Texas assisted living regulations PDF and licensing guide

Last updated 2026-07-25

Where can you download the official Texas assisted living regulations PDF?

The official Texas assisted living regulations live in 26 Texas Administrative Code (TAC) Chapter 92. You can download the full text as a PDF from two primary sources: the Texas Health and Human Services Commission (HHSC) website under the Licensing & Credentialing section, and the Texas Secretary of State's online database of administrative rules ^[1]. Both sources provide the same legally binding text. The HHSC site often includes supplemental guidance documents, sample forms, and application packets that aren't part of the rule text itself but are critical for compliance. Look for the "Assisted Living Facility Rules and Regulations" section under Provider Resources. The Secretary of State's version is the authoritative legal version updated immediately when rules change. The full Chapter 92 runs over 100 pages and covers everything from definitions and application procedures to staffing ratios, medication management, resident rights, and enforcement actions. Most operators print Subchapter A (General Provisions and Definitions), Subchapter B (Licensing), Subchapter C (Physical Plant and Operational Standards), and Subchapter G (Staff Requirements) for day-to-day reference. The rest you'll consult when specific situations come up. If you need historical versions to see what changed after a recent amendment, the Secretary of State's archive maintains past rule editions. HHSC also publishes a summary of rule changes on their "What's New" page when major amendments take effect ^[1].

What is an assisted living facility in Texas and how does it differ from a nursing home?

A	4-8 residents	Lower staffing ratio (1:8 day, 1:16 night), often in residential structures
B	9-16 residents	1:8 day, 1:16 night, must meet additional physical plant standards
C	17+ residents	1:15 day, 1:20 night, institutional fire/safety codes, registered nurse required on staff or on call	All three types must meet baseline requirements for resident rights, service planning, medication assistance training, and emergency preparedness.

Texas defines an assisted living facility as "an establishment that furnishes, in one or more facilities, food and shelter to four or more persons who are unrelated to the proprietor of the establishment, and provides personal care services" ^[2]. The key is personal care services: help with activities of daily living like bathing, dressing, grooming, eating, and mobility. Residents must be ambulatory or capable of self-preservation in an emergency. An assisted living facility (ALF) is not a nursing home. Nursing homes in Texas are licensed as nursing facilities or skilled nursing facilities under separate regulations (26 TAC Chapter 19). They provide 24-hour skilled nursing care, administer complex medical treatments, and serve residents with higher acuity needs who cannot safely evacuate or whose medical condition requires RN supervision. ALFs cannot provide skilled nursing services. If a resident needs continuous nursing care, they must transfer to a nursing facility. Medicare does not cover assisted living room and board, though it may cover specific skilled services delivered by a home health agency that visits an ALF resident ^[3]. Most ALF residents pay privately or use Medicaid waiver programs (Community Based Alternatives or STAR+PLUS) that cover a portion of services if the facility is waiver-enrolled ^[4]. Texas ALFs are split into three types by size and corresponding regulatory requirements: | Type | Capacity | Key Differences |

What does assisted living provide compared to a group home?

Assisted living in Texas means personal care help: bathing, dressing, grooming, toileting, transferring, eating, and medication administration or reminders. It's a regulated service model, not a building type. Facilities provide 24-hour supervision, meals, housekeeping, social activities, and assistance tailored to each resident's service plan ^[2]. A group home is a broader term. In Texas regulatory parlance, a "group home" could be an assisted living facility (if it serves adults who need personal care), a licensed foster care or residential child care operation (under 26 TAC Chapter 748 or 749), a community home for individuals with intellectual or developmental disabilities (under 26 TAC Chapter 45), or even an unlicensed shared housing arrangement. The term itself doesn't appear in the ALF regulations. If you plan to serve adults who need help with daily activities in a residential setting, you are operating an assisted living facility under Texas law and must hold an ALF license. If you serve individuals with IDD and provide habilitation services, you're in a different licensing track (HCS or TxHmL waiver programs). If you house people but provide no personal care or habilitation, you may not need a state license at all, though local zoning and building codes will apply. The practical difference: ALFs must employ or contract trained caregivers, maintain individualized service plans, pass annual inspections, and meet medication-management standards. A group home that is not an ALF (for example, a sober living house that provides only housing and peer support) faces no state licensing requirement under HHSC, though it may need local permits or registration.

How do you apply for a Texas assisted living facility license?

