Last updated 2026-07-25
TL;DR
In Texas, assisted living facilities are licensed by the Health and Human Services Commission (HHSC) under Texas Health and Safety Code Chapter 247. You'll pick a license type (A, B, or C) based on resident mobility and care needs, pass a life safety code inspection, submit fingerprints and background checks for owners and staff, and pay a base application fee plus per-bed charges. Plan on several months from application to opening.
What is an assisted living facility in Texas?
Under Texas law, an assisted living facility (ALF) is an establishment that provides food, shelter, and personal care or health services to four or more people unrelated to the owner, on a 24-hour basis. That's the core legal test HHSC uses when it decides whether your property needs a license at all. Texas Health and Safety Code Chapter 247 is the statute that governs this, and it defines the facility not by its marketing name (memory care, senior living, residential care home) but by what it actually does: house people and help with daily activities. The statute states an assisted living facility is "an establishment that furnishes, in one or more facilities, food and shelter to four or more persons who are unrelated to the proprietor of the establishment and provides personal care services for the residents" [1]. If you're housing three or fewer unrelated residents and providing that level of care, you may fall outside the licensing requirement, but don't assume that without confirming with HHSC directly, because local zoning and other state rules can still apply. Texas licenses three types of assisted living facilities, and the type you apply for shapes your staffing, physical plant, and admission policies for the life of the license.
What is assisted living, in plain terms?
Assisted living is a residential care model 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 a hospital or nursing home provides. Residents typically live in private or semi-private rooms and get support built around their remaining independence rather than total medical management. The federal government doesn't license assisted living. Licensing happens at the state level, which is why Texas rules look different from Florida's or California's. Texas HHSC is the licensing and regulatory authority for the state, and it inspects every facility against Chapter 247 and the accompanying administrative rules in Texas Administrative Code Title 26, Chapter 553 [2]. If you're comparing this model to other residential care options, our overview of assisted living walks through how the term is used across different states, since "assisted living" means something a little different depending on where you're licensing.
What is a group home, and how does it differ from an assisted living facility?
A group home is a broader term. It usually describes a small residential setting, often for a specific population like adults with intellectual or developmental disabilities (IDD), people in mental health recovery, or youth in state custody. In Texas, some of these settings are licensed under completely different statutes and agencies than assisted living. An assisted living facility under Chapter 247 is specifically aimed at people who need help with personal care and daily living, often but not always older adults. A group home serving people with IDD in Texas, by contrast, may be licensed as a Home and Community-based Services (HCS) provider or under Intermediate Care Facilities for Individuals with an Intellectual Disability (ICF/IID) rules, both of which HHSC also regulates, but under different chapters and with different staffing and Medicaid billing structures [3]. If your target population is seniors needing help with ADLs (activities of daily living), you're almost certainly filing for an assisted living license. If your target population is adults or children with IDD, autism, or certain behavioral health diagnoses, you need to confirm with HHSC which program category actually fits, because applying under the wrong chapter wastes months.
What does an assisted living facility provide?
| Type A | Residents can evacuate the building without physical help from staff during an emergency | Residents don't require routine attendance during nighttime hours | |
|---|---|---|---|
| Type B | Residents may need help evacuating (physical limitations, cognitive impairment) | Residents need staff attendance during the night and may need help with mobility | |
| Type C (four to sixteen residents, adult foster care model) | Similar to Type B in a smaller, more home-like setting | Personal care in a small residential setting, often a single-family home | This structure comes directly from HHSC's assisted living licensing rules under 26 TAC Chapter 553 [2]. Get the type wrong on your application and you'll be re-filing paperwork and possibly re-doing your life safety inspection. |
A Texas ALF provides housing, meals, and personal care services. Personal care means help with activities like bathing, dressing, grooming, toileting, and mobility. Facilities also typically manage medication oversight (though the level of involvement depends on license type), housekeeping, laundry, and some form of social or recreational activity programming. What a facility does not automatically provide is skilled nursing care, which is the dividing line between assisted living and a nursing facility. Texas assisted living rules cap how "medically fragile" a resident can be depending on license type, and require a facility to arrange for a resident's transfer if their needs exceed what the license allows [2]. Here's how the three Texas license types break down by resident mobility and care level: | License Type | Resident Mobility | Care Level |
What is assisted living vs nursing home?
The short answer: assisted living is for people who need help with daily living, and a nursing home (called a nursing facility in Texas licensing language) is for people who need ongoing skilled medical or nursing care. Nursing facilities in Texas are licensed under a completely separate chapter, Texas Health and Safety Code Chapter 242, and are subject to federal Medicare and Medicaid Conditions of Participation if they accept those programs [4]. Staffing is the clearest practical difference. Nursing facilities must have licensed nurses on site around the clock in most cases and are built around a medical model. Assisted living facilities are built around a residential model, with personal care attendants and unlicensed staff doing most direct care, supplemented by medication aides and, depending on license type, some nursing oversight. Cost structure differs too. Nursing facility care is often paid through Medicaid (for those who qualify) or Medicare for short skilled-nursing stays after a hospitalization. Assisted living is overwhelmingly private-pay in Texas, with a limited Medicaid waiver option covered further below.
