Last updated 2026-07-26
TL;DR
Texas Health and Human Services Commission licenses assisted living facilities under Texas Health and Safety Code Chapter 247. Operators apply through HHSC's Long Term Care Regulation division, choose a facility type (Type A, B, C, or E) based on resident mobility and care needs, pass a life safety inspection, and pay license fees that scale with bed capacity.
What is assisted living?
Assisted living is a residential care setting where people who need help with daily activities, like bathing, dressing, medication reminders, or meal prep, live in a home-like environment instead of a hospital-style institution. It sits between fully independent living and a nursing home. Residents usually have their own room or apartment, plus staff on site to help as needed. In Texas, assisted living isn't a casual industry term. It's a specific licensed category defined in state law. Texas Health and Safety Code Chapter 247 governs "assisted living facilities" and gives the Health and Human Services Commission (HHSC) authority to license and inspect them [1]. If you're operating a home in Texas and calling it assisted living, calling it a personal care home, or calling it a residential care facility, you almost certainly need this license. HHSC's own rule defines an assisted living facility as an establishment that furnishes food, shelter, and personal care services to four or more people unrelated to the proprietor [1]. That four-person threshold matters a lot. Smaller homes with three or fewer unrelated residents can sometimes operate outside the licensing requirement, though local zoning and other rules still apply. Anything at four residents or more triggers HHSC licensure.
What is a group home?
"Group home" is a broader, less legally precise term than assisted living facility. People use it to describe any residential setting where a small number of unrelated adults live together and receive some level of support or supervision. Depending on the population served, a group home might be licensed under a completely different regulatory scheme than assisted living. In Texas, a home serving adults with intellectual or developmental disabilities is often licensed as a Home and Community-based Services (HCS) provider or an ICF/IID, not as an assisted living facility. A home serving people in mental health recovery might fall under a different HHSC program entirely. A home serving seniors who need help with ADLs (activities of daily living) is the one that typically needs the assisted living license under Chapter 247. If you're planning to open a group home and you're not sure which license category fits, don't guess. Confirm with your state licensing agency before you sign a lease or start construction, because the wrong license type can mean a wasted build-out and a stalled application. For readers comparing categories, our assisted living facility overview breaks down how these programs differ by state.
What is an assisted living facility (and what makes Texas's definition specific)?
| Type A | Residents who are mentally and physically capable of following instructions in an emergency, no more than minimal physical assistance needed to evacuate | Can be on any floor with adequate egress | |
|---|---|---|---|
| Type B | Residents who need staff assistance to evacuate, or who are not physically or mentally capable of self-preservation | Stricter physical plant and staffing-on-duty rules, awake overnight staff required | |
| Type C | Small (4-bed) adult foster care type homes | Reduced physical plant requirements, family-style setting | |
| Type E | Residents who need help evacuating but can respond to instructions with staff assistance | Falls between A and B in evacuation capability | These categories come directly from HHSC's assisted living facility licensing standards under 26 Texas Administrative Code Chapter 553 [2]. Choosing the wrong type on your application is one of the most common reasons applications stall, because your physical plant (door widths, fire alarm systems, sprinklers) has to match the type you're requesting. |
An assisted living facility, under Texas Health and Safety Code Section 247.002, is an establishment that furnishes, in one or more facilities, food and shelter to four or more people who are unrelated to the proprietor, and provides personal care services [1]. The key phrase is "personal care services," which HHSC rule defines as help with activities like bathing, dressing, grooming, toileting, or supervision of self-administered medication. Texas licenses assisted living facilities under four types, and the type you apply for depends on residents' mobility and evacuation capability, more than the services you offer: | Facility type | Who it serves | Key requirement |
What is assisted living vs nursing home?
