Last updated 2026-07-26
TL;DR
Texas Health and Human Services Commission licenses assisted living facilities under Texas Health and Safety Code Chapter 247 and 26 TAC Chapter 553. Operators file Form 3720, pass a life safety and program survey, and choose a license type (A, B, B-SCU, or C) based on resident mobility and cognitive needs. Expect months of lead time, not weeks.
What is assisted living?
Assisted living is a licensed residential setting where people who need help with daily activities, bathing, dressing, medication reminders, meals, get that help while living in something closer to a home or apartment than a hospital. It sits between fully independent senior housing and a nursing facility. In Texas, the legal term is "assisted living facility" (ALF), and it's defined in the Texas Health and Safety Code as an establishment that furnishes food, shelter, and personal care services to four or more residents unrelated to the operator, for compensation [1]. That four-resident threshold matters a lot: three or fewer residents generally falls outside HHSC's assisted living licensing requirement, though other rules (fire code, zoning, private pay contracts) can still apply. Assisted living is not a single fixed script. Some Texas facilities look like small converted homes with six beds. Others are 120-unit campuses with a memory care wing. HHSC's licensing rules flex around that range through the license type system covered below.
What is a group home?
"Group home" is the term people use in everyday conversation for a small residential facility, often serving people with intellectual or developmental disabilities (IDD), mental illness, or substance use recovery needs, though it's also used loosely for small senior care homes. It is not itself a Texas licensing category. In Texas, a small home-style setting for seniors or adults needing assisted living services gets licensed as an assisted living facility under Chapter 247, the same law that covers big campuses. A small home serving people with IDD instead often falls under HHSC's Intermediate Care Facility (ICF/IID) rules or a Home and Community-based Services (HCS) waiver provider agreement, a different regulatory track entirely [2]. So before you file anything, nail down which population you intend to serve. "Group home for seniors" in Texas almost always means an ALF license. "Group home for adults with IDD" usually means an HCS or ICF/IID enrollment through HHSC's IDD services division, not the assisted living licensing unit. Mixing these up is the single most common mistake people make when they start researching.
What is an assisted living facility, exactly, under Texas law?
| Type A | Residents who are physically and mentally capable of evacuating the building unassisted in an emergency | |
|---|---|---|
| Type B | Residents who need staff assistance to evacuate, including some non-ambulatory residents | |
| Type B-SCU | Type B plus a certified Alzheimer's/dementia special care unit | |
| Type C (adult foster care) | Small settings, typically 4 residents, adult foster care model | This breakdown comes from HHSC's assisted living licensing rules and forms guidance [4]. Your license type drives your staffing ratios, physical plant requirements (like evacuation capability and sprinkler rules), and fire marshal review, so get this classification right at the planning stage, not after you've signed a lease. |
Under Texas Health and Safety Code Chapter 247, an assisted living facility is an establishment licensed by HHSC that provides personal care services, lodging, and meals to four or more unrelated residents who need help with at least one activity of daily living, and it may also provide, coordinate, or arrange for medication administration or other health-related services depending on license type [1]. The implementing rules live in the Texas Administrative Code, Title 26, Chapter 553 ("Licensing Standards for Assisted Living Facilities") [3]. That chapter is the actual operating manual: it covers admission and retention criteria, staffing ratios, physical plant standards, resident rights, medication procedures, and the inspection process. If you read one document cover to cover before you apply, make it this one. HHSC further breaks ALFs into license types based on the residents' mobility and cognitive status: | License Type | Who it serves |
What does assisted living provide, day to day?
An assisted living facility in Texas is required to provide, at minimum: three meals a day plus snacks, housekeeping and laundry, help with personal care (bathing, grooming, toileting, mobility), social and recreational activity opportunities, and 24-hour supervision appropriate to the license type [3]. Medication oversight varies by staffing and license type. Facilities can provide medication administration if they employ or contract a licensed nurse or use unlicensed staff trained under HHSC's medication aide or delegated task rules; otherwise residents self-administer with reminders only. This is a detail a lot of new operators get wrong: "help with medications" is not automatically the same as "administering medications," and the distinction changes your staffing plan and your liability exposure. What assisted living does not typically provide is skilled nursing care on a continuous basis, ventilator care, or complex wound care, that level of need generally requires a nursing facility license instead. HHSC's rules specifically limit which residents an ALF can retain based on acuity, and a facility that keeps a resident whose needs exceed its license type risks a deficiency citation during inspection.
What is the difference between assisted living and a nursing home?
