Last updated 2026-07-26
TL;DR
Texas assisted living facilities are licensed by the Health and Human Services Commission under Texas Health and Safety Code Chapter 247. You'll pick a facility type (Type A, B, or C), meet staffing and life safety rules, pass a pre-licensure survey, and pay license fees that scale with bed count. Processing typically runs several months, not weeks.
What is assisted living?
Assisted living is a licensed residential setting where people who need help with daily activities, like bathing, dressing, medication reminders, or mobility, live in a home-like setting instead of a hospital or nursing facility. Residents get personal care and supervision but generally don't need the round-the-clock skilled nursing care a nursing home provides. In Texas, this category is regulated as an "assisted living facility" under Texas Health and Safety Code Chapter 247, which the Health and Human Services Commission (HHSC) enforces through its Long Term Care Regulation division [1]. The statute defines an assisted living facility as an establishment that furnishes food, shelter, and personal care services to four or more people who are unrelated to the proprietor, and that provides that care for longer than 24 hours [1]. That four-person threshold matters a lot for anyone starting small. If you're housing three or fewer unrelated residents and not marketing as assisted living, you may fall outside the licensing requirement, but don't assume that on your own. Confirm with your state licensing agency before you open doors, because HHSC's own interpretation of "personal care services" and "unrelated persons" can turn a small operation into a licensable one faster than people expect.
What is an assisted living facility (and how is it different from a group home)?
An assisted living facility in Texas is a licensed building or set of buildings where non-medical personal care and supervision are provided to four or more unrelated residents for compensation, under HHSC's Chapter 247 rules [1][2]. The term covers everything from large purpose-built communities to small residential homes converted for this use. "Group home" is not a distinct Texas license category for the adult assisted living population. It's more of a colloquial term people use for a small, home-like residential care setting. Depending on the population served and services offered, that small home might be licensed as a Type A or Type B assisted living facility, or it could fall under a completely different license, like an intermediate care facility for individuals with an intellectual disability (ICF/IID), a personal care home for people with mental illness, or a different HHSC program entirely. If you're planning to serve seniors who need help with daily living but not heavy medical care, you're most likely looking at Chapter 247 assisted living licensure. If you're planning to serve adults with intellectual or developmental disabilities, or a population with more complex behavioral or medical needs, look at the assisted living facility overview and cross check it against HHSC's other long-term care license types before you commit to a building or a business plan.
What is assisted living vs nursing home in Texas?
| Typical resident need | Help with ADLs, supervision, medication reminders | Skilled nursing, rehab, complex medical care | |
|---|---|---|---|
| Nursing staff requirement | Not required 24/7 in most license types | Licensed nurse required around the clock | |
| Setting | Residential, home-like | Institutional, medical model | |
| Licensing statute | Tex. Health & Safety Code Ch. 247 [1] | Tex. Health & Safety Code Ch. 242 [3] | |
| Medicare coverage | Generally not covered as a residence | Skilled nursing stays can be covered short-term [4] | The line blurs in real life. Some assisted living residents age in place and eventually need nursing-facility-level care, which is one reason HHSC requires facilities to have a written policy on resident discharge and transfer when needs exceed what the license allows. |
The core difference is the level and type of care. Assisted living provides personal care, supervision, and help with daily activities in a residential, non-medical setting. Nursing homes (called "nursing facilities" in Texas licensing language) provide skilled nursing care, rehabilitation, and medical monitoring for people who need a licensed nurse involved in their care around the clock. Nursing facilities in Texas are licensed under a separate chapter, Texas Health and Safety Code Chapter 242, and are inspected against federal nursing home requirements tied to Medicare and Medicaid certification, in addition to state rules [3]. Assisted living facilities are licensed under Chapter 247 and are not required to have a registered nurse on-site at all times, though Type C (which HHSC now folds into revised assisted living categories) and higher-need facilities do carry more medical oversight obligations. Here's a rough comparison that operators find useful when explaining the difference to families or investors. | Feature | Assisted living facility (Ch. 247) | Nursing facility (Ch. 242) |
What does assisted living provide?
