Last updated 2026-07-25
TL;DR
A Texas assisted living license is issued by the Health and Human Services Commission under Texas Health and Safety Code Chapter 247. Operators apply through HHSC's Long-term Care Regulation division, choose a Type A, Type B, or Type C license based on resident needs, meet staffing and life-safety rules, and pass a pre-licensing survey before admitting residents.
What is assisted living?
Assisted living is housing that combines a residence with personal care help like bathing, dressing, medication reminders, and meal prep, for people who don't need full nursing home care but can't safely live alone anymore. It sits between independent living and skilled nursing on the care spectrum. In Texas, the legal term is "assisted living facility," defined in Texas Health and Safety Code Chapter 247 as an establishment that furnishes food, shelter, and personal care services to four or more people unrelated to the operator, for longer than 24 hours [1]. That four-resident threshold matters a lot: operate for three or fewer unrelated residents and you may fall outside this licensing category entirely, though local zoning and other rules can still apply. Most residents pay privately or through long-term care insurance. Texas assisted living is generally not covered by Medicare, though a limited number of facilities participate in the state's Medicaid waiver program for people who qualify financially and functionally, which is a separate track from straight licensing. If you're comparing this model to other residential care types before you commit to a business plan, it helps to read up on assisted living facilities generally before you look at Texas specifics.
What is a group home, and how is it different from assisted living?
A group home is a smaller residential setting, usually serving people with intellectual or developmental disabilities (IDD), mental illness, or those in addiction recovery, rather than primarily older adults. Group homes often operate under different licensing chapters than assisted living, even within the same state. In Texas, an IDD group home typically falls under HHSC's Home and Community-based Services (HCS) or Texas Home Living (TxHmL) Medicaid waiver programs and their related licensing standards, not Chapter 247. Mental health and substance use recovery residences may fall under entirely separate state rules or, in some cases, operate with no state license at all if they don't provide personal care services (this varies by city and county too, so confirm with your state licensing agency and local zoning office). The practical difference for an operator: assisted living licensing focuses heavily on aging-related care needs, staffing ratios tied to resident acuity, and physical plant rules built around older adults with mobility and cognitive decline. Group home licensing for IDD or behavioral health populations focuses more on individualized service plans, behavioral supports, and Medicaid waiver compliance. If your business plan mixes populations, you may need more than one license type, and mixing licensed and unlicensed models under one roof is a common compliance trap. For a broader look at how these categories differ nationally, see assisted living.
What is an assisted living facility, exactly, under Texas law?
| Type A | Residents who are mobile and can evacuate with minimal physical assistance, no significant behavioral or nursing needs | Lower overnight staffing requirements than Type B/C | |
|---|---|---|---|
| Type B | Residents who need some help evacuating, may have moderate physical or cognitive limitations | Requires overnight awake staff | |
| Type C (formerly "adult foster care" small facility) | Small facility, typically serving 4 to 16 residents in a home-like setting | Different staffing and physical plant standards scaled to home size | HHSC's facility descriptions confirm that "Type A facilities serve residents who are capable of evacuating the facility with minimal assistance" while Type B facilities serve residents who need more evacuation assistance [2]. Get the license type wrong on your application and you'll either under-staff for the residents you actually admit, or over-invest in physical plant features you didn't need. Almost every Texas assisted living facility, regardless of type, must also register its fire and life safety compliance with the State Fire Marshal's Office in addition to HHSC review [3]. Don't treat this as a formality; it's a separate inspection with its own timeline. |
Under Texas Health and Safety Code Section 247.002, an assisted living facility is defined as an establishment furnishing food, shelter, and personal care services (or personal care and nursing services) to four or more unrelated residents, whether or not for profit [1]. HHSC's Long-term Care Regulation (LTCR) division licenses and inspects these facilities. Texas breaks assisted living into three license types based on the acuity and mobility needs of residents served, which HHSC lays out in its facility type guidance: | License type | Who it serves | Key staffing/mobility note |
What does assisted living provide, day to day?
