Last updated 2026-07-25
TL;DR
Texas doesn't issue one single "group home license." Depending on who you serve, you'll apply through the Texas Health and Human Services Commission (HHSC) for an Assisted Living Facility license, an HCSSA license for adult foster care, or an HHSC-regulated program certification for IDD (HCS/ICF) homes. Expect a paper or online application, a life-safety inspection, fingerprint-based background checks, and several months of lead time.
What is a group home, exactly, in Texas licensing terms?
A "group home" isn't a legal category Texas actually licenses under that name. It's the common phrase people use for a small residential setting where a handful of unrelated adults live together and get some level of care or supervision. What license you actually need depends entirely on who lives there and what kind of care they need. In Texas, HHSC (Texas Health and Human Services Commission) regulates several distinct program types that people casually lump under "group home": Assisted Living Facilities (ALFs) for seniors and adults needing personal care, Adult Foster Care as a certified Home and Community Support Services Agency (HCSSA) service, and Home and Community-based Services (HCS) or Intermediate Care Facilities (ICF/IID) for people with intellectual and developmental disabilities [1]. Mental health and recovery residences run under a mix of state behavioral health rules, voluntary certification for recovery housing, and sometimes no state license at all if no personal care is provided. The first move for anyone starting this process is figuring out which of these buckets your intended home falls into, because the application, the inspection standards, and the staffing ratios are completely different documents. Confusing an ALF application with an HCS provider enrollment packet wastes months. If you're comparing Texas to how other states define this space, it helps to read a broader primer on assisted living before you commit to a program type.
What is assisted living, and what is an assisted living facility?
Assisted living is a category of licensed housing that provides room, meals, and help with daily activities like bathing, dressing, and medication reminders, but not the round-the-clock skilled nursing care you'd get in a nursing home. An assisted living facility (ALF) is the physical, licensed building where that care happens. Texas defines an assisted living facility under Texas Health and Safety Code Chapter 247 as an establishment that furnishes food, shelter, and personal care services to four or more residents unrelated to the proprietor, on a 24-hour basis [2]. HHSC licenses ALFs under two general categories: Type A (residents who can evacuate on their own or with minimal physical help) and Type B (residents who need staff assistance to evacuate, or have moderate to severe cognitive impairment). There's also a Type C designation for smaller adult foster care-style homes with three to four residents, and specialty designations layered on top, like an Alzheimer's/dementia certification if you're marketing memory care [2]. The license type you choose drives your fire-safety requirements, staff-to-resident ratios, and even how your building has to be laid out. Getting this classification wrong on your application is one of the most common reasons ALF applications bounce back for revision. For a plain-language rundown of the resident experience side of this, see assisted living facility and assisted living facilities.
What does assisted living provide, day to day?
| Meals and housekeeping | Yes | n/a | |
|---|---|---|---|
| Medication reminders/administration | Yes | n/a | |
| Bathing, dressing, mobility help | Yes | n/a | |
| Skilled wound care, IV therapy | No | Yes | |
| 24/7 skilled nursing supervision | No (Type B has more support, not skilled nursing) | Yes | |
| Rehabilitation therapy (PT/OT) | Not typically built in | Yes, usually contracted separately | If you're building out your service menu for a licensing application, it pays to be conservative on paper. Promising more than your license type allows is a fast way to get cited during an inspection. |
Assisted living provides housing plus a defined menu of personal care and supportive services, not medical treatment. Under Texas rules, a licensed ALF has to provide three meals a day plus snacks, housekeeping, laundry, help with activities of daily living (bathing, dressing, toileting, mobility), medication administration or reminders, and 24-hour staff supervision appropriate to the facility type [2]. What it does not automatically provide is skilled nursing care, IV therapy, wound care beyond simple first aid, or ventilator support, unless the facility has specific additional licensure or waivers for that level of care. Texas ALFs can serve residents needing some nursing-adjacent tasks (Type B homes allow for residents needing more hands-on help), but there's a ceiling. Residents whose medical needs exceed what the license type allows generally have to transfer to a nursing facility. A quick reference on what falls inside versus outside the ALF scope: | Service | Typically included in Texas ALF license | Usually requires nursing facility or home health add-on |
What's the actual difference between assisted living and a nursing home?
