Last updated 2026-07-26
TL;DR
Texas Health and Human Services Commission (HHSC) licenses assisted living facilities under Texas Health and Safety Code Chapter 247. You'll need a completed application, life safety code inspection, staffing plan, background checks, and a facility that meets Type A, B, or C standards. Initial licensing typically takes several months from application to survey.
What is assisted living?
Assisted living is housing for people who need help with daily activities like bathing, dressing, medication management, or meals, but who don't need the round-the-clock skilled nursing care a nursing home provides. It sits in the middle of the care spectrum: more support than independent living, less medical intervention than a nursing facility. In Texas, this level of care is regulated as an "assisted living facility" (ALF) under Texas Health and Safety Code Chapter 247, and HHSC is the licensing authority [1]. The state defines an ALF as an establishment that furnishes food, shelter, and personal care services to four or more people unrelated to the proprietor, with additional definitions for smaller settings. If you're researching this topic for the first time, it helps to also read a general primer on assisted living before working through Texas-specific rules, since license categories, fees, and inspection cycles vary a lot state to state.
What is a group home?
A group home is a residential setting, usually a house in a regular neighborhood, where a small number of unrelated residents live together and receive supervision or care. The term gets used loosely across the industry to cover everything from IDD group homes to adult foster care to small assisted living settings. In Texas, whether a group home needs an ALF license depends on the number of residents, the level of care provided, and who's paying for it. A home serving three or fewer unrelated adults with only minimal supervision may fall outside HHSC's ALF licensing requirement entirely, while a home serving four or more with personal care services almost certainly needs a license [1]. Homes serving people with intellectual or developmental disabilities may instead fall under HHSC's Home and Community-based Services (HCS) or Intermediate Care Facility (ICF/IID) programs, which have separate licensing tracks. This distinction trips up a lot of new operators. Don't assume that because you're calling your business a "group home" instead of an "assisted living facility" you're exempt from licensing. HHSC looks at what you actually do, not what you name the business.
What is an assisted living facility (and what is assisted living facility, exactly, under Texas law)?
| Type A | Residents who are physically and mentally capable of following directions in an emergency, without significant help | Basic life safety standards | |
|---|---|---|---|
| Type B | Residents who need staff assistance evacuating, or who are not capable of following directions in an emergency | Stricter fire/life safety standards, awake night staff | |
| Type C (small facility, formerly "adult foster care"-style) | Small settings, typically 3 to 16 residents, with more home-like requirements | Modified life safety rules for small occupancy | These categories come from HHSC's licensing rules found in 26 Texas Administrative Code Chapter 553 [2]. Getting the type wrong on your application is one of the most common reasons initial reviews stall, because your building's fire alarm system, sprinkler coverage, and exit configuration have to match the type you're applying for before HHSC will schedule a survey. If you're comparing Texas requirements against other states, our general page on the assisted living facility license category is a useful side-by-side starting point. |
Under Texas Health and Safety Code Section 247.002, an assisted living facility is an establishment that furnishes food and shelter to four or more people who are unrelated to the proprietor, and provides personal care services or administers medication, or both [1]. The statute also covers facilities with fewer residents in certain circumstances, so the four-person threshold isn't an absolute safe harbor. HHSC licenses ALFs in three types, and the type dictates what kind of resident you can serve and what physical plant standards apply: | License Type | Who it serves | Key requirement |
What does assisted living provide?
An assisted living facility in Texas is required to provide, at minimum: room and board, help with activities of daily living (bathing, dressing, toileting, transferring, eating), medication administration or reminders, housekeeping, laundry, and social and recreational activities. Facilities must also have an awake staff member on duty at all times capable of responding to emergencies, though the specific staffing ratio depends on license type and resident acuity [2]. What assisted living does NOT provide, at least not as a core service, is ongoing skilled nursing care, like IV therapy, wound vac management, or ventilator support. If a resident's needs progress beyond what personal care staff can safely manage, Texas rules generally require the facility to either arrange additional licensed services or help the resident transition to a nursing facility. Meals are a specific compliance point inspectors check closely: facilities must offer at least three meals a day meeting nutritional standards, with snacks available, and dietary accommodations for residents with medically prescribed diets. Bring in a registered dietitian consult early if you're building your menu program from scratch. It's cheaper to fix a menu on paper than to fail a survey over it.
