Last updated 2026-07-26
TL;DR
In Houston, assisted living facilities are licensed by Texas HHSC, not the city, under Texas Health and Safety Code Chapter 247. Licenses cover Type A, Type B, and Type C (small/large) facilities. Medicare does not pay for assisted living room and board; Medicaid may help through the STAR+PLUS waiver in certain licensed settings.
What is assisted living?
Assisted living is a licensed residential setting where adults get help with daily activities like bathing, dressing, medication reminders, and meals, while keeping some independence. It sits between fully independent senior housing and a nursing home. Staff are present around the clock, but the care level is lower than skilled nursing. In Texas, the legal term is "assisted living facility," and it's defined and regulated under Texas Health and Safety Code Chapter 247. The Texas Health and Human Services Commission (HHSC) is the licensing authority statewide, including for every facility operating inside Houston or unincorporated Harris County [1]. There is no separate City of Houston assisted living license; the city handles things like fire code, building permits, and zoning, but the actual care license comes from the state. Most people search "licensed assisted living Houston" expecting a city directory. What they actually need to check is the HHSC facility search tool, which lists every licensed assisted living facility in the Houston metro by name, address, license type, and current status, including any enforcement actions [2].
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 support. Depending on the state, a "group home" might be licensed as an assisted living facility, an adult foster care home, a personal care home, or a facility for people with intellectual or developmental disabilities (IDD). Texas doesn't have a generic "group home" license category for adults with disabilities the way some states do. Instead, homes serving people with IDD are usually licensed under HHSC's Home and Community-based Services (HCS) or Texas Home Living (TxHmL) Medicaid waiver programs, which have their own certification standards separate from Chapter 247 assisted living rules [1]. A small residential home serving seniors who need help with daily living, on the other hand, almost always falls under the assisted living license. So if you're picturing a house with four to six residents and live-in caregivers, ask yourself who you intend to serve. Seniors needing personal care: that's assisted living licensing. Adults with IDD needing Medicaid waiver services: that's a different HHSC program track entirely, with different staffing and training rules. For a broader look at how these categories compare, see assisted living facility.
What is an assisted living facility (and what does the license actually cover)?
Under Texas Health and Safety Code Section 247.002, an assisted living facility is an establishment that furnishes food, shelter, and personal care services to four or more people unrelated to the proprietor, and provides varying levels of support with daily living activities [1]. The exact wording matters because it sets the four-resident threshold that separates a licensed facility from a private caregiving arrangement. HHSC issues four main license types, and each has different physical plant and evacuation requirements: | License type | Who it serves | Key requirement | |---|---|---| | Type A | Residents who are mobile without help and don't need nighttime attendance | Basic supervision level | | Type B | Residents who need staff assistance to evacuate or have nighttime needs | Higher staffing ratio, evacuation assistance | | Type C (small) | 4-16 residents, often a converted house | Small facility physical standards | | Type C (large) | More than 16 residents | Institutional physical standards | (Type C designations sometimes get folded into Type B rules depending on current HHSC minimum standards; always confirm the current classification chart with your state licensing agency before you build a program around it.) [3] Every one of these still requires an HHSC license before you can accept a single paying resident, and operating unlicensed is a criminal offense under Chapter 247 with civil penalties attached [1].
What is assisted living vs a nursing home?
The short answer: assisted living is personal care and supervision; a nursing home is medical care. Nursing homes, called "nursing facilities" in Texas licensing language, are certified to provide skilled nursing care, rehabilitation therapy, and 24-hour licensed nursing supervision under a completely different regulatory chapter than assisted living [1]. Assisted living residents typically need help with activities of daily living, hygiene, mobility, medication reminders, but not hands-on medical treatment from a nurse around the clock. Nursing home residents often need wound care, IV therapy, ventilator support, or recovery from a hospital stay that requires a licensed nurse on-site continuously. Cost and staffing reflect that difference. Assisted living staffing ratios in Texas are set by facility type and resident needs, while nursing facilities must meet federal Medicare/Medicaid staffing conditions of participation, including a registered nurse on duty for at least eight consecutive hours a day, seven days a week, under 42 CFR 483.35 [4]. If your business plan requires nursing-level care for most residents, you're describing a nursing facility, and that license path, cost, and inspection regime is entirely different from assisted living.
What does assisted living provide, day to day?
A licensed assisted living facility in Texas has to provide, at minimum: three meals a day plus snacks, help with personal hygiene and dressing, medication management or reminders (depending on license type), housekeeping and laundry, social and recreational activities, and 24-hour staff availability for emergencies [3]. Beyond the floor set by HHSC minimum standards, most operators also provide transportation to medical appointments, on-site or coordinated therapy services, and some level of health monitoring like blood pressure checks. What a facility can't do without additional licensing is deliver skilled nursing care as an ongoing service line; if a resident's needs progress to that point, the facility has to either bring in licensed home health under a separate agreement or help the family transition the resident to a nursing facility. This is where a lot of new operators get tripped up. HHSC requires every assisted living facility to have a written resident assessment and a policy for identifying when a resident's needs exceed the facility's license type, plus a discharge or transfer plan for that situation [3]. Skipping this piece of the policy manual is one of the more common inspection deficiencies.
