Last updated 2026-07-24
TL;DR
Texas regulates assisted living facilities through the Health and Human Services Commission (HHSC) under Texas Health and Safety Code Chapter 247 and 26 TAC Chapter 553. Operators need a state license before admitting residents, must meet staffing and life-safety rules tied to facility Type (A, B, or C), and pass a pre-licensing inspection. Medicare does not pay for assisted living room and board; Medicaid may help through HHSC's Community First Choice or STAR+PLUS waiver programs for qualifying residents.
What is assisted living, and what is an assisted living facility?
Assisted living is a residential care model for adults who need help with daily activities like bathing, dressing, medication reminders, or meal prep, but who don't need the round-the-clock skilled nursing care a nursing home provides. An assisted living facility (ALF) is the licensed building or program where that care happens, typically a house, converted home, or purpose-built residence with private or semi-private rooms, shared common areas, and staff on site. In Texas, the legal term is exact. Texas Health and Safety Code Chapter 247 defines an assisted living facility as an establishment that furnishes food, shelter, and personal care services to four or more people unrelated to the owner [1]. Fewer than four residents generally falls outside the licensing requirement, which is why some small adult foster care or family-style homes operate differently. If you're taking in four or more unrelated adults needing personal care in Texas, you almost certainly need an HHSC license. The distinction between 'assisted living' as a concept and 'assisted living facility' as a licensed entity matters for paperwork. When you fill out your HHSC application, you're not licensing a service, you're licensing a specific physical location, under a specific facility Type, with a specific bed count. Change the address or add beds beyond your approved capacity, and you need an amended license.
What is a group home, and how is it different from an assisted living facility?
'Group home' is a broader, less legally precise term than 'assisted living facility.' People use it to describe small residential settings serving people with intellectual and developmental disabilities (IDD), mental illness, substance use recovery needs, or seniors, often with fewer than 10 residents in a house-like setting. In Texas, a group home serving people with IDD is usually licensed differently than an assisted living facility, often under HHSC's Home and Community-based Services (HCS) or Texas Home Living (TxHML) Medicaid waiver programs rather than Chapter 247. A group home for seniors needing personal care, on the other hand, usually does fall under the assisted living license if it serves four or more unrelated residents. The practical upshot: if your target population is IDD, look at HCS/TxHML licensing rules, not straight ALF rules. If your target population is seniors or adults needing help with daily living but not habilitation services, Chapter 247 assisted living licensing is the right track. Confirm with your state licensing agency before building a program around the wrong license type, because the staffing ratios, training hours, and inspection checklists differ.
What is assisted living vs nursing home? What's the actual difference?
| Governing law | Texas Health & Safety Code Ch. 247 [1] | Texas Health & Safety Code Ch. 242 | |
|---|---|---|---|
| Care level | Help with ADLs, medication reminders | Skilled nursing, daily medical care | |
| Licensed nurse on site | Not always required 24/7 | Required around the clock | |
| Medicare coverage | No, for room and board | Yes, limited, short-term only [2] | |
| Typical resident | Mobile or semi-mobile, stable health | Higher acuity, post-hospital or chronic | A lot of families get this wrong when a parent's needs are increasing. If someone needs daily wound care, IV therapy, or has advanced dementia with wandering and fall risk, an assisted living facility (especially Type A) may not be equipped to keep them safe, and the facility itself may be required to discharge the resident under Texas's transfer/discharge rules if their needs exceed the facility's licensed scope [1]. |
The core difference is the level of medical care. Assisted living is for people who are mostly independent but need help with activities of daily living (ADLs) and maybe medication management. Nursing homes (called 'skilled nursing facilities' in Medicare terms) are for people who need daily skilled nursing care, rehabilitation therapy, or complex medical supervision. Texas licenses nursing homes separately, under Texas Health and Safety Code Chapter 242, with a licensed nurse required on site around the clock in most cases. Assisted living facilities under Chapter 247 do not require the same level of continuous licensed nursing presence, though Type B and Type C facilities (discussed below) do require more staff awake and available overnight than Type A. | Feature | Assisted Living (ALF) | Nursing Home (SNF) |
What does assisted living provide, day to day?
