Last updated 2026-07-25
TL;DR
Texas assisted living facilities are licensed by the Health and Human Services Commission under Texas Health and Safety Code Chapter 247. You'll need a Type A, B, or C license depending on resident acuity, a state application and fee, a life-safety inspection, and staffing that meets 26 TAC Chapter 553 rules before HHSC issues the license.
What is assisted living?
Assisted living is housing plus personal care for adults who need help with daily activities like bathing, dressing, medication reminders, or meal prep, but who don't need the round-the-clock skilled nursing you'd find in a nursing home. Residents typically have their own room or apartment, share common spaces, and get support from staff who are on-site but not necessarily medical professionals. In Texas, the state doesn't use the phrase loosely. "Assisted living facility" is a licensed category defined in Texas Health and Safety Code Chapter 247, and any establishment providing personal care services to four or more unrelated adults for pay has to hold that license [1]. Smaller homes serving three or fewer residents may fall outside the ALF licensing requirement depending on the arrangement, which is one reason people confuse assisted living with informal adult foster care. Always confirm the resident-count threshold and any exemptions with your state licensing agency before you assume you're exempt. The federal government doesn't license assisted living at all. Licensing is a state function, which is why Texas rules look different from Florida's or California's. If you're comparing models across states, the assisted living facility overview is a good starting point before you get into Texas specifics.
What is a group home?
A group home is a residential setting, usually a house, where a small number of unrelated people live together and get supervision or care matched to a specific need, like intellectual and developmental disabilities (IDD), mental health recovery, or substance use recovery. The term is used loosely across the industry, but in regulatory terms a group home is almost always a smaller, more specialized operation than a licensed assisted living facility. In Texas, group homes for people with IDD are typically licensed as Home and Community-based Services (HCS) providers or Intermediate Care Facilities (ICF/IID) under separate HHSC rules, not under the assisted living statute. Group homes for seniors needing personal care, on the other hand, often end up needing an ALF license once they cross the four-resident threshold. If your model is IDD-focused rather than senior personal care, you're on a different licensing track entirely, and mixing them up early is a common (and expensive) planning mistake. The assisted living facilities hub breaks down how these categories diverge state by state.
What is an assisted living facility, exactly, under Texas law?
| Type A | Residents who can evacuate on their own, no significant behavioral or nursing needs | Lowest acuity, fewest staffing requirements | |
|---|---|---|---|
| Type B | Residents who need staff assistance to evacuate, or have moderate physical/cognitive limitations | More staff coverage, awake night staff required | |
| Type C (also called "small facility" in some HHSC materials) | Small, often adult foster care style settings | Different physical plant and staffing thresholds | HHSC's licensing rules for these categories live in 26 Texas Administrative Code Chapter 553 [2]. The exact staffing ratios, physical plant specs, and fire code requirements differ by type, so pick your license type based on the residents you actually intend to serve, not the one with the lightest paperwork. Downgrading acuity to avoid Type B or C requirements later gets flagged fast in survey. |
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 that provides personal care services for compensation [1]. Personal care means help with dressing, bathing, eating, or similar activities of daily living, along with supervision of self-administered medication. Texas issues three license types depending on the population served: | License type | Who it serves | Key feature |
What does assisted living provide day to day?
Assisted living provides three things bundled together: a place to live, meals, and help with daily activities. Beyond that baseline, most Texas ALFs also offer medication reminders (not administration, unless staff are appropriately credentialed), housekeeping, laundry, transportation coordination, and some level of social or recreational programming. What assisted living does not typically provide is skilled nursing care, like IV therapy, wound care beyond basic first aid, or ventilator management. Texas rules require that if a resident's needs exceed what the facility's license type allows, the facility has to arrange a transfer or bring in licensed home health services under a coordinated care plan. HHSC surveyors check resident records specifically for this kind of "scope creep," where a resident's condition has quietly moved beyond what the facility is licensed to handle. Staffing has to be "sufficient in numbers and qualifications to meet the needs of residents" per 26 TAC Chapter 553 [2], and Type B facilities specifically require an awake attendant on duty at all times. That's a real cost driver worth budgeting for early, not something to discover after you've signed a lease.