Assisted living is for people who need help with daily activities but not around-the-clock skilled nursing care; a nursing home (skilled nursing facility) is for people who need continuous medical or rehabilitative care from licensed nurses. The regulatory difference in Texas is stark: ALFs are licensed under Health and Safety Code Chapter 247 and 26 TAC Chapter 553, while nursing facilities are licensed under Chapter 242 and 26 TAC Chapter 554, an entirely separate statute with its own staffing minimums, Medicaid certification pathway, and survey process [5]. Practically, the difference shows up in three places. Staffing: nursing homes must employ licensed nurses on-site around the clock and meet federal minimum staffing standards tied to Medicare/Medicaid certification; ALFs staff to resident need but don't carry the same federal nursing hour mandate. Payment: nursing home care is routinely covered by Medicaid (with financial and functional eligibility) and short Medicare-covered stays after a qualifying hospitalization; assisted living generally is not (see the Medicare section below). Physical plant: nursing facilities must meet hospital-adjacent life safety code requirements; ALF physical plant rules under 26 TAC Chapter 553 are less intensive but still substantial, especially for Type B and B-SCU facilities where residents can't self-evacuate. If you're deciding which license to pursue, ask yourself honestly what acuity you want to serve. Chasing a nursing home license because you assume it earns more per bed, without the staffing and capital to back a 24/7 licensed nursing model, is a fast way to end up on a plan of correction in your first year.
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 doesn't cover long-term care (also called custodial care) if that's the only care you need" and specifically lists assisted living facility costs as excluded [6]. Medicare Part A may cover a short-term skilled nursing facility stay after a qualifying inpatient hospital stay of at least three days, but that's a nursing facility benefit, not an assisted living benefit, and it's time-limited (up to 100 days per benefit period, with cost-sharing kicking in after day 20) [7]. It does not convert into ongoing assisted living coverage. Medicaid is a different story, sort of. Texas Medicaid does not pay for room and board in assisted living, but it can help cover personal care services for eligible residents through certain waiver programs, most relevantly STAR+PLUS and the Assisted Living Waiver-adjacent services administered through Texas's managed care system [8]. Eligibility is income- and asset-tested and the coverage covers services, not the roof over someone's head. If Medicaid reimbursement is part of your business model, confirm current program rules and provider enrollment requirements directly with HHSC and your Medicaid managed care organization before you build a pro forma around it. For a broader look at how funding streams work across states, see assisted living facilities.
How do I start a group home (assisted living facility) in Texas?
Starting an assisted living facility in Texas runs through several stages, and none of them are fast. Here's the realistic sequence. 1. Confirm your license type and population. Decide Type A, B, B-SCU, or C based on the residents you intend to serve, and confirm current definitions with HHSC because rule text and forms get updated [4]. 2. Check zoning and site suitability before you sign a lease. Local zoning ordinances, fire marshal requirements, and building codes vary by city and county, and HHSC licensing won't rescue you from a zoning fight after you've committed to a property. Confirm zoning classification with your city or county planning department. 3. Submit a Letter of Intent and license application, HHSC Form 3720, along with required attachments (fire marshal approval, floor plans, health inspection, criminal history checks for owner and staff, financial documentation) [9]. HHSC's Long-term Care Regulation division handles ALF applications; check the current application packet on the HHSC site since form numbers and required attachments are periodically revised. 4. Pass a life safety code inspection and a licensing survey. HHSC (often working with the State Fire Marshal's Office for life safety) inspects the physical plant before initial licensure, and again on a routine survey cycle after you're operating. 5. Build your staffing plan and policy manual. 26 TAC Chapter 553 sets minimum staffing expectations tied to resident count and license type, plus required policies on medication management, resident rights, abuse/neglect reporting, emergency preparedness, and admission/discharge criteria. This paperwork load is where most new operators underestimate the time commitment; a policy manual built from scratch, not a template, easily takes 60 to 100 hours of drafting and review. 6. Pay applicable license fees. Fee amounts and fee schedules are set by HHSC rule and change periodically, so confirm the current fee schedule directly on HHSC's licensing fee page rather than relying on a number from an old blog post. 7. Await licensure decision, then complete pre-operational requirements (staff training documentation, resident admission agreements, emergency contacts) before your first admission. This is genuinely a multi-month process even when everything goes smoothly. Budget for delays from incomplete applications, fire marshal scheduling backlogs, and revision requests. A well-built State Group Home Licensing Kit can shortcut the drafting of policies and forms (HHSC still has to review and approve your specific application; no kit or vendor can promise approval or a faster timeline, and you should treat any claim otherwise as a red flag).
What staffing does Texas require in an assisted living facility?
