Last updated 2026-07-25
TL;DR
Starting an assisted living facility in Texas means forming a legal entity, securing a compliant building, passing a Texas HHSC licensing survey, and meeting Chapter 247 staffing and Life Safety Code rules. HHSC (Health and Human Services Commission) issues the license, not a city or county, though local zoning and fire marshal sign-off still apply before HHSC will schedule your inspection.
What is assisted living?
Assisted living is a type of licensed 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 a hospital or nursing home provides. Residents typically live in private or semi-private rooms or apartments and get support services layered on top of housing. In Texas, this category is licensed as an Assisted Living Facility (ALF) under Texas Health and Safety Code Chapter 247 and the related administrative rules in 26 Texas Administrative Code Chapter 553 [1][2]. 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, on a 24-hour basis [1]. That "four or more" threshold matters. If you're housing three or fewer unrelated adults with care services, you may fall outside the ALF licensing requirement entirely, though you should still confirm with your state licensing agency because other rules (fire code, zoning) can still apply at smaller scale.
What is an assisted living facility, exactly, under Texas law?
Under 26 TAC Chapter 553, an assisted living facility is a licensed facility that provides personal care services, help with self-administration of medication, and supervision for residents who need some support with daily living but not full-time nursing care [2]. Texas licenses ALFs at two levels: Type A and Type B. Type A facilities house residents who are physically and mentally capable of following directions in an emergency and evacuating with minimal staff assistance. Type B facilities house residents who need staff help to evacuate, who are non-ambulatory at night, or who have moderate cognitive limitations. Some operators pursue a Type C designation for small, adult foster care-style homes serving three or fewer residents, which has its own licensing track separate from Chapter 247 ALF rules. The level you choose changes almost everything downstream: staffing ratios, fire sprinkler requirements, and the physical plant standards HHSC will inspect against. Decide early, because retrofitting a Type A building to meet Type B life safety standards after the fact gets expensive fast.
What is assisted living vs nursing home?
Assisted living and nursing homes both provide residential long-term care, but the intensity of medical care is the dividing line. Assisted living residents need help with daily activities; nursing home residents typically need ongoing skilled nursing care, post-acute rehabilitation, or management of complex medical conditions. Nursing homes in Texas are licensed separately under Texas Health and Safety Code Chapter 242 and are certified to bill Medicare and Medicaid for skilled nursing stays [3]. Assisted living facilities are licensed under Chapter 247 and, with limited exceptions through Medicaid waiver programs, are generally private-pay [1]. Staffing reflects the difference too. Nursing homes must have licensed nurses on duty and a medical director; ALFs need a "designated staff person" trained in specific competencies but don't require round-the-clock RN coverage under Chapter 247. If your target residents need IV therapy, wound vac management, or ventilator care, you're looking at a nursing home license, not ALF.
What does assisted living provide, day to day?
Texas ALF rules require facilities to provide at minimum: three meals a day plus snacks, housekeeping, laundry, help with personal hygiene and dressing, medication reminders or assistance with self-administered medication, and 24-hour supervision appropriate to the license type [2]. Facilities must also have an emergency call system or equivalent method for residents to summon help. Beyond the floor set by state rule, most successful operators add social and recreational programming, transportation to medical appointments, and some level of health monitoring (blood pressure checks, weight tracking) even though these aren't strictly mandated line items. Residents and families are shopping for quality of life, more than the compliance minimum, and that's usually where a home either gets referrals or doesn't. One thing ALFs cannot do without extra licensure: administer medications directly (as opposed to assisting with self-administration) unless staff meet specific delegation or exemption requirements under Texas Board of Nursing delegation rules. Get this wrong and it's one of the most common citation types HHSC surveyors write up.
How do I start a group home or ALF in Texas, step by step?