Texas assisted living facilities are required to provide, at minimum, room and board, help with activities of daily living, and some level of supervision, with the exact scope depending on the license type (A, B, or the newer combined categories HHSC uses following legislative updates) [1][2]. Beyond the baseline, most facilities also coordinate medication management, arrange or provide meals that meet dietary needs, and offer some social and recreational programming. What assisted living does not automatically include is skilled nursing care, rehab therapy, or a physician on staff. If your facility takes on residents who need injections, wound care, or ventilator support, you're likely operating outside your license type and inviting a deficiency citation, or worse, an emergency suspension. HHSC's licensing rules break this down by facility type. Historically, Type A facilities serve residents who are physically and mentally capable of evacuating without help and don't need routine attendant care during nighttime hours. Type B facilities serve residents who need staff assistance to evacuate, or who need nighttime attendant care, or who are unable to manage their own medication. Confirm current type definitions and any restructuring with your state licensing agency, since HHSC has updated facility classifications and it's easy to work from an outdated fact sheet. If you're building a program for a more specialized population, like memory care or residents with serious mental illness, look at how HHSC's rules on staffing ratios and physical plant requirements shift for those populations before you finalize a facility layout. The assisted living facilities comparison page is a good next stop for seeing how Texas stacks up against neighboring states on this.
How do I start a group home (assisted living facility) in Texas, step by step?
Starting a licensed assisted living facility in Texas is closer to opening a small regulated business than renting out a spare bedroom. Here's the realistic sequence. 1. Confirm your license type and population. Decide whether you're serving general seniors needing ADL support, or a specialized population, and confirm the correct HHSC license category with the agency directly, since the fit determines your staffing and physical plant rules [1]. 2. Check zoning and the physical building. Your building has to meet local zoning for residential care use and the state's life safety code requirements, which generally track National Fire Protection Association standards adopted by reference in HHSC rule. Fire marshal sign-off is a real hurdle, not a formality, and it often takes longer than operators expect. 3. Write your policies and procedures manual. HHSC will ask for written policies covering admission and discharge criteria, medication management, emergency preparedness, resident rights, abuse/neglect reporting, and staff training before it will license you. This is the single most time-consuming paperwork step for first-time operators, and it's also the piece most often rejected for being generic or copy-pasted from another state's template. 4. Build your staffing plan. You need a qualified administrator (Texas requires assisted living facility administrators to be licensed separately through the Texas Department of Licensing and Regulation for many facility types) plus a documented staffing pattern that matches resident acuity and facility size [5]. 5. Submit your license application and fee to HHSC. Applications are submitted to HHSC's Long Term Care Regulation division along with the required fee, which is set out in HHSC's licensing fee rules and scales by facility size [1][2]. 6. Pass the pre-licensure inspection. HHSC surveyors will inspect the physical plant, review your policy manual, and check staffing documentation before issuing an initial license. Expect a full life safety review alongside the health and personal care review. 7. Get your license and start operating within its terms. Initial Texas assisted living licenses are not indefinite. Confirm current renewal periods and any provisional license terms with HHSC, since renewal cycles and provisional license practices can change with legislation. If you want a structured starting point instead of assembling this from scratch, the State Group Home Licensing Kit from GroupHomePath ($299 one-time) walks through state-specific application steps and includes policy manual templates built around what regulators actually ask for. It won't approve your license and it's not a substitute for your own legal review, but it saves the many hours of guessing what HHSC wants in a first policy draft.
What are the Texas assisted living staffing requirements?