A licensed Texas assisted living facility provides three bundled things at minimum: a private or shared living space, meals, and personal care assistance with activities of daily living (ADLs) like bathing, grooming, dressing, toileting, and mobility. Beyond that baseline, most facilities also offer medication administration or reminders, housekeeping, laundry, social and recreational activities, and 24-hour staff availability, though the level of staffing varies by license type. What it does not typically provide is skilled nursing care on an ongoing basis, ventilator care, or intensive medical monitoring; residents who need that level of care usually need to transition to a skilled nursing facility. Texas rules require assisted living operators to have a written plan for how they handle residents whose needs exceed what the facility is licensed to provide, and HHSC surveyors will check that this plan is more than paperwork. Medication management deserves its own callout. Depending on license type and staff credentials, facilities may administer medications (a higher level requiring specific staff training or licensure) or only assist with self-administration (reminding, opening bottles, reading labels). Confusing these two is one of the most common citations found during HHSC inspections, according to state survey trends discussed in public HHSC policy communications; get your medication policy reviewed by someone who has actually read Chapter 247 before you open.
What is assisted living vs. nursing home, in plain terms?
Assisted living is for people who need help with daily activities but don't require ongoing skilled medical or nursing care. A nursing home (skilled nursing facility, or SNF) is for people who need round-the-clock nursing care, rehabilitation after hospitalization, or management of complex medical conditions. The regulatory difference in Texas is stark. Nursing facilities are licensed under a different chapter of Texas law and federal Medicare/Medicaid Conditions of Participation, with registered nurses required on staff and much heavier documentation and clinical oversight. Assisted living facilities in Texas are licensed under Chapter 247 and do not need to meet the same nursing staffing ratios; a Type A facility, for instance, may not require any licensed nurse on staff at all, depending on resident needs. Cost reflects this difference too. Nationally, nursing home care runs dramatically higher than assisted living: Genworth's 2023 Cost of Care Survey put the median annual cost of a semi-private nursing home room at $104,025, compared to $64,200 for assisted living [4]. Texas-specific costs vary by market (rural facilities generally cost less than Austin, Dallas, or Houston-area ones), so check current local rate surveys rather than relying on national medians for your business plan.
Does Medicare cover assisted living facilities?
No. Medicare does not cover the cost of room and board or personal care services at an assisted living facility. CMS is explicit about this: Medicare Part A and Part B do not pay for long-term custodial care, which is what assisted living primarily provides [5]. Medicare will cover certain medical services a resident receives while living in assisted living, like doctor visits, physical therapy after a qualifying hospital stay, or durable medical equipment, but it will not pay the facility's monthly fee for housing and personal care. Medicaid is a different story, and this is where operators get confused. Texas Medicaid, through its STAR+PLUS program and certain HCBS waivers, can help cover some assisted living-type services for financially and functionally eligible residents, but this is not universal, not automatic, and facilities must specifically enroll and contract to accept it [6]. If your business model depends on Medicaid waiver residents, plan for a separate provider enrollment process on top of your HHSC facility license; the two applications are not the same thing and run on different timelines.
How do I start a group home or assisted living facility in Texas?
Starting a licensed Texas assisted living facility runs through several sequential steps with HHSC, and skipping ahead (like signing a lease before confirming zoning) is the single most expensive mistake new operators make. 1. Decide your license type (A, B, or C) based on the resident population and acuity you intend to serve. 2. Confirm zoning and local occupancy rules with your city or county before you sign a lease or purchase property; HHSC licensing does not override local zoning, and the two processes run independently. 3. Submit a Letter of Intent and the formal application packet to HHSC Long-term Care Regulation, along with the required fee (confirm current fee amounts on HHSC's fee schedule page, since these are adjusted periodically). 4. Develop your policy and procedure manuals: admissions, medication management, emergency preparedness, staffing plans, resident rights, and abuse/neglect reporting protocols. HHSC reviews these as part of licensing. 5. Complete required background checks for the license holder, administrator, and staff through the Texas Department of Public Safety and the HHSC Employee Misconduct Registry. 6. Pass the State Fire Marshal's life safety inspection and any local fire code review. 7. Schedule and pass HHSC's pre-licensing survey, an on-site inspection confirming your physical plant, staffing, and policies meet Chapter 247 and the associated administrative rules in 26 Texas Administrative Code Chapter 553. 8. Receive your license and post it as required before admitting your first resident. HHSC's own guidance describes this as an application and survey process managed through its Long-term Care Regulation division, with facilities required to be "in compliance with licensing standards" before a license is issued [7]. Budget real time for this: many operators find the policy manual and staffing plan development take longer than the physical construction or renovation work, especially if you're writing these documents from scratch instead of adapting a proven template. This is exactly the kind of paperwork-heavy stage where a structured starting point saves weeks. GroupHomePath's $299 State Group Home Licensing Kit gives you a state-specific application checklist and editable policy manual framework so you're not drafting a medication management policy or emergency preparedness plan from a blank page. Find it at /licensing-kit-builder.
