Licensed group homes in Texas: how to get licensed

Last updated 2026-07-25

What is a group home, exactly?

A group home is a residential setting, usually a house or small building, where a limited number of unrelated people live together and receive some level of support, supervision, or care. The term gets used loosely, but in Texas it maps to specific license types depending on who lives there and what care they need. If the residents are older adults or people with disabilities needing help with daily activities like bathing, dressing, or medication reminders, you're likely looking at an Assisted Living Facility (ALF) license through the Texas Health and Human Services Commission (HHSC). If the residents have intellectual or developmental disabilities and the setting provides Home and Community-based Services, you may be looking at HCS provider enrollment instead of, or in addition to, a facility license. If the population is adults with mental illness or people in recovery from substance use, the licensing path is different again, and some recovery residences in Texas aren't licensed at all but are instead certified through a recognized certification organization under Texas Health and Safety Code Chapter 260A ^[1]. The short version: 'group home' is a category of housing, not a single license. Texas regulates the activity (personal care, medication administration, behavioral health services) more than it regulates the label on the building.

What is assisted living, and what is an assisted living facility?

Assisted living is a model of care that combines housing with help for daily living tasks, without the round-the-clock skilled nursing you'd find in a nursing home. An assisted living facility is the licensed building where that care is delivered. Under Texas Health and Safety Code Chapter 247, an assisted living facility is defined as an establishment that furnishes food, shelter, and personal care services for four or more people unrelated to the proprietor, for longer than 24 hours ^[2]. HHSC further sorts ALFs into Type A, Type B, and Type C license types, mainly based on residents' mobility and ability to evacuate unassisted, and whether the facility offers nighttime attendance for people who need it ^[3]. Type A facilities generally serve residents who are physically and mentally capable of evacuating the building without help. Type B facilities serve residents who need some evacuation assistance, may be non-ambulatory, or need help during the night. Type C is a specific license for adult foster care settings with three or fewer residents in HHSC's own foster care program. Each type carries its own staffing and physical plant expectations, so the population you intend to serve should decide your license type before you sign a lease or start construction.

What is assisted living vs nursing home, and what's the real difference?

Assisted living gives residents help with daily activities in a home-like setting; a nursing home (also called a skilled nursing facility) provides 24-hour skilled nursing care for people with more serious medical needs. The distinction matters for licensing, staffing, and payment source, and mixing the two up is one of the fastest ways to misfile your application. Nursing homes in Texas are licensed separately from ALFs, under Health and Safety Code Chapter 242, and must have licensed nurses on-site around the clock along with a medical director ^[4]. Assisted living facilities are not required to have a registered nurse on staff at all times; instead they must have someone available to respond to needs and, depending on license type, meet minimum staffing ratios for waking and sleeping hours ^[3]. The practical test HHSC and most operators use: if residents need ongoing skilled nursing intervention (wound care, IV therapy, ventilator management), that's nursing home territory. If residents mainly need supervision, help with activities of daily living, and medication reminders, that's assisted living. Get this wrong on your application and you'll be asked to either downgrade your license type or bring on nursing staff and physical plant features you didn't plan for.

What does assisted living provide to residents day to day?

Assisted living in Texas typically provides three meals a day, housekeeping, laundry, help with bathing and dressing, medication management or reminders, social activities, and staff supervision. It does not typically include hands-on skilled nursing care unless the facility has added that capacity and disclosed it. HHSC rules require ALFs to provide, at minimum, food service meeting nutritional standards, a clean and safe living environment, staff assistance with activities of daily living as needed, and a system for handling medications consistent with the resident's service plan ^[3]. Facilities must also have an emergency preparedness and evacuation plan on file, which gets checked during your initial survey and every renewal inspection after that. Beyond the floor set by state rule, what a facility 'provides' really comes down to its own service agreement with each resident or their family. Some Texas ALFs offer memory care programming, transportation to medical appointments, or on-site therapy visits; none of that is required by the base ALF license, so read your own admission agreements carefully before advertising services you're not actually staffed to deliver.

Does Medicare cover assisted living facilities?

