Last updated 2026-07-25
TL;DR
Texas doesn't license a separate "adult foster care" category in El Paso. Small homes caring for unrelated adults fall under the Texas Health and Human Services Commission's Assisted Living Facility (ALF) license, including the Type A/Type B small-home rules. Expect a facility application, fire and life-safety inspection, staffing and training requirements, and city zoning review before you can open.
Is there a separate adult foster care license in Texas?
No. Texas doesn't have a standalone "adult foster care" license the way some states do (Michigan and Oregon, for example, run dedicated AFC programs). In Texas, a home that takes in unrelated adults who need help with daily living, whether it's three residents or thirty, falls under the Assisted Living Facility license issued by the Texas Health and Human Services Commission (HHSC) under Texas Health and Safety Code Chapter 247 [1]. HHSC licenses ALFs in four types based on resident mobility and evacuation capability: Type A (residents can evacuate independently), Type B (residents need some evacuation help), Type C (also called "adult foster care" in the rule text itself, capped at four residents in a single-family home setting), and Type E (independent, low-acuity residents) [2]. That Type C category is the closest thing Texas has to the adult foster care model people search for, a small home, family-style setting, capped resident count. If you're picturing a house in El Paso with three or four residents and a live-in or daily caregiver, you're almost certainly looking at a Type C ALF license, not a nursing facility license and not a personal care home license from another state's framework. Don't assume your home is exempt just because it's small. HHSC's threshold for licensure is providing personal care services to more than three unrelated persons, or being held out to the public as providing such care, under 40 Texas Administrative Code Chapter 92 [3].
What is assisted living, exactly?
Assisted living is residential care for adults who need help with daily activities like bathing, dressing, medication reminders, and meals, but who don't need the round-the-clock skilled nursing care of a nursing home. Texas Health and Safety Code defines an assisted living facility as an establishment that "furnishes food and shelter to four or more persons who are unrelated to the proprietor" and provides "personal care services" or arranges for residents' needs to be met [1]. The personal care piece is what separates assisted living from a boarding house. A boarding house rents rooms. An assisted living facility helps someone get dressed, takes their blood pressure, reminds them to take medication, and coordinates with a home health agency or hospice when needed. In Texas, and in El Paso specifically, this is licensed and inspected by HHSC's Health Care Regulation division, not by the county and not by a separate senior services department. If you're comparing models across states, see our guide to assisted living facilities licensing generally.
What is a group home versus an assisted living facility?
"Group home" is a general term, not a licensing category in Texas. People use it loosely to mean any small residential setting where several unrelated adults live together with support staff. That could describe a Type C assisted living facility for seniors, or it could describe an intermediate care facility (ICF/IID) for adults with intellectual and developmental disabilities, or a licensed community-based mental health residence. Which license you need depends entirely on who you're serving. If your residents are older adults or adults with physical frailty who need help with daily living, you're looking at HHSC's ALF license under Chapter 247. If you're serving adults with intellectual or developmental disabilities in a small home, you may be looking at HHSC's ICF/IID program or a Home and Community-based Services (HCS) provider contract, which is a different application track entirely [4]. This matters for El Paso operators because the zoning and staffing rules differ by category too. Don't file paperwork for the wrong license type. Call HHSC's Health Care Regulation intake line before you submit anything, and confirm with your state licensing agency which category matches your intended population.
What does assisted living actually provide day to day?
A licensed Texas ALF has to provide, at minimum: three meals a day plus snacks, help with activities of daily living (bathing, grooming, toileting, transferring), medication administration or assistance per the resident's care plan, housekeeping and laundry, social and recreational activity, and 24-hour supervision appropriate to the facility type [1][2]. What it does not have to provide is skilled nursing care on-site around the clock. If a resident's needs progress to needing IV therapy, wound care beyond simple dressing changes, or continuous nursing oversight, HHSC rules generally require the facility to arrange a higher level of care or discharge planning to a nursing facility, unless the ALF has specific waivers or is staffed for it [2]. Staffing minimums vary by ALF type and are tied to resident count and acuity, not a flat statewide number per bed. Texas requires an awake, on-duty attendant at all times in Type B and Type C homes given the higher assistance needs of residents, and Type A/E facilities have somewhat different overnight staffing expectations based on resident evacuation capability [2]. Confirm current staffing ratios with HHSC before you build a staffing plan, because these get revised.