Texas requires assisted living facilities to have enough staff, on duty and awake as needed, to meet resident needs based on the facility's licensed type and the acuity of residents in care [1]. There isn't a single statewide numeric ratio (like "1 staff per 8 residents") published the way some states do it. Instead HHSC evaluates staffing sufficiency against resident needs assessments and the facility's own staffing plan, which the facility must document and be able to produce during survey. A few staffing rules are fixed regardless of facility size. Facilities must have a qualified administrator, and for many facility types that administrator must hold a Texas assisted living facility administrator license through the Texas Department of Licensing and Regulation, which requires specific education, examination, and continuing education [5]. Direct care staff generally need documented training in first aid, CPR, resident rights, abuse and neglect reporting, and the facility's emergency plan before they can work unsupervised. For overnight coverage, the key variable is whether residents can self-evacuate. Facilities licensed to serve residents who need help evacuating (historically Type B) are required to have awake, direct care staff on-site overnight, more than on-call staff. Facilities serving only residents who can evacuate independently sometimes had more flexibility here under older rules; confirm current overnight staffing requirements for your specific license type with HHSC before finalizing a staffing budget, since this is one of the areas most likely to change with rule updates.
How much does it cost to get an assisted living license in Texas?
Texas charges an initial license fee and a separate license renewal fee for assisted living facilities, and both scale with the number of licensed beds, per HHSC's published fee schedule [2]. Because fee schedules get updated periodically through rulemaking, don't rely on a number you saw in an old blog post, confirm the current fee amount directly on HHSC's licensing fee page before you budget [2]. Beyond the license fee itself, real startup costs include the building (purchase, lease, or renovation to meet fire and life safety code), fire suppression and alarm system upgrades if the building wasn't already built for residential care occupancy, staff wages during the run-up to opening, liability insurance, and the cost of preparing your policy manual and staff training materials. For a small residential-scale facility, renovation and fire/life safety compliance is usually the single biggest line item, often dwarfing the license fee itself. There's also a cost most first-time operators underestimate: the time between submitting your application and actually admitting your first resident. If your building needs any fire marshal-required upgrades, that timeline alone can run months. Budget cash flow assuming you'll be paying rent, insurance, and at least some staff before you have a single paying resident.
How long does it take to get licensed in Texas?
There's no single fixed timeline, and any source that promises a set number of weeks is guessing. Realistically, expect the process, from finalizing your policy manual through pre-licensure inspection to license issuance, to run several months for a well-prepared applicant, and considerably longer if your building needs fire or life safety renovation, or if your application is returned for corrections. HHSC reviews applications for completeness first. Missing policies, incomplete staffing plans, or an unresolved fire marshal inspection are the most common reasons applications stall. The single best way to compress your timeline isn't to rush the state, it's to submit a complete, correct application the first time, because incomplete submissions go back into a queue rather than getting fast-tracked. Don't sign a lease or buy a property assuming a specific approval date. Build your business plan around a range, and treat any promise of a fixed or expedited approval date, from a consultant, a template seller, or anyone else, with real skepticism. No vendor can promise a state licensing timeline, and Texas HHSC doesn't offer a paid fast-track for initial licensure.
What happens during a Texas assisted living inspection?
HHSC conducts a pre-licensure survey before issuing your initial license, and then periodic inspections (both scheduled renewal surveys and unannounced complaint investigations) after you're operating [1]. Surveyors check three broad areas: the physical plant and life safety compliance, resident care documentation and personal care service delivery, and administrative compliance including staffing records, training documentation, and policy implementation. Expect surveyors to review resident files for care plans, medication administration records, and incident reports. They'll interview residents and staff. They'll walk the building checking for things like unobstructed exits, working smoke detectors, properly stored medications, and posted emergency evacuation plans. Any deficiency gets documented, and depending on severity, you may get a plan-of-correction deadline or, for serious health and safety violations, a more immediate enforcement action. The most common first-time deficiencies aren't exotic. They're missing or incomplete staff training records, medication logs with gaps, and physical plant issues like blocked exits or expired fire extinguisher inspection tags. A tight policies and procedures framework built before your survey, not scrambled together the week before, is the difference between a clean inspection and a stressful one.
Does Medicare cover assisted living facilities?