At minimum, Texas rule requires ALFs to provide three meals a day plus snacks, help with ADLs (bathing, grooming, toileting, mobility), housekeeping, laundry, social and recreational activities, and 24-hour supervision appropriate to the facility Type [3]. Medication administration or assistance depends on the license type and the resident's needs, and must follow the facility's written medication policy. HHSC rule 26 TAC §553.261 lays out specific service requirements including staffing sufficient to meet resident needs, emergency preparedness plans, and resident rights documentation that must be provided at admission [3]. Facilities also need a written policy and procedures manual covering admission and discharge criteria, medication management, emergency response, abuse/neglect reporting, and infection control, since inspectors will ask to see it during survey. Beyond the minimum, plenty of Texas assisted living operators layer in memory care programming, transportation to appointments, on-site therapy visits, and social work coordination. None of that is required by the base ALF license, but it's often what differentiates one facility from another in a competitive market.
How do I start a group home or assisted living facility in Texas?
Here's the realistic sequence, based on HHSC's published licensing process [4]: 1. Decide on facility Type (A, B, or C) based on the resident population you intend to serve, since this drives staffing, physical plant, and fire safety requirements. 2. Confirm zoning and property compliance with your local city or county planning department. Texas doesn't override local zoning for ALFs the way some states do for small group homes, so check this early, not after you sign a lease. 3. Complete facility construction or renovation to meet the Life Safety Code requirements referenced in 26 TAC Chapter 553, coordinated with your local fire marshal. 4. Submit the HHSC assisted living facility license application, including your policy manual, staffing plan, floor plan, and fire marshal approval. 5. Pass the HHSC pre-licensure inspection, called a survey, before admitting any residents. 6. Once licensed, post your license and complete required staff training (including the state's mandated dementia care training hours if you accept residents with Alzheimer's or related dementia, tracked separately for Type A vs Type B/C). This is not a fast process. Between property prep, application review, and inspection scheduling, plan on this taking several months at minimum, and HHSC does not guarantee any specific timeline. Don't sign a long lease assuming a quick approval. A lot of first-time operators underestimate the paperwork burden, not the caregiving part. If you want a structured starting point instead of assembling every form and policy template from scratch, a state group home licensing kit can save real time on the administrative half of this process, though it doesn't replace your own zoning check or HHSC's inspection.
What are the different types of Texas assisted living licenses (Type A, B, C)?
Texas assigns ALFs a Type based on the mobility and evacuation capability of residents, which then drives staffing and building requirements under 26 TAC §553. Type A facilities serve residents who are mobile and can follow directions to evacuate in an emergency without physical assistance. Staffing overnight can be lighter, and physical plant requirements are less intensive than Type B or C. Type B facilities serve residents who need staff assistance to evacuate, including some who are non-ambulatory or have cognitive impairment affecting their ability to respond to instructions during an emergency. These facilities require more overnight staff awake and on duty, and stricter fire and building code compliance. Type C facilities are specifically for residents in a personal care setting who need staff assistance to evacuate and who require overnight staff attendance at a defined ratio, often used for smaller specialized settings. Getting this classification wrong at application time is one of the most common and costly mistakes. If you apply as Type A but actually plan to serve residents with dementia who can't self-evacuate, your license won't match your operation, and HHSC can cite you or require corrective action during survey. Confirm the exact definitional language and staffing ratio for each Type with HHSC before finalizing your business plan [4].
What staffing does Texas require for assisted living facilities?
Staffing requirements scale with facility Type and resident acuity, and HHSC rule requires 'sufficient direct care staff' to meet the assessed needs of all residents at all times [3]. There is no single statewide number like 'one staff per eight residents' written into the general ALF statute; instead the requirement is functional, meaning your staffing plan has to be justified against your actual resident population and their care plans. What is fixed: administrators of licensed ALFs must complete HHSC-approved training and, depending on facility size and Type, may need to hold an assisted living manager or nursing home administrator license depending on services offered. Direct care staff need documented orientation covering resident rights, emergency procedures, infection control, and abuse/neglect reporting before working unsupervised. Most operators build their staffing plan backward from acuity, not forward from a formula. Start with your projected census, map out ADL needs and wander risk for that population, then staff to cover overnight, day, and evening shifts with enough coverage that a single call-out doesn't leave the building short. HHSC surveyors will ask to see your staffing schedule against your resident roster during inspection, so paper plans that don't match reality on the ground are a common citation.
