Last updated 2026-07-24
TL;DR
Opening a group home in Texas means picking the right license type through the Texas Health and Human Services Commission (HHSC), whether that's an Assisted Living Facility, a Community Home for people with IDD, or a licensed adult foster care setting, then meeting staffing, fire safety, and zoning rules before your pre-licensing inspection. Expect months of paperwork, 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 people who need support with daily living share a home with paid staff on site. In Texas, the term covers a lot of ground: homes for adults with intellectual or developmental disabilities (IDD), homes for people recovering from mental illness or substance use, and small assisted living settings for seniors. There isn't one single "group home license" in Texas. Instead, HHSC issues different license and certification types depending on who lives there and what care they need [1]. This matters because the application you file, the staffing ratios you follow, and the inspection checklist an HHSC surveyor uses are all different depending on which category your home falls into. A four-bed home for adults with IDD funded through the HCS Medicaid waiver is regulated differently than a 16-bed Type B assisted living facility for seniors who can't evacuate without help. Get the category wrong on your application and you'll lose weeks refiling. If you're still deciding which population to serve, it's worth reading up on assisted living facilities and assisted living before you commit to a license type, because switching later usually means a new application, not an amendment.
What is assisted living, and how is it different from a nursing home?
| Typical resident need | Help with ADLs, supervision | Skilled nursing, medical care |
|---|---|---|
| Nurse staffing | Not required 24/7 in all types | Licensed nurse coverage required |
| License types | A, B, C, E | Single facility license |
| Medicare coverage | Generally not covered | Short-term rehab stays may be covered |
Assisted living is a residential option for people 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 nursing home provides. Texas licenses these as Assisted Living Facilities (ALFs) under Texas Health and Safety Code Chapter 247, with four license types (A, B, C, E) based on the residents' mobility and evacuation capability [2]. A nursing home (called a "nursing facility" in Texas rules) is licensed separately under Health and Safety Code Chapter 242 and is built around skilled nursing, physician oversight, and rehabilitation services for people who typically need daily medical care [3]. Nursing facilities have registered nurses on staff around the clock in most cases; assisted living facilities do not carry that same nursing staffing requirement. The practical difference for an operator: a nursing facility is a medical institution with far heavier staffing, equipment, and Certificate of Need requirements in many states (Texas does not currently require CON for nursing facilities, but check current HHSC guidance). An assisted living facility is closer to a residential home with services layered in. If your business model is a small group home in a house, you almost certainly want the ALF path, not nursing facility licensure. | Feature | Assisted Living Facility (Ch. 247) | Nursing Facility (Ch. 242) |
What is an assisted living facility under Texas law?
Under Texas Health and Safety Code Section 247.002, 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, and provides personal care services beyond room and board [2]. The statute's actual language: an ALF "provides food and shelter to four or more persons who are unrelated to the proprietor of the establishment" and "provides personal care services" [2]. HHSC further splits ALFs into license types based on resident mobility and evacuation ability: - Type A: residents are physically and mentally capable of self-preservation in an emergency without staff help.
- Type B: residents need staff assistance to evacuate, or need nighttime attendance.
- Type C (also called "adult foster care" in the small-home context): a smaller, family-style home, generally serving three to four residents.
- Type E: a newer category HHSC created for facilities meeting specific dementia-care and higher-need criteria; confirm current type definitions with HHSC because these categories get updated periodically. If you're picturing a small residential home for three or four seniors who need medication help but can walk out on their own in a fire, you're likely looking at a Type A or Type C license. If your residents include people who can't self-evacuate, you need Type B, and that comes with heavier physical plant requirements (sprinklers, wider doorways, staff-to-resident ratios during overnight hours).
How do I start a group home in Texas, step by step?
Starting a licensed group home in Texas runs through several stages, and skipping ahead on any of them tends to cost you time later. Here's the sequence most operators follow, based on HHSC's published licensing process [4]: 1. Decide your population and license type. IDD group homes typically route through HHSC's Community Living Assistance and Support Services (CLASS) or Home and Community-based Services (HCS) waiver programs plus a facility license; assisted living for seniors goes through Chapter 247 ALF licensure; mental health and recovery residences may fall under different HHSC behavioral health licensing categories. Confirm which applies to you with your state licensing agency before you sign a lease. 2. Choose and secure a property that meets zoning and life-safety code requirements. This includes confirming the property is zoned for a residential care use (many cities treat small group homes as a protected residential use under the federal Fair Housing Act, but zoning still varies by municipality). Read up on zoning and property considerations before signing a lease you can't get licensed in. 3. Submit your license application to HHSC, including your policy and procedure manual, staffing plan, emergency preparedness plan, and financial disclosure. HHSC requires applicants to submit specific forms depending on facility type; check the current HHSC Provider Licensing and forms page for the exact packet [1]. 4. Pass your fire marshal and life safety code inspection, plus your HHSC pre-licensure survey. Surveyors check physical plant, staff files, resident record systems, and emergency plans against the rule text, not against a vibe. 5. Get your license issued, then keep operating within the terms: annual renewal, incident reporting, staff training documentation, and unannounced surveys are ongoing obligations, not one-time hurdles. Budget realistically for the timeline. Many states quote 60 to 120 days for licensing review once a complete application is submitted, but Texas HHSC does not publish one universal number across all license types, and incomplete applications restart the clock. Call your regional HHSC licensing office early and ask what their current average processing time looks like for your specific license type.