What's the difference between assisted living and a nursing home?
Assisted living and nursing homes differ mainly in the level of medical care and the regulatory framework behind them. Nursing homes (called skilled nursing facilities federally) provide 24-hour licensed nursing care and are certified for Medicare and Medicaid reimbursement under federal nursing home requirements in 42 CFR Part 483 [3]. Assisted living facilities are licensed at the state level only, with no equivalent federal certification program, and staff generally are not required to include round-the-clock RNs. Cost structures differ too. Nursing home care is billed largely through Medicare Part A (for short skilled stays) and Medicaid (for long-term custodial care), while assisted living is almost always private-pay or funded through a state Medicaid waiver program, not standard Medicaid. Genworth's Cost of Care data, last published in detail for 2021 (with newer years available by subscription), put the median U.S. assisted living cost around $4,500/month and nursing home semi-private room cost around $7,908/month [4]. Texas-specific numbers move year to year, so check current HHSC or AARP cost-of-care resources rather than relying on national medians for your business plan. The regulatory difference matters operationally too: a nursing home resident who declines medically doesn't have to move, because the facility is licensed for that level of care. An assisted living resident who declines past what the ALF's license type allows may need to transfer, which is a discharge planning issue Texas surveyors look at closely.
Does Medicare cover assisted living facilities?
No. Medicare does not pay for assisted living room and board or personal care services. CMS is explicit about this: Medicare covers medically necessary skilled care in specific settings, but "Medicare doesn't cover long-term care (also called custodial care)" including the type of help most assisted living residents need with daily activities [5]. Medicare may still pay for medical services a resident receives while living in an ALF, like doctor visits, physical therapy, or durable medical equipment, but it will not cover the facility's monthly rate for housing, meals, or personal care staff. That distinction confuses a lot of families and prospective operators alike. Medicaid is a different story, but even there, Texas Medicaid doesn't pay assisted living room and board directly. Some residents may qualify for the STAR+PLUS Home and Community Based Services waiver, which can help cover personal care and habilitation services for eligible low-income residents in certain assisted living settings, but families still typically pay room and board out of pocket [6]. If Medicaid waiver funding is part of your business model, talk to HHSC's Medicaid and CHIP Services division early, because waiver slots and provider enrollment have their own separate application track from the ALF license itself.
How do I start a group home or assisted living facility in Texas?
Starting an assisted living facility in Texas runs through the HHSC Long Term Care Regulatory division, and the process has a handful of concrete steps you can plan around. 1. Decide your license type and business structure. Pick Type A, B, or C based on the residents you'll serve, and set up your legal entity (LLC or corporation) before you apply, since HHSC licenses the operating entity, more than the building. 2. Secure and prep your site. You need a location that meets 26 TAC Chapter 553 physical plant standards (room sizes, exits, fire suppression) and local zoning approval. Zoning is a state-by-state, city-by-city variable; confirm with your municipality and county before you sign a lease, because a residential-zoned property that's fine for a family home may still need a conditional use permit for a licensed facility. 3. Submit the license application to HHSC. This includes facility floor plans, ownership disclosure, criminal background checks for owners and staff (through the Texas DFPS/HHSC background check system), and your policy and procedure manual covering admission criteria, medication management, emergency preparedness, and resident rights. 4. Pass the life safety and health inspection. HHSC and, for larger or higher-acuity facilities, the State Fire Marshal's office will inspect before licensure. Expect them to check exits, sprinkler or smoke detector coverage, resident room square footage, and staff files. 5. Build your staffing plan and hire. Texas requires administrators to meet specific training or licensure requirements depending on facility type, and direct care staff need required orientation hours before working unsupervised. Confirm current administrator qualification requirements with HHSC, since these have been updated in past rule cycles. 6. Get your license and open. Once HHSC issues the license, you're subject to ongoing unannounced inspections, typically annual, plus complaint-driven surveys if anyone files a grievance. Application fees, renewal fees, and the exact document checklist change periodically, so confirm current amounts directly on the HHSC Assisted Living Facilities licensing page [7] rather than trusting a number from an old blog post, including this kind of overview. If you want a structured way to organize the paperwork side (policy manuals, staffing plans, forms) before you submit, the $299 State Group Home Licensing Kit is built around exactly this kind of state-specific document assembly, though it doesn't replace direct confirmation with HHSC on current fees and forms.