What happens during a Texas assisted living inspection?
HHSC conducts licensing surveys before initial licensure and periodically afterward (and in response to complaints) to check compliance with Chapter 247 and 26 TAC Chapter 553. Surveyors review your physical plant, staffing records, resident files, medication logs, emergency plans, and policy manual against the rule text. Common citation areas nationally and in Texas specifically include incomplete resident care plans, medication administration records that don't match physician orders, missed staff training documentation, and fire drill logs that aren't current. Correcting citations usually requires a written plan of correction submitted within a timeframe HHSC specifies in the survey report. HHSC publishes inspection and complaint history for licensed facilities, which prospective operators and families can search. If you're buying an existing facility or taking over a license, pull that history first. It tells you more about the real operational condition of the business than the sale listing will. For a deeper walk-through of what inspectors check room by room, see our guide on assisted living facility licensing standards.
Does Medicare cover assisted living facilities?
No. Medicare does not cover the cost of room and board at an assisted living facility. CMS is explicit about this: Medicare Part A and Part B do not pay for long-term custodial care, including assisted living, because assisted living is considered a housing and personal care arrangement, not a medical benefit [2]. Medicare may still cover medically necessary services a resident receives while living in an ALF, such as physician visits, physical therapy ordered by a doctor, or durable medical equipment, the same way it would for someone living at home. But the facility's monthly rate for housing, meals, and personal care assistance comes out of pocket, long-term care insurance, or in some cases Medicaid. This surprises a lot of families mid-crisis, and it's worth explaining clearly to prospective residents and their adult children during your admissions process, both because it's the law and because it heads off billing disputes later.
Does Medicaid pay for assisted living in Texas, and how does funding work?
Texas Medicaid does not pay for room and board in assisted living the way it pays for nursing home care, but it can help cover personal care services for qualifying residents through specific programs. The STAR+PLUS Medicaid managed care program and HHSC's Community First Choice option can fund personal attendant services for eligible low-income Texans, including some who live in assisted living settings, depending on individual eligibility and program capacity [5]. Medicaid.gov confirms that home and community-based services (HCBS) waivers, which many states including Texas use to divert people from nursing homes, can fund services delivered in residential settings, but the funding covers care services, not the rent or room charge itself [6]. That distinction, care dollars versus housing dollars, is the single most confusing part of Texas assisted living funding for new operators and families alike. If you plan to accept Medicaid waiver residents, you'll need to enroll separately as a Medicaid provider through HHSC and meet additional documentation requirements beyond your base ALF license. Budget extra time for this; provider enrollment review is a separate process from facility licensing and runs on its own timeline. For operators comparing funding models across states, our assisted living facilities overview walks through how Medicaid HCBS waivers vary by state.
What are common mistakes operators make with Texas ALF regulations?
The single most common mistake is signing a property lease or purchase agreement before confirming local zoning allows an assisted living use at that address. Texas state licensing doesn't override a city's zoning code, and a property that's perfect on paper can sit unusable for months while you fight a zoning variance. The second is misjudging facility Type. Operators sometimes apply as Type A to simplify staffing, then find their actual resident population (people with dementia who wander, or residents who can't self-evacuate) doesn't match that license, forcing a costly reclassification mid-operation. The third is treating the policy manual as a paperwork formality instead of an operating document. HHSC surveyors check whether your actual practice matches your written policy, more than whether the policy exists. A binder full of boilerplate that nobody on staff has read is worse than a shorter manual staff actually follow, because it creates a paper trail of your own non-compliance. Finally, underestimating the training and documentation burden for staff. Every hire needs documented orientation, and every incident (falls, medication errors, elopement attempts) needs a paper trail that HHSC can review. Build your documentation system before you open, not after your first incident.
Frequently asked questions
What is assisted living?
Assisted living is residential care for adults who need help with daily activities like bathing, dressing, or medication reminders, but don't require full-time skilled nursing care. It combines housing, meals, and personal care support in a licensed residential setting, distinct from independent living (no care) and nursing homes (skilled medical care).
