Last updated 2026-07-25
TL;DR
Texas group homes are licensed by the Health and Human Services Commission, usually as Assisted Living Facilities or through Home and Community Support Services Agencies. Rules cover staffing ratios, fire safety, resident agreements, and zoning. Medicare does not pay for room and board; Medicaid may cover care costs through specific waiver programs.
What is a group home in Texas?
A "group home" isn't a single license category in Texas. It's a catch-all term people use for a small residential setting where several unrelated adults live together and get some level of support, whether that's help with medication, meals, supervision, or personal care. Depending on who lives there and what services get delivered, the actual license Texas requires might be an Assisted Living Facility (ALF) license, a Home and Community Support Services Agency (HCSSA) license, or in some cases a certification tied to an intellectual and developmental disability (IDD) waiver program. The Texas Health and Human Services Commission (HHSC) is the state agency that regulates most of these settings [1]. If you're picturing a house with six bedrooms and a live-in caregiver serving seniors who need help bathing and taking medication, you're almost certainly looking at ALF licensure under Texas Health and Safety Code Chapter 247 [2]. If you're setting up a home for adults with intellectual or developmental disabilities funded through a Medicaid waiver like HCS (Home and Community-based Services), you're dealing with a different regulatory track entirely, often layered with HHSC's IDD-specific rules and possibly local mental health authority contracts. Don't skip this step. Calling your local HHSC regional office and describing exactly who you plan to serve and what services you'll provide is the single most useful phone call you can make before you sign a lease or buy furniture.
What is assisted living, and what is an assisted living facility?
Assisted living is a level of care between independent living and a nursing home. Residents typically live in their own room or apartment but get help with what regulators call "activities of daily living," things like bathing, dressing, toileting, and medication reminders. An assisted living facility (ALF) is the licensed building or program that provides that care. In Texas, an ALF is defined under Health and Safety Code Section 247.002 as an establishment that furnishes food, shelter, and personal care services to four or more people unrelated to the operator, and provides at least one of a specific list of personal care services [2]. Texas actually splits ALFs into types based on the residents' needs and mobility, ranging from Type A (residents who can evacuate independently and need minimal overnight help) to Type B (residents who need more assistance, including overnight, and may not be able to evacuate on their own) [3]. There's also a Type C designation for smaller "adult foster care" style homes serving three or fewer residents in some configurations, though the specifics of that category have shifted over the years, so confirm current definitions with HHSC directly. The distinction matters because staffing ratios, fire safety requirements, and physical plant rules differ by type. A Type B facility, for instance, generally needs an awake overnight attendant because residents may need help evacuating in an emergency, while a Type A facility may not, depending on resident mobility. Get the type wrong on your application and you'll either be under-resourced for the residents you actually admit, or you'll over-build for a population you're not serving.
What is assisted living vs nursing home? What's the actual difference?
| Governing law | Health & Safety Code Ch. 247 [2] | Health & Safety Code Ch. 242 [4] | |
|---|---|---|---|
| Staffing | Personal care attendants, not required to be RNs | Licensed nurses required, often 24/7 | |
| Medical acuity | Low to moderate | Moderate to high, skilled care | |
| Typical resident | Needs help with ADLs, largely mobile | Needs medical monitoring, may be bedbound | |
| Medicare coverage | Not covered (custodial care) | Short-term skilled stays may be covered | A lot of families get confused here because both settings can look similar from the outside, a house or building with staff and communal meals. The regulatory and clinical line is real, though, and it determines what license you need if you're opening one. |
The short answer: assisted living is for people who need help with daily living tasks but not constant medical supervision. A nursing home (called a "skilled nursing facility" in Medicare/Medicaid language) is for people who need ongoing medical care, often including a nurse on-site around the clock and higher levels of clinical monitoring. Nursing homes in Texas are licensed separately under Health and Safety Code Chapter 242 [4], not Chapter 247. They're required to have licensed nursing staff, must meet federal Medicare/Medicaid Conditions of Participation if they accept those payers, and generally serve residents with more complex medical needs, post-surgical recovery, or conditions requiring frequent physician involvement. Here's a simple comparison: | Feature | Assisted Living Facility (Texas) | Nursing Home (Texas) |
What does assisted living provide, exactly?