What is assisted living vs nursing home (what is the difference between assisted living and nursing home)?
The core difference is medical intensity and staffing. Nursing homes (called "nursing facilities" in Texas regulatory language) are licensed under a different chapter of the Health and Safety Code and are required to have licensed nurses on site around the clock, plus a physician of record, because their residents typically need ongoing skilled medical care [3]. Assisted living facilities are staffed primarily by personal care attendants and do not require 24-hour licensed nursing. Cost and setting differ too. Assisted living residences look and feel more like apartments or group homes, with private or semi-private rooms and shared common areas, and residents generally retain more independence. Nursing facilities are set up more like a hospital unit, with nursing stations, medical equipment, and a higher staff-to-resident ratio for clinical tasks. Regulators inspect them differently as well. Nursing facilities are surveyed under federal Medicare/Medicaid certification standards administered by CMS in partnership with the state, on top of state licensing [4]. Assisted living facilities in Texas are licensed and inspected purely under state law unless the facility separately participates in a Medicaid waiver program. For operators trying to decide which model fits their business plan, it's worth reading about both assisted living facilities and how they compare against skilled nursing licensing before you commit to a building or a staffing budget.
Does Medicare cover assisted living facilities?
No. Medicare does not cover the cost of room and board or personal care in an assisted living facility. Medicare.gov states plainly that Medicare does not pay for "custodial care," which includes help with daily activities like bathing and dressing when that's the only care needed, and that this exclusion applies to assisted living settings [5]. Medicare may still pay for medically necessary services a resident receives while living in an ALF, like doctor visits, physical therapy following a covered hospital stay, or durable medical equipment, but it does not pay the facility for room, board, or custodial personal care. Medicaid is a different story, and this is where a lot of confusion comes from. Texas Medicaid does not pay for room and board in assisted living either, but it can help cover personal care services for eligible low-income residents through Medicaid waiver programs, most notably STAR+PLUS, administered through HHSC [6]. Facilities that want to accept Medicaid waiver clients need to enroll separately as a Medicaid provider on top of holding their ALF license; the license alone doesn't make you eligible for Medicaid reimbursement.
How to start a group home in Texas (how do I start a group home)?
Starting a licensed group home or assisted living facility in Texas generally follows this sequence, though your timeline will vary based on how fast you move on financing and construction: 1. Decide your license type (Type A, B, or C) based on the resident population you intend to serve, and confirm which HHSC program applies if you're serving people with IDD rather than general elderly/disabled populations. 2. Choose and secure a property that can be built out or converted to meet fire, life safety, and physical plant standards for your license type. Check local zoning before you sign a lease; residential zoning that permits group homes under fair housing accommodations is not automatic everywhere, and city or county rules vary. Confirm with your local planning department and with your state licensing agency before committing to a location. 3. Submit your Application for a License to HHSC, along with required fees. Confirm current fee amounts with HHSC, since fee schedules change and are set in state rule, not statute. 4. Pass a life safety code inspection, typically coordinated with the local fire marshal and HHSC surveyors. 5. Develop your policy and procedure manuals, covering admission and discharge criteria, medication management, emergency preparedness, abuse/neglect reporting, staffing plans, and resident rights, all of which HHSC will review during licensing survey [2]. 6. Complete required background checks for owners, administrators, and staff through the Texas Department of Public Safety and the HHSC Employee Misconduct Registry. 7. Hire and train a licensed administrator; Texas requires ALFs to have an administrator who meets specific education, experience, or licensing requirements depending on facility size and type. 8. Schedule and pass your initial licensing survey, where HHSC inspectors evaluate the physical plant, staffing, records, and policies against 26 TAC Chapter 553. This is also the stage where a lot of first-time operators underestimate paperwork volume. Building out compliant admission agreements, staffing schedules, med management logs, and emergency plans from scratch eats weeks of time you could spend on construction or hiring. A structured tool like the $299 State Group Home Licensing Kit (see /licensing-kit-builder) exists specifically to shortcut that document-assembly phase across state-specific requirements, though it doesn't replace working directly with your HHSC regional office on your specific application.
What staffing does Texas require for an assisted living facility?