What licenses and certifications does Texas require, beyond the basic facility license?
Beyond the ALF or IDD facility license itself, expect to layer in several other requirements. A local fire marshal inspection and sign-off is standard for any residential care license in Texas; HHSC's life safety code review typically references the fire marshal's certification as part of the file [4]. A local health inspection may apply if you're serving prepared meals on site, depending on your municipality's food service rules. Staff working in the home generally need background checks run through the Texas Department of Public Safety and the HHSC Nurse Aide Registry / Employee Misconduct Registry check, confirming no one on staff is barred from working with vulnerable populations [1]. If your home participates in Medicaid waiver programs (HCS, CLASS, or others), your agency also needs a separate Medicaid provider enrollment on top of the facility license, which runs through HHSC and the Texas Medicaid & Healthcare Partnership. If you plan to administer medications, Texas rules generally require either a licensed nurse or specifically trained and delegated unlicensed staff (through a Registered Nurse delegation process) to handle medication administration in ALF settings. This is one of the most commonly cited deficiencies in state survey reports nationally, so build your medication management policy carefully rather than treating it as boilerplate.
What does assisted living actually provide day to day?
Assisted living in Texas typically provides three meals a day, help with activities of daily living (bathing, dressing, toileting, mobility), medication reminders or administration depending on staff licensure, housekeeping, laundry, and some level of social or recreational activity. It is not a medical model; it's a supportive residential model. HHSC's Chapter 247 rules require facilities to have a written plan of care for each resident, updated as needs change, along with staff trained to meet those needs [2]. Staffing ratios aren't fixed at one universal number across all Texas ALF types; instead, HHSC rules require "sufficient staff" to meet residents' needs based on acuity, with more prescriptive overnight coverage requirements for Type B facilities where residents can't self-evacuate. This is deliberately flexible language in the rule text, which means your staffing plan submitted with your application needs to show your math: how many residents, what acuity level, what shifts, what backup coverage. Surveyors will ask you to defend that plan against actual practice during inspection, so don't just copy a template staffing plan from another state. Food service also carries requirements: therapeutic diets when ordered by a physician, accommodation for allergies, and a dietitian consultation requirement in some facility types. If you're building your policy manual from scratch, this is one of the sections that takes the most iteration, because it has to match both the rule text and your actual kitchen capacity.
Does Medicare cover assisted living facilities?
No. Medicare does not cover the room and board or personal care costs of assisted living. CMS is direct about this: Medicare Part A and Part B do not pay for long-term custodial care in an assisted living facility, though Medicare may still cover medically necessary services a resident receives while living there, like doctor visits, physical therapy, or a short skilled nursing stay after a hospitalization [5]. This is one of the most common points of confusion for families and new operators alike. Medicare will pay for the nurse practitioner visit or the wound care supplies; it will not pay the facility's monthly rate. Payment for assisted living in Texas typically comes from private pay, long-term care insurance, or, for people who qualify financially and functionally, the STAR+PLUS Medicaid managed care program, which can cover assisted living services for eligible members through Texas's Medicaid managed care system [6]. If your business model depends on Medicaid waiver reimbursement (common for IDD group homes through HCS or CLASS, and increasingly for assisted living through STAR+PLUS), you need a Medicaid provider enrollment in addition to your HHSC facility license, and you should read the funding-and-medicaid considerations early, before you lock in your rent and staffing budget around an assumed reimbursement rate you haven't confirmed.
What are the zoning and property rules for a Texas group home?
