Last updated 2026-07-25
TL;DR
Starting a foster group home in Texas means picking the right license category through HHSC (child foster care, adult foster care, or ALF), meeting minimum standards under Texas Administrative Code Title 26, passing background checks and a fire/life safety inspection, and submitting a full application packet. Expect several months from application to license, not weeks.
What is a group home, exactly?
A group home is a residential setting, usually a single-family style house, where a small number of unrelated people live together and receive supervision, personal care, or treatment services from staff. It's not a hotel and it's not a hospital. It sits in the middle: more support than independent living, less clinical than a nursing facility. In Texas, the term covers a lot of different license types depending on who lives there. A child foster group home serves kids in the conservatorship of the state or placed by a parent through a licensed child-placing agency. An adult foster care home serves adults who need help with daily activities but not skilled nursing. A group home for people with intellectual or developmental disabilities (IDD) operates under a different set of standards again, often tied to HCS (Home and Community-based Services) waiver requirements. The Texas Health and Human Services Commission (HHSC) is the state agency that licenses and regulates most of these homes, though child foster care specifically runs through HHSC's Child Care Regulation division under Texas Human Resources Code Chapter 42 [1]. If you're asking "how do I start a group home" in Texas, the very first fork in the road is deciding which population you intend to serve, because that decision determines your statute, your minimum standards handbook, and your inspecting division. Don't skip this step to save time. Operators who pick a license category based on what real estate they already own, instead of what population and program they actually want to run, end up re-doing their whole application later.
What is assisted living, and how is it different from a group home?
Assisted living is a specific, licensed category of senior housing that combines a private or semi-private living unit with help for activities of daily living (bathing, dressing, medication reminders) and some level of supervision, without providing the round-the-clock skilled nursing care of a nursing home. In Texas, these are called Assisted Living Facilities (ALFs) and they're licensed under Texas Health and Safety Code Chapter 247 [2]. A group home, by contrast, is a broader term that isn't limited to seniors. Group homes exist for children in foster care, adults with IDD, people in mental health recovery, and people in substance use recovery. An ALF is technically a type of group home model applied specifically to the senior population, but in day-to-day licensing language, Texans usually use "group home" to mean the smaller, family-style setting (often under 16 residents, frequently far fewer) and "assisted living facility" as the formal regulatory term for the senior-focused version. If your target population is older adults who need help with daily living but not a nursing level of care, you'll be applying for an ALF license, not a generic "group home" license. Texas categorizes ALFs by size and by the level of care provided (Type A generally serves residents who can evacuate without physical help; Type B serves residents who need evacuation assistance or have moderate cognitive impairment) [2]. For more on how these license types differ nationally, see assisted living facility and assisted living facilities.
What is an assisted living facility and what does it provide day to day?
An assisted living facility is a licensed residence that provides housing plus personal care services, meals, medication management support, and 24-hour staff availability for residents who need help with daily activities but don't require the intensive medical care a nursing home delivers. Texas Health and Safety Code §247.002 defines it as an establishment that furnishes food, shelter, and personal care services for four or more people unrelated to the proprietor [2]. Day to day, an ALF typically provides help with bathing, dressing, toileting, and mobility. It provides medication administration or reminders depending on staff licensure, three meals a day plus snacks, housekeeping and laundry, social and recreational activities, and staff present around the clock, even if that staff isn't a nurse on every shift. What it does not typically provide is skilled nursing care, IV therapy, wound care beyond basic first aid, or ventilator support. Those services push a resident into needing a nursing facility or a higher-acuity ALF designation with additional waivers. If you're building out your program description for the state application, this is the exact language reviewers look for: a clear line between personal care services (in scope) and skilled medical services (out of scope, unless you've got the additional licensure and staffing to support it). Get this line blurry in your policy manual and you'll get a deficiency citation at your first inspection.