Assisted living and nursing homes both provide residential care, but they differ in the level and intensity of medical services. Assisted living, including in Texas, is a personal care model. Staff help residents with daily tasks, but there's no requirement for 24-hour licensed nursing care on site. Nursing homes (called "nursing facilities" in Texas regulation) are licensed under a different chapter, Texas Health and Safety Code Chapter 242, and must have a licensed nurse on duty and provide skilled nursing and rehabilitation services [3]. Practically, this means nursing homes take residents who need IV therapy, wound care, ventilator support, or post-surgical recovery care. Assisted living facilities are for people who are more independent but need help with daily living and maybe medication management. Texas assisted living facilities generally cannot keep residents who need continuous nursing care unless the facility is also licensed for a higher level of service. Cost is different too. Nursing home care is far more expensive on average nationally, largely because of the higher staffing ratios and medical equipment. Genworth's Cost of Care Survey, a widely cited industry benchmark, has tracked assisted living and nursing home costs annually and consistently shows nursing home semi-private rooms costing more per month than assisted living [4]. If you're deciding which license path fits your business plan, this distinction should drive the decision, not the other way around.
What does assisted living provide?
A Texas-licensed assisted living facility has to provide, at minimum: three meals a day (or the equivalent), housekeeping, laundry, help with personal care and ADLs, supervision of self-administered medication, some form of social and recreational activity, and a way to respond to emergencies 24 hours a day. HHSC rule spells these out as minimum standards under 26 TAC Chapter 553 [2]. Beyond the minimums, a lot varies by facility type and the population you're licensed to serve. A Type B facility, because its residents need more help evacuating, must have awake staff on duty overnight. A Type A facility with more independent residents may not require that. Medication management is one area operators underestimate. Texas rules distinguish between administering medication (a licensed task, generally requiring a nurse or delegated aide under specific protocols) and supervising self-administration (helping a resident who can still take their own pills, just needs a reminder or help opening the bottle). Get this distinction wrong in your policy manual and it'll surface in your first inspection. Our guide on assisted living facilities walks through how other states structure similar staffing and care-level rules if you're comparing markets.
How do I start a group home (Texas assisted living) step by step?
Starting an assisted living facility in Texas runs through several sequential steps, and skipping ahead (like buying a property before confirming zoning, or hiring staff before your application is even submitted) is the single most common way operators waste money. 1. Decide on facility type (A, B, C, or E) based on the residents you intend to serve and their evacuation capability [2]. 2. Confirm local zoning allows a residential care use at your chosen property. Zoning is handled at the city or county level, not by HHSC, so confirm with your local planning or zoning department directly. 3. Complete required pre-licensing orientation. HHSC requires applicants to attend a pre-application orientation or webinar before submitting a full application, per HHSC's Long Term Care Regulation provider guidance [5]. 4. Submit your license application to HHSC's Long Term Care Regulation division, along with the applicable fee. HHSC's fee schedule sets license fees based on facility bed capacity, and these fees are published on HHSC's licensing fee page and are subject to change, so confirm with your state licensing agency for the current amount before budgeting [6]. 5. Prepare your physical plant to meet fire, safety, and building code standards for your facility type. This often requires coordination with the State Fire Marshal's Office for life safety code compliance, since Texas assisted living facilities must meet applicable provisions of the Life Safety Code adopted by reference in HHSC rule [2]. 6. Develop your policy and procedure manual covering admission and discharge criteria, medication management, staffing plans, emergency preparedness, resident rights, and abuse/neglect reporting protocols. 7. Hire and train a qualified administrator. Texas requires assisted living facility administrators to hold a license issued by HHSC under the Assisted Living Facility Administrators Licensing rules, separate from the facility license itself [7]. 8. Pass your pre-licensure inspection. An HHSC surveyor visits the facility to confirm the physical plant, staffing, and policies match what's on the application before a license is issued. 9. Receive your license and open. Initial licenses in Texas are typically issued for a set period and must be renewed; confirm current renewal cycles and requirements with HHSC directly since these details are updated periodically. If you want a structured way to organize all of this documentation instead of building every policy from scratch, our $299 State Group Home Licensing Kit gives you state-specific templates for the policy manual, staffing plan, and application checklist pieces of this process.