Zoning is where a lot of otherwise well-prepared applicants get stuck, and it has nothing to do with HHSC. Cities and counties control zoning, and a property that's perfect on paper for an ALF license can still sit in a zone that doesn't allow a residential care business. The federal Fair Housing Act generally requires that small group homes for people with disabilities be treated as a permitted residential use, not subject to special zoning restrictions that don't apply to families of similar size, and courts have applied this to block cities from using zoning to exclude small group homes [7]. That said, "small" typically means something like six or fewer unrelated residents in most municipal codes; larger facilities can face more zoning scrutiny, and municipalities can still apply neutral rules like parking, occupancy limits, and building code compliance. Before you sign a lease or make an offer on a property, call the city or county planning department directly and ask: is a residential care facility of my resident count a permitted use in this zone, do I need a special use permit or conditional use permit, and what building code occupancy classification applies (this affects sprinklers, exits, and fire-rated walls). Skipping this step is one of the most expensive mistakes a new operator can make, because you can pass every HHSC requirement and still get blocked by a local zoning board.
What does the HHSC inspection actually check?
The pre-licensure inspection (and every renewal survey after it) checks your facility against the specific rule chapter for your license type. For an ALF, that means Texas Administrative Code Title 26, Chapter 553 provisions covering physical plant safety, resident rights, staffing, medication management, food service, and record keeping . Surveyors typically review: resident and staff files (background checks, training records, TB screening documentation), your policy and procedure manual against actual practice (do you do what your policy says you do), medication storage and administration logs, emergency and disaster preparedness plans, fire drills documentation, and physical plant items like smoke detectors, fire extinguishers, exit signage, and door widths. Common deficiencies flagged in Texas ALF surveys and cited broadly across long-term care licensing nationally include missing or expired staff training documentation, medication administration records with gaps, incomplete individual service plans, and fire drill logs that don't match the required frequency. Building your policy manual around the actual rule text, and then training your staff to follow it exactly (more than have it on a shelf), is the single best thing you can do to pass your first inspection cleanly. Read more on what to expect in inspections before your survey date is set.
How much does it cost to open a group home in Texas?
Costs vary enormously depending on whether you're buying a home, leasing one, or converting an existing property, so treat any flat number with suspicion. That said, a few real cost categories to budget for: HHSC license application and inspection fees vary by facility type and bed count; confirm the exact current fee schedule with HHSC's Provider Licensing division rather than relying on an old number, because fee schedules get updated [1]. Beyond the state fee, budget for a fire marshal inspection fee (set locally), any required sprinkler system retrofit if your building doesn't already meet Type B life safety code, background check fees per staff member, liability insurance (a real and recurring cost that new operators frequently underestimate), and the policy manual and staffing plan development itself, whether you build it yourself or use a template. Many operators underestimate the soft costs: the months of carrying rent or a mortgage on a property while your application is under review, staff you hire and train before you have a single paying resident, and the admin time spent responding to HHSC's requests for additional documentation. If your paperwork is clean and complete on first submission, you avoid the most common source of delay, which is back-and-forth correction cycles rather than the review itself taking long. Building a compliant policy and procedure manual from the actual Texas rule text, rather than adapting a generic template from another state, is genuinely one of the higher-leverage places to spend money or time up front. This is the gap our $299 State Group Home Licensing Kit is built to close: a starting policy manual and staffing plan framework built around your state's specific licensing rules, so you're not paying an attorney by the hour to draft from a blank page.
What's the difference between assisted living and IDD group homes in Texas staffing and rules?
An assisted living facility under Chapter 247 and an IDD group home funded through HCS or CLASS waivers are regulated on different tracks, even though both can look like a house with a few residents and paid staff. ALFs answer to Chapter 247 and its administrative rules, with staffing tied to resident mobility and acuity as discussed above [2]. IDD group homes, by contrast, are usually tied to a specific Medicaid waiver program (HCS or CLASS), which comes with its own service planning requirements, staff qualification standards (often including specific training in behavior support and person-centered planning), and a different HHSC survey process focused on individual service plans and habilitation goals rather than a medical model of care. Staff in IDD settings typically need training in the state's approved curriculum for direct support professionals, and HHSC's contract monitoring for waiver providers is a separate compliance track from facility licensure itself. If you're building a business that could serve either population, don't assume the paperwork is interchangeable. The application forms, the survey tools, and the reimbursement mechanism (Medicaid waiver billing versus private pay or STAR+PLUS) are genuinely different systems, and conflating them in your business plan is a common early mistake.
Frequently asked questions
What is assisted living?
Assisted living is a residential care option for people who need help with daily activities like bathing, dressing, and medication reminders, but not full-time skilled nursing care. In Texas, these are licensed as Assisted Living Facilities under Health and Safety Code Chapter 247, with license types based on resident mobility and evacuation ability [2].
What is a group home?