Here's the realistic order of operations, based on how HHSC structures its own application process [4]. 1. Form your legal entity (LLC or corporation) and get an EIN. Decide who the license holder will be; HHSC licenses the entity, more than an individual. 2. Choose your license type (Type A, Type B, or Type C) based on the resident population you intend to serve. 3. Confirm zoning and the local fire marshal's requirements before you sign a lease or purchase. Local zoning ordinances vary by city and county, so confirm with your state licensing agency and your local planning department; HHSC will not license a facility if it can't legally operate at that address. See our zoning and property resources if you're still scouting a site. 4. Submit your Life Safety Code plans to HHSC or the State Fire Marshal's Office for review, depending on facility size and construction type, before construction or renovation is finalized [2]. 5. Complete construction or renovation to meet 26 TAC Chapter 553 physical plant standards (room size, bathroom ratios, corridor width, sprinkler and alarm systems). 6. Submit your ALF license application to HHSC Long Term Care Regulation, along with the application fee, disclosure of ownership, and required policies (fire safety plan, resident rights policy, medication policy, staffing plan). 7. Hire and train your administrator and direct care staff. Texas requires an ALF administrator to complete HHSC-approved training and, depending on facility size, hold a state administrator's license. 8. Pass the pre-licensing survey. An HHSC surveyor inspects the physical plant, reviews policies, and checks staff files before issuing the initial license. 9. Open, admit residents, and prepare for your first annual licensing survey (Texas surveys ALFs at least once every 12 months, with additional complaint-driven inspections as needed) [4]. Budget real time for step 4. Fire and life safety plan review is the step that most often stalls first-time applicants, because architects unfamiliar with ALF-specific code (versus standard residential or commercial code) miss requirements the first time through.
How do I start a group home for people with disabilities or mental illness in Texas?
If your population is adults with intellectual or developmental disabilities (IDD) or mental illness rather than the general assisted living population, you may be licensed under a different chapter entirely. Group homes serving people with IDD often fall under Texas HHSC's Home and Community-based Services (HCS) or Texas Home Living (TxHmL) Medicaid waiver programs, which have their own provider enrollment and licensing pathway separate from Chapter 247 ALF rules. Mental health and recovery residences may be licensed differently again, sometimes not requiring a state facility license at all if they're unlicensed sober living homes, though that landscape is shifting and you should confirm current requirements with your state licensing agency before assuming an exemption applies. The practical takeaway: "group home" is not one license in Texas. Match your population to the correct HHSC program area first, because applying under the wrong chapter wastes months. If you're building a multi-population strategy, review our assisted living facility overview and compare it against IDD-specific waiver requirements before you commit to a building.
What is the difference between assisted living and nursing home care, in terms of licensing burden?
| Licensing agency | Texas HHSC | Texas HHSC | |
|---|---|---|---|
| Federal Medicare/Medicaid certification | Generally not required | Required for CMS reimbursement | |
| Nursing staff requirement | Designated trained staff, not RN-mandated | Licensed nurses on duty, medical director required | |
| Typical payer mix | Private pay, long-term care insurance, limited waiver | Medicare, Medicaid, private pay | |
| Survey frequency | At least annually | Annual, tied to CMS survey cycle | If you're deciding between the two license types for a new project, the honest answer is: start with ALF unless your business model specifically depends on Medicare-reimbursed skilled nursing stays. Nursing home licensure carries a materially higher staffing cost structure and a longer, harder approval process. |
Nursing homes face a heavier regulatory load than ALFs across nearly every dimension: mandatory RN staffing, a medical director, more frequent state surveys tied to CMS Certification, and participation in the federal nursing home Five-Star Quality Rating System [5]. ALFs answer to state licensing standards only, unless they separately choose to accept Medicaid waiver residents, which layers on additional program requirements. | Feature | Assisted Living Facility (Ch. 247) | Nursing Home (Ch. 242) |
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. Medicare.gov states plainly that Medicare "doesn't cover long-term care (also called custodial care)" if that's the only kind of care a person needs, and assisted living is generally considered custodial, not medical, care [6]. Medicare Part A may cover a short skilled nursing facility stay after a qualifying hospitalization, and Medicare Part B can cover doctor visits, physical therapy, or medical equipment a resident receives while living in an ALF, but the room, board, and daily personal care itself is excluded [6]. Medicaid is different. Some states, including Texas, offer limited assisted-living-type support through home and community-based services (HCBS) waivers, which can help cover personal care costs for financially eligible residents, but this is not the same as ALF room-and-board coverage and availability is capped by waiver enrollment slots [7]. If Medicaid waiver residents are part of your business plan, budget extra time to get set up as an approved HCBS provider on top of your HHSC facility license, and check current waiver rules directly at Medicaid.gov [7].
What does it cost and how long does licensing take in Texas?