What does the Texas assisted living application actually require?
HHSC's application packet for a new assisted living license generally requires: the completed license application form, proof of ownership or lease of the physical location, floor plans showing resident rooms and common areas, your written policies and procedures, staffing plan and job descriptions, proof of liability insurance, background check clearances for the administrator and license holder, and the applicable fee. You'll also need a designated administrator who meets Texas's qualification requirements. Texas requires assisted living facility administrators to be licensed separately through HHSC's Assisted Living Facility Administrator licensing program, which has its own education, exam, and continuing education requirements distinct from the facility license itself [2]. Don't assume your facility license and your administrator license are the same paperwork; they aren't, and both must be current. Expect HHSC to request specific documentation of your emergency preparedness plan, including evacuation procedures and arrangements for sheltering or relocating residents during disasters. This isn't boilerplate in Texas; after Hurricane Harvey and other major weather events, HHSC significantly increased scrutiny of emergency plans for licensed long-term care facilities, and reviewers will ask pointed questions about your actual transportation and shelter arrangements, more than a generic template paragraph.
What are the staffing requirements for a Texas assisted living facility?
Staffing requirements in Texas assisted living scale with license type and resident acuity, and this is set out in the administrative rules under 26 TAC Chapter 553. Type A facilities, serving more independent residents, generally have lighter awake-staff requirements overnight than Type B facilities, which must have an awake staff member present at all times to help evacuate residents who can't do so unassisted [2]. All license types must maintain enough staff to meet residents' scheduled and unscheduled needs around the clock, which HHSC surveyors evaluate partly through staffing schedules and partly through direct observation during inspection. A facility that looks fine on paper but is short-staffed on the survey day will get cited. Medication aides, if your facility administers medications rather than just assisting with self-administration, must complete state-approved training and certification. Texas maintains a Medication Aide Program through HHSC with specific curriculum and testing requirements [8]. Direct care staff more broadly need documented training in resident rights, abuse and neglect reporting, infection control, and emergency procedures before or shortly after their start date; HHSC will ask to see training records during inspection, more than policies describing the training program.
How does the Texas assisted living inspection process work?
Texas assisted living facilities go through a pre-licensing survey before opening, then routine unannounced inspections roughly annually after that, plus complaint investigations any time HHSC receives a report. Surveyors check physical plant safety, staffing levels against your posted schedule, resident records, medication management, and whether your written policies match what's actually happening on the floor. If a survey finds deficiencies, HHSC issues a statement of deficiencies and requires a plan of correction with a specific timeline to fix each item. Serious violations, especially anything touching resident health and safety, can result in enforcement actions ranging from a required corrective action plan up to license suspension or revocation in the most severe or repeated cases, under the enforcement authority granted to HHSC in Chapter 247 [1]. Operators who treat inspections as a one-time hurdle instead of an ongoing operating discipline tend to struggle at renewal. The facilities that do well year over year usually run their own informal mock survey using the same standards HHSC applies, catching gaps in documentation or physical plant maintenance before a real surveyor does. If you're building out a broader compliance framework across facility types, our guide to assisted living facility licensing basics covers how inspection cycles typically work across states.
How much does it cost to get a Texas assisted living license?
Licensing fees for Texas assisted living facilities are set by HHSC and adjusted periodically, so always confirm current amounts directly on HHSC's fee schedule rather than relying on a number from an outside article, since these figures change. Beyond the state license fee itself, expect real costs in property (purchase or lease meeting zoning and fire code requirements), renovation to meet physical plant standards (things like resident room square footage, bathroom accessibility, and fire suppression systems), staffing before you have paying residents, insurance, and the administrator licensing fee and exam cost. Most new operators underestimate the pre-revenue runway: you're paying rent, insurance, and at least some staff salary from the day you sign your lease until the day HHSC issues your license and you can legally admit your first resident, and that gap commonly runs several months once you account for the application review period, fire marshal inspection scheduling, and the pre-licensing survey itself. If you're comparing markets or considering multiple locations, cross-reference our overview on senior assisted living facilities near me for how local market saturation and rent costs factor into the decision, and look at assisted living at home if a smaller residential-scale model fits your capital better than a larger purpose-built facility.
Frequently asked questions
What is assisted living?
Assisted living is housing that provides help with daily activities like bathing, dressing, and medication management for people who need support but not full nursing care. In Texas, it's legally defined under Health and Safety Code Chapter 247 as care and shelter provided to four or more unrelated residents, and it requires an HHSC license.
What is a group home?