How to start a group home or assisted living facility in the Houston area
Starting in Houston means working through the state licensing process, because HHSC, not the city, issues the license. Here's the realistic sequence. 1. Pick your population and license type. Decide if you're serving seniors needing personal care (Chapter 247 assisted living) or adults with IDD under a Medicaid waiver program, since the application packets are different [1]. 2. Confirm zoning and fire code with the City of Houston or Harris County before you sign a lease. A residential-zoned house may need a certificate of occupancy change or a variance to legally operate as a licensed care facility; this is a local government matter, separate from HHSC. Check with your municipal planning and fire marshal's office directly, since requirements vary by property and jurisdiction. 3. Submit the HHSC assisted living facility license application, along with the required fee. License fees are set in Texas Administrative Code and vary by facility size and type; confirm the current fee schedule with HHSC before budgeting [3]. 4. Pass a life safety code and fire inspection, plus an HHSC pre-licensing survey of the physical plant, staffing plan, and policy manual. 5. Hire and document a qualified administrator. Texas requires assisted living facility administrators to be licensed separately through the Texas Department of Licensing and Regulation's Assisted Living Facility Administrator program, with required coursework and an exam [5]. 6. Build your policy and procedure manual covering admission and discharge criteria, medication management, emergency preparedness, staff training, and resident rights, since HHSC will review these documents as part of licensing and every subsequent inspection. For operators comparing this against other states' rules, assisted living and assisted living facilities walk through licensing structures state by state.
How do I start a group home if I'm serving adults with IDD, not seniors?
If your Houston project is a home for adults with intellectual or developmental disabilities rather than aging seniors, the path runs through HHSC's HCS (Home and Community-based Services) or TxHmL waiver programs instead of the Chapter 247 assisted living license [1]. That means applying through HHSC's provider enrollment process for the specific waiver, meeting different staff qualification and training standards (including specific hours of pre-service training on topics like behavior support and rights protection), and going through a Medicaid provider certification survey rather than (or in addition to) a straight assisted living inspection. The practical difference for a Houston operator: waiting lists for these waiver slots are long and state-managed, so your residents typically come through the interest list system rather than open-market referrals the way private-pay assisted living residents do. Budget significant extra lead time for provider enrollment paperwork, background checks for every staff member through the Employee Misconduct Registry and criminal history checks, and a facility inspection focused on habilitation programming, not personal care services [1].
Does Medicare cover assisted living facilities in Houston?
No. Medicare does not pay for the room, board, or personal care costs of assisted living, in Houston or anywhere else in the country. Medicare.gov's long-term care coverage page confirms Medicare does not cover long-term custodial care, including ongoing room-and-board style assisted living costs [6]. What Medicare will sometimes cover, even for someone living in an assisted living facility, is short-term medically necessary services: a home health nurse visit, physical therapy after a hospital stay, or durable medical equipment, if those services meet Medicare's own coverage criteria independent of where the person lives [6]. Medicaid is a different story, and this is where confusion is common. Texas Medicaid, through the STAR+PLUS managed care program, can help pay for personal care services and some room-and-board offsets for eligible low-income seniors and adults with disabilities, but only through specific HCS or STAR+PLUS waiver arrangements, not as a blanket assisted living benefit, and availability depends on waiver slots and income/asset limits set by HHSC [7]. If your Houston facility plans to accept Medicaid waiver residents, you need a separate Medicaid provider agreement on top of your HHSC facility license; the license alone doesn't make you a Medicaid biller.
What are the staffing and inspection requirements for a licensed assisted living facility in Houston?
HHSC requires assisted living facilities to maintain sufficient staff on duty around the clock to meet resident needs based on the facility's license type and the current resident population's acuity, with specific ratios detailed in the Texas Administrative Code minimum standards for assisted living facilities [3]. Inspections happen on a regular cycle plus in response to complaints. HHSC conducts an initial licensing survey before your license is issued, then periodic renewal surveys, and unannounced complaint investigations any time someone reports a concern. Surveyors review resident records, medication administration logs, staff training files, the physical building for life safety compliance, and interview residents and staff directly. Common deficiencies cited in Texas assisted living surveys include incomplete resident assessments, medication administration records with gaps, insufficient staff training documentation, and fire drill logs that aren't current. None of these are hard to fix once you know they're coming, but they're expensive to fix under the pressure of an active complaint investigation. Building the policy manual and training log system before you open, not after your first inspection, is the difference between a routine survey and a plan of correction with a deadline attached.
Where do zoning and property rules fit into Houston licensing?