How does assisted living compare to a nursing home?
| Licensing chapter | Health & Safety Code Ch. 247 [1] | Health & Safety Code Ch. 242 [5] | |
|---|---|---|---|
| 24/7 skilled nursing | Not required | Required | |
| Typical resident need | ADL help, supervision | Skilled medical/nursing care | |
| Setting | Home-like, smaller resident counts (esp. Type C) | Larger, hospital-adjacent model | |
| Medicaid coverage | Limited (STAR+PLUS waiver in some cases) | Yes, through Medicaid nursing facility benefit | For someone choosing between the two, the honest litmus test is: does this person need a nurse managing their medical condition every day, or do they need help getting dressed and someone checking on them regularly? The former is a nursing home question. The latter is assisted living. |
The core difference is medical acuity and staffing intensity, more than "size of building." A nursing home (called a nursing facility or skilled nursing facility in Texas regulation) is licensed under a different chapter (Texas Health and Safety Code Chapter 242) and is required to have licensed nursing staff on-site 24/7, including a registered nurse for specific shifts [5]. Assisted living facilities are not required to have RN coverage around the clock. | Feature | Assisted Living Facility (Texas) | Nursing Facility (Texas) |
Does Medicare cover assisted living facilities?
No, and this trips up a lot of new operators and families both. Medicare does not pay for room and board or personal care services in an assisted living facility. CMS is direct about this: Medicare covers medically necessary skilled care, not custodial or long-term residential care [6]. What Medicare will cover, even for someone living in an ALF, is medically necessary services like doctor visits, physical therapy following a qualifying hospital stay, and durable medical equipment, the same as it would for anyone living at home. It just won't pay the facility's monthly rate. Medicaid is a different story, but it's complicated in Texas. Texas Medicaid doesn't pay room and board in assisted living either, but the STAR+PLUS program, Texas's managed care Medicaid waiver for people who are elderly or have disabilities, can cover personal attendant care and other services for eligible members who happen to live in an ALF setting [7]. Room and board is still typically private-pay or covered through the resident's own Social Security/SSI income. If Medicaid funding is central to your business plan, read our funding-and-medicaid guidance before you assume a revenue stream that doesn't exist.
How do I start a group home in El Paso, Texas?
The realistic sequence, in the order HHSC and the City of El Paso actually expect you to do it: 1. Decide your population and license type. Seniors and adults needing ADL help point you to HHSC's Assisted Living Facility license (Type A, B, C, or E). Adults with intellectual/developmental disabilities point you toward HCS or ICF/IID programs instead [2][4]. 2. Confirm zoning before you sign a lease. El Paso's zoning code treats small residential care homes differently than large facilities. Group homes for a small number of unrelated individuals with disabilities are often permitted in residential zones under the federal Fair Housing Act's reasonable accommodation protections, but confirm classification with the City of El Paso Planning and Inspections Department before committing to a property . Zoning fights kill more group home plans than licensing paperwork does. 3. Secure the physical property and pass life-safety review. HHSC requires facility inspections covering fire safety, means of egress, resident room square footage, bathroom-to-resident ratios, and kitchen sanitation before it issues a license [3]. Older houses in El Paso's central and lower-valley neighborhoods often need retrofits (sprinklers, hallway widths, exit door hardware) to meet these standards. 4. Write your policy and procedure manual. HHSC will want to see admission/discharge policies, medication management procedures, emergency preparedness plans (including heat emergency plans, which matter a lot in El Paso's summer heat), staff training records, and resident rights disclosures [3]. 5. Hire and train staff to meet the administrator and attendant qualifications set by your ALF type. Texas requires ALF administrators to complete HHSC-approved training and, depending on facility size, hold a specific administrator's license [2]. 6. Submit your license application to HHSC's Health Care Regulation division with the required fee (fees are set by facility size and type, confirm current amounts with HHSC directly since these are periodically updated by rule) [3]. 7. Pass your pre-licensure inspection. HHSC surveyors will walk the property checking against Chapter 247 requirements before issuing your initial license. Build the paperwork stack once and reuse the structure for every state expansion. That's the exact gap our $299 State Group Home Licensing Kit is built to close: application checklists, sample policy language, and staffing plan templates organized by state, so you're not starting from a blank page for each jurisdiction.