Staffing requirements in Texas scale with license type and resident needs, but every licensed ALF must have staff awake and on duty 24 hours a day capable of responding to emergencies [2]. Type B facilities, which serve residents who can't self-evacuate without help, generally require more staff per resident overnight than Type A facilities. Facilities must also designate a qualified administrator. HHSC rules require administrators to meet education and experience thresholds, and larger facilities may require a licensed nursing home administrator or a separately credentialed assisted living manager, depending on facility size. Direct care staff must complete required orientation and ongoing training hours covering topics like resident rights, infection control, emergency procedures, and abuse/neglect reporting. Medication aides, if your facility administers medication rather than just reminding residents to take it, must be certified through a state-approved medication aide training program and registered with HHSC. This is a frequent inspection finding: facilities that let uncertified staff pass medications get cited quickly, and repeated violations can jeopardize the license.
What does the Texas HHSC inspection process actually check?
HHSC conducts an initial licensing survey before issuing your license, then follow-up inspections on a recurring cycle plus complaint-driven investigations at any time. Surveyors evaluate the physical plant against fire and life safety code, resident records, staffing ratios and training documentation, medication management practices, food service and sanitation, and whether required policies exist and are actually being followed in practice, more than on paper [2]. Common citation areas nationally and in Texas include incomplete medication administration records, missing or expired staff training certifications, fire drill documentation gaps, and inadequate individual service plans for residents. Building your record-keeping systems before you ever apply, not after your first survey finding, saves enormous headache. HHSC also investigates complaints from residents, families, or staff at any point during your license period, separate from the routine inspection cycle. A pattern of substantiated complaints can trigger enforcement action, up to and including license revocation, so your internal grievance and incident reporting process matters as much as your physical building compliance.
How much does it cost and how long does licensing take in Texas?
HHSC charges licensing fees that vary by facility size and license type, and these fees change periodically through administrative rule updates rather than through the statute itself. Confirm current fee amounts directly with HHSC's Long-term Care Regulation division before budgeting, since quoting a fixed number here risks being outdated by the time you read this. Timeline is similarly variable and depends heavily on how prepared your application package is and how quickly your building passes its life safety inspection. A realistic expectation for many operators is several months from initial application submission to license issuance, factoring in application review, life safety inspection scheduling (often through your local fire marshal), and any required corrections. Facilities that submit incomplete applications or that need construction changes to meet Type B life safety standards should expect longer timelines. Don't budget your opening date around a best-case scenario. Build in a buffer for at least one round of correction requests from HHSC, since that's common even for well-prepared applications.
What ongoing compliance is required after licensing?
Once licensed, Texas ALFs must renew their license periodically and remain subject to unannounced inspections. Facilities must maintain current staff training records, resident service plans, incident reports, and emergency preparedness plans on an ongoing basis, more than at initial licensure. HHSC also requires facilities to report specific incidents, like resident death, serious injury, or allegations of abuse or neglect, within required timeframes. Failure to report on time is itself a citable offense separate from whatever the underlying incident was. Operators expanding to a second location need to treat it as a near-full relicensing process. Texas licenses facilities by location, not by ownership entity, so opening a second home means a second full application, a second life safety inspection, and a second survey, even if your policies and staff training programs carry over directly. If you're planning multi-site growth, it's worth reviewing resources on assisted living at home models and smaller-footprint licensing categories, since Type C small facility rules may fit an expansion strategy better than replicating a large Type B building.
How does Texas licensing compare to other states?
Every state licenses assisted living differently, and Texas's three-tier Type A/B/C system is not universal. Some states use a single "assisted living" license with acuity-based waivers instead of separate categories; others license by bed count thresholds rather than resident capability to self-evacuate. If you're evaluating multiple states for expansion, or trying to understand whether a policy manual built for one state will transfer to another, start by comparing baseline definitions. Pages like senior assisted living facilities near me and facility assisted living cover how other jurisdictions define and license this level of care, which is useful context before you assume Texas's Type A/B/C framework maps cleanly onto another state's rules. It usually doesn't.
Frequently asked questions
What is assisted living?
Assisted living is housing that combines a private or semi-private living space with help for daily activities like bathing, dressing, and medication management. It's less medically intensive than a nursing home. In Texas, it's regulated as an assisted living facility (ALF) and licensed by HHSC under Texas Health and Safety Code Chapter 247.
What is a group home?