What is the difference between assisted living and a nursing home?
| Licensing statute (TX) | Health & Safety Code Ch. 247 [2] | Health & Safety Code Ch. 242 [3] | |
|---|---|---|---|
| 24-hour skilled nursing | Not required | Required | |
| Typical staff | Direct care aides, medication aides, RN/LVN consultant | RNs and LVNs on every shift | |
| Level of medical need served | Stable, needs help with ADLs | Complex or unstable medical needs | |
| Medicare coverage | Generally not covered | Short-term skilled stays can be covered | If you're not sure which model fits your building and your target resident, start with the acuity level you can staff safely, not the acuity level that sounds more impressive on paper. |
The core difference is the level of medical care and the staffing model. Assisted living is personal care plus supportive housing, with unlicensed direct care staff doing most of the hands-on work and a nurse consulting or supervising, not necessarily on-site 24/7. A nursing home (called a "nursing facility" in Texas regulation) provides skilled nursing care around the clock, with licensed nurses on every shift, and it's built for residents who need ongoing medical treatment, rehabilitation, or complex chronic disease management. Nursing facilities in Texas are licensed under Texas Health and Safety Code Chapter 242 [3] and must meet federal Medicare/Medicaid conditions of participation if they accept those payment sources. Assisted living facilities, licensed under Chapter 247, have a lighter medical staffing requirement and generally cost less per month than nursing home care, precisely because they're not delivering skilled nursing. Here's a comparison that operators (and families) commonly need: | Feature | Assisted Living Facility | Nursing Home (Nursing Facility) |
Does Medicare cover assisted living facilities?
No. Medicare does not cover the cost of room and board or personal care services in an assisted living facility. CMS is direct about this: Medicare Part A and Part B do not pay for long-term custodial care of the kind ALFs provide, including help with bathing, dressing, and other activities of daily living [4]. What Medicare will cover, even for someone who lives in an ALF, is medically necessary services delivered under Medicare's normal rules: doctor visits, some home health services if the person qualifies, durable medical equipment, and short-term skilled nursing or rehab in a certified nursing facility after a qualifying hospital stay. None of that pays the ALF's monthly rate. Long-term ALF costs are typically paid out of pocket, through long-term care insurance, or in some states through Medicaid waiver programs for people who qualify financially and medically. Texas offers Medicaid-funded community-based options like the STAR+PLUS program and HCS waivers for people with IDD, but straight assisted living room-and-board is largely a private-pay market in Texas. If you're modeling your business plan around Medicare reimbursement for ALF stays, that's a planning error worth catching before you sign a lease.
How do I start a group home in Texas? (the step-by-step process)
Starting a group home in Texas follows a sequence, and skipping steps or doing them out of order is the single biggest cause of delayed licensure. Here's the realistic order operators actually use. 1. Decide your population and license type. Child foster group home (HHSC Child Care Regulation, Human Resources Code Ch. 42) [1], adult foster care or ALF (HHSC Long-term Care Regulation, Health & Safety Code Ch. 247) [2], or an IDD-specific group home tied to HCS waiver enrollment. This decision drives every later step. 2. Form your business entity and get your tax IDs. Most operators use an LLC or nonprofit corporation depending on funding goals. You'll need an EIN before you can apply for most Texas provider enrollments. 3. Secure a location that fits zoning. Confirm with your local city or county planning department that group home or residential care use is permitted at the address, and confirm with your state licensing agency what physical plant standards apply (square footage per resident, number of bathrooms, fire exits, sprinkler requirements). Zoning fights are one of the most common reasons a promising home site falls through. 4. Write your policy and procedure manual. This includes admission and discharge criteria, medication management procedures, staffing plan, emergency preparedness plan, resident rights, grievance procedures, and abuse/neglect reporting protocols. HHSC will ask for this as part of the application packet, not after. 5. Complete required background checks. Texas requires criminal history checks and central registry checks (for child care, this includes the Texas DFPS central registry for reported abuse/neglect) for owners, operators, and anyone with regular contact with residents [1]. 6. Submit your license application to the correct HHSC division, along with the application fee. Fees vary by license type and capacity, so confirm the current fee schedule with HHSC directly. 7. Pass your pre-licensing inspection. A state inspector will check the physical building for fire and life safety code compliance, look at your written policies, and in many cases interview you about emergency procedures. 8. Hire and train staff before residents move in. You need documented training records, more than a hiring plan, by the time your inspector arrives. 9. Receive your license and begin intake, then prepare for your first annual (or more frequent, in the early period) monitoring visit. For a state-by-state comparison of how these steps differ outside Texas, see assisted living and senior assisted living facilities near me.