No. Medicare generally does not cover the cost of living in an assisted living facility, because Medicare is designed to pay for medical care, not room and board or custodial personal care [4]. Medicare.gov is direct about this limitation: Medicare Part A and Part B do not pay for long-term custodial care, which is the category assisted living falls into for coverage purposes [4]. What Medicare can cover, even for someone living in assisted living, is medically necessary services delivered there or elsewhere, like doctor visits, some home health services under specific conditions, and durable medical equipment. But the rent, the personal care aide, the meals, none of that is a Medicare-covered benefit. Medicaid is a different story, and a more complicated one. Some states use Medicaid Home and Community-Based Services (HCBS) waivers to help cover certain services within assisted living settings, though Medicaid generally still won't pay for room and board [6]. Texas has HCBS waiver programs, and coverage of assisted living-adjacent services through Medicaid varies by program and eligibility category, so confirm current Texas Medicaid HCBS waiver rules with HHSC and the Texas Medicaid program directly rather than assuming coverage exists for a specific resident's situation.
What license type should I apply for: Type A, Type B, or something else?
The right Texas assisted living license type depends almost entirely on the acuity and evacuation ability of the residents you plan to serve, not on the size or style of your building. Historically, Type A licenses fit residents who can evacuate a building without physical assistance from staff and who don't require nighttime attendant care. Type B licenses fit residents who need staff help to evacuate, need overnight attendant care, or can't reliably manage their own medications. HHSC has restructured facility classifications over time through rulemaking, so don't rely on an older article's exact category names without confirming the current structure directly with the agency. What hasn't changed is the underlying logic: the more support a resident needs to get out of the building safely and to manage daily medical and personal needs, the more staffing, training, and physical plant requirements your license carries. Getting this wrong in either direction causes real problems. Under-license (apply for the lighter category) and take on higher-need residents, and you're operating outside your license scope, which is a survey finding waiting to happen. Over-license (apply for the heavier category) when you don't need to, and you're carrying staffing costs and administrator credentialing requirements you didn't have to take on. Talk through your target population honestly with HHSC's licensing staff before you file.
How is Texas assisted living licensing different from other states?
Texas licenses assisted living facilities through a single statewide agency, HHSC, under one statute (Chapter 247), which is more centralized than states that split authority between health departments and separate social services agencies [1]. That's generally a plus for operators: one set of rules, one inspecting body, one fee schedule to track. Where Texas differs meaningfully from some other states is the administrator licensing requirement. Texas requires a separate, examination-based administrator license through the Texas Department of Licensing and Regulation for many assisted living facility types, which adds a real credentialing step beyond just hiring an experienced manager [5]. Some states don't require this at all, or require only facility-level training rather than an individually licensed administrator. If you're comparing Texas to a state you've operated in before, or you're deciding where to open your first facility, the assisted living hub page is a useful jumping-off point for seeing how administrator licensing, staffing ratio rules, and fee structures vary state to state before you commit capital to one state's process.
What should be in my policies and procedures manual before I apply?
HHSC expects a written policy manual covering, at minimum: admission and discharge criteria, resident rights and grievance procedures, medication management and administration, emergency preparedness and evacuation, abuse/neglect/exploitation reporting, staff training and supervision, infection control, and incident reporting [1]. This isn't a form you fill in once. It's the operational backbone surveyors will check against what actually happens in your building. The biggest mistake first-time applicants make is treating the policy manual as a licensing hurdle rather than the document staff actually use. If your medication management policy says one thing and your medication log shows something else during survey, that's a deficiency, and it's an entirely avoidable one. Write policies you can actually follow, train staff on them before your pre-licensure survey, and keep the manual current as HHSC updates its rules. If you'd rather start from a framework built specifically around what state licensing agencies ask for rather than a generic template, that's exactly the gap the State Group Home Licensing Kit ($299 one-time) is built to close, with state-specific policy manual starting points you adapt to your facility rather than write from a blank page. It's not legal advice and it doesn't replace your own attorney's review, but it gives you a real starting draft instead of a blank cursor.
Frequently asked questions
What is assisted living?
Assisted living is a licensed residential care setting where people who need help with daily activities, like bathing, dressing, or medication management, live in a home-like environment with staff support, but without the round-the-clock skilled nursing care a nursing home provides. In Texas, it's licensed under Health and Safety Code Chapter 247 by HHSC.
What is a group home?