How long does Texas ALF licensing actually take?
HHSC doesn't publish a single guaranteed timeline, and you shouldn't trust anyone who promises one. Realistically, expect the process from application submission to license issuance to run several months, driven mainly by how quickly your physical plant passes inspection and how complete your paperwork is on first submission. The biggest delay drivers, based on how state licensing processes generally work across states, are incomplete background check submissions, floor plans that don't match actual construction, and policy manuals missing required sections (emergency preparedness plans and medication management policies are common gaps). None of these get fixed by rushing; they get fixed by having the document checklist right the first time. Budget for a second inspection visit as a real possibility, not a failure. Minor corrections (a missing fire extinguisher tag, an unlabeled medication cart) are routine and don't usually restart your whole application.
What staffing does Texas require in an assisted living facility?
Texas staffing rules under 26 TAC Chapter 553 require facilities to have enough staff, in both number and qualification, to meet residents' scheduled and unscheduled needs at all times [2]. Type B facilities specifically require an awake staff member on duty overnight, since residents at that level need help evacuating. Type A facilities have somewhat lighter overnight requirements since residents are expected to self-evacuate. Administrators must meet training or licensure standards set by HHSC, and direct care staff need documented orientation before working alone with residents, plus ongoing training on topics like abuse/neglect reporting, infection control, and emergency procedures. Medication aides who assist with medication administration (beyond simple reminders) generally need to be certified through the Texas Department of State Health Services medication aide program. Staffing ratios aren't a single fixed number across all facilities; they scale with resident acuity and facility type, which is exactly why picking the right license type up front matters so much for your labor cost model.
How does Texas ALF licensing compare to other states?
Every state licenses assisted living differently, and Texas is neither the strictest nor the loosest. States like Florida and California have their own three-tier or acuity-based systems too, but the specific thresholds (resident count, staffing ratios, medication administration rules) don't transfer across state lines. If you're building a multi-state footprint or just comparing before you commit to Texas, the senior assisted living facilities near me and facility assisted living guides walk through how other states structure their license categories, which helps you spot what's unusual about Texas's Type A/B/C system versus, say, a state that licenses purely by bed count. One thing that is consistent everywhere: no state issues a federal Medicare certification for assisted living, and every state treats it as a state-regulated personal care and housing service rather than a medical facility, following the pattern set at the federal level for nursing homes versus the largely state-only oversight of ALFs [3].
What inspections and ongoing compliance should I expect?
Once licensed, Texas assisted living facilities go through routine HHSC surveys, typically on an annual cycle, plus complaint investigations triggered by resident, family, or staff reports. Surveyors check resident records, medication logs, staff training files, physical plant conditions, and resident rights compliance. Common citation areas in personal care and assisted living surveys nationally include medication management errors, incomplete staff training documentation, and inadequate resident care plan updates. Texas-specific citation data is published through HHSC's survey and certification reports; if you want to see actual deficiency patterns before you open, request recent survey history for comparable facilities through HHSC's public records process. A license can be denied, suspended, or revoked for serious violations, and HHSC has enforcement authority under Chapter 247 to issue administrative penalties short of full revocation for lesser violations [1]. Keep your policy manual current and your staff training documented in real time; "we did the training but didn't log it" is functionally the same as not having done it, from a surveyor's perspective.
Frequently asked questions
What is assisted living?
Assisted living is a housing and care model for adults who need help with daily activities like bathing, dressing, or medication reminders but don't require 24-hour skilled nursing. Residents live in private or shared rooms with access to meals, staff support, and social activities. It's licensed at the state level, and in Texas that means holding a Type A, B, or C license 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 staff support matched to a specific need, such as IDD, mental health, or recovery. Licensing varies widely by population; in Texas, IDD group homes are typically licensed under HCS or ICF/IID programs, separate from the assisted living facility license used for senior personal care homes.
What is an assisted living facility?
