Last updated 2026-07-25
TL;DR
Texas assisted living facilities are licensed by the Health and Human Services Commission under Texas Health and Safety Code Chapter 247 and 26 TAC Chapter 553. Facilities are classified Type A, B, or C based on resident mobility and care needs. Operators need a license before admitting residents, a fire marshal inspection, staffing that meets awake-staff and administrator rules, and ongoing HHSC surveys.
What is assisted living?
Assisted living is a housing and care model for adults who can't fully live alone but don't need the round-the-clock skilled nursing you'd get in a hospital-like setting. Residents get help with things like bathing, dressing, medication reminders, and meals, plus a private or semi-private room, while keeping more independence than a nursing home allows. In Texas, this isn't just an industry term. It's a licensed category. The state defines it in Texas Health and Safety Code Chapter 247, and any operator housing four or more unrelated people and providing personal care services has to hold a license from HHSC before opening the doors [1]. The federal government doesn't run a national assisted living license. It's entirely a state-by-state system, which is why Texas rules look different from, say, Florida's or California's. If you're comparing states, our assisted living facility overview walks through how licensing categories vary.
What is a group home, and how is it different from assisted living?
A group home is a broader, less formal term for a residential setting where a small number of unrelated people live together and get some level of support, supervision, or care. It gets used for a lot of things: homes for adults with intellectual or developmental disabilities, recovery residences, foster care settings, and yes, sometimes small assisted living operations. In Texas, the term "group home" isn't the legal licensing category for seniors needing personal care. That category is "assisted living facility" under Chapter 247. If your home serves people with intellectual or developmental disabilities specifically, you may instead fall under HHSC's separate IDD program rules, not the assisted living chapter. Get this classification wrong at the application stage and you'll be sent back to refile under the correct license type, which costs weeks. If you're deciding which resident population and license type fits your project, start with our group home and assisted living facilities guides before you file anything with the state.
What is an assisted living facility under Texas law?
Texas Health and Safety Code Section 247.002 defines an assisted living facility as an establishment that furnishes food, shelter, and personal care services to four or more people unrelated to the operator, and that provides services beyond just room and board, such as help with activities of daily living or administration of medication [1]. HHSC further breaks facilities into three types under 26 TAC Section 553.5: - Type A: residents are physically and mentally capable of evacuating the building unassisted in an emergency and don't require attendant assistance overnight for evacuation.
- Type B: residents may need staff assistance to evacuate, may be non-ambulatory, or may need overnight attendant care.
- Type C (also called "small facility" in older rule text): a specific small-facility category with its own staffing and physical plant allowances [2]. The type you apply for drives almost everything downstream: how many awake staff you need at night, what your evacuation plan has to prove, and which physical plant standards (door widths, ramps, alarm systems) apply.
What does assisted living provide, exactly?
At minimum, a licensed Texas assisted living facility provides three meals a day, housekeeping, laundry, and 24-hour supervision. Beyond that baseline, most facilities provide help with activities of daily living: bathing, dressing, toileting, transferring, and mobility. Medication services are a big one. Facilities can offer medication administration or just medication reminders, depending on staff qualifications and what's documented in the resident's individual service plan. HHSC requires every resident to have a service plan completed within a set timeframe after admission, and that plan drives the staffing and care level billed or documented for that resident [2]. What assisted living does not provide is ongoing skilled nursing care, like IV therapy, ventilator management, or complex wound care, unless the facility has specific arrangements and the resident's needs still fall under what a Type A or B facility is licensed to handle. If a resident's needs exceed what the facility license allows, the facility has to arrange a higher level of care or discharge planning, more than keep the resident on-site out of convenience.