"Group home" isn't an official Texas license category for adult assisted living. It's a common term for a small, residential-style care setting. Depending on the population and services, that home might actually be licensed as a Texas assisted living facility, an ICF/IID, or another HHSC license type entirely, so confirm which category applies with HHSC directly.
What is an assisted living facility?
An assisted living facility is an establishment licensed to provide food, shelter, and personal care services to four or more unrelated residents for longer than 24 hours, per Texas Health and Safety Code Chapter 247. It provides supervision and help with daily living but generally not skilled nursing care.
What is assisted living vs nursing home?
Assisted living provides personal care and supervision in a residential setting without requiring 24-hour nursing staff. Nursing homes provide skilled nursing and medical care around the clock and are licensed in Texas under a separate law, Chapter 242, tied to federal nursing home certification requirements.
What does assisted living provide?
At minimum, Texas assisted living facilities provide room and board, help with activities of daily living, supervision, and typically medication management support. What's included beyond that depends on the license type (A, B, or updated HHSC categories) and doesn't include skilled nursing or complex medical care.
How do I start a group home in Texas?
Confirm your correct HHSC license type and population, secure a building that meets zoning and life safety code, write a full policies and procedures manual, build a staffing plan with a licensed administrator, submit your application and fee to HHSC, and pass the pre-licensure inspection before admitting residents.
What is the difference between assisted living and nursing home care?
The core difference is medical intensity. Assisted living serves people needing help with daily activities and supervision. Nursing homes serve people needing skilled nursing, rehabilitation, and continuous medical monitoring, and are held to a different, more medically-focused set of federal and state requirements.
Does Medicare cover assisted living facilities?
No. Medicare does not cover assisted living room, board, or custodial personal care costs, according to Medicare.gov. Medicare can still cover medically necessary services a resident receives, like doctor visits or certain home health services, but not the cost of living in the facility itself.
How do I start a group home in Texas if I only want to serve 2 or 3 residents?
Texas's assisted living licensing threshold under Chapter 247 applies to facilities serving four or more unrelated residents. Serving fewer people may fall outside that specific requirement, but other licensing categories can still apply depending on services provided, so confirm your specific situation with HHSC before assuming you're exempt.
How much does a Texas assisted living license cost?
Texas charges initial and renewal license fees that scale by licensed bed count, set through HHSC rulemaking and published on HHSC's licensing fee schedule. Because fees change periodically, confirm the current amount directly with HHSC rather than relying on an older published figure.
Does Texas require an assisted living administrator to be licensed separately?
Yes, for many facility types. Texas requires assisted living facility administrators to hold a separate license through the Texas Department of Licensing and Regulation, which involves education requirements, an exam, and continuing education, in addition to whatever HHSC requires of the facility itself.
How long does Texas assisted living licensing take?
There's no fixed timeline promised by the state. A well-prepared applicant with a complete policy manual, staffing plan, and a building already meeting fire and life safety code can expect a process running several months; incomplete applications or buildings needing renovation take considerably longer.
What's the difference between Type A and Type B assisted living licenses in Texas?
Historically, Type A fits residents who can evacuate without staff help and don't need overnight attendant care. Type B fits residents needing evacuation assistance, overnight attendant care, or medication management help. HHSC has updated classifications over time, so confirm current category definitions directly with the agency.
Sources
- Texas Health and Safety Code, Chapter 247 (Assisted Living Facilities): Definition of assisted living facility, four-or-more-resident threshold, and licensing authority under Chapter 247
- Texas HHSC, Long Term Care Regulation licensing fees: Assisted living facility licensing overview and fee scaling by facility size
- Texas Health and Safety Code, Chapter 242 (Nursing Facilities): Nursing facility licensing statute and separation from assisted living licensure
- Medicare.gov, Long-Term Care coverage information: Medicare does not cover assisted living room, board, or custodial personal care costs
- Texas Occupations Code, Chapter 247 (Assisted Living Facility Administrators): Texas requires assisted living facility administrators to hold a separate license
- Medicaid.gov, Home & Community-Based Services: Medicaid HCBS waivers can cover certain services in residential settings but generally not room and board