Houston is one of the few major U.S. cities without a traditional zoning code, but that doesn't mean anything goes. Deed restrictions, homeowners' association rules, and the city's chapter on land use and building code still apply, and Harris County has its own permitting rules outside city limits. Before signing a lease or purchase agreement for a Houston assisted living property, confirm with the city's Planning and Development Department (or the relevant county office if you're outside city limits) whether the property's current use classification and any deed restrictions allow a residential care facility. Fire marshal sign-off on life safety code compliance, ADA accessibility if applicable, and a certificate of occupancy update are separate steps from your HHSC license application, and they can take longer than the state paperwork if the building needs retrofitting. A lot of operators lose months by signing a lease before confirming any of this. Get written confirmation from the local building and fire authorities before you commit to a property, not after.
Frequently asked questions
What is assisted living?
Assisted living is a licensed residential care setting for adults, usually seniors, who need help with daily activities like bathing, dressing, and medication reminders but don't need full-time skilled nursing care. In Texas, it's licensed under Health and Safety Code Chapter 247 through HHSC, not by cities like Houston directly [1].
What is a group home?
A group home is a general term for a residential setting where a small group of unrelated people live together with support staff. In Texas, homes for seniors needing personal care are licensed as assisted living facilities, while homes for adults with IDD are typically certified under HHSC's HCS or TxHmL Medicaid waiver programs instead.
What is an assisted living facility?
Under Texas Health and Safety Code Section 247.002, an assisted living facility is an establishment that provides food, shelter, and personal care services to four or more unrelated residents, with varying levels of support for daily living activities [1]. It requires an HHSC license before accepting any residents.
What is the difference between assisted living and a nursing home?
Assisted living provides personal care and supervision (help with hygiene, meals, medication reminders); a nursing home provides skilled medical care with a licensed nurse on duty around the clock, under separate federal staffing rules at 42 CFR 483.35 [4]. Assisted living residents are generally more independent and don't need continuous medical treatment.
Does Medicare cover assisted living facilities?
No. Medicare does not pay for the room, board, or personal care costs of assisted living anywhere in the U.S., per Medicare.gov's long-term care coverage guidance [6]. Medicare may still cover separate medically necessary services, like home health visits or therapy, for someone who happens to live in an assisted living facility.
How do I start a group home in Houston?
Decide your population (seniors needing personal care versus adults with IDD), confirm zoning and fire code with the city or county, apply for the correct HHSC license (assisted living under Chapter 247, or an HCS/TxHmL waiver provider agreement), hire a licensed administrator, and build your policy manual before your pre-licensing survey [1][3][5].
Does Houston have its own assisted living license separate from the state?
No. The City of Houston doesn't issue a health care license for assisted living. HHSC licenses all assisted living facilities statewide under Chapter 247 [1]. The city's role is limited to zoning, building permits, fire code, and certificate of occupancy requirements for the physical property.
How much does it cost to get an assisted living license in Texas?
License fees vary by facility size and type and are set in the Texas Administrative Code. Because fee schedules change, confirm the current amount directly with HHSC's licensing division before budgeting, rather than relying on older published figures [3].
What's the minimum number of residents to require an assisted living license in Texas?
Texas law defines an assisted living facility as serving four or more unrelated residents receiving personal care services [1]. Homes with three or fewer unrelated residents generally fall outside this licensing requirement, though local rules and other program-specific thresholds can still apply.
Can an assisted living facility in Houston accept Medicaid?
Only through specific arrangements. Texas Medicaid, via STAR+PLUS or HCS waiver programs, can help cover personal care and some costs for eligible residents, but a facility needs a separate Medicaid provider agreement on top of its HHSC license; the assisted living license alone doesn't make a facility a Medicaid biller [7].
Who inspects assisted living facilities in Houston?
HHSC conducts the licensing survey, periodic renewal inspections, and complaint investigations for every assisted living facility statewide, including those in Houston [1][3]. Local fire marshals and building inspectors separately handle life safety code and occupancy compliance for the physical property.
What training does an assisted living administrator need in Texas?
Texas requires assisted living facility administrators to hold a separate license through the Texas Department of Licensing and Regulation's Assisted Living Facility Administrator program, which includes required coursework and a licensing exam before they can legally run a facility [5].
Sources
- Texas Health and Safety Code, Chapter 247 (Assisted Living Facilities): Definition of assisted living facility, four-resident threshold, licensing authority, and IDD/nursing facility distinctions
- Texas HHSC, Long-term Care Provider Search: Public tool to search licensed assisted living facilities by city, including Houston
- Texas Administrative Code, Title 26, Chapter 553 (Licensing Standards for Assisted Living Facilities): Minimum standards for staffing ratios, resident assessment requirements, and license type classifications
- 42 CFR 483.35, Nursing Services (Code of Federal Regulations): Federal registered nurse staffing requirement for nursing facilities
- Texas Department of Licensing and Regulation, Assisted Living Facility Administrators Law, Texas Occupations Code Chapter 1902: Separate state license required for assisted living facility administrators
- Medicare.gov, Long-Term Care Coverage: Medicare does not cover long-term custodial or assisted living costs
- Texas HHSC, STAR+PLUS Program: Medicaid STAR+PLUS program can help cover personal care services for eligible members