What licenses and permits does a Texas group home actually need?
At minimum, expect to need: your state facility license from the correct HHSC division (Child Care Regulation for foster care, Long-term Care Regulation for ALF/adult foster care), a local business license or certificate of occupancy from your city or county, a fire marshal inspection sign-off, and if you're serving meals prepared on-site at any real scale, a food service permit from your local health department. If your home will accept Medicaid waiver funding (common for IDD group homes under the HCS program or for some adult foster care arrangements), you'll also need a separate Medicaid provider enrollment, which is a distinct process from your HHSC facility license and runs through Texas Medicaid's enrollment system rather than the facility licensing office [5]. Getting licensed and getting Medicaid-enrolled are two different finish lines. A lot of new operators assume the state license alone lets them bill Medicaid, and it doesn't. Depending on your population, you may also need staff-level credentials: medication aide certification for staff who administer medications, CPR/first aid certification for direct care staff, and specific training hours mandated by the minimum standards for your license category. Texas Administrative Code Title 26 lays out these minimum standards in detail by license type, and the exact hour requirements and renewal cycles are worth confirming directly with HHSC since they get updated periodically.
What are the staffing and background check requirements?
Staffing ratios and required qualifications differ by license type, but a few things are consistent across most Texas group home categories: every operator, employee, and regular volunteer with resident contact must clear a criminal history background check, and in child care settings, a Texas DFPS central registry check for abuse/neglect history is also required [1]. For adult foster care and ALFs, HHSC's minimum standards typically require a designated administrator who meets education or experience thresholds, adequate awake staff overnight if residents can't self-evacuate, and documented initial and ongoing training in topics like resident rights, abuse reporting, medication assistance (if applicable), and emergency response. Exact staff-to-resident ratios are set out in the applicable minimum standards chapter and vary by facility type and resident acuity, so confirm current ratios with HHSC before you finalize your staffing budget, because these numbers get revised. One area operators underestimate: documentation. It's not enough to have trained staff, you need training records, background check clearance dates, and continuing education logs available for inspection at any time. An inspector who finds a qualified, well-trained staff member with no paper trail will often cite you anyway, because the standard is about verifiable compliance, not good intentions.
What does zoning and the physical building need to look like?
Zoning is where a lot of promising group home projects die, and it's almost always a local government issue, not a state one. Texas municipalities set their own zoning codes, and while the federal Fair Housing Act (42 U.S.C. §3604) protects group homes for people with disabilities from certain kinds of discriminatory zoning restrictions, that protection has real limits and doesn't override all local land use rules [6]. Before you sign a lease or close on a property, confirm with your local planning or zoning department whether your intended license type is a permitted use, a conditional use requiring a hearing, or prohibited outright in that zone. Ask specifically about occupancy limits, parking requirements, and whether a group home use requires a special use permit. Some cities cap the number of unrelated residents allowed under general residential zoning regardless of license type, which can force a smaller resident count than your license would otherwise allow. On the physical building side, expect state minimum standards to address: square footage per resident (often a minimum number of square feet in bedrooms, separate from common areas), maximum residents per bedroom, number of bathrooms per resident count, means of egress and fire exits, smoke detectors and, depending on size and license type, a fire sprinkler system, and accessibility features if you're serving residents with mobility limitations. These physical plant standards are usually inspected before licensure and again periodically after. Confirm the exact square footage and ratio requirements with HHSC since they differ by license category and by whether the home is new construction or an existing residential conversion. For deeper detail on adapting an existing home, see assisted living at home.
How long does it take to get licensed, and what does it cost?