No. Medicare does not cover the cost of room and board or personal care in an assisted living facility. Medicare.gov states plainly that Medicare and most private health insurance plans typically don't cover the cost of non-medical long-term care, which is what most assisted living services fall under ^[5]. Medicare will still pay for medical care a resident receives while living in an ALF, things like doctor visits, physical therapy, or a hospital stay, the same as it would anywhere else. It just won't pay the facility's monthly rate for housing, meals, or help with daily activities. Medicaid is a different story, and this is where Texas operators need to pay close attention. Texas Medicaid does not directly pay for room and board in ALFs either, but the STAR+PLUS managed care program and certain HCS/waiver programs can cover personal care services and some assisted living service costs for eligible low-income residents through HHSC's long-term services and supports system ^[6]. If you plan to accept Medicaid-funded residents, you'll need to enroll as a Medicaid provider separately from your HHSC facility license, and that's a process with its own timeline and paperwork.

How to start a group home in Texas: the licensing steps

Starting a licensed group home in Texas runs through several sequential steps with HHSC, and skipping ahead (like signing a lease before you know your license type) is the most common expensive mistake new operators make. 1. Decide your population and license type. Confirm with your state licensing agency whether you need an ALF license (Type A, B, or C), an HCS provider enrollment, a recovery residence certification, or some combination, based on who you intend to serve. 2. Check zoning and fire code before committing to a property. Local zoning ordinances vary by city and county, and a residential-zoned house may or may not permit a licensed care facility as a matter of right. Confirm with your local planning department and state or local fire marshal separately from HHSC review. 3. Submit a plan review or letter of intent to HHSC. For ALFs, HHSC generally requires review of building plans before construction or renovation, to confirm the physical plant meets requirements in 26 Texas Administrative Code Chapter 553 ^[3]. 4. Build your staffing plan and policy manual. You'll need job descriptions, staffing ratios by shift, a medication administration policy, an emergency preparedness plan, and abuse/neglect/exploitation reporting procedures, all in writing before HHSC will schedule your licensing survey. 5. Complete background checks. Owners, administrators, and staff with direct resident contact must clear criminal history checks through the Texas Department of Public Safety and the HHSC Nurse Aide/Employee Misconduct Registry as applicable. 6. Submit the license application and fee. Fees vary by facility size and license type; confirm current fee schedules with HHSC directly, since these are adjusted periodically by rule. 7. Pass your initial licensing survey. An HHSC surveyor will inspect the physical plant, review your policies, and interview staff before issuing the license. Building this packet from scratch, matching your specific population and city, takes most first-time operators several months of back-and-forth. That's exactly the gap a structured assisted living facility planning resource is meant to close, whether you build the manuals yourself or start from a template built around HHSC's own checklist.

How do I start a group home if I've never run one before?

Start by shadowing the rules, not the real estate. New operators often fall in love with a house first and the license second; flip that order. Read 26 Texas Administrative Code Chapter 553 for ALFs (or the relevant HCS/behavioral health rules for your population) before you sign anything ^[3]. Call your regional HHSC office and ask directly what license type fits your intended population, what plan review looks like for your city, and what the current processing timeline is running. HHSC processing times move around based on staffing and application volume, so get the current estimate rather than trusting a number from a blog post, including this one. Line up your administrator early. Some Texas ALF license types require a licensed administrator with specific training hours; verify current administrator licensing requirements with HHSC before you count on a particular hire. Budget for both a plan review and a physical inspection cycle, and build in slack for re-inspection if something gets flagged the first time (a missing fire door closer, a mislabeled medication cart, an incomplete staff file, these are the kinds of things that cause do-overs, not disqualifications). Finally, write your policy and procedure manual before your first hire, not after. Staff can't follow a medication administration policy that doesn't exist yet, and HHSC surveyors will ask to see it on day one of your survey.

What staffing does a licensed group home need in Texas?