What is the difference between assisted living and nursing home (licensing and staffing)?
Beyond the care-level distinction, the licensing and staffing requirements diverge sharply. Texas nursing facilities, licensed under Chapter 242, must meet federal Medicare/Medicaid Conditions of Participation if they accept those payers, including specific registered nurse coverage and a federally mandated minimum staffing standard framework that CMS has been developing and adjusting in recent years [8]. Assisted living facilities in Texas are state-licensed only; there's no federal license for assisted living because Medicare and Medicaid don't cover assisted living room and board the way they cover nursing facility stays. Staffing ratios also differ by design, more than by rule. Nursing homes need licensed nurses around the clock. Texas assisted living facilities need "sufficient staff" to meet resident needs based on their assessed acuity, which HHSC rule requires facilities to document through individual service plans, but the specific numeric ratio is not fixed the same way federal nursing home staffing rules are. Inspection frequency and survey scope differ too. Both are subject to HHSC oversight, but nursing facilities face more frequent federal survey cycles tied to Medicare/Medicaid certification, while assisted living inspections are driven by the state license renewal cycle and complaint investigations.
Does Medicare cover assisted living facilities?
No. Medicare does not cover the cost of room and board at an assisted living facility. Medicare.gov states plainly that Medicare does not pay for "custodial care" (help with daily activities like bathing and dressing) when that's the only care needed, and it does not cover long-term residential care in assisted living [9]. Medicare Part A can still cover medically necessary services delivered while someone happens to live in assisted living, like a home health nurse visit or short-term rehab after a hospital stay, but not the facility's monthly rent-and-care fee itself. Medicaid is a different story, and this is where it gets state-specific. Texas Medicaid, through its STAR+PLUS Home and Community Based Services waiver program, can help cover personal care services and case management for eligible low-income residents in some assisted living settings, but it does not typically cover room and board costs either [10]. Coverage details, eligible service types, and enrollment caps change, so confirm current STAR+PLUS waiver rules with HHSC or Texas Medicaid directly before building coverage assumptions into a business plan. This is a critical point for anyone building a financial model around a Texas assisted living facility: most residents (or their families) pay privately, at least for the base room-and-board rate. Don't assume Medicaid will backstop your occupancy the way it does in nursing facilities.
What does an HHSC inspection actually check?
HHSC surveyors conducting a Texas assisted living facility inspection review several categories: life safety and physical plant compliance (fire alarms, sprinklers, exits, evacuation capability matched to your facility type), resident records and service plans, medication management practices, staffing schedules against required ratios, resident rights postings and grievance procedures, and food service sanitation. Inspections happen at three points: before initial licensure, on a periodic basis tied to your license renewal cycle, and in response to a complaint. HHSC also conducts unannounced inspections, meaning you don't get advance notice of the exact date. Deficiencies get cited by category, and depending on severity, HHSC can require a plan of correction, assess an administrative penalty, or in serious cases move to suspend or revoke the license under the enforcement provisions in Chapter 247 [1]. The most common paperwork-level citations tend to involve incomplete resident service plans, medication administration records that don't match what's actually being given, and missing or outdated staff training documentation. None of these are expensive to fix if you build the habit early; they're expensive if you're scrambling to reconstruct them the week before a survey.
What does the application and fee process actually cost?