Assisted living provides a mix of housing, meals, and personal care support, but the exact list depends on the facility type and what's spelled out in the resident's individual service plan. Texas rules require ALFs to provide, at minimum, meals, help with activities of daily living as needed, and some form of supervision or monitoring appropriate to the facility type [3]. Common services include medication reminders (not necessarily administration, which may require additional staff qualifications), housekeeping, laundry, transportation to medical appointments, and social or recreational activities. Some ALFs contract with outside home health or hospice agencies to bring in skilled nursing visits for residents who need them, without the ALF itself becoming a medical provider. What assisted living generally does not provide: ongoing skilled nursing care, IV therapy, ventilator management, or the kind of 24/7 clinical monitoring you'd get in a nursing home. If a resident's needs escalate past what the facility is licensed to handle, Texas rules require the facility to have a plan for referral or discharge to a higher level of care, and this should be spelled out in your resident admission agreement and policies.
Does Medicare cover assisted living facilities?
No. Medicare does not pay for room and board or custodial personal care in an assisted living facility, and this is one of the most persistent points of confusion for new operators and families alike. Medicare.gov states plainly that Medicare "doesn't cover long-term care (also called custodial care)" if that's the only care a person needs [5]. What Medicare will cover, separately, are Medicare-eligible medical services a resident receives while living in assisted living, things like doctor visits, physical therapy ordered by a physician, or a short skilled nursing facility stay after a qualifying hospitalization. But the ALF's monthly charge itself, covering rent, meals, and personal care staff, is private-pay or, in some states and circumstances, covered through Medicaid waiver programs, not Medicare. This distinction should shape how you market your facility and what you tell prospective families during intake. Promising or implying Medicare coverage for your monthly rate is a legal and ethical problem, more than a marketing misstep.
Does Medicaid pay for Texas group homes and assisted living?
Sometimes, through specific programs, not as a blanket rule. Texas Medicaid does not generally pay for room and board in assisted living the way it might cover a nursing home stay. But Texas offers Medicaid waiver programs, run through HHSC, that can help cover personal care and support services for eligible people living in community settings, including some group home and assisted living arrangements. The most relevant for IDD group homes is the Home and Community-based Services (HCS) waiver, which funds services for people with intellectual and developmental disabilities living in small residential settings, often four or fewer people per home [6]. For adults needing personal care support more broadly, Texas also runs STAR+PLUS, a Medicaid managed care program that includes long-term services and supports for qualifying members [7]. CMS and Medicaid.gov describe home and community-based services waivers as a mechanism that lets states "provide long-term care services in home and community settings rather than institutional settings" [8]. If your business model depends on Medicaid waiver reimbursement, you need to apply to become an approved provider under that specific waiver, which is a separate process from your basic facility license and often takes months. Budget real time for this, and don't assume licensure automatically means you're an approved Medicaid provider.
How to start a group home in Texas: step by step
Starting a group home in Texas means picking your population and license type first, then working through licensing, staffing, zoning, and inspection requirements in roughly this order. Skipping steps or doing them out of sequence is the single biggest cause of delayed openings. 1. Decide who you'll serve and confirm the license category. Seniors needing ADL help point you toward ALF licensure under Chapter 247 [2]. Adults with IDD often point toward HCS waiver provider enrollment plus HHSC facility standards. Call HHSC's Long Term Care Regulation division to confirm which category fits your plan before you do anything else. 2. Secure and evaluate your property. Zoning matters enormously here. Many Texas cities treat small group homes (six or fewer unrelated residents with disabilities) as a permitted residential use under the Texas Fair Housing Act's alignment with federal fair housing law, but local rules vary and larger facilities may trigger commercial zoning, fire code, and building code review. Confirm with your city or county planning department and your state fire marshal's office early, before signing a lease. For a deeper look at how this plays out in practice, see our zoning and property guidance. 3. Complete the HHSC license application. This includes facility floor plans, fire inspection approval, a criminal background check (fingerprinting) for owners and staff, proof of financial capacity, and your policy and procedure manuals covering admissions, medication management, emergency preparedness, and resident rights. 4. Build your staffing plan. Texas ALF rules set minimum staffing based on facility type and resident count, and require specific training hours for administrators and direct care staff. An administrator of a Type A or Type B facility generally must complete state-approved training and pass a competency exam; confirm current hour requirements with HHSC since these get updated periodically. 5. Pass your pre-licensing inspection. HHSC (or a contracted local fire authority for life safety code items) will inspect the physical building before issuing a license. Expect review of fire exits, sprinkler or alarm systems depending on facility size, resident room square footage, and bathroom accessibility ratios. 6. Apply for Medicaid waiver enrollment if relevant. This is separate from your facility license and has its own application, provider agreement, and sometimes a separate site visit. 7. Open, and prepare for ongoing annual inspections and complaint-driven surveys. Texas ALFs are subject to regular HHSC surveys, and any substantiated complaint can trigger an unannounced visit. If you want a structured way to organize the paperwork across these steps, application forms, sample policy templates, and a staffing plan worksheet, our $299 Texas licensing kit builder walks through each document you'll need to assemble before your HHSC submission. It won't get you approved faster and it's not a substitute for legal advice, but it does save you from reinventing the policy manual from scratch.