Staffing requirements depend on your license type, but every Texas ALF must have enough staff awake and available to meet residents' scheduled and unscheduled needs, both during the day and overnight. Type B facilities, which serve residents needing nighttime attendance or evacuation assistance, generally carry stricter overnight staffing expectations than Type A facilities. HHSC rule requires facilities to have a sufficient number of qualified staff on duty to meet the needs of residents based on the facility's resident population and services offered, and to document staffing schedules that reflect actual coverage, more than planned coverage ^[3]. Surveyors will cross-check your posted schedule against time clock or sign-in records during inspection, so an accurate paper trail matters as much as the actual coverage. Medication aides and staff administering medications need specific state-approved training and, in most cases, a Medication Aide Permit from HHSC, unless a licensed nurse handles all medication administration directly. Administrators of certain ALF types must complete HHSC-approved training and continuing education; confirm current hour requirements with HHSC since these get updated periodically by rule. For HCS or IDD-focused group homes, staffing ratios and direct support professional qualifications are governed separately, tied to each resident's individual service plan and the acuity documented in it.

What does the inspection process actually look like?

HHSC conducts an initial licensing survey before your first license is issued, then periodic unannounced inspections after that, plus complaint investigations if someone files a complaint against the facility. Surveys check the physical building, staff files, resident records, medication storage, food service, and emergency plans against the standards in 26 TAC Chapter 553 for ALFs ^[3]. A typical survey day involves a walkthrough of the physical plant (checking things like handrails, exits, smoke detectors, and water temperature), a review of a sample of resident files and staff files, and interviews with residents and staff where possible. If the surveyor finds deficiencies, the facility gets a statement of deficiencies and must submit a plan of correction with a timeline for fixing each item. Serious violations, especially ones involving resident health and safety, can lead to enforcement action ranging from required corrective action to license suspension or revocation, depending on severity and history. HHSC posts inspection results publicly, and prospective residents' families increasingly check those records before choosing a facility, so treat every survey as both a compliance exercise and a reputation event. A fire marshal inspection, separate from the HHSC survey, is also required before licensing and periodically after, covering fire suppression systems, exits, and evacuation capacity specific to your resident population's mobility level.

What does it cost to license a group home in Texas?

Costs break into three buckets: state licensing fees, physical plant costs, and ongoing compliance costs, and only the first one is set by a public fee schedule. HHSC charges licensing fees that vary by facility size and license type; confirm the current fee schedule directly with HHSC since these are set and periodically adjusted by rule, not fixed in statute. Physical plant costs depend entirely on your building and location: a residential home converted to a Type A ALF costs far less to bring up to code than new construction designed for Type B evacuation-assistance needs. Add architectural or engineering review if your local jurisdiction requires stamped plans for occupancy changes. Ongoing costs include staff training and certification renewals, background check fees through DPS, liability insurance (which underwriters price based on resident acuity and facility size), and the administrative time of maintaining policy manuals, incident logs, and staff files ready for surprise inspection. A lot of first-time operators underestimate the paperwork cost specifically: writing a compliant policy and procedure manual, staffing plan, and emergency preparedness plan from scratch, matched to your state's exact rule citations, easily eats weeks of unpaid founder time. That's the specific gap the $299 State Group Home Licensing Kit at /licensing-kit-builder is built around: state-specific manual templates so you're filling in your facility's details instead of drafting policy language from a blank page.

How does zoning affect where I can open a group home?

Zoning determines whether you can legally operate a group home at a given address, and it's decided at the city or county level, completely separate from your HHSC license. A property can meet every HHSC physical plant requirement and still be illegal to operate at that address if local zoning doesn't allow it. Many Texas cities treat small group homes (six or fewer residents) as a permitted residential use, consistent with federal Fair Housing Act protections that limit how municipalities can restrict housing for people with disabilities. Larger facilities or ones serving bigger resident counts may fall under conditional use permits, special exceptions, or commercial zoning categories depending on the local ordinance. Before signing a lease, contact your city or county planning and zoning office directly and ask, in writing if possible, whether a licensed care facility of your specific size and population is permitted at that address. Get that answer before you invest in plan review or renovation, because a great house in the wrong zone is a very expensive lesson. For a deeper look at how to evaluate a specific property before committing to it, see assisted living facilities for a broader property and zoning walkthrough that applies across states.

Frequently asked questions

What is assisted living?