Assisted living is for people who need help with daily tasks but not continuous medical care; a nursing home (Texas calls these nursing facilities) is for people who need daily skilled nursing care, rehabilitation, or medical monitoring that a licensed nurse has to supervise. Nursing facilities in Texas are licensed under a completely separate chapter, Texas Health and Safety Code Chapter 242, and they're required to have licensed nurses on duty around the clock along with a physician-directed plan of care [3]. Assisted living facilities are not required to have a nurse on-site continuously; medication administration in many Type A and B homes can be handled by trained unlicensed staff under specific delegation rules from a registered nurse. Cost and payer mix differ too. Nursing facility care is far more likely to be paid through Medicaid's long-term care benefit or Medicare's short-term skilled nursing benefit after a hospital stay. Assisted living, as you'll see below, gets almost no help from Medicare at all, and Texas Medicaid coverage for it is narrow and waiver-based. If a prospective resident's care needs are ambiguous, the honest answer is: get a nursing assessment before you accept them into an ALF-level home. Admitting someone who actually needs nursing-facility-level care is a licensing and liability problem waiting to happen.
Does Medicare cover assisted living facilities?
No. Medicare does not cover the room-and-board or personal care costs of assisted living. CMS is explicit about this: Medicare does not pay for long-term care, which it defines as "non-medical care for people who have a chronic illness or disability," including the kind of custodial help assisted living provides [4]. Medicare Part A will pay for a short stay in a skilled nursing facility after a qualifying hospital stay, and Part B covers medically necessary services delivered wherever you live, including doctor visits or physical therapy that happens to occur inside an assisted living building. But the facility's daily rate, room charge, and personal care staff time are private-pay, long-term care insurance, or in some cases state Medicaid waiver dollars. Texas Medicaid does offer help for assisted-living-level services through the STAR+PLUS Home and Community Based Services (HCBS) waiver program, which can cover Assisted Living/Residential Care services for financially and medically eligible members, but this is a waiver benefit administered through managed care, not a direct Medicaid State Plan entitlement, and availability depends on waiver slots and eligibility screening [5]. If your business model depends on Medicaid-funded residents, budget real time for the STAR+PLUS enrollment and waiver-slot process; it is not fast and it is not guaranteed. For operators building financial projections around this, it's worth reading our companion coverage on Medicaid waiver mechanics before you assume any revenue stream. And never promise a family that Medicare will cover the stay; that's a compliance and an ethics problem.
How do I start a group home in Texas? (step by step)
Starting a group home in Texas means choosing your license category first, then working through HHSC's application, inspection, and enrollment process for that specific program. Here's the realistic sequence. 1. Decide your population and program type. Seniors and adults needing personal care: Assisted Living Facility (Chapter 247). Adults with intellectual/developmental disabilities: HCS or ICF/IID program enrollment through HHSC. Adult foster care as a certified home health-adjacent service: HCSSA certification. Each has its own statute, application form, and inspection checklist [1][2]. 2. Confirm zoning and property fit before you sign a lease. Texas doesn't have one statewide zoning rule for group homes; it's handled at the city and county level, and some cities have overlay rules under the Fair Housing Act's reasonable-accommodation provisions for group homes serving people with disabilities. Check with your local planning department and don't assume a residential zone automatically allows a licensed care home. 3. Build your policy and procedure manual. HHSC will want to see written policies on medication management, emergency evacuation, resident rights, abuse/neglect reporting, staffing plans, and admission/discharge criteria before they'll issue a license. This is usually the single biggest paperwork lift in the whole process. 4. Submit the license application to HHSC along with the required fee. Fees vary by facility type and bed count; confirm the current fee schedule with HHSC's Long Term Care Regulation division before budgeting, since fee tables get updated periodically [2]. 5. Pass the pre-licensure inspection. HHSC surveyors will check life-safety code compliance (often coordinated with the State Fire Marshal's Office for larger facilities), staffing documentation, resident record systems, and physical plant requirements like exits, sprinklers, and bedroom sizing. 6. Complete required background checks. Owners, administrators, and direct-care staff go through fingerprint-based criminal history checks through the Texas Department of Public Safety and the HHSC Nurse Aide/Employee Misconduct Registry check process before they can work unsupervised with residents [6]. 7. Hire and train to the required staffing ratios for your facility type, then request your final licensing survey. 8. If you plan to accept Medicaid waiver residents, start the separate Medicaid provider enrollment and managed care contracting process early. It runs on its own timeline, independent of your HHSC license. Building this packet from scratch, state statute by state statute, is genuinely one of the slower parts of opening a home; that's the specific gap our $299 State Group Home Licensing Kit is built to close, with state-specific checklists and policy templates so you're not starting the manual from a blank page.