Under Texas Health and Safety Code Section 247.002, an assisted living facility is an establishment providing food, shelter, and personal care services for compensation to four or more unrelated residents. It's a distinct licensed category from nursing homes, adult day care, or unlicensed independent living, and Texas issues Type A, B, or C licenses based on resident acuity.
What is assisted living vs nursing home?
Assisted living provides housing plus help with daily activities; nursing homes provide 24-hour skilled nursing care and are federally certified under 42 CFR Part 483. Assisted living is state-licensed only, with no federal certification equivalent, and is typically private-pay, while nursing home stays are often covered short-term by Medicare Part A or long-term by Medicaid.
What does assisted living provide?
Assisted living provides housing, meals, and personal care help such as bathing, dressing, and medication reminders, plus housekeeping, laundry, and social programming in most facilities. It does not provide skilled nursing services like IV therapy or complex wound care; residents whose needs exceed the facility's license type must transfer or receive coordinated outside home health services.
How do I start a group home in Texas?
Pick your license type (Type A, B, or C for senior assisted living, or a separate IDD program license if serving that population), secure a compliant and properly zoned property, submit your application and policy manuals to HHSC, pass background checks and a life safety inspection, build your staffing plan, and wait for HHSC to issue the license before admitting residents.
Does Medicare cover assisted living facilities?
No. CMS states Medicare doesn't cover long-term custodial care, which includes most assisted living room, board, and personal care costs. Medicare may still pay for separate medical services a resident receives, like doctor visits or physical therapy, but not the facility's monthly rate. Some residents may qualify for Texas Medicaid waiver programs that help cover personal care costs, though not room and board.
What's the difference between Type A, Type B, and Type C assisted living licenses in Texas?
Type A serves residents who can self-evacuate and have no significant nursing or behavioral needs. Type B serves residents who need staff help evacuating or have more physical or cognitive limitations, requiring awake overnight staff. Type C covers small, adult-foster-care-style settings with different physical plant and staffing rules under 26 TAC Chapter 553.
How much does it cost to get a Texas assisted living license?
HHSC publishes current application and licensing fees on its Assisted Living Facilities licensing page, and these amounts change periodically, so don't rely on older secondhand figures. Beyond the state fee, budget for background checks, fire marshal inspection costs, and any physical plant modifications needed to meet Chapter 553 building standards.
Can I run an assisted living facility out of my house in Texas?
Possibly, depending on resident count and local zoning. Facilities serving four or more unrelated residents generally need an ALF license under Chapter 247, and residential zoning rules vary by city and county, so a conditional use permit is often required even for smaller home-based operations. Confirm both the resident threshold and zoning requirements with your local planning department before committing to a property.
What staffing is required for a Texas assisted living facility?
Texas requires staffing sufficient in number and qualification to meet resident needs at all times under 26 TAC Chapter 553. Type B facilities require an awake staff member overnight due to higher resident acuity. Administrators need to meet HHSC training or licensure standards, and medication aides generally need certification through the state's medication aide program.
How long does it take to get licensed as an assisted living facility in Texas?
There's no single guaranteed timeline; the process commonly takes several months from application to license issuance, depending on how quickly your building passes life safety inspection and how complete your paperwork is. Incomplete background checks or missing policy manual sections (like emergency preparedness or medication management) are common causes of delay.
Sources
- Texas Statutes, Health and Safety Code Chapter 247: Definition of assisted living facility and licensing authority in Texas
- Texas Administrative Code, Title 26, Chapter 553: Staffing sufficiency requirements and Type A/B/C facility standards
- Electronic Code of Federal Regulations, 42 CFR Part 483: Federal requirements for nursing homes distinct from state-only assisted living licensing
- Genworth Cost of Care Survey 2021: National median monthly costs for assisted living versus nursing home care
- Medicare.gov, Long-Term Care: Medicare does not cover long-term custodial care including most assisted living costs
- Texas HHSC, STAR+PLUS Home and Community Based Services: Texas Medicaid waiver program that can help cover personal care services for eligible residents
- Texas HHSC, Assisted Living Facilities licensing information: Current application process, fees, and license type information for Texas ALFs