A group home is a residential setting, usually smaller than a large assisted living facility, that houses people with intellectual/developmental disabilities, mental illness, or those in addiction recovery. In Texas these typically fall under different licensing programs than assisted living, often tied to HHSC's IDD waiver services rather than Chapter 247.
What is an assisted living facility?
Under Texas Health and Safety Code Section 247.002, an assisted living facility is an establishment that furnishes food, shelter, and personal care services (or personal care and nursing services) to four or more unrelated residents. HHSC licenses these as Type A, Type B, or Type C depending on resident mobility and care needs.
What is assisted living facility, in one sentence?
It's a licensed residential setting combining housing, meals, and help with daily activities like bathing and medication reminders, for people who need support but not the round-the-clock skilled nursing care a nursing home provides.
What is assisted living vs nursing home?
Assisted living serves people who need help with daily activities but not ongoing medical care; nursing homes serve people needing round-the-clock skilled nursing. Nursing homes require RN staffing and follow federal Medicare/Medicaid Conditions of Participation; Texas assisted living is licensed under Chapter 247 with lighter nursing staffing requirements.
What does assisted living provide?
At minimum: housing, meals, and help with activities of daily living like bathing, dressing, toileting, and mobility. Most Texas facilities also provide medication management or reminders, housekeeping, social activities, and staff availability around the clock, scaled to the facility's license type (A, B, or C).
How do I start a group home in Texas?
Decide your population and license type, confirm local zoning before signing a lease, submit your application and fees to HHSC, write required policy manuals, complete background checks, pass the State Fire Marshal inspection, then pass HHSC's pre-licensing survey. Only after receiving your license can you legally admit residents.
What is the difference between assisted living and nursing home care?
Assisted living helps with daily living activities in a more independent, home-like setting. Nursing home care provides intensive medical and nursing supervision for people with complex health needs or recovery requirements. Cost reflects this: Genworth's 2023 survey found nursing home semi-private rooms cost a median $104,025 a year versus $64,200 for assisted living nationally.
Does Medicare cover assisted living facilities?
No. Medicare does not pay for room, board, or personal care services at assisted living facilities, per CMS guidance on long-term custodial care. Medicare may cover specific medical services (doctor visits, therapy) a resident receives while living there, but not the facility's monthly cost.
Does Texas Medicaid cover assisted living?
Texas Medicaid can help cover some assisted living-type services for financially and functionally eligible residents through STAR+PLUS and certain HCBS waivers, but this isn't automatic. Facilities must separately enroll to accept Medicaid, and eligibility rules for residents are strict; confirm current program details with HHSC.
How much does a Texas assisted living license cost?
HHSC sets and periodically adjusts license fees, so confirm the current amount directly with HHSC's fee schedule rather than relying on outdated figures. Beyond the license fee, budget for property, renovation to meet physical plant standards, staffing, insurance, and the separate administrator licensing exam and fee.
What's the difference between a Type A, Type B, and Type C assisted living license in Texas?
Type A serves residents who can evacuate with minimal help and have no significant behavioral or nursing needs. Type B serves residents needing more evacuation assistance and requires awake overnight staff. Type C is typically a smaller, home-like facility (often 4 to 16 residents) with staffing and physical plant standards scaled to that size.
Do I need a separate administrator license to run a Texas assisted living facility?
Yes. Texas requires assisted living facility administrators to hold a separate license through HHSC's Assisted Living Facility Administrator program, with its own education, exam, and continuing education requirements. This is distinct from the facility's own operating license and must be current before residents are admitted.
Sources
- Texas Health and Safety Code, Chapter 247: Definition of assisted living facility as serving four or more unrelated residents, and HHSC's enforcement authority
- Texas HHSC, Assisted Living Facilities: Type A vs Type B facility distinctions based on resident evacuation ability and staffing
- Texas State Fire Marshal's Office: Life safety and fire code review required in addition to HHSC licensing review
- Genworth, Cost of Care Survey 2023: Median annual cost of nursing home semi-private room ($104,025) vs assisted living ($64,200) nationally
- Medicare.gov, Long-Term Care coverage: Medicare does not cover long-term custodial care such as room, board, and personal care in assisted living
- Texas HHSC, STAR+PLUS Program: Texas Medicaid STAR+PLUS program can cover some long-term services for eligible residents
- Texas HHSC, Long-term Care Regulation: HHSC manages the licensing application and survey process for long-term care facilities including assisted living
- Texas HHSC, Medication Aide Program: Medication aides administering medication in facilities must complete state-approved training and certification