You apply through the HHSC Regulatory Services Division. Start by submitting an Initial Licensure Packet at least 90 days before you want to open ^[5]. The packet includes: - A completed ALF Application (Form 3654)

• The non-refundable $2,700 application fee plus per-bed license fees ($35 per bed for Type A and B, $70 per bed for Type C) ^[5]
• Fingerprint-based criminal background checks for the owner, administrator, and any other controlling persons
• Verification of a registered agent for service of process
• Proof of general liability insurance ($100,000 per occurrence minimum)
• A certified floor plan stamped by a Texas-licensed architect or engineer
• Fire marshal approval or a letter stating the inspection is scheduled
• Documentation of water and wastewater service approval
• Résumés and credentials for the administrator and any nursing staff
• A sample resident contract and admission agreement
• Policies and procedures covering medication management, infection control, resident rights, emergency preparedness, and grievance procedures HHSC reviews the application for completeness. Once accepted, they schedule a pre-licensure survey. An inspector visits the property to verify the physical plant meets code (room sizes, egress, sprinklers, handrails, accessible bathrooms), that staff training records are in place, and that operational policies align with Chapter 92. If deficiencies are found, you have 10 days to submit a corrective action plan. After the survey passes and all fees are paid, HHSC issues the license. It's valid for two years and must be renewed before expiration ^[1]. Budget 4 to 6 months from first contact to license-in-hand, longer if the fire marshal is backlogged or your building needs retrofits. For operators tackling the paperwork maze, GroupHomePath's Texas Licensing Kit organizes the checklist, sample policies, and form templates into a single step-by-step package.

What are the staffing and training requirements for Texas ALFs?

Texas sets minimum staff-to-resident ratios by facility type ^[6]: - Type A and B: At least one direct-care staff on duty for every 8 residents during daytime and evening hours, and one staff for every 16 residents overnight.

• Type C: At least one direct-care staff for every 15 residents during daytime and evening hours, and one for every 20 residents overnight. All facilities must have "sufficient staff to meet the individual needs of each resident," so if your residents have high acuity (multiple transfers, behavioral challenges, frequent medication administration), you'll need more staff than the ratios require. The administrator or a designated staff member must be on-call 24/7 when not physically present. Type C facilities must employ a registered nurse or contract with one who is available on-call. The RN oversees medication management training, reviews resident health status, and consults on care plans. Smaller facilities (Type A and B) don't require an RN on staff, but the administrator or a delegated supervisor must complete medication administration training approved by HHSC ^[6]. All direct-care staff must complete orientation within 7 days of hire and annual in-service training covering resident rights, abuse prevention, infection control, emergency procedures, and assisting with ADLs. New administrators must complete 12 hours of pre-service training before hire, plus 12 hours of continuing education annually ^[6]. HHSC provides a list of approved training vendors on its website. Every staff member with resident contact must clear a criminal background check through TexasOnline and be listed on the Employee Misconduct Registry check. Convictions for violent crimes, abuse, neglect, or exploitation are disqualifying ^[5].

What are the physical plant and safety requirements?

Chapter 92 Subchapter C lays out structural and environmental standards. Resident bedrooms must provide at least 80 square feet per person in shared rooms and 100 square feet in private rooms ^[7]. Ceilings must be at least 7.5 feet high. Each bedroom needs an outside window for natural light and emergency egress (or an approved alternative evacuation route). Bathrooms must have grab bars next to toilets and in showers or tubs. At least one bathroom per 8 residents is required, and if you serve residents who need transfer assistance, you need accessible fixtures (roll-in showers, raised toilets). Every facility must have a working call system so residents can summon help from bedrooms and bathrooms. Fire safety is critical. Type A and B facilities in residential-style buildings must have interconnected smoke alarms in every bedroom, corridor, and common area, plus at least one fire extinguisher per floor ^[7]. Type C facilities and any facility in a non-residential structure must have a full automatic sprinkler system, a fire alarm panel, illuminated exit signs, and emergency lighting. All facilities need an approved evacuation plan and must drill it quarterly. The local fire marshal inspects and issues a letter of approval before you can get licensed. If your building predates modern codes, you may qualify for a waiver or equivalency ruling, but you'll need an architect's letter and engineering documentation. Kitchens must meet commercial health codes if you prepare meals on-site for more than 12 people. If you operate Type A and serve 4-8 residents in a homelike setting, you can use a residential kitchen with standard inspections by the local health department.