What is a group home?
A group home is a small residential setting, usually house-like, that serves people needing supervision or support, including seniors, people with IDD, mental illness, or recovery needs. The specific license required depends on the population served; in Texas, senior group homes with 4+ unrelated residents needing personal care usually fall under assisted living licensing.
What is an assisted living facility?
An assisted living facility (ALF) is the licensed building and program that provides food, shelter, and personal care services to residents who need help with daily activities. In Texas, Health and Safety Code Chapter 247 defines and regulates ALFs serving four or more unrelated residents, requiring an HHSC license before operation.
What is assisted living vs nursing home?
Assisted living serves people who are mostly independent but need help with daily activities; nursing homes serve people needing daily skilled nursing or medical care. Texas licenses them under separate laws (Chapter 247 for assisted living, Chapter 242 for nursing homes), with nursing homes requiring 24/7 licensed nursing staff that assisted living does not always require.
What does assisted living provide?
Texas rule requires ALFs to provide meals, help with activities of daily living, housekeeping, laundry, social activities, and supervision appropriate to the facility's licensed Type. Medication assistance and additional services like memory care or transportation vary by facility and by the resident's individual care plan.
How do I start a group home in Texas?
Decide your population and facility Type, confirm local zoning allows the use, prepare the property to meet fire and life-safety code, submit HHSC's assisted living license application with your policy manual and staffing plan, and pass the pre-licensure survey before admitting residents. Budget several months minimum for the full process.
Does Medicare cover assisted living facilities?
No. CMS confirms Medicare does not pay for assisted living room and board because it's considered custodial care, not a medical benefit. Medicare can still cover medically necessary services a resident receives while living there, like doctor visits or physical therapy, but not the facility's monthly housing and care charge.
Does Medicaid pay for assisted living in Texas?
Texas Medicaid doesn't cover room and board in assisted living, but programs like STAR+PLUS and Community First Choice can fund personal care services for eligible low-income residents living in some assisted living settings. Housing costs still come from the resident's own funds, family, or long-term care insurance.
What's the difference between Type A, B, and C assisted living licenses in Texas?
Type A serves residents who can evacuate independently with light staffing needs. Type B and Type C serve residents who need staff assistance to evacuate, including people with cognitive impairment or mobility limits, and require more overnight staff and stricter building requirements. Confirm exact definitions and ratios with HHSC before applying.
How long does it take to get an assisted living license in Texas?
HHSC doesn't publish a guaranteed timeline, and the process (zoning confirmation, property prep, application review, fire marshal approval, and pre-licensure survey) commonly takes several months. Delays are common when zoning issues surface late or when the application's staffing plan doesn't match the facility Type requested.
Do Texas assisted living facilities need a nurse on staff?
Not always. Unlike nursing homes, which require 24/7 licensed nursing coverage under Chapter 242, assisted living facilities under Chapter 247 must provide staffing sufficient to meet resident needs, which may or may not require a licensed nurse depending on facility Type and resident acuity.
What's the difference between assisted living and a nursing home for a family choosing care?
Choose assisted living if your loved one is mostly independent but needs help with daily tasks and medication reminders. Choose a nursing home if they need daily skilled nursing care, rehabilitation therapy, or complex medical monitoring that assisted living staff aren't licensed to provide.
Sources
- Texas Health and Safety Code, Chapter 247: Definition of an assisted living facility and licensing requirement for facilities serving four or more unrelated residents
- CMS.gov, Medicare Coverage of Long-Term Care: Medicare does not cover room and board at assisted living facilities
- Texas Administrative Code, Title 26, Chapter 553 (Assisted Living Facilities): Service, staffing, and policy requirements for licensed assisted living facilities
- Texas Health and Human Services Commission, Assisted Living Facilities Licensing: HHSC licensing process, facility Type classifications, and application requirements
- Texas Health and Human Services Commission, STAR+PLUS Program: STAR+PLUS Medicaid managed care can fund personal attendant services for eligible Texans
- Medicaid.gov, Home & Community-Based Services: Medicaid HCBS waivers fund care services in residential settings but not room and board