HHSC does not publish a single flat licensing fee on a consumer-facing rate card; fees are tied to facility size (number of beds) and are set in Texas Administrative Code fee schedules that HHSC updates periodically [2]. Confirm the current fee schedule directly with HHSC Long Term Care Regulation before budgeting, since fee amounts change and vary by facility size and license type. What you can plan around with more confidence is the timeline shape, not a guaranteed number of days: entity formation and zoning confirmation, several weeks; architectural life safety plan review, commonly the longest single step for first-time applicants; construction or renovation, months, depending on scope; then application review and survey scheduling once the building is ready. HHSC's own guidance emphasizes submitting complete applications, since missing documentation is the most common cause of delay in the review queue [4]. Don't assume any published number is a promise. Treat every fee and timeline figure as a starting point to verify with HHSC before you sign a lease or start construction.
What staffing does a Texas assisted living facility need?
Chapter 553 requires an administrator on record for every licensed ALF, and that administrator must complete HHSC-approved training; larger facilities and Type B facilities have additional supervisory and awake-staff requirements tied to resident acuity [2]. Direct care staff need documented orientation and ongoing training in areas like resident rights, emergency procedures, and infection control. Staffing ratios in Texas are not a single fixed number across the board; they scale with license type and resident needs assessments, and HHSC surveyors check both paper staffing plans and actual observed coverage during inspections. Facilities also must maintain awake night staff for Type B populations specifically because those residents may need help evacuating. Write your staffing plan around your actual resident acuity, more than the legal floor. A home that consistently runs at the bare minimum staffing level tends to draw more complaint-driven surveys, and Texas HHSC does investigate complaints outside the normal annual survey cycle [4].
What happens during the Texas HHSC licensing survey?
An HHSC surveyor conducts an on-site inspection before your initial license is issued and at least annually afterward. The surveyor checks the physical plant against Life Safety Code and Chapter 553 physical standards, reviews resident and staff records, and observes actual care delivery against your written policies [2][4]. Common first-survey findings include incomplete staff training documentation, medication assistance procedures that don't match Board of Nursing delegation rules, missing or expired fire inspection certificates, and emergency preparedness plans that haven't been updated to match the actual building layout. None of these are exotic; they're the same handful of issues that trip up new operators across most states, more than Texas. If a surveyor finds deficiencies, HHSC issues a statement of deficiencies and you submit a plan of correction with a timeline. Serious violations can trigger enforcement action up to license revocation, so don't treat the plan of correction as a formality; HHSC can and does follow up to confirm correction actually happened.
Where does the paperwork burden actually land, and how do you manage it?
The heaviest lift for most first-time Texas ALF applicants isn't the building, it's the policy manual: fire and life safety plan, resident rights policy, medication assistance policy, emergency preparedness plan, staffing plan, admission and discharge criteria, and grievance procedures all have to exist in writing before HHSC will schedule your survey [2][4]. Some operators write these from scratch with an attorney or consultant; others start from a structured template built around the specific chapter they're licensing under, then customize for their building and population. Either path works, but a policy manual that's generic (copied from another state, or written for the wrong ALF sub-type) is one of the fastest ways to get sent back for revisions. If you want a starting structure instead of building every policy from a blank page, our $299 State Group Home Licensing Kit gives you a state-specific policy and application framework built around Texas HHSC's actual document requirements, so you're editing instead of drafting from zero. It doesn't replace legal review or guarantee approval, and only HHSC can approve your license, but it removes a lot of the blank-page time.
What should you check before you sign a lease or buy a building?
Before committing to any property, confirm four things directly with the relevant local and state agencies, not with a real estate agent or general contractor's assumption: local zoning classification allows an assisted living or residential care use at that address, the local fire marshal's requirements for occupancy classification, whether the building's existing construction type can meet ALF-specific Life Safety Code without a full structural retrofit, and HHSC's current physical plant standards for your intended license type (Type A vs Type B) [2]. A building that's zoned fine for a single-family group home use might still fail zoning for a larger ALF, since some municipalities distinguish residential care facilities by resident count or by whether the operation is licensed. This is a local zoning question, not a state one, so confirm with your city or county planning department directly; requirements vary block by block in ways state guidance can't capture. If you're comparing multiple potential sites or multiple state markets, our assisted living facilities comparison guide and senior assisted living facilities near me resource are useful starting points before you narrow down a location.
Frequently asked questions
What is assisted living?
Assisted living is licensed residential care for adults who need help with daily activities like bathing, dressing, and medication reminders, but not full-time skilled nursing care. In Texas, it's licensed as an Assisted Living Facility (ALF) under Health and Safety Code Chapter 247, covering housing plus personal care services for four or more unrelated residents on a 24-hour basis.
What is a group home?
A group home is a residential setting where a small number of unrelated people live together and receive support services, often for populations like people with IDD, mental illness, or seniors needing assistance. In Texas, the specific license required depends heavily on the population served; it may fall under ALF rules (Chapter 247), IDD waiver programs, or another HHSC program area entirely.