What's the difference between assisted living and a nursing home in Texas?
| Licensing agency | HHSC | HHSC | |
|---|---|---|---|
| Skilled nursing on-site | Not required | Required, licensed nurses on duty | |
| Typical resident need | ADL help, supervision | Daily medical/nursing care | |
| Medicaid program | Community-based waiver programs, not standard Medicaid | Medicaid nursing facility benefit | |
| Physical plant | Residential-style, apartment or room-based | Hospital-adjacent, medical equipment throughout | If a family is choosing between the two, the honest test is: does this person need a nurse checking on them daily, or do they need help getting dressed and someone making sure they take their pills? The first is a nursing home question. The second is assisted living. |
The core difference is medical intensity and staffing. Nursing homes (called "nursing facilities" in Texas rule, licensed under Health and Safety Code Chapter 242) are required to have licensed nurses on duty and are built for residents who need daily skilled nursing care, rehabilitation after hospitalization, or complex medical management [3]. Assisted living facilities are built for people who are mostly stable medically but need help with daily living and some supervision. Staffing in assisted living leans on unlicensed direct care staff and a designated administrator or manager, not around-the-clock RNs. | Feature | Assisted living (Ch. 247) | Nursing facility (Ch. 242) |
Does Medicare cover assisted living facilities?
No. Medicare does not pay for room and board or personal care services in assisted living. CMS's own coverage page states plainly that Medicare Part A and Part B do not cover long-term custodial care, and that assisted living costs are generally the resident's responsibility [4]. Medicare Part A might cover a short skilled nursing facility stay after a qualifying hospitalization, but that's a completely different benefit and setting than ongoing assisted living residency. Medicaid is a different story, sort of. Texas doesn't pay for room and board in assisted living through standard Medicaid, but the state runs home and community-based services waiver programs, like STAR+PLUS, that can help cover personal care and habilitation services for eligible low-income residents living in certain assisted living settings [5]. Coverage details, waiting lists, and eligibility rules change, so anyone counting on Medicaid-funded residents needs to confirm current waiver rules with your state licensing agency and the local Medicaid managed care organization before building a business model around it. Most assisted living residents, in Texas and nationally, pay privately or through long-term care insurance. That's a financial planning reality operators need to walk families through honestly, not something to gloss over during move-in.
How do I start a group home or assisted living facility in Texas?
Here's the realistic sequence, not the marketing-brochure version. 1. Decide your resident population and license type. Seniors needing personal care fall under Chapter 247 assisted living. Different populations (IDD, behavioral health) may fall under different HHSC program areas entirely. 2. Pick a location and confirm zoning. Cities and counties regulate residential care use through zoning codes, which HHSC does not control. Call your local planning department before you sign a lease. Our zoning and property coverage on the site walks through common local hurdles like occupancy limits and parking requirements. 3. Line up your building. It has to meet the physical plant standards in 26 TAC Chapter 553, which cover things like minimum square footage per resident, bathroom ratios, and emergency egress. A local fire marshal inspection and often a health inspection are required before HHSC will issue a license [2]. 4. Submit the license application to HHSC. This includes the facility's policies and procedures manual, staffing plan, disclosure of ownership, and application fee. Confirm current fee amounts with your state licensing agency since these are adjusted periodically by rule. 5. Pass the pre-licensing survey. HHSC (or its designated regional office) inspects the physical building and reviews your paperwork before issuing the initial license. 6. Hire and train staff to meet Chapter 247 staffing ratios, including a qualified administrator who meets HHSC's education and experience requirements or completes the required manager training course. 7. Get your license, then keep it. Facilities are subject to unannounced inspections and must maintain compliance continuously, more than at initial licensure. This is also where a lot of first-time operators underestimate the paperwork load. The policies and procedures manual alone, covering resident rights, medication management, emergency preparedness, abuse reporting, and staffing, is a real drafting project, not a fill-in-the-blank form. Building it from scratch usually eats weeks. That's the specific gap our $299 State Group Home Licensing Kit is built to close: state-specific policy templates and application checklists so you're not starting from a blank page.
What staffing does Texas require in assisted living facilities?
Texas requires an awake, on-site attendant at all times in Type B and Type C facilities, since residents in those categories may need overnight evacuation assistance. Type A facilities have more flexibility since residents are capable of self-evacuation, but HHSC still requires sufficient staff to meet resident needs around the clock [2]. Every facility must have a designated administrator responsible for day-to-day operations, and that person has to meet HHSC's qualification standards, which typically require either a combination of education and experience or completion of a state-approved assisted living manager training course. Direct care staff need documented training on topics like resident rights, infection control, emergency procedures, and abuse/neglect/exploitation reporting before they're left working unsupervised. Staffing ratios aren't a single fixed number across all facilities; HHSC ties adequacy to the acuity and number of residents and the facility type, which is why your staffing plan submitted at application has to show, resident by resident category, how you'll cover shifts. This is one of the most common reasons initial applications bounce back for revision, so build the staffing plan around your actual projected census, not a rough guess.