Assisted living is a care model that provides housing plus help with daily activities like bathing, dressing, and medication reminders, without the round-the-clock skilled nursing found in a nursing home. In Texas, it's delivered through licensed Assisted Living Facilities regulated by HHSC under Health and Safety Code Chapter 247.

What is a group home?

A group home is a residential setting where a small number of unrelated people live together with some level of supervision or care. In Texas, the specific license required (ALF, HCS provider, or certified recovery residence) depends on the population served, not on the term 'group home' itself.

What is an assisted living facility?

An assisted living facility is a licensed establishment that provides food, shelter, and personal care for four or more unrelated residents for longer than 24 hours, as defined in Texas Health and Safety Code Chapter 247. HHSC licenses ALFs as Type A, Type B, or Type C depending on resident mobility and care needs.

What is assisted living vs nursing home?

Assisted living helps residents with daily activities in a home-like setting; a nursing home provides 24-hour skilled nursing care for people with serious medical needs. Nursing homes must have licensed nurses on-site around the clock under Chapter 242; ALFs do not carry that same nursing staffing requirement.

What does assisted living provide?

At minimum, Texas ALF rules require meals meeting nutritional standards, a safe living environment, help with daily activities as needed, and a system for managing medications tied to each resident's service plan. Anything beyond that (memory care, transportation, therapy) depends on the individual facility's own service agreement.

Does Medicare cover assisted living facilities?

No. Medicare.gov states that Medicare typically doesn't cover non-medical long-term care costs, which includes assisted living room, board, and personal care. Medicare will still cover medical services a resident receives while living there, like doctor visits or physical therapy, just not the facility's monthly rate.

How do I start a group home in Texas?

Confirm your population and required license type with HHSC, check local zoning before committing to a property, submit building plans for review, write your staffing and policy manuals, complete background checks, pay the license fee, and pass your initial HHSC licensing survey before admitting residents.

What's the difference between assisted living and a nursing home in terms of who they serve?

Assisted living generally serves people who need supervision and help with daily activities but not ongoing medical intervention. Nursing homes serve people needing continuous skilled nursing care, such as wound care or IV therapy. The right setting depends on the resident's actual medical acuity, more than their age.

Does Medicaid pay for assisted living in Texas?

Texas Medicaid doesn't directly cover room and board in ALFs, but programs like STAR+PLUS and certain HCS waivers can cover personal care and some service costs for eligible low-income residents. Operators wanting to accept Medicaid-funded residents must enroll as Medicaid providers separately from their HHSC facility license.

How long does it take to get a group home license in Texas?

There's no fixed statewide timeline; it depends on plan review turnaround, inspection scheduling, and how complete your application is on first submission. Confirm current processing estimates directly with your HHSC regional office, since staffing and application volume both affect how long each step actually takes.

Do I need a special zoning permit for a group home in Texas?

It depends on your city or county and how many residents you plan to serve. Many municipalities treat small group homes as a permitted residential use consistent with Fair Housing Act protections, while larger facilities may need a conditional use permit. Confirm with your local planning department before signing a lease.

What license type do I need if I want to serve people with intellectual disabilities instead of seniors?

That population typically falls under Home and Community-based Services (HCS) provider enrollment rather than the standard ALF license used for seniors. The application, staffing rules, and service plan requirements differ from ALF licensing, so confirm the correct program with HHSC based on your intended resident population.

Sources

1. Texas Health and Safety Code, Chapter 260A: Recovery residences in Texas can be certified under Chapter 260A rather than licensed as facilities.
2. Texas Health and Safety Code, Chapter 247: Definition of an assisted living facility as serving four or more unrelated residents for more than 24 hours.
3. Texas Administrative Code, Title 26, Chapter 553: HHSC rules for ALF license types (A, B, C), staffing sufficiency, physical plant, and service requirements.
4. Texas Health and Safety Code, Chapter 242: Nursing homes are licensed under a separate chapter requiring 24-hour licensed nursing care and a medical director.
5. Medicare.gov, Long-Term Care: Medicare typically doesn't cover non-medical long-term care costs like assisted living room and board.
6. Texas HHSC, STAR+PLUS Program: STAR+PLUS managed care can cover personal care and long-term services and supports for eligible Medicaid members.