Long-term Care Regulation background check process. A disqualifying finding can bar someone from working in direct care, so this should be completed before, not after, hiring [4].
Sources
- Texas Health and Safety Code, Chapter 247 (Assisted Living Facilities): Assisted living facilities in Texas are licensed under Health and Safety Code Chapter 247
- Texas HHSC, Home and Community-based Services (HCS) Program: HCS provides services and supports to people with intellectual disability living in community settings including small group homes
- Texas HHSC, Recovery Residence Certification: Recovery residences follow a certification path distinct from full facility licensure
- Texas Administrative Code, Title 26, Chapter 553 (Licensing Standards for Assisted Living Facilities): Staffing, administrator licensing, medication assistance, and facility type (A/B) rules for Texas ALFs
- Texas Health and Safety Code, Chapter 242 (Nursing Homes): Nursing homes in Texas are licensed under Health and Safety Code Chapter 242 with 24-hour licensed nursing requirements
- Medicare.gov, Nursing Home Care Coverage: Medicare does not cover long-term custodial care such as assisted living and only covers short-term skilled nursing after a qualifying hospital stay
- Texas HHSC, STAR+PLUS Program: STAR+PLUS provides Medicaid managed care services for some seniors and people with disabilities including community-based services