Staffing requirements in 26 TAC Chapter 553 scale with license type and resident acuity rather than a single flat ratio for every facility. Type B and B-SCU facilities, where residents may need evacuation assistance or have dementia, carry higher staffing and awake-staff expectations than Type A facilities where residents can self-evacuate. Across license types, HHSC requires the facility to have staff "awake and on duty" as appropriate to resident needs at all times, a designated manager or administrator responsible for daily operations, and a medication aide, nurse, or delegating RN arrangement if the facility administers medications rather than just reminding residents to take their own [3]. Staff must also complete required orientation and ongoing training hours, and criminal history and Employee Misconduct Registry checks are required for anyone with direct resident contact. Because exact staff-to-resident ratios and training hour minimums are tied to specific rule subsections that get amended, don't build your staffing budget off a number from a forum post. Pull the current text of 26 TAC Chapter 553 or call HHSC's Long-term Care Regulation policy staff to confirm the ratio that applies to your license type and resident census before you finalize hiring plans.
What happens during a Texas ALF inspection?
HHSC conducts an initial licensing survey before you can open, then routine unannounced surveys on a recurring cycle, plus complaint investigations triggered by reports from residents, families, or staff. Surveyors check physical plant and life safety compliance, staffing records, medication management, resident records and care plans, resident rights protections, and food service sanitation. Deficiencies get documented on a statement of deficiencies, and the facility must submit a plan of correction with timelines. Serious violations, immediate threats to resident health and safety, can result in enforcement actions ranging from administrative penalties to license suspension or revocation, this authority comes directly from Chapter 247's enforcement provisions [1]. HHSC also maintains public inspection and complaint history, so a facility's survey record is not private; prospective operators buying an existing facility should pull that history before closing a purchase. The practical lesson: build your policy manual and staff training program to match the inspection checklist from day one, not as an afterthought once a surveyor flags a gap. Facilities that treat their admission agreements, medication logs, and incident reports as living compliance documents, updated and reviewed regularly, tend to have much shorter and less painful survey days than facilities that only look at their paperwork once a year.
How much does it cost to license and open an assisted living facility in Texas?
There's no single honest number here, and anyone who gives you one flat figure is guessing. Costs break into three buckets: state licensing fees (relatively small, set by HHSC rule and subject to change, confirm current amounts on HHSC's fee schedule), physical plant costs (renovation or new construction to meet life safety and ADA-adjacent accessibility standards, which varies enormously by whether you're converting an existing home or building new), and pre-operational costs (staff training, policy development, initial insurance, working capital to cover the gap between opening and stabilized occupancy). For a small Type C or Type A home in an existing residential structure, renovation and pre-opening costs are typically far lower than for a purpose-built Type B or B-SCU campus with commercial fire suppression and wider hallways for wheelchair evacuation. Don't shortcut a real construction and staffing budget by assuming a friend's numbers from a different state, or even a different Texas county, will transfer directly. Zoning, labor costs, and local fire marshal requirements all shift the number.
How is assisted living different from a group home for adults with IDD or mental illness?
If your intended residents have intellectual or developmental disabilities rather than age-related or physical care needs, Texas licensing runs through a different door entirely. HHSC's IDD services division oversees Home and Community-based Services (HCS) waiver providers and Intermediate Care Facilities for Individuals with an Intellectual Disability (ICF/IID), governed by separate rule chapters and a separate enrollment and contracting process from Chapter 247 assisted living licensure [2]. Similarly, group homes focused on mental health recovery or substance use often intersect with Texas's behavioral health licensing and, depending on services offered, may not require an assisted living license at all if they're not providing personal care services to four or more unrelated residents in the Chapter 247 sense. These distinctions matter enormously for which state division you're even supposed to be talking to. If you're building out multiple service lines, or you're not sure which population your business plan actually targets, resolve that question first. Calling HHSC's Long-term Care Regulation intake line and describing your intended population, in one clear paragraph, will save you weeks of filing paperwork with the wrong division. For background on how populations shape licensing categories more broadly, see assisted living facility and assisted living.
Frequently asked questions
What is assisted living?
Assisted living is a licensed residential care setting for people who need help with daily activities like bathing, dressing, or medication reminders but don't need continuous skilled nursing care. In Texas it's regulated as an assisted living facility (ALF) under Health and Safety Code Chapter 247, distinct from nursing home licensing under Chapter 242.
What is a group home?
"Group home" is a common term for a small residential care setting, often for seniors, people with IDD, or mental health/recovery populations. It isn't a formal Texas license category itself; depending on the population served, it gets licensed as an assisted living facility, an HCS provider, or an ICF/IID under different HHSC rule chapters.
What is an assisted living facility?