Realistically, plan for a process that runs several months from the day you submit a complete application to the day you receive a license, not weeks. The exact timeline depends heavily on how complete your initial application packet is, how quickly your building passes its life safety inspection, and current caseload at your HHSC regional office. Applications with missing policy documents or unresolved zoning issues routinely stretch past six months. Costs break into a few buckets: the state application fee (varies by license type and capacity; confirm the current fee schedule directly with HHSC since fees are periodically revised), any local permit or inspection fees, the cost of building modifications needed to meet physical plant standards, staff background check fees, and general startup costs like insurance, staff wages before intake begins, and your policy manual development. Building out or renovating a property to meet fire code and accessibility standards is typically the largest line item, and it's the one operators most often underestimate. Don't budget for a fast timeline and assume everything else will keep pace. Building your staffing plan, finalizing your lease, and starting your background checks in parallel with the license application (rather than sequentially after approval) is the realistic way to avoid a gap where you're paying rent and staff wages with zero residents generating revenue.
What should go in your policy and procedure manual?
Your policy manual is the operational backbone HHSC reviews before licensure and references again at every inspection. At minimum, it should cover: admission and discharge criteria and process, resident rights and grievance procedures, medication storage and administration protocols, staffing plan and shift coverage, emergency preparedness (fire, severe weather, medical emergency, missing resident), abuse and neglect reporting procedures with specific reporting timelines, infection control practices, incident reporting, and record-keeping and confidentiality practices consistent with HIPAA where applicable. A generic, downloaded template rarely survives contact with a real inspection, because inspectors check whether your actual practice matches your written policy, not whether the policy sounds professional. If your manual says medications are double-checked by two staff members and your med room log doesn't show two signatures, that's a citation. This is genuinely the part of the process where a purpose-built starting point saves the most time, since building all of this from a blank page for a specific Texas license category is a heavy lift for a first-time operator. GroupHomePath's $299 State Group Home Licensing Kit is built around exactly this gap: state-specific application checklists and policy manual templates you adapt to your license category, rather than starting from zero. You can find it at /licensing-kit-builder, though the state's own minimum standards and application forms remain the authoritative source you must follow.
What happens at the state inspection?
The pre-licensing inspection covers two tracks at once: physical plant (fire safety, exits, square footage, bathrooms, kitchen if applicable) and administrative/program review (your policies, staff files, training documentation, and sometimes an interview about how you'd handle specific emergency scenarios). Expect the inspector to check smoke detectors and fire extinguishers, verify posted evacuation routes, review your emergency preparedness plan against actual building layout, check staff files for completed background checks and training records, and review a sample of your policies against what you can demonstrate in practice. For ALFs and adult foster care, medication storage and administration documentation gets particular attention because medication errors are one of the most common serious deficiency categories nationally. If deficiencies come up (and for first-time operators, some almost always do), you'll typically get a written list and a timeframe to correct them, followed by a re-inspection before the license is issued. Treat the first inspection as a real test, not a formality. Walk your own building the week before with the licensing checklist in hand and fix what you find before the state does.
Frequently asked questions
What is assisted living in simple terms?
Assisted living is licensed housing for adults, usually seniors, who need help with daily activities like bathing, dressing, or medication but don't need the round-the-clock skilled nursing care a nursing home provides. It combines a private or shared living space with personal care staff on-site and meals, housekeeping, and activities included.
What is a group home?
A group home is a residential setting, typically a single-family style house, where a small number of unrelated people live together and receive supervision or care from staff. In Texas, group homes can serve children in foster care, adults with intellectual or developmental disabilities, people in mental health or substance use recovery, or seniors, each under a different license category.
What is an assisted living facility?
An assisted living facility (ALF) is a licensed residence, defined in Texas under Health and Safety Code Chapter 247, that provides housing, meals, and personal care services for four or more unrelated residents. Texas categorizes ALFs by resident evacuation ability and care level, generally as Type A or Type B facilities.
What is the difference between assisted living and a nursing home?