Texas ties assisted living facility license fees to the number of licensed beds, with the fee schedule published by HHSC and subject to periodic updates. Because these fee amounts change, don't rely on a number you saw in a forum post or an old article; confirm the current fee schedule directly on HHSC's licensing fees page before submitting payment with your application [6]. Beyond the state license fee itself, budget separately for: the Life Safety Code inspection and any required physical plant upgrades, the Assisted Living Facility Administrator license fee for whoever runs the home day to day, background check and fingerprinting costs for staff (required under HHSC's employee misconduct registry and criminal history checks), and any local business licensing or zoning permit fees, which are entirely separate from state licensing and vary by city and county. Most of the real cost variance between operators isn't the state fee, it's the physical plant work. A Type B facility with awake overnight staff and stricter evacuation infrastructure costs meaningfully more to build out than a Type A facility with more independent residents. Get your facility type decision right at the start, because retrofitting a building from Type A specs to Type B specs after the fact is one of the more expensive mistakes an operator can make.
What are common reasons Texas applications get delayed or denied?
The most frequent hold-ups aren't dramatic, they're procedural. Incomplete applications (missing attachments, unsigned forms, mismatched facility type and physical plant plans) sit in queue until HHSC sends a deficiency letter and the applicant responds. Skipping the required pre-application orientation before submitting also causes delays, since HHSC's process expects that step first [5]. Zoning conflicts are another major one, and they're entirely outside HHSC's control. An applicant can have a perfect state application and still be unable to open because the local zoning board doesn't allow a residential care facility use at that address, or requires a conditional use permit that takes months to get. Confirm zoning before you commit to a lease or purchase, not after. Background check issues on key staff, especially the administrator, are also common. Texas requires criminal history checks and checks against the Texas employee misconduct registry for anyone with direct resident contact, and a disqualifying finding on a key hire can stall the whole opening timeline. Finally, financial or ownership disclosure problems, particularly for applicants who've had a license action against them in another state, can trigger additional HHSC review. If your ownership group has any prior licensing history anywhere, be upfront about it on the application rather than letting HHSC discover it during background review.
How does Texas licensing compare to starting a group home in other states?
Every state runs its own licensing scheme, and there's no federal assisted living license, so the process, facility-type categories, and fee structures in Texas won't map cleanly onto another state's system. Some states use a single "assisted living" license type; Texas splits it into four (A, B, C, E) based on evacuation capability, which is a more granular approach than many states take. If you're planning to operate in more than one state, or you're comparing Texas to a neighboring state before deciding where to build, it helps to look at the population-specific pages for your target market, like our senior assisted living facilities near me resource, or our assisted living at home guide if you're considering a smaller, home-based model instead of a larger licensed facility. The one constant across states: nobody should start buying property or hiring staff before they've confirmed, in writing, what license category and physical plant standard applies to their specific plan. A phone call or email to the licensing agency at the start saves months later.
Frequently asked questions
What is assisted living?
Assisted living is a residential care model where people who need help with daily activities like bathing, dressing, or medication reminders live in a home-like setting with staff support, rather than in a hospital-style institution. In Texas, it's a specific licensed category under Health and Safety Code Chapter 247, not a generic descriptive term.
What is a group home?
Group home is a general term for a residential setting where several unrelated adults live together with some level of support. The specific license required depends on who lives there: seniors needing ADL help typically fall under assisted living licensing, while people with intellectual or developmental disabilities are usually licensed under a different HHS program entirely.
What is an assisted living facility?
Under Texas Health and Safety Code Section 247.002, an assisted living facility furnishes food, shelter, and personal care services to four or more unrelated residents. HHSC licenses these facilities under four types (A, B, C, E) based on residents' ability to evacuate in an emergency, with each type carrying different physical plant and staffing rules.
What is assisted living vs nursing home?
Assisted living provides personal care and daily living support without required round-the-clock licensed nursing. Nursing homes, licensed in Texas under Chapter 242, provide skilled nursing and rehabilitation care and must have licensed nurses on duty. Nursing homes serve people with higher medical acuity; assisted living serves people who are more independent but need daily support.
What does assisted living provide?
Texas-licensed assisted living facilities must provide at minimum three meals a day, housekeeping, laundry, help with personal care and daily activities, supervision of self-administered medication, some social activities, and 24-hour emergency response capability, per HHSC's minimum standards under 26 TAC Chapter 553.