A group home is a residential setting, usually a house, where several unrelated people who need support with daily living share housing with paid staff. In Texas this can mean a small assisted living facility for seniors, a Community Home for people with IDD, or a licensed home for people in mental health or substance use recovery, each regulated under different HHSC rules [1].
What is an assisted living facility?
Under Texas Health and Safety Code 247.002, an assisted living facility furnishes food, shelter, and personal care services to four or more unrelated residents, going beyond basic room and board into help with daily living activities [2]. Texas licenses ALFs as Type A, B, C, or E depending on residents' ability to evacuate without staff assistance.
What is assisted living vs nursing home?
Assisted living provides help with daily living and light supervision in a residential setting, licensed under Chapter 247 in Texas. A nursing home, licensed under Chapter 242, provides skilled nursing and medical care with licensed nurses on staff around the clock [2][3]. Nursing homes suit people needing ongoing medical management; assisted living suits people needing supportive daily care.
Does Medicare cover assisted living facilities?
No. Medicare does not pay for room, board, or personal care in an assisted living facility. CMS confirms Medicare may still cover medically necessary services a resident receives, like doctor visits or short-term skilled nursing after a hospital stay, but not the facility's monthly rate itself [5]. Most residents pay privately or through Medicaid managed care programs like STAR+PLUS.
How do I start a group home in Texas?
Decide which population and license type fits (ALF, IDD waiver home, or behavioral health license), secure a property that clears local zoning and fire code, submit your HHSC application with a policy manual and staffing plan, pass your fire marshal and HHSC surveys, and then maintain compliance through ongoing training, incident reporting, and renewal surveys [1][4].
How long does it take to get a group home license in Texas?
There's no single published timeline across all Texas license types. Many states quote 60 to 120 days for a complete application, but incomplete submissions restart HHSC's review clock. Call your regional HHSC licensing office directly and ask for their current average processing time for your specific license type before you finalize a lease timeline.
Can any house be used for a Texas group home?
No. The property has to clear local zoning (many small group homes qualify as a protected residential use under the Fair Housing Act, but city rules on occupancy and parking still apply), plus building and fire code requirements tied to your license type. Type B facilities, where residents can't self-evacuate, generally require more extensive physical plant upgrades like sprinklers.
What staffing does a Texas assisted living facility need?
Texas rules require 'sufficient staff' to meet residents' needs based on acuity rather than one fixed ratio, with more specific overnight coverage rules for Type B facilities where residents need help evacuating. Your staffing plan, submitted with your license application, has to show the math behind your coverage and hold up during HHSC's inspection.
Do I need a nurse on staff for a Texas group home?
It depends on license type and services offered. Assisted living facilities don't require 24/7 licensed nursing coverage the way nursing facilities do, but medication administration generally requires either a licensed nurse or unlicensed staff trained and delegated through a registered nurse delegation process under Texas rules.
What's the difference between a group home and assisted living facility?
In everyday language people use 'group home' broadly, but in Texas licensing terms, an assisted living facility is a specific license category under Chapter 247 for adults, usually seniors, needing help with daily living. 'Group home' more often refers informally to IDD or behavioral health residential settings licensed under a different HHSC track entirely.
How much does it cost to open a group home in Texas?
Costs vary widely by property, bed count, and license type: HHSC application fees, fire marshal inspection fees, possible sprinkler retrofits, background checks, liability insurance, and staffing before you have paying residents. Confirm current fee schedules directly with HHSC's Provider Licensing division rather than relying on outdated figures.
Does Texas require a background check for group home staff?
Yes. Staff generally need a criminal history check through the Texas Department of Public Safety and a check against the HHSC Employee Misconduct Registry and Nurse Aide Registry to confirm they aren't barred from working with vulnerable populations, as part of standard HHSC licensing requirements for residential care staff.
Sources
- Texas HHSC, Provider Licensing and Forms: HHSC issues different license and certification types for residential care facilities and publishes application forms by facility type
- Texas Health and Safety Code, Chapter 247: Definition of assisted living facility and the four ALF license types (A, B, C, E)
- Texas Health and Safety Code, Chapter 242: Nursing facilities are licensed separately from assisted living facilities under Chapter 242
- Texas HHSC, Long-term Care Provider Licensing Process: Sequence of license application, physical plant review, and survey required before a facility license is issued
- CMS/Medicare.gov, Assisted Living Coverage: Medicare does not cover long-term custodial care such as assisted living, though it may cover related medical services
- Texas HHSC, STAR+PLUS Medicaid Managed Care: STAR+PLUS is the Texas Medicaid managed care program that can cover assisted living services for eligible members
- Texas Administrative Code, Title 26, Chapter 553: State rules governing ALF physical plant, staffing, medication management, and resident rights used during HHSC inspections