What paperwork does the HHSC application actually require?
The HHSC application packet for an Assisted Living Facility license typically requires an owner/entity disclosure form, floor plans showing exits and room dimensions, a staffing plan with job descriptions, a policy and procedure manual covering resident rights and emergency preparedness, proof of liability insurance, fire marshal or life-safety inspection documentation, and the application fee [2]. For HCS or ICF/IID provider enrollment, the packet shifts toward program-specific requirements: a provider enrollment application through HHSC's Provider Enrollment portal, a Medicaid provider agreement, individual program plans, and compliance with the specific service-delivery standards for that waiver program [1]. Across all program types, expect HHSC to ask for: - A completed license or certification application form specific to your program type
- Certificate of Occupancy or equivalent local zoning/building approval
- Fire and life-safety inspection sign-off
- Criminal background check clearances for owners and staff
- Written policies: medication administration, abuse/neglect reporting, emergency preparedness, resident rights, admission and discharge criteria, grievance procedures
- A staffing plan showing coverage ratios by shift
- Proof of financial solvency for larger facilities Don't submit a partial packet hoping to fill in gaps later. Incomplete applications go to the back of the review queue at most state agencies, and Texas is no exception in practice, even where it isn't written into rule.
How much does a Texas group home license cost, and how long does it take?
Costs and timelines vary by program type and bed count, and HHSC updates fee schedules periodically, so treat any number here as a planning range you should confirm directly with HHSC's Long Term Care Regulation division before budgeting [2]. As a general planning framework, expect these cost categories rather than a single number: the HHSC application/license fee itself (typically a few hundred to low thousands of dollars depending on facility size), a criminal background check fee per required staff member, local fire marshal or building inspection fees, and any state fire code retrofit costs if your building doesn't already meet life-safety requirements for the facility type you're licensing. Timeline-wise, most operators should plan on three to six months from a completed application submission to a final license, and that assumes the physical building already meets code and doesn't need major renovation. If you're converting a residential home into a Type B ALF or an IDD group home, sprinkler retrofits, door widening, or additional egress work can add months and real money before HHSC will even schedule the licensing survey. Nothing about this process moves faster because you're in a hurry. Build your opening timeline around the slowest step, which is usually the life-safety inspection and any required construction corrections, not the paperwork review itself.
What staffing does Texas require in a group home?
Texas staffing requirements differ by facility type, but every licensed ALF has to maintain enough staff, awake and on duty, to meet the supervision level required by its license category. Type A facilities (residents who can self-preserve in an emergency) generally have lighter overnight staffing requirements than Type B facilities, where residents may need physical assistance to evacuate [2]. HHSC also requires a designated facility administrator who meets specific training or licensure requirements, and direct-care staff have to complete initial orientation training covering topics like resident rights, infection control, and emergency procedures before working unsupervised. For IDD group homes operating under HCS or ICF/IID standards, staffing ratios are tied to each resident's individual program plan and level of need rather than a flat facility-wide ratio. Medication administration is its own regulatory layer. Unlicensed staff can administer medications in many Texas ALFs only after completing HHSC-approved medication aide training and under specific delegation and supervision rules from a licensed nurse. Skipping this step, or having staff hand out medications without the required training certificate, is one of the more common citations HHSC surveyors write up. When you're writing your staffing plan for the license application, be specific: name the shifts, the ratios, the backup coverage plan for call-outs, and the training records system you'll use to prove compliance during inspections.
What happens during a Texas group home inspection?