What does the application and paperwork actually look like?
HHSC's ALF application packet asks for corporate documents (your LLC or corporation formation paperwork), a floor plan of the facility, fire marshal approval, proof of liability insurance, your policy and procedure manual, staffing plan with proposed schedules, and background check clearances for owners, administrators, and staff [3]. Background checks in Texas run through the Texas Department of Public Safety and, in some cases, the HHSC Provider Investigations division, and cover criminal history that could disqualify someone from working in a licensed facility [3]. Build in extra time here. Fingerprint processing and criminal history review can take several weeks, and you cannot open with unscreened staff on the floor. Don't underestimate the floor plan requirement. HHSC wants dimensioned drawings showing resident bedrooms, common areas, bathroom locations, and emergency egress routes, not a hand sketch. If you're leasing a converted single-family home in a neighborhood like Kern Place or the Upper Valley, get an architect or contractor familiar with ALF code requirements to help you, because retrofitting after a failed inspection costs more than doing it right the first time.
What inspections should I expect after I'm licensed?
HHSC conducts unannounced surveys, typically annually, plus follow-up visits if a complaint is filed or if a prior survey found deficiencies [3]. Inspectors check resident records, medication administration logs, staffing schedules against actual coverage, kitchen and food safety, fire drills, and resident rights postings. El Paso operators should also expect periodic fire marshal inspections separate from HHSC's survey, plus any city code enforcement checks tied to your certificate of occupancy. Keep your fire inspection certificate current and visible, because HHSC surveyors will ask for it during their own visit. Deficiencies get documented on a statement of deficiencies, and HHSC requires a plan of correction with specific timelines. Repeated or severe deficiencies can lead to enforcement action, including admission holds or license revocation in serious cases [3]. Keep your own compliance log separate from what the state gives you, dated and signed, so you have a paper trail if a finding is ever disputed.
What staffing plan do I need to build?
Your staffing plan has to match your ALF type and your actual resident acuity, not a generic template. At minimum, plan for an administrator (licensed per HHSC rules for your facility size), direct care attendants covering all shifts including overnight, and a medication aide or licensed nurse if any residents require medication administration beyond self-administration [2]. Staff training in Texas typically covers first aid/CPR, resident rights, abuse/neglect/exploitation reporting requirements, infection control, and fire/emergency response, with HHSC specifying minimum training hours depending on role [3]. Build recurring training into your calendar, more than onboarding, because HHSC surveyors check training records during inspections and gaps are an easy citation. One detail specific to El Paso and West Texas broadly: heat safety training matters more here than in a lot of states. Summer heat index days regularly push past 100°F, and your emergency plan should specifically address cooling, hydration monitoring, and power-outage contingencies for medically fragile residents.
What zoning issues come up specifically in El Paso?
Group homes serving people with disabilities are protected under the federal Fair Housing Act, which generally requires cities to make reasonable accommodations allowing small group homes in residential zones, even where local zoning would otherwise restrict multi-unrelated-occupant housing . That said, "reasonable accommodation" doesn't mean automatic approval; you typically still have to apply for it. El Paso's Planning and Inspections Department reviews land use and occupancy classifications for residential care uses. Because zoning designations and review procedures change and vary by parcel, confirm your specific address's zoning classification and any required accommodation process directly with the city before signing a lease or purchase agreement. Parking, occupant load, and accessibility (ADA-compliant bathrooms, ramps if needed) also come up during city building permit review, separate from HHSC's licensing inspection. Budget time and money for both reviews running in parallel, not sequentially, because HHSC will often want proof of a valid certificate of occupancy before issuing your license.
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 not full-time skilled nursing care. In Texas, it's licensed as an Assisted Living Facility under Health and Safety Code Chapter 247, with four sub-types (A, B, C, E) based on resident mobility and evacuation ability [1][2].