What inspections happen before and after licensing?
Before HHSC issues an initial license, the facility typically needs a fire marshal inspection confirming the building meets life safety code requirements for the resident population, and a health/sanitation inspection. HHSC's own licensing survey then reviews the physical plant against 26 TAC Chapter 553 standards and checks that policies, staffing documentation, and resident records are in order. After licensure, HHSC conducts inspections on a regular cycle plus complaint-driven investigations. If a survey finds deficiencies, the facility gets a plan of correction timeline; unresolved or serious violations can lead to enforcement action, including license suspension or revocation in serious cases. Our inspections hub covers what surveyors commonly flag across states, which is a useful gut check even though the specific citation numbers here are Texas-specific. Keep your own compliance file current between surveys: staff training records, medication logs, incident reports, and fire drill documentation. Surveyors ask for these first, and gaps here are a much more common citation source than physical plant problems in facilities that have been open a while.
What does it cost and how long does licensing take in Texas?
Exact license fees and processing timelines change periodically under HHSC rule updates, so don't rely on a number you saw in a forum post from a few years back. Confirm current application fees, per-bed fees if applicable, and expected processing time directly with your state licensing agency before you budget your startup costs. What you can plan around structurally: expect the pre-application phase (zoning confirmation, building lease or purchase, fire marshal coordination) to take longer than the HHSC review itself in most cases. Facilities that go in with a completed, accurate application package, meaning a staffing plan matched to actual resident acuity, a policies manual that isn't generic boilerplate, and a building already passing fire code, tend to move through the state review faster than facilities that submit incomplete packets and then spend months in a back-and-forth correction cycle. There's no such thing as an expedited or guaranteed-approval track. Anyone telling you otherwise isn't being straight with you. HHSC reviews every application against the same statutory and rule standards regardless of who's asking.
What ongoing compliance do Texas assisted living operators need to maintain?
Licensure isn't a one-time event. Facilities have to renew their license periodically, keep staff training current, update resident service plans as care needs change, and report specific incidents (like resident death, abuse allegations, or elopement) to HHSC within required timeframes under Chapter 247 and its implementing rules [1][2]. Operators also need a working relationship with local emergency services and a current, tested emergency preparedness plan, something Texas has emphasized more heavily since major weather events like Winter Storm Uri in February 2021 exposed gaps in backup power and resident evacuation planning across the state's licensed facility sectors. HHSC issued emergency rules in 2021 requiring long-term care facilities, including assisted living facilities, to develop and maintain emergency preparedness and response plans addressing power outages and extreme weather, adopted under 26 TAC Section 553.264 [6]. If you're running (or planning to run) more than one facility, or you're evaluating a facility for acquisition, ask to see the last two HHSC survey reports. Public complaint and inspection history is generally available through HHSC's regulatory services, and it tells you more about actual day-to-day compliance than anything in a sales brochure.
Frequently asked questions
What is assisted living?
Assisted living is residential care for adults who need help with daily activities like bathing, dressing, and medication management but don't require full-time skilled nursing care. It combines housing, meals, supervision, and personal care support. In Texas, it's a licensed category under Health and Safety Code Chapter 247, distinct from nursing homes and from unlicensed independent senior housing.
What is a group home?
A group home is a general term for a residential setting where a small number of unrelated people live together with some level of support or supervision. It covers many populations, including seniors, people with disabilities, and those in recovery. In Texas, the specific licensing category for senior personal care is 'assisted living facility,' not 'group home.'
What is an assisted living facility?
Under Texas Health and Safety Code Section 247.002, an assisted living facility furnishes food, shelter, and personal care to four or more unrelated residents, along with services like help with daily activities or medication administration. It requires a license from the Texas Health and Human Services Commission before it can legally operate.