How do I start a group home if I'm serving people with IDD specifically?
If your focus is adults with intellectual or developmental disabilities, your path runs through the HCS waiver program more than through standard ALF licensure. HHSC administers HCS, and providers must go through a separate enrollment process, including a program provider application, financial disclosure, and site-specific certification for each home [6]. Homes serving four or fewer people with IDD, funded through HCS, are often exempt from full ALF licensure under Chapter 247 but are instead regulated under HHSC's IDD-specific standards, which cover staffing, individual service planning, restraint and behavior support policies, and incident reporting. This is a meaningfully different rulebook than the ALF chapter, with different training requirements for direct support staff and different documentation expectations tied to each resident's person-centered plan. Because HCS is a Medicaid waiver, there's usually a waiting list for the waiver slot itself, separate from your provider enrollment. Some operators serve private-pay IDD residents while building out HCS capacity, but check current interest list timelines with HHSC, since these change and vary heavily by region.
What does zoning and neighborhood approval actually look like?
Zoning fights are one of the most common reasons a promising group home project stalls out before it opens. Federal fair housing law protects small group homes for people with disabilities from being excluded by local zoning that treats them differently than an ordinary family household, but the details of "small" and "family household" get litigated city by city. Practically, this means a six-bed home for seniors or adults with disabilities is often allowed in a single-family residential zone without a special use permit, but a larger facility, say 16 or 24 beds, usually gets treated as a commercial or institutional use requiring rezoning, site plan review, and often a public hearing where neighbors can object. Before you lease or buy a property, call the city or county planning department, ask directly whether your bed count and population type require a special use permit, and get the answer in writing if you can. Also confirm parking requirements, since many cities have separate off-street parking minimums for group care facilities that differ from a standard residential lot. For more on how this plays out across different property types, our assisted living facility guide covers common zoning categories operators run into.
What should the resident agreement and policy manual cover?
Texas HHSC requires ALFs to provide residents with a written contract covering services, fees, discharge criteria, and resident rights before or at admission [3]. At minimum, your resident agreement should spell out the monthly rate, what's included versus billed separately, refund and deposit terms, conditions under which the facility can transfer or discharge a resident, and the process for resolving disputes. Beyond the resident contract, HHSC inspectors will look for a full policy and procedure manual covering: medication administration and storage, emergency and disaster preparedness (including evacuation plans, which matter enormously in Texas given hurricane and heat-related emergency planning), infection control, abuse and neglect reporting, staff training records, and incident reporting procedures. Get your medication management policy right in particular. Improper medication storage or administration errors are among the most common citations in state ALF inspection reports nationally, and Texas surveyors pay close attention to whether staff administering medications have the required training or certification for the tasks they're performing.
What are common inspection findings, and how do you prepare?
HHSC conducts both initial licensing inspections and ongoing unannounced surveys, and the most frequent problem areas tend to cluster around a short list: staffing ratios not matching posted schedules, incomplete or outdated resident care plans, fire safety equipment not tested on schedule, and medication logs with gaps or errors. Before any inspection, walk your own building like a surveyor would. Check that fire extinguishers have current inspection tags, that exit signage is illuminated, that your staff schedule on paper matches who's actually clocked in, and that every resident file has an updated service plan signed within the required timeframe. Keep a simple audit binder, updated monthly, with your fire drill logs, staff training certificates, and medication administration records organized by resident. When an inspector shows up unannounced, being able to hand over organized documentation in five minutes instead of scrambling for twenty makes a real difference in how the visit goes, even though it doesn't change the substantive standards you're being measured against.
Frequently asked questions
What is assisted living?
Assisted living is a residential care option for people who need help with daily activities like bathing, dressing, or medication management but don't need the round-the-clock medical care a nursing home provides. Residents typically live in private or semi-private rooms and receive meals, personal care support, and supervision as part of a monthly fee.