How do I start a group home in Texas?
Decide your facility type (A, B, C, or E), confirm local zoning allows the use, complete HHSC's required pre-application orientation, submit your license application with the applicable fee, prepare your physical plant to meet fire and life safety codes, build your policy manual, hire a licensed administrator, and pass HHSC's pre-licensure inspection.
What is the difference between assisted living and nursing home licensing?
Nursing homes must meet federal Medicare/Medicaid Conditions of Participation, including required licensed nurse coverage, if they accept those payers. Assisted living facilities in Texas are state-licensed only, with staffing requirements tied to resident acuity and service plans rather than a fixed federal nurse-staffing rule.
Does Medicare cover assisted living facilities?
No. Medicare does not pay for room and board or custodial care at assisted living facilities. Medicare can cover specific medical services delivered to someone who happens to live in assisted living, like home health visits, but not the facility's monthly care fee itself, per Medicare.gov guidance.
Does Medicaid pay for assisted living in Texas?
Texas Medicaid's STAR+PLUS waiver program can help cover personal care services for some eligible low-income residents in assisted living settings, but it generally does not cover room and board. Coverage details and enrollment limits change, so confirm current rules directly with HHSC or Texas Medicaid before relying on this in a financial plan.
How much does a Texas assisted living license cost?
Texas ties license fees to the number of licensed beds, with the schedule published and periodically updated on HHSC's licensing fee page. Because fee amounts change, confirm the current schedule directly with HHSC rather than relying on a fixed number, and budget separately for physical plant upgrades and administrator licensing costs.
What are the four types of Texas assisted living facility licenses?
Texas licenses Type A (residents largely capable of self-evacuation), Type B (residents needing staff assistance to evacuate, with awake overnight staff required), Type C (small four-bed adult foster care style homes), and Type E (residents needing evacuation help but who can follow instructions with assistance), each under 26 TAC Chapter 553.
Do I need a separate administrator license to run a Texas assisted living facility?
Yes. Texas requires the administrator of a licensed assisted living facility to hold a separate Assisted Living Facility Administrator license issued by HHSC, in addition to the facility's own license. This is a distinct credential with its own qualification and training requirements.
How often does HHSC inspect assisted living facilities?
HHSC inspects before initial licensure, periodically tied to the license renewal cycle, and in response to complaints. Inspections can be unannounced. Surveyors check physical plant safety, resident service plans, medication management, staffing, and resident rights compliance, and can require a plan of correction for deficiencies.
Sources
- Texas Health and Safety Code, Chapter 247: HHSC's authority to license and regulate assisted living facilities and enforcement provisions
- 26 Texas Administrative Code Chapter 553: Facility type classifications (A, B, C, E), minimum standards, and Life Safety Code requirements for Texas assisted living facilities
- Texas Health and Safety Code, Chapter 242: Nursing facility licensing requirements including licensed nurse staffing, separate from assisted living licensure
- Genworth Cost of Care Survey: Nursing home costs are consistently higher than assisted living costs nationally
- HHSC Long Term Care Regulation, Provider Guidance: Applicants must complete pre-application orientation before submitting a full assisted living facility license application
- HHSC Long Term Care Regulation License Fees: Assisted living facility license fees are set based on bed capacity and subject to change
- 26 Texas Administrative Code Chapter 554 (Assisted Living Facility Administrators): Texas requires a separate license for assisted living facility administrators
- CMS, Minimum Staffing Standards for Long-Term Care Facilities: CMS has established federal minimum staffing standard requirements applicable to Medicare/Medicaid-certified nursing facilities
- Medicare.gov, Nursing Home Care coverage information: Medicare does not cover long-term custodial care or room and board in assisted living settings
- Texas HHSC, STAR+PLUS Program: Texas Medicaid's STAR+PLUS waiver can help cover personal care services for eligible residents in some assisted living settings