How does medication management work in a Texas ALF?

Texas ALFs may assist residents with self-administered medications, but they may not administer medication (place it in the resident's mouth or inject it) unless a staff member is a licensed nurse. Assistance means handing the resident their pre-filled pill box, opening a bottle cap, or reminding them it's time to take their pills ^[8]. Staff who provide medication assistance must complete an 8-hour HHSC-approved medication assistance course and renew it annually. The training covers the five rights (right resident, medication, dose, time, route), documentation, storage, and when to escalate to nursing judgment. A licensed nurse (RN or LVN) or pharmacist must supervise the training. Facilities must store medications in a locked cabinet or locked medication cart. Controlled substances need double-lock (locked box inside a locked room or cabinet). Each resident's medications are kept in individual containers labeled by a pharmacy. The facility maintains a Medication Administration Record (MAR) documenting every dose given and any refusals or side effects noted. If a resident becomes unable to self-administer even with assistance (for example, they cannot swallow reliably or refuse medications due to cognitive decline), the facility must arrange for a licensed nurse to administer, contract with a home health agency, or transfer the resident to a higher level of care ^[8]. You cannot put pills in someone's mouth if they can't cooperate, even with training.

What does a Texas HHSC inspection look for?

HHSC conducts unannounced surveys at least once every two years, and more often if you've had past violations. Inspectors arrive, identify themselves, and begin by touring the facility and speaking with residents. They review resident files, service plans, medication records, staff training logs, incident reports, and financial agreements. Inspectors check physical environment compliance: room sizes, grab bars, smoke alarms, locked medication storage, food temperatures, and cleanliness. They observe meal service, talk to staff about emergency procedures, and verify that the posted evacuation plan matches what staff describe. They interview residents privately to assess whether their care plans are being followed, whether they feel safe, and whether they have access to their funds and personal belongings. Any resident complaint triggers deeper scrutiny. Deficiencies are classified by severity. A "low" deficiency (for example, one missing staff training certificate) results in a citation and a plan of correction due within 10 days. A "medium" deficiency (inadequate staffing during a shift) may trigger a follow-up visit. A "high" deficiency (physical abuse, unsafe environment, medication errors causing harm) can lead to immediate sanctions, fines, or emergency license suspension. You receive a written survey report listing each deficiency, the rule violated, and the corrective action required. Most first-time deficiencies are paperwork or minor physical plant issues. Repeat or serious violations lead to escalating enforcement: civil penalties ($500 to $5,000 per violation per day), probationary license status, or revocation. HHSC publishes survey results online. Prospective residents and families can look up any facility's inspection history, deficiencies, and complaint investigations on the HHSC Long-Term Care Provider Search tool.

What are the fees and financial requirements for a Texas ALF license?

Initial application costs $2,700 plus $35 per licensed bed for Type A and B facilities, or $70 per licensed bed for Type C ^[5]. So a 10-bed Type B facility pays $2,700 + $350 = $3,050 at application. A 30-bed Type C pays $2,700 + $2,100 = $4,800. Biennial renewal is $1,500 plus the per-bed fee. You must also submit proof of financial viability. HHSC wants to see that you have enough liquid assets or access to credit to operate for at least three months without revenue. For new construction or major renovation, they may require a letter from your lender or a CPA-certified financial statement ^[5]. You need general liability insurance ($100,000 per occurrence, $300,000 aggregate minimum). Most lenders and landlords want $1 million, and you should carry it. Professional liability and abuse/neglect coverage are not legally required but are standard risk management. Operating reserves are not codified in a specific dollar amount in Chapter 92, but if you're undercapitalized, HHSC can deny or revoke your license. Budget for at least 90 days of operating expenses in the bank before you admit your first resident. That includes payroll, insurance, food, utilities, and debt service.

How do you start a group home or assisted living facility in Texas from scratch?