HHSC conducts both a pre-licensure survey before your first license is issued and ongoing periodic inspections after you're operating, plus complaint-driven investigations if someone reports a concern. Surveyors check the physical building for life-safety compliance (exits, smoke detectors, sprinkler systems where required, bedroom square footage), review resident records for care plans and required assessments, verify staff training and background check files, and observe medication administration practices. Facilities that fail to correct deficiencies can face a range of enforcement actions from HHSC, including a directed plan of correction, an administrative penalty, denial of license renewal, or in serious health-and-safety cases, an emergency suspension. Texas Health and Safety Code Chapter 247 gives HHSC explicit authority to deny, suspend, or revoke an ALF license for failure to comply with licensing standards [2]. The most common first-time-operator mistakes at inspection: incomplete or missing background check documentation for new hires, medication logs with gaps or unclear initials, fire drill records that aren't kept current, and physical plant issues like blocked exits or expired fire extinguisher tags. None of these are hard to fix. They're just easy to forget when you're also trying to run the home day to day, which is exactly why a written, dated compliance calendar matters more than good intentions. For a broader look at how inspection cycles work across states, our inspections hub covers the general pattern even where Texas specifics differ.
Do zoning and local rules affect where I can open a Texas group home?
Yes. Even after HHSC licenses your program, your city or county zoning code determines whether you can legally operate at a given address, and this is a separate approval process from state licensing. Texas doesn't override local zoning for most group home types, though group homes serving people with disabilities may have some protection under the federal Fair Housing Act's reasonable accommodation requirements, which can require a city to make an exception to zoning rules that would otherwise exclude a small group home from a single-family residential district. Before signing a lease or purchase contract, call the local planning or zoning department and ask directly: is a licensed assisted living at home or group residential care use allowed at this address, and does it require a special use permit, a variance, or is it permitted outright? Get the answer in writing if you can. Verbal assurances from a leasing agent are not a substitute for a zoning letter. Separately, check whether your county requires its own health department sign-off, food service permit (if you're preparing meals on-site), or septic/water system approval, especially in rural counties where infrastructure requirements can be stricter than in a city with municipal utilities.
How is a Texas IDD group home different from an ALF?
An IDD group home in Texas typically operates under the HCS (Home and Community-based Services) Medicaid waiver program or as a licensed ICF/IID (Intermediate Care Facility for Individuals with an Intellectual Disability), and it's regulated through a different HHSC division with different staffing, training, and individual program plan requirements than a senior-focused ALF [1]. Where an ALF license is largely about a building meeting life-safety and personal-care standards for a general adult population, an IDD program is built around each resident's individual service plan, developed with input from a service coordinator and reviewed on a required schedule. Staffing ratios, direct support professional training hours, and behavioral support protocols are all tied to that plan rather than a flat facility-wide standard. If you're planning to serve people with intellectual or developmental disabilities specifically, don't try to retrofit an ALF license application for this population. Start directly with HHSC's HCS/ICF program enrollment track, because the application, training curriculum, and Medicaid provider agreement requirements are structured differently from day one. Our populations-served coverage breaks down how staffing and training differ by the population you're licensed to serve.
Frequently asked questions
What is assisted living?
Assisted living is licensed residential care that provides housing, meals, and help with daily activities like bathing, dressing, and medication reminders, for people who don't need full-time skilled nursing care. In Texas, it's regulated as Assisted Living Facility licensure under Health and Safety Code Chapter 247, administered by HHSC.
What is a group home?
"Group home" is a general term, not a specific Texas license category. It usually refers to a small residential setting housing several unrelated adults who receive some level of supervision or care, licensed in Texas under whichever specific program fits: Assisted Living Facility, HCS/ICF for IDD, or adult foster care through an HCSSA.
What is an assisted living facility?
An assisted living facility is the licensed building and program where assisted living services happen. Texas defines it under Health and Safety Code Chapter 247 as an establishment providing food, shelter, and personal care to four or more unrelated residents on a 24-hour basis, licensed as Type A, Type B, or Type C depending on resident needs.
What is assisted living vs nursing home?