Does Medicare cover assisted living facilities?
No. Medicare does not cover the cost of room, board, or personal care in an assisted living facility. CMS is explicit about this: Medicare covers medically necessary skilled nursing care and rehabilitation in a certified skilled nursing facility for a limited time following a qualifying hospital stay, but it does not pay for long-term custodial care or the assisted living setting itself [5]. Medicaid is a different story, but only partly helpful. Texas Medicaid does not pay for room and board in assisted living. What it can pay for, for eligible low-income seniors and adults with disabilities, is personal care and supportive services delivered inside a licensed assisted living setting through the STAR+PLUS Home and Community Based Services (HCBS) waiver program, administered by HHSC [6]. The resident or their family still has to cover room and board out of pocket, Social Security income, or a long-term care insurance policy. This is one of the most common points of confusion for people planning a facility and for families choosing one. Build your financial model assuming private pay is your primary revenue source, with STAR+PLUS HCBS as a possible supplemental funding stream for a portion of qualifying residents, not a guaranteed base.
How do I start a group home or assisted living facility in Texas?
Starting a licensed assisted living facility in Texas runs through several sequential steps, and skipping ahead on any of them tends to cost you time later. 1. Confirm your population and license type. Decide whether you're serving seniors needing personal care (Chapter 247 assisted living) or a different population that falls under IDD, behavioral health, or another HHSC program area, and pick Type A, B, or C accordingly. 2. Check zoning and secure your property. Your building has to meet local zoning requirements for a residential care use, plus the physical plant standards in 26 TAC Chapter 553, including things like room size, exits, and accessibility. This step trips up more first-time operators than any other, because a building that looks perfect on paper can fail a fire marshal walkthrough. 3. Pass fire and life safety inspection. Texas requires a life safety code inspection, typically coordinated with the local fire marshal or the State Fire Marshal's Office, before HHSC will issue a license. 4. Submit your license application to HHSC. This includes your facility floor plan, staffing plan, policies and procedures manual, disclosure of ownership, and criminal background check clearances for owners, operators, and staff with direct resident contact. 5. Pay applicable fees. Texas assesses a base license fee plus additional per-bed fees; confirm the current fee schedule directly with HHSC's Long-Term Care Regulation division since these amounts are adjusted periodically. 6. Undergo a pre-licensing survey. An HHSC surveyor visits before you can admit residents, checking your physical plant, staffing, and written policies against Chapter 247 and its rules. 7. Receive your license and begin operations. Licenses are typically issued for a set renewal period and are subject to routine unannounced surveys after that. Building your own policy manuals, staffing plan templates, and application checklist from scratch is a real time sink, and it's exactly the kind of paperwork that trips up first-time applicants. That's the gap our $299 State Group Home Licensing Kit is built to close, with state-specific document templates so you're not starting from a blank page.
What are the staffing requirements for a Texas assisted living facility?
Staffing requirements scale with your license type and resident census, but every Texas ALF needs an administrator who meets HHSC qualification standards, direct care staff sufficient to meet resident needs around the clock, and a system for medication management appropriate to the license type. Type A facilities generally require the least intensive nighttime staffing since residents can self-evacuate. Type B and Type C facilities, serving residents with greater mobility or cognitive limitations, require staff awake and present overnight, and the administrative rules specify staff-to-resident ratios and required qualifications in more detail than most first-time applicants expect [2]. Every direct care staff member and anyone with unsupervised access to residents needs a criminal background check through the Texas Department of Public Safety and, in many cases, an Employee Misconduct Registry and Nurse Aide Registry check, since HHSC cross-references these registries as part of licensing and ongoing survey compliance. Don't underbudget your staffing plan on the application. HHSC surveyors will check your actual staffing against what you submitted, and a facility that's short-staffed on inspection day risks a deficiency citation before it ever admits a resident.
What does the Texas inspection and survey process look like?
Before your first resident moves in, HHSC conducts an initial licensing survey covering your physical plant, fire and life safety compliance, staffing documentation, and written policies. After you're operating, HHSC conducts unannounced surveys, generally on a periodic cycle, plus complaint investigations if someone files a concern about the facility. Common deficiency areas in assisted living surveys nationally and in Texas include medication management errors, incomplete resident care plans, staffing shortfalls relative to the approved plan, and physical plant issues like blocked exits or missing fire extinguisher inspections. None of these are exotic; they're the boring, procedural details that get missed when an operator is moving fast to open. If HHSC finds deficiencies, you'll typically get a required plan of correction with a deadline. Serious or repeated violations can lead to enforcement actions up to license revocation, so treat every survey finding as something to close out completely, more than paper over until the next visit.
What ongoing renewal and compliance requirements apply?