Starting an ALF in Texas involves seven major phases: 1. Market research and business planning. Identify your target population (seniors, adults with IDD, memory care, low-income, private-pay), map competitor locations, and model revenue (average private-pay rate in Texas is $3,500 to $5,000 per month; Medicaid waiver rates are $1,800 to $2,500) ^[4]. Write a business plan that covers startup capital, 12-month cash flow, staffing plan, and marketing strategy. 2. Secure a property. Find a residential or commercial building that meets or can be retrofitted to Chapter 92 standards. Confirm zoning allows assisted living (it's often permitted in residential zones under a special-use permit or conditional-use permit). Hire an architect to draw a code-compliant floor plan. Budget $50,000 to $150,000 for renovations if you're converting a house; new construction runs $150 to $200 per square foot. 3. Form your business entity. Register an LLC or corporation with the Texas Secretary of State. Get your federal EIN, open a business bank account, and designate a registered agent. If you plan to accept Medicaid waivers, apply for a National Provider Identifier (NPI) and enroll as a Medicaid provider through TMHP (Texas Medicaid & Healthcare Partnership) ^[4]. 4. Assemble your team. Hire an administrator who meets HHSC qualifications (high school diploma or GED, 12 hours of pre-service training, and often prior long-term care experience). Recruit direct-care staff and schedule them for orientation and medication-assistance training. 5. Prepare your licensing packet. Gather all documents listed in the application checklist: criminal background checks, insurance certificates, policies and procedures, floor plans, fire marshal approval, and financial statements. Submit the packet to HHSC Regulatory Services at least 90 days before your target opening date ^[5]. 6. Pass the pre-licensure survey. HHSC schedules an on-site inspection. The surveyor checks physical plant, staff credentials, and operational policies. Correct any deficiencies within 10 days. Once you pass, pay the license fee and receive your license certificate. 7. Open and admit residents. Post your license prominently. Market to discharge planners, hospitals, case managers, and families. Each admission requires a signed contract, a physician's statement verifying the resident is appropriate for ALF level of care, and an individualized service plan ^[2]. Maintain compliance: complete incident reports, update care plans quarterly, track staff training, and prepare for your first annual survey. For operators new to the licensing process, the GroupHomePath Texas Licensing Kit consolidates checklists, policy templates, and form samples specific to Chapter 92, saving months of research and reducing compliance risk. The timeline from concept to first resident is typically 9 to 15 months. Property acquisition and renovation are the longest variables. Licensing itself takes 4 to 6 months once you submit a complete application.

Does Medicare or Medicaid cover assisted living in Texas?

Medicare does not pay for assisted living room and board. It covers skilled nursing care in a Medicare-certified nursing facility and home health services delivered in any setting, but it does not reimburse the housing or personal care services that make up the bulk of ALF costs ^[3]. Texas Medicaid offers two waiver programs that can cover assisted living services for eligible individuals: - Community Based Alternatives (CBA): Serves seniors and adults with disabilities who meet nursing-facility level of care. CBA pays for personal care, case management, and some therapy, but not room and board. The facility receives a service rate (roughly $40 to $60 per day), and the resident contributes most of their income toward rent and food ^[4]. - STAR+PLUS: A managed-care program for dual-eligible (Medicare and Medicaid) members. Some STAR+PLUS plans include assisted living as a covered benefit through their health plan network ^[4]. To accept Medicaid waiver residents, your facility must enroll as a Medicaid provider through TMHP, sign waiver participation agreements, and meet additional HHSC waiver standards (often stricter than base licensing). Not all ALFs choose to participate; many remain private-pay only to avoid Medicaid rate constraints and administrative burden. Families often piece together funding: the resident pays privately for room and board ($2,000 to $3,500/month), and Medicaid or VA Aid & Attendance covers care services. Some facilities offer Medicaid beds alongside private-pay beds to diversify revenue and fulfill mission commitments.

Frequently asked questions

What is assisted living?

Assisted living is a residential setting where adults receive help with activities of daily living (bathing, dressing, medication reminders, meals) while maintaining as much independence as possible. In Texas, it's a regulated service requiring a state license if you serve four or more unrelated individuals.

What is a group home?

A group home is a general term for any shared residential setting serving unrelated individuals. In Texas, if the home provides personal care services, it is an assisted living facility and requires HHSC licensure. If it serves individuals with IDD or children in foster care, different licensing tracks apply.

What is an assisted living facility?

An assisted living facility (ALF) in Texas is a licensed establishment that provides housing, meals, and personal care services to four or more unrelated adults. It is governed by 26 TAC Chapter 92 and subject to HHSC oversight, regular inspections, and staffing and safety standards.

What is the difference between assisted living and a nursing home?