A group home is a residential setting where a small number of unrelated residents live together with some level of supervision or care. Whether it needs an assisted living license in Texas depends on resident count, care level provided, and which population it serves; homes for people with IDD often fall under separate HHSC programs instead of standard ALF licensing.
What is an assisted living facility under Texas law?
Texas Health and Safety Code Section 247.002 defines it as an establishment furnishing food and shelter to four or more unrelated people, plus personal care services or medication administration. HHSC licenses these facilities as Type A, Type B, or Type C depending on resident evacuation capability and facility size.
What does assisted living provide that a private home doesn't?
Licensed assisted living provides room and board, help with daily activities, medication administration or reminders, housekeeping, laundry, at least three meals a day, social activities, and 24-hour awake staff able to respond to emergencies. It does not typically provide ongoing skilled nursing care.
What is the difference between assisted living and a nursing home?
Nursing homes provide 24-hour licensed nursing care and are staffed by nurses for medically complex residents; they're also subject to federal Medicare/Medicaid certification standards through CMS. Assisted living facilities are staffed mainly by personal care attendants, don't require round-the-clock licensed nursing, and are licensed purely at the state level in Texas unless separately enrolled in a Medicaid waiver.
Does Medicare cover assisted living facilities in Texas?
No. Medicare.gov states Medicare does not cover custodial care, which includes most assisted living services. Medicare may cover medically necessary care a resident receives while living there, like therapy or doctor visits, but not room, board, or personal care costs charged by the facility itself.
Does Medicaid pay for assisted living in Texas?
Texas Medicaid doesn't cover room and board in assisted living, but eligible low-income residents may get help with personal care costs through Medicaid waiver programs like STAR+PLUS, run through HHSC. Facilities must enroll separately as Medicaid providers; holding an ALF license alone doesn't make you Medicaid-eligible for reimbursement.
How do I start a group home or assisted living facility in Texas?
Decide your license type, secure a compliant property, confirm zoning, submit your application and fees to HHSC, pass a life safety inspection, build required policy manuals, complete background checks, hire a qualified administrator, and pass your initial licensing survey. Expect the process to take several months from application to license issuance.
What's the difference between Type A, Type B, and Type C assisted living licenses in Texas?
Type A serves residents who can evacuate independently in an emergency. Type B serves residents who need staff help evacuating or can't follow directions in an emergency, and requires stricter life safety standards. Type C covers small facilities, generally 3 to 16 residents, with modified rules suited to home-like settings.
How much does an assisted living license cost in Texas?
Fees vary by facility size and license type and change periodically through HHSC rule updates. Rather than quoting a fixed number that may be outdated, confirm current fee schedules directly with HHSC's Long-term Care Regulation division before budgeting your application.
How long does it take to get an assisted living license in Texas?
There's no fixed statutory timeline, and it depends on application completeness, life safety inspection scheduling, and any correction requests. Many operators should realistically plan for several months between application submission and license issuance, with extra buffer time for at least one round of corrections.
Do I need a separate license for each group home location in Texas?
Yes. HHSC licenses facilities by physical location, not by owner or company. Opening a second home requires a full separate application, life safety inspection, and survey, even if your staff training programs and policy manuals are reused from your first location.
What training do staff need at a Texas assisted living facility?
Staff need orientation and ongoing training covering resident rights, infection control, emergency procedures, and abuse/neglect reporting. Staff who administer medication must complete a state-approved medication aide training program and register with HHSC; facilities that let untrained staff pass medication risk quick citations during inspection.
Sources
- Texas Health and Safety Code, Chapter 247: HHSC licenses assisted living facilities and the statute sets the general definition and licensing authority
- 26 Texas Administrative Code Chapter 553: HHSC licensing rules for Type A, B, and C assisted living facilities, staffing, and inspection standards
- Texas Health and Safety Code, Chapter 242: Nursing facility licensing requirements including 24-hour licensed nursing staff, distinct from assisted living licensing
- CMS.gov, Nursing Home Compare/Conditions of Participation: Nursing facilities are subject to federal Medicare/Medicaid certification standards administered by CMS
- Medicare.gov, Long-term care coverage: Medicare does not cover custodial care or assisted living room and board
- Texas HHSC, STAR+PLUS program: STAR+PLUS Medicaid waiver can help cover personal care services for eligible residents in community settings