What is an assisted living facility?
An assisted living facility is a licensed establishment that provides food, shelter, and personal care services to residents who need help with daily activities but not intensive medical or nursing care. Texas defines it under Health and Safety Code Chapter 247 as serving four or more unrelated residents on a 24-hour basis, with licensing administered by HHSC.
What is assisted living vs nursing home?
Assisted living serves residents needing help with daily activities like dressing and medication reminders; nursing homes serve residents needing ongoing skilled nursing care or medical management. In Texas, ALFs are licensed under Chapter 247 and are largely private-pay, while nursing homes are licensed under Chapter 242 and can bill Medicare and Medicaid for certified skilled nursing stays.
What does assisted living provide?
Texas ALF rules require at minimum three daily meals plus snacks, housekeeping, laundry, help with personal hygiene, medication assistance, 24-hour supervision matched to license type, and an emergency call system. Most operators add social programming and transportation on top of these state-mandated minimums to stay competitive.
How do I start a group home in Texas?
Form a legal entity, pick the correct license category for your population (ALF under Chapter 247, or an IDD/mental health waiver program), confirm zoning and fire marshal requirements, get your building plans approved for Life Safety Code, submit your HHSC application with required policies, hire and train staff, and pass the pre-licensing survey before admitting residents.
What is the difference between assisted living and nursing home licensing?
Nursing homes require licensed nursing staff on duty and a medical director, and they can be Medicare/Medicaid certified for reimbursement. Assisted living facilities need a designated trained staff person but not mandatory RN coverage, and they're generally private-pay. Both are licensed by Texas HHSC but under different statutory chapters (242 vs 247).
Does Medicare cover assisted living facilities?
No. Medicare does not cover room, board, or custodial personal care in an assisted living facility. Medicare.gov confirms Medicare excludes long-term custodial care; it may still cover doctor visits, therapy, or short skilled nursing stays a resident receives separately, but not ALF housing or daily care costs.
How do I start a group home if I want to serve Medicaid-eligible residents?
You'll typically need to enroll as a provider under a Medicaid home and community-based services (HCBS) waiver program in addition to your standard HHSC facility license, since Chapter 247 ALF licensing alone doesn't guarantee Medicaid billing eligibility. Check current waiver program rules and enrollment slots directly at Medicaid.gov before building your business plan around Medicaid residents.
What license type should I choose, Type A or Type B, in Texas?
Type A suits residents who can evacuate independently with minimal help and don't have significant cognitive impairment. Type B suits residents needing staff assistance to evacuate, who are non-ambulatory at night, or who have moderate cognitive limitations. Type B carries stricter physical plant and staffing requirements, so choosing wrong early gets expensive to fix later.
How long does it take to get an assisted living license in Texas?
There's no single guaranteed timeline; it depends on entity setup, zoning confirmation, Life Safety Code plan review, construction or renovation, and HHSC's application review queue. Life safety plan review is commonly the longest bottleneck for first-time applicants. Confirm current processing expectations directly with HHSC Long Term Care Regulation.
Do I need a special administrator's license to run a Texas ALF?
Yes, generally. Texas requires ALF administrators to complete HHSC-approved training, and depending on facility size, hold a state administrator's license or certification. This is separate from any nursing license and focuses on facility operations, resident rights, and regulatory compliance rather than clinical nursing skills.
Sources
- Texas Health and Safety Code, Chapter 247: Definition of an assisted living facility and the four-or-more unrelated resident threshold under Texas law
- Texas Administrative Code, Title 26, Chapter 553 (Licensing Standards for Assisted Living Facilities): Physical plant, staffing, Type A/Type B distinctions, and required policies for Texas ALF licensing
- Texas Health and Safety Code, Chapter 242: Nursing home licensing requirements under a separate Texas statutory chapter from assisted living
- Texas HHSC, Long Term Care Regulation, Assisted Living Facilities: HHSC application process, survey frequency, and complaint-driven inspections for ALFs
- Medicare.gov, Nursing Home Care coverage page: Nursing home Medicare certification and Five-Star Quality Rating System context
- Medicare.gov, Long-Term Care coverage page: Medicare does not cover custodial long-term care such as assisted living room, board, and personal care
- Medicaid.gov, Home & Community-Based Services: Medicaid HCBS waiver programs can help cover personal care costs for eligible residents, separate from ALF room-and-board licensing