Assisted living provides personal care help (bathing, dressing, medication reminders) with staff on-site around the clock but not necessarily nurses on every shift. A nursing home provides skilled nursing care with licensed nurses on duty at all times, for residents with more complex or unstable medical needs. Nursing homes are licensed in Texas under Health and Safety Code Chapter 242, ALFs under Chapter 247.
Does Medicare cover assisted living facilities?
No. Medicare does not pay for room, board, or personal care services in an assisted living facility, according to CMS guidance on what Medicare covers. Medicare may still cover unrelated medical services like doctor visits or short-term skilled nursing after a qualifying hospital stay, but not the ongoing ALF residency cost itself.
How do I start a group home in Texas?
Pick your license category (child foster care, adult foster care/ALF, or IDD group home), form your business entity, confirm zoning at your intended address, write your policy manual, complete background checks, submit your application and fee to the relevant HHSC division, pass the pre-licensing inspection, and hire and train staff before intake begins.
How much does it cost to open a group home in Texas?
Costs vary widely by license type and property condition, and there's no single fixed figure. Expect a state application fee (confirm current amount with HHSC), building modification costs to meet fire and physical plant standards, staff wages before intake starts, insurance, and policy development costs. Building renovation is usually the largest expense for new operators.
How long does it take to get a group home license in Texas?
Plan for several months from a complete application submission to license issuance, not weeks. Timelines stretch significantly if your application is missing documents, your building fails its first fire/life safety inspection, or your local HHSC regional office has a heavy caseload. Applications submitted with incomplete policy manuals are the most common cause of delay.
Which state agency licenses group homes in Texas?
The Texas Health and Human Services Commission (HHSC) licenses most group home types. Child foster care runs through HHSC's Child Care Regulation division under Texas Human Resources Code Chapter 42, while adult foster care and assisted living facilities run through HHSC's Long-term Care Regulation division under Health and Safety Code Chapter 247.
Can Medicaid help pay for a group home in Texas?
For some populations, yes, through specific Medicaid waiver programs like HCS (Home and Community-based Services) for people with intellectual or developmental disabilities, or STAR+PLUS for certain adults needing long-term services. Straight assisted living room and board for seniors is generally private-pay in Texas, and Medicaid enrollment as a provider is a separate process from your HHSC facility license.
Do I need a special license for a group home versus a regular rental house?
Yes. Providing supervision, personal care, or treatment services to unrelated residents in exchange for payment requires a state license in Texas, regardless of whether the building itself is a standard single-family house. Operating unlicensed when a license is required can result in fines, forced closure, and referral for prosecution.
What's the difference between a group home and a nursing home?
A group home is a broad category covering small residential settings for many populations (children in foster care, adults with disabilities, seniors) with varying levels of care. A nursing home specifically provides 24-hour skilled nursing care for people with complex medical needs, licensed under a distinct statute (Texas Health and Safety Code Chapter 242) with stricter medical staffing requirements.
Does zoning affect whether I can open a group home?
Yes, significantly. Local zoning codes determine whether your intended address permits group home use outright, requires a conditional use permit, or prohibits it. The federal Fair Housing Act offers some protection against discriminatory zoning for disability-related group homes, but it doesn't eliminate all local land use requirements, so confirm zoning before signing a lease.
Sources
- Texas Health and Human Services, Child Care Regulation / Texas Human Resources Code Chapter 42: Child foster care licensing authority and background check/central registry requirements
- Texas Health and Safety Code Chapter 247, Assisted Living Facilities: Definition and licensing requirements for assisted living facilities in Texas
- Texas Health and Safety Code Chapter 242, Convalescent and Nursing Facilities: Nursing facility licensing statute in Texas
- Medicare.gov, Long-Term Care coverage information: Medicare does not cover long-term custodial or assisted living care
- Texas Health and Human Services, Texas Medicaid Provider Enrollment (1 Texas Administrative Code §352.3): Medicaid provider enrollment is a separate process from state facility licensing
- U.S. Department of Justice, Fair Housing Act, 42 U.S.C. §3604: Federal Fair Housing Act protections relevant to group home zoning