Texas group home licensing: the full 2026 setup guide

Last updated 2026-07-25

What is a group home, exactly, in Texas terms?

A group home is a residential setting where a small number of unrelated people, usually people with disabilities, mental illness, or age-related needs, live together and get support with daily activities and sometimes medical care. Texas doesn't use "group home" as a formal license category. Instead, the Texas Health and Human Services Commission (HHSC) licenses these operations under categories like Assisted Living Facility (ALF), Home and Community Support Services Agency (HCSSA), or through the IDD provider enrollment system tied to HHSC's 1915(c) waiver programs ^[1]. So when people search "Texas group home licensing," they're usually asking about one of three different regulatory paths: a small residential home for seniors or adults with disabilities needing personal care (ALF), a home health or hospice-style agency delivering skilled or personal care in a residence (HCSSA), or a licensed provider agency operating Home and Community-based Services (HCS) or Texas Home Living (TxHmL) group homes for people with intellectual and developmental disabilities ^[2]. Get the population wrong at the start and you'll fill out the wrong application, pay the wrong fee, and wait months for HHSC to tell you to start over. This is the single most common mistake first-time operators make in Texas.

What is assisted living, and how does Texas define an assisted living facility?

Assisted living is a residential care model for adults who need help with activities of daily living (bathing, dressing, medication reminders, mobility) but don't need the round-the-clock skilled nursing care of a nursing home. In Texas, an assisted living facility is legally defined and licensed under Texas Health and Safety Code Chapter 247 and its implementing rules in 26 Texas Administrative Code Chapter 553 ^[3]. Texas Health and Safety Code §247.002 defines an assisted living facility as "an establishment that furnishes, in one or more facilities, food and shelter to four or more persons who are unrelated to the proprietor of the establishment" and provides personal care services, or administers medication, or has a service agreement with a licensed home health or hospice agency to provide these services ^[4]. Note the threshold: four or more unrelated residents triggers the license requirement. Smaller homes with three or fewer residents may fall outside ALF licensing, though local zoning and other state rules can still apply, so confirm with your state licensing agency before assuming an exemption applies to your specific setup. Texas assigns ALFs into license types based on the level of care residents need: Type A (residents who are physically and mentally capable of evacuating the building without help), Type B (residents who need staff assistance to evacuate, or who are not capable of following directions in an emergency), and Type C, which covers small "adult foster care" homes of three to sixteen residents that meet specific requirements ^[5]. If your model matches what most people picture when they say "group home for seniors," you're most likely looking at Type B licensing, since many residents in these homes need help evacuating or have cognitive impairment. For background on how assisted living licensing works across states generally, see our assisted living facility guide and our page on assisted living facilities near you concept, which explains how state rules shape what you'll find in a local market search.

What is assisted living vs nursing home, and how does that distinction matter for licensing?

Assisted living provides help with daily living and light health monitoring in a home-like setting; a nursing home (called a "nursing facility" in Texas rule) provides 24-hour skilled nursing care for people with serious medical needs. The difference matters enormously for licensing because nursing facilities are regulated under a completely different chapter, Texas Health and Safety Code Chapter 242, with far more intensive staffing, physician oversight, and Medicaid certification requirements ^[6]. If your residents need injections, wound care, IV therapy, or ventilator support around the clock, you're in nursing facility territory, and that license is a different, heavier lift with its own application, survey process, and much higher staffing ratios. If your residents are largely independent but need supervision, medication management, and help with two or three activities of daily living, ALF licensing fits better. A lot of people ask "what is assisted living vs nursing home" expecting a simple answer, but the honest answer is that it's a spectrum, and Texas draws the regulatory line based on the level of skilled nursing care needed, more than resident age or diagnosis. Get a documented assessment of what your target population actually needs before you pick a license type. Guessing wrong here costs you an application fee and months of delay.

What does assisted living provide, day to day, under Texas rules?

Under Texas rule, an assisted living facility must provide, at minimum, three meals a day plus snacks, housekeeping, laundry, staff-provided personal care assistance, social and recreational activities, and 24-hour supervision by awake staff for Type B facilities ^[5]. Medication administration or assistance is common but the facility has to have a documented policy and, in many cases, a licensed nurse involved depending on whether staff are administering versus merely assisting with self-administered medication. 26 TAC §553.261 sets minimum staffing: Type B facilities must have staff awake and on duty 24 hours a day, and the ratio of staff to residents has to be sufficient to meet resident needs based on the facility's own assessment and staffing plan, which HHSC reviews at licensing and during inspections ^[7]. There's no single statewide numeric ratio like "1 staff per 8 residents" written into Texas ALF rule; instead the facility submits a staffing plan tied to its resident acuity mix, and inspectors check whether that plan is actually being followed. Beyond care, the physical building has to meet specific requirements: minimum square footage per resident bedroom, a minimum number of bathrooms per resident count, emergency lighting, smoke detectors, and a current life safety inspection from the state fire marshal's office or local authority having jurisdiction ^[3]. This is where a lot of applicants get tripped up, because they buy or lease a house before confirming it can meet these physical plant requirements, and retrofitting an existing residential structure is expensive.

How to start a group home in Texas: what's the actual sequence?

Starting a Texas group home (whether ALF, HCSSA, or IDD provider) follows a similar backbone even though the specific forms differ. Here's the realistic sequence, not the marketing version. 1. Pick your population and license type. Decide whether you're serving seniors needing custodial care (ALF), people needing skilled home health services in a residential setting (HCSSA), or people with intellectual/developmental disabilities under a Medicaid waiver (HCS/TxHmL provider enrollment). This decision drives everything downstream, including which HHSC division reviews your application. 2. Check zoning and land use before you sign a lease. Texas municipalities regulate group homes through local zoning codes, and federal Fair Housing Act protections limit how cities can restrict small group homes for people with disabilities, but the protections and exceptions are nuanced and vary by city ordinance. Confirm with your local planning department and your state licensing agency before committing to a property. 3. Prepare and submit your license application to HHSC Long-Term Care Regulation. For ALFs, this means submitting the application, a set of required policies (admission, discharge, medication, emergency preparedness, abuse