Assisted living helps with daily activities and supervision; a nursing home provides continuous skilled nursing care under Texas Health and Safety Code Chapter 242, with licensed nurses on duty around the clock. Nursing homes serve people with ongoing medical needs; assisted living serves people who are largely independent but need support with daily tasks.
What does assisted living provide?
Texas-licensed assisted living provides meals, housekeeping, laundry, help with bathing/dressing/mobility, medication administration or reminders, and 24-hour staff supervision matched to the facility's license type. It does not include skilled nursing services like IV therapy or wound care beyond basic first aid unless separately licensed for that.
How do I start a group home in Texas?
Pick your population and license category (ALF, HCS/ICF for IDD, or HCSSA adult foster care), confirm local zoning allows the use, build your policy manual and staffing plan, submit HHSC's application with required fees, pass background checks and a life-safety inspection, then complete Medicaid enrollment separately if you plan to accept waiver residents.
Does Medicare cover assisted living facilities?
No. CMS states Medicare does not cover long-term custodial care, which includes assisted living room, board, and personal care costs. Medicare Part A may cover a short skilled nursing facility stay after a qualifying hospitalization, and Part B covers medical services received anywhere, but not the facility's daily assisted living charges.
What's the difference between assisted living and nursing home costs and coverage?
Nursing home stays are more often covered short-term by Medicare Part A after hospitalization, and long-term by Medicaid's nursing facility benefit. Assisted living is almost entirely private-pay or long-term care insurance, with Texas Medicaid help available only through the narrower STAR+PLUS HCBS waiver for eligible members.
How much does a Texas assisted living or group home license cost?
Costs vary by facility type and bed count and HHSC updates its fee schedule periodically, so confirm current numbers directly with HHSC's Long Term Care Regulation division. Budget for the application/license fee, staff background check fees, and any local fire-code or building corrections needed to pass inspection.
How long does it take to get a Texas group home license?
Most operators should plan on roughly three to six months from a complete application to final licensure, assuming the building already meets life-safety code. Facilities needing sprinkler installation, egress changes, or other construction to meet code can add several more months before HHSC will schedule the licensing survey.
What staffing does a Texas assisted living facility need?
Staffing requirements differ by license type (Type A vs Type B vs Type C) and are based on resident evacuation ability and care needs, with HHSC requiring a qualified administrator and trained direct-care staff on every shift. Medication administration by unlicensed staff requires HHSC-approved medication aide training and RN delegation.
Does Texas require background checks for group home staff?
Yes. Owners, administrators, and direct-care staff must clear fingerprint-based criminal history checks through the Texas Department of Public Safety, along with a check against the HHSC Employee Misconduct Registry, before working unsupervised with residents in a licensed facility.
Do I need a separate Medicaid enrollment to accept waiver residents in Texas?
Yes. Your HHSC facility license and your Medicaid provider enrollment are separate processes. If you want to accept STAR+PLUS HCBS waiver residents or HCS/ICF Medicaid funding, you'll need to complete HHSC's provider enrollment and managed care contracting on top of your standard facility license.
Sources
- Texas Health and Human Services, Home and Community-based Services (HCS) Program: HHSC regulates HCS and ICF/IID programs for people with intellectual and developmental disabilities as a distinct program category from assisted living
- Texas Health and Safety Code, Chapter 247 (Assisted Living Facilities): Definition of an assisted living facility, license types (A, B, C), and HHSC's authority to deny, suspend, or revoke a license for noncompliance
- Texas Health and Safety Code, Chapter 242 (Nursing Facility Administrators / Convalescent and Nursing Facilities): Nursing facilities are licensed under a separate chapter requiring licensed nursing staff and physician-directed care plans
- Medicare.gov, Long-Term Care: Medicare does not cover long-term custodial care such as assisted living room, board, and personal care
- Texas Health and Human Services, STAR+PLUS Home and Community Based Services: Texas Medicaid offers assisted-living-level services through the STAR+PLUS HCBS waiver for eligible members, administered through managed care
- Texas Health and Human Services, Nurse Aide Registry and Employee Misconduct Registry: Direct-care staff must be checked against the HHSC Employee Misconduct Registry before working unsupervised with residents