Under Texas Health and Safety Code Chapter 247, an assisted living facility is an establishment licensed by HHSC that provides personal care services, lodging, and meals to four or more unrelated residents needing help with daily activities, with license types (A, B, B-SCU, C) set by resident mobility and cognitive status.
What is assisted living vs. a nursing home?
Assisted living serves people needing help with daily activities but not continuous skilled nursing; nursing homes serve people needing ongoing medical or rehabilitative nursing care. Texas licenses them under separate statutes (Chapter 247 vs. Chapter 242) with different staffing minimums, physical plant standards, and Medicaid/Medicare interaction.
What does assisted living provide?
Texas ALFs must provide meals, housekeeping, laundry, personal care assistance, social activities, and supervision appropriate to license type. Medication administration is only provided if the facility has qualifying licensed or delegated staff; otherwise residents self-administer with reminders, per 26 TAC Chapter 553.
How do I start a group home in Texas?
Confirm your license type and population, check local zoning, submit HHSC's assisted living license application (Form 3720) with required attachments, pass a fire marshal and licensing survey, build a compliant staffing and policy plan, pay applicable fees, and complete pre-operational steps before your first resident admission. Expect a multi-month timeline.
How do I start a group home for adults with disabilities specifically?
If your residents have intellectual or developmental disabilities, you generally don't apply through the assisted living (Chapter 247) pathway. Instead you'd pursue HHSC's HCS waiver provider enrollment or ICF/IID licensing, which have separate application, staffing, and contracting requirements from assisted living.
Does Medicare cover assisted living facilities?
No. CMS states Medicare doesn't cover custodial long-term care, which includes assisted living room-and-board and personal care costs. Medicare may cover a short skilled nursing facility stay after a qualifying hospitalization, but that's a separate, time-limited nursing home benefit, not ongoing assisted living coverage.
Does Medicaid pay for assisted living in Texas?
Texas Medicaid doesn't cover assisted living room and board, but certain waiver programs administered through the state's managed care system can help cover personal care services for financially and functionally eligible residents. Confirm current program details with HHSC and your Medicaid managed care organization before budgeting around it.
What license types does Texas use for assisted living facilities?
Texas uses Type A (residents who can self-evacuate), Type B (residents needing evacuation assistance), Type B-SCU (Type B plus a certified dementia special care unit), and Type C (small adult foster care settings, typically around four residents). Your license type drives staffing and physical plant requirements.
How long does it take to get an assisted living license in Texas?
There's no fixed statutory timeline, and it's realistically a multi-month process once you count application review, fire marshal inspection scheduling, and any required revisions. Facilities that submit incomplete applications or haven't finalized their physical plant before applying tend to see the longest delays.
What's the minimum number of residents before I need an assisted living license in Texas?
Texas Health and Safety Code Chapter 247 generally applies to establishments serving four or more unrelated residents who need personal care services. Homes serving three or fewer may fall outside ALF licensing, though zoning, fire code, and private contract obligations can still apply, so confirm with HHSC and your local jurisdiction.
What's the difference between assisted living and independent living?
Independent living is unlicensed senior housing with amenities like meals or activities but no personal care assistance built in. Assisted living is licensed by the state (in Texas, under Chapter 247) specifically because it provides hands-on help with daily activities like bathing, dressing, or medication reminders.
Sources
- Texas Health and Safety Code, Chapter 247 (Assisted Living Facilities): Definition of assisted living facility, four-or-more-resident threshold, and HHSC enforcement authority
- Texas HHSC, Intellectual and Developmental Disabilities Services: IDD group home settings are licensed/enrolled through HCS and ICF/IID pathways, separate from ALF licensing
- Texas Administrative Code, Title 26, Chapter 553 (Licensing Standards for Assisted Living Facilities): Staffing, medication administration, resident retention, and services required of Texas ALFs
- Texas HHSC, Assisted Living Facilities licensing overview: Description of Type A, B, B-SCU, and Type C assisted living license categories
- Texas Health and Safety Code, Chapter 242 (Nursing Facilities): Nursing facilities are licensed under a separate chapter with distinct staffing and certification requirements
- Medicare.gov, Long-Term Care coverage: Medicare does not cover custodial long-term care including assisted living costs
- Medicare.gov, Skilled Nursing Facility Care coverage: Medicare Part A skilled nursing facility benefit is time-limited and tied to a qualifying hospital stay
- Medicaid.gov, Home & Community-Based Services: Medicaid can cover personal care services through waiver programs but not assisted living room and board
- Texas HHSC, Long-term Care Provider Forms (Form 3720): HHSC Form 3720 is used for assisted living facility license applications