What is the difference between assisted living and a nursing home?
Assisted living serves residents who need help with daily activities but are medically stable, staffed mainly by unlicensed direct care workers. Nursing homes serve residents needing daily skilled nursing care, with licensed nurses required on duty. Texas licenses assisted living under Chapter 247 and nursing facilities under a separate chapter, Chapter 242, with different staffing and physical plant rules.
Does Medicare cover assisted living facilities?
No. CMS guidance is clear that Medicare does not cover room, board, or custodial personal care in assisted living. Medicare may cover a short skilled nursing facility stay after a qualifying hospital stay, but that's a separate benefit and setting. Most assisted living residents pay privately, through long-term care insurance, or in some cases through Medicaid waiver programs.
How do I start a group home in Texas?
Confirm which population and license type fits your project, check local zoning before signing a lease, prepare a building meeting HHSC physical plant standards, submit a license application with a staffing plan and policies manual, pass the fire marshal and HHSC pre-licensing survey, and hire staff meeting Chapter 247 qualifications before admitting residents.
How do I start an assisted living business in Texas specifically?
The path is the same as any Chapter 247 facility: secure a compliant building, confirm zoning, submit your HHSC license application with a completed staffing plan and policies and procedures manual, pass fire marshal and health inspections, and pass HHSC's pre-licensing survey. Budget realistic time for corrections; first-pass approval without any revisions is uncommon.
What's the difference between Type A, Type B, and Type C assisted living facilities in Texas?
Type A facilities house residents capable of evacuating unassisted in an emergency. Type B facilities house residents who may need staff help to evacuate or overnight attendant care. Type C is a distinct small-facility category with its own staffing and physical plant allowances under 26 TAC Chapter 553. The type dictates staffing and building requirements.
Does Texas Medicaid pay for assisted living?
Standard Texas Medicaid doesn't cover assisted living room and board. However, home and community-based services waiver programs like STAR+PLUS can help cover personal care services for eligible low-income residents in certain assisted living settings. Eligibility and availability change, so confirm current rules with your state Medicaid managed care contact before relying on this funding source.
How much does it cost to get an assisted living license in Texas?
Exact HHSC application and licensing fees change periodically under state rule updates, so there's no single reliable number to quote. Confirm current fee schedules directly with the Texas Health and Human Services Commission before budgeting. Beyond the state fee, plan for building modification costs, fire marshal inspection prep, and staff training costs.
Do I need a special license for a small assisted living home in Texas?
Yes. Any establishment housing four or more unrelated residents and providing personal care services needs an HHSC assisted living license under Chapter 247, regardless of how small the home is. Homes housing three or fewer unrelated residents with personal care may fall outside this specific threshold, but zoning and other local rules can still apply, so confirm with your state licensing agency.
What happens during a Texas assisted living inspection?
HHSC surveyors review the physical building against Chapter 553 standards, check staffing records and training documentation, review resident service plans and medication logs, and interview staff and residents where appropriate. Deficiencies result in a required plan of correction with a timeline; serious or repeated violations can lead to license suspension or revocation.
Sources
- Texas Health and Safety Code, Chapter 247 (Assisted Living Facilities): Definition of assisted living facility and four-or-more-resident licensing threshold
- Texas Administrative Code, Title 26, Chapter 553 (Licensing Standards for Assisted Living Facilities): Facility type classifications (A, B, C) and staffing/physical plant standards
- Texas Health and Safety Code, Chapter 242 (Convalescent and Nursing Facilities): Nursing facility licensing requirements and licensed nursing staff mandate
- Medicare.gov, Skilled Nursing Facility (SNF) Care coverage page: Medicare does not cover custodial or room-and-board care in assisted living settings
- Texas Health and Human Services, STAR+PLUS Program: Texas Medicaid waiver program that can help cover personal care services in certain community settings
- Texas Administrative Code, Title 26, Section 553.264 (Emergency Preparedness and Response): HHSC emergency preparedness rule requiring assisted living facilities to plan for power outages and extreme weather following Winter Storm Uri