What is a group home?
"Group home" is a general term for a small residential setting where unrelated adults live together with support staff. It's not an official Texas license category. Depending on the population served, the actual license is either HHSC's Assisted Living Facility license or a disability services program like HCS or ICF/IID [2][4].
What is an assisted living facility?
An assisted living facility is a licensed establishment providing food, shelter, and personal care services to four or more unrelated people. Texas defines it in Health and Safety Code Section 247.002 and requires HHSC licensure before you can operate one, regardless of how small the home is [1].
What is assisted living facility staffing supposed to look like?
Staffing is set by facility type and resident acuity, not a flat number. Texas requires an awake attendant on duty at all times in Type B and Type C homes, plus a licensed administrator meeting HHSC training requirements. Confirm current staffing ratios with HHSC, since rules are periodically revised [2][3].
What is the difference between assisted living and nursing home?
Nursing homes provide 24/7 skilled nursing care and are licensed under Texas Health and Safety Code Chapter 242. Assisted living facilities, licensed under Chapter 247, provide help with daily living and supervision but are not required to have round-the-clock nursing staff [1][5].
Does Medicare cover assisted living facilities?
No. Medicare does not pay for room, board, or personal care services in assisted living. It only covers medically necessary skilled services like doctor visits or therapy, the same coverage a resident would get living anywhere else, per CMS coverage guidance [6].
How do I start a group home?
Pick your population and matching license type, confirm zoning with your city, secure a property that can pass fire/life-safety inspection, write your policy manual, hire and train staff, then submit your application with fees to the state licensing agency. In El Paso, that agency is HHSC for assisted living [2][3][8].
How do I start an adult foster care home in El Paso specifically?
Texas doesn't have a separate "adult foster care" license; the closest match is HHSC's Type C Assisted Living Facility license, capped at four residents in a home setting. Apply through HHSC's Health Care Regulation division and confirm City of El Paso zoning before signing a lease [2][8].
Is a license required to run a small adult care home in Texas?
Yes. Texas requires licensure for any establishment providing personal care services to more than three unrelated persons, or holding itself out publicly as doing so, under 40 Texas Administrative Code Chapter 92. There's no informal or unlicensed exemption for small homes [3].
How long does it take to get an assisted living license in Texas?
There's no fixed statewide timeline published by HHSC that applies to every applicant, because it depends on application completeness, background check processing, and inspection scheduling. Budget several months from application submission to license issuance, and confirm current processing expectations with HHSC directly [3].
Can Medicaid pay for someone living in an assisted living facility in Texas?
Texas Medicaid doesn't cover room and board in assisted living, but the STAR+PLUS managed care waiver program can cover personal attendant care services for eligible members who live in an ALF setting. Room and board still comes from the resident's own income [7].
What's the difference between Type A, B, C, and E assisted living facilities in Texas?
The types reflect resident evacuation ability and staffing intensity: Type A residents can self-evacuate, Type B residents need evacuation assistance, Type C is a small home model capped at four residents, and Type E serves independent, lower-acuity residents. Requirements and staffing differ by type under HHSC rule [2].
Sources
- Texas Health and Safety Code, Chapter 247 (Assisted Living Facilities): Definition and licensing requirement for assisted living facilities in Texas
- Texas HHSC, Assisted Living Facilities program page: ALF facility types (A, B, C, E) and staffing/evacuation distinctions
- Texas Administrative Code, Title 40, Chapter 92 (Licensing Standards for Assisted Living Facilities): Licensing threshold, application requirements, inspection and enforcement rules for ALFs
- Texas HHSC, Home and Community-based Services (HCS) Program page: Separate licensing/contracting track for group homes serving adults with intellectual/developmental disabilities
- Texas Health and Safety Code, Chapter 242 (Nursing Facility Licensing): Nursing facility licensing requirements including 24/7 nursing staffing
- Medicare.gov, Long-term care coverage information: Medicare does not cover long-term custodial or residential assisted living care
- Texas HHSC, STAR+PLUS Program page: STAR+PLUS Medicaid waiver can cover attendant care services for eligible members in community settings