Assisted living provides personal care and supervision for residents who are largely independent and ambulatory. Nursing homes provide 24-hour skilled nursing care for residents with complex medical needs, higher acuity, or who cannot evacuate independently. Medicare covers nursing home care but not assisted living room and board.

Does Medicare cover assisted living facilities?

No. Medicare does not pay for assisted living room and board. It may cover skilled services (like wound care or physical therapy) delivered by a visiting home health agency to an ALF resident, but the housing and personal care costs are the resident's responsibility.

How do I start a group home in Texas?

Secure a suitable property, confirm zoning allows assisted living, form a business entity, hire an administrator, complete the HHSC licensing application (including criminal background checks, floor plans, fire marshal approval, and a $2,700 fee), pass a pre-licensure survey, and receive your license before admitting residents.

How much does it cost to open an ALF in Texas?

Startup costs range from $100,000 to $500,000 depending on property size, renovation needs, and whether you build new. Major expenses: property lease or purchase, renovations ($50,000 to $150,000), licensing fees ($3,000 to $5,000), insurance, initial staffing, furnishings, and three months of operating reserves.

Can I operate an assisted living facility from my home?

Yes, if you meet Chapter 92 requirements. A Type A license allows 4 to 8 residents. Your home must pass fire, health, and safety inspections, meet room-size and egress standards, and you must employ trained caregivers. Zoning and neighbors' concerns are often the bigger hurdles.

What training do ALF staff need in Texas?

All direct-care staff must complete orientation within 7 days of hire and annual in-service training. Staff who assist with medications need an 8-hour HHSC-approved medication-assistance course. Administrators need 12 hours of pre-service training and 12 hours annually. Criminal background checks are required for all staff.

How often does HHSC inspect Texas ALFs?

At least once every two years, unannounced. Facilities with past violations or complaints may be inspected more frequently. Inspectors review resident files, observe care delivery, check physical plant compliance, and interview residents. Results are public and posted online.

Can a Texas ALF provide skilled nursing care?

No. Assisted living facilities may only assist with self-administered medications and provide personal care. If a resident needs skilled nursing (IV therapy, wound care, continuous RN monitoring), they must receive it from a contracted home health agency or transfer to a licensed nursing facility.

Do I need a nurse on staff in a Texas ALF?

Type C facilities (17+ beds) must employ or contract with a registered nurse who is available on call. Type A and B facilities do not require a nurse on staff, but someone must complete medication-assistance training and a nurse must supervise that training.

What is the difference between Type A, B, and C assisted living in Texas?

Type A serves 4 to 8 residents, Type B serves 9 to 16, and Type C serves 17 or more. Larger facilities face stricter staffing ratios, fire safety requirements (sprinklers, alarm systems), and must have an RN on call. All types follow the same resident-rights and care-planning rules.

Where can I download Texas ALF regulations?

Visit the Texas Health and Human Services Commission website (hhs.texas.gov) under Licensing & Credentialing, or search the Texas Secretary of State's online administrative code database for 26 TAC Chapter 92. Both offer free PDF downloads of the full rule text and amendments.

Sources

1. Texas Health and Human Services Commission, Assisted Living Facility Rules: 26 TAC Chapter 92 governs ALF licensing, available as PDF from HHSC; biennial renewal required
2. 26 Texas Administrative Code §92.2, Definitions: Definition of assisted living facility: four or more unrelated persons, personal care services, food and shelter
3. Medicare.gov, What Medicare Covers: Medicare Part A covers skilled nursing facility care but not assisted living room and board
4. Texas Health and Human Services, Community Based Alternatives Waiver: CBA waiver covers personal care services in ALFs for nursing-facility-eligible individuals; does not cover room and board
5. 26 Texas Administrative Code §92.21, Application for Initial License: $2,700 application fee plus $35/bed (Type A/B) or $70/bed (Type C); criminal background checks required for all controlling persons
6. 26 Texas Administrative Code §92.61, Staffing Requirements: Type A/B: 1:8 day/evening, 1:16 night; Type C: 1:15 day/evening, 1:20 night; RN required on-call for Type C
7. 26 Texas Administrative Code §92.41, Physical Plant Standards: Bedrooms: 80 sq ft/person shared, 100 sq ft private; 7.5-ft ceilings; grab bars; smoke alarms; egress windows
8. 26 Texas Administrative Code §92.45, Medication Services: ALFs may assist with self-administration only; staff need 8-hour HHSC-approved training; nurse supervision required