What is a group home?
A group home is a residential setting where a small number of unrelated people, often seniors or adults with disabilities, live together with staff support. It's not one specific license type; in Texas, the actual regulatory category depends on who lives there, ranging from Assisted Living Facility licensure to IDD waiver-specific standards under HHSC.
What is an assisted living facility?
An assisted living facility (ALF) is the licensed building or program providing housing, meals, and personal care services to residents who need help with daily activities. In Texas, ALFs are defined and regulated under Health and Safety Code Chapter 247, with sub-types (A, B, and others) based on residents' care and mobility needs.
What is the difference between assisted living and nursing home?
Assisted living serves people who need help with daily tasks but not constant medical care; nursing homes serve people needing ongoing skilled nursing and medical monitoring. Nursing homes require licensed nursing staff around the clock and are regulated separately (Texas Health and Safety Code Chapter 242 versus Chapter 247 for ALFs).
Does Medicare cover assisted living facilities?
No. Medicare does not cover the room, board, or custodial personal care costs of assisted living. Medicare.gov states it doesn't cover long-term custodial care. Medicare may still pay separately for covered medical services a resident receives, like doctor visits or short-term skilled nursing after a hospital stay.
How do I start a group home in Texas?
Start by confirming which license category fits your target population with HHSC (ALF under Chapter 247, or IDD waiver standards for HCS providers), then secure a property that clears local zoning, complete the HHSC application with fire and background check clearance, build a compliant staffing plan, and pass your pre-licensing inspection.
Does Medicaid pay for group homes in Texas?
Not as a blanket rule, but specific programs help. The HCS waiver funds services for people with IDD in small residential homes, and STAR+PLUS covers long-term services and supports for other qualifying Medicaid members. Room and board itself is typically not a covered Medicaid expense; enrollment as a waiver provider is a separate process from facility licensing.
What's the difference between a Type A and Type B assisted living facility in Texas?
Type A facilities generally serve residents who can evacuate a building on their own with minimal physical assistance and don't need overnight attendance for most needs. Type B facilities serve residents who need more help, including overnight assistance, and may not be able to evacuate independently in an emergency, which triggers stricter staffing and life-safety requirements.
Do Texas group homes need a special zoning permit?
It depends on size and population. Small group homes (often six or fewer residents with disabilities) are frequently allowed in residential zones without special permits under fair housing protections, but larger facilities usually require a special use permit, site plan review, and sometimes a public hearing. Always confirm with your local planning department before signing a lease.
What training do staff need to work in a Texas assisted living facility?
Administrators of licensed ALFs generally must complete state-approved training and pass a competency exam before running Type A or Type B facilities. Direct care staff need training in areas like medication assistance, emergency procedures, and resident rights; specific hour requirements are set by HHSC and get updated periodically, so confirm current standards directly.
How long does it take to get an assisted living license in Texas?
Timelines vary based on application completeness, background check turnaround, and inspection scheduling, and HHSC does not publish a guaranteed timeframe. Operators should expect the process, from application submission to license issuance, to take several months when accounting for fire inspection coordination and any corrections requested after initial review.
What does assisted living provide that independent living doesn't?
Assisted living adds hands-on support with activities of daily living, such as bathing, dressing, mobility assistance, and medication reminders, along with staff supervision and meal service built into the monthly cost. Independent living communities typically offer housing and amenities but not personal care staff as a core included service.
Sources
- Texas Health and Human Services, Long Term Care Regulation: HHSC regulates assisted living facilities in Texas
- Texas Health and Safety Code, Chapter 247: Definition and licensing requirements for assisted living facilities in Texas
- Texas Administrative Code, Title 26, Chapter 553 (Assisted Living Facilities): ALF facility types, resident contract, and service requirements
- Texas Health and Safety Code, Chapter 242: Nursing home licensing requirements in Texas
- Medicare.gov, Long-term care coverage: Medicare does not cover custodial long-term care such as assisted living room and board
- Texas HHSC, Home and Community-based Services (HCS) Program: HCS waiver funds services for people with IDD in small residential settings
- Texas HHSC, STAR+PLUS Program: STAR+PLUS Medicaid managed care program covers long-term services and supports
- Medicaid.gov, Home & Community-Based Services: HCBS waivers let states provide long-term care in community settings rather than institutions