Texas assisted living licenses aren't a one-time approval. You'll need to renew on HHSC's schedule, keep staff background checks and required training current, maintain your fire inspection certifications, and report any changes in ownership, administrator, or physical plant to HHSC as required under Chapter 247 and its administrative rules [1][2]. Most operators build a simple internal compliance calendar tracking license renewal dates, staff certification expirations, fire inspection renewal, and required in-service training hours for direct care staff. It's not glamorous work, but it's the difference between a routine renewal and a scramble. If you're weighing whether to open a standalone home versus a licensed facility with more beds, it helps to compare the regulatory load across models. Our guides on assisted living facilities and assisted living at home break down how requirements shift with scale and setting.
Frequently asked questions
What is assisted living?
Assisted living is residential housing paired with help for daily activities like bathing, dressing, and medication reminders, for people who don't need the round-the-clock skilled nursing care a nursing home provides. It's licensed at the state level, and in Texas it falls under Health and Safety Code Chapter 247, administered by HHSC.
What is a group home?
A group home is a residential setting, often small-scale, that houses people needing support, commonly people with intellectual or developmental disabilities, mental health needs, or in state custody. In Texas, group homes for different populations are licensed under different HHSC programs, not necessarily the same Chapter 247 assisted living rules.
What is an assisted living facility?
Under Texas Health and Safety Code Chapter 247, an assisted living facility is an establishment providing food and shelter to four or more unrelated people plus personal care services, on a 24-hour basis. Texas licenses three subtypes, Type A, B, and C, based on resident mobility and nighttime care needs.
What is assisted living facility, exactly, versus a senior apartment?
A senior apartment is independent housing with no required personal care services and no state health licensing. An assisted living facility is licensed housing that must provide personal care services like help with bathing and dressing, and is regulated and surveyed by the state health agency, HHSC in Texas.
What is assisted living vs nursing home?
Assisted living serves people needing help with daily activities in a residential setting; nursing homes (nursing facilities) provide skilled nursing and medical care for people with more intensive health needs. Texas licenses them under separate statutes: Chapter 247 for assisted living, Chapter 242 for nursing facilities.
What does assisted living provide?
Texas assisted living facilities provide housing, meals, personal care assistance (bathing, dressing, mobility, toileting), medication oversight appropriate to license type, housekeeping, laundry, and activity programming. They do not provide ongoing skilled nursing care; residents needing that level of care must transfer to a nursing facility.
How do I start a group home in Texas?
Confirm which HHSC program fits your target population, secure a property that meets zoning and physical plant rules, pass a fire and life safety inspection, submit your license application with staffing plans and background checks, pay the required fees, and pass HHSC's pre-licensing survey before admitting residents.
How do I start a group home for a specific population like IDD or mental health?
You'll likely apply under a different HHSC program than Chapter 247 assisted living, such as HCS or ICF/IID for intellectual and developmental disabilities. Confirm the correct program category directly with HHSC before you build out a property, since staffing and Medicaid billing rules differ significantly by program.
Does Medicare cover assisted living facilities?
No. Medicare covers short-term skilled nursing and rehab care in certified nursing facilities after a qualifying hospital stay, but it does not cover room, board, or personal care in an assisted living facility, according to CMS coverage guidance.
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 personal care services covered through the STAR+PLUS Home and Community Based Services waiver, administered by HHSC, while the resident still pays room and board separately.
What's the difference between Type A, B, and C assisted living licenses in Texas?
Type A serves residents who can evacuate without physical help and don't need nighttime attendance. Type B and Type C serve residents needing help evacuating or nighttime staff presence, with Type C generally being a smaller, home-like setting for four to sixteen residents.
How long does it take to get an assisted living license in Texas?
There's no fixed statewide timeline published by HHSC, and it varies based on how quickly your physical plant passes inspection, how complete your application is, and current HHSC processing volume. Budget several months from application submission to license issuance, and confirm current processing times with HHSC directly.
What is the difference between assisted living and a nursing home for staffing purposes?
Nursing homes require licensed nurses on duty around the clock in most cases, following a medical model under federal Conditions of Participation. Assisted living facilities use personal care attendants and medication aides as primary direct care staff, with nursing oversight requirements that vary by state license type.
Sources
- Texas Health and Safety Code, Chapter 247: Definition of an assisted living facility as an establishment housing four or more unrelated persons and providing personal care services
- Texas Administrative Code, Title 26, Chapter 553: License type definitions (Type A, B, C) and physical plant, staffing, and personal care rules for Texas assisted living facilities
- Texas HHSC, Home and Community-based Services (HCS) Program: HCS is a separate HHSC-administered program for people with intellectual and developmental disabilities, distinct from Chapter 247 assisted living licensing
- Texas Health and Safety Code, Chapter 242: Nursing facilities in Texas are licensed under a separate statutory chapter from assisted living facilities
- Medicare.gov, Nursing Home Care Coverage: Medicare covers skilled nursing facility care for a limited time after a qualifying hospital stay but does not cover long-term custodial or assisted living care
- Texas HHSC, STAR+PLUS Home and Community Based Services: STAR+PLUS HCBS waiver can cover personal care services for eligible Medicaid recipients living in assisted living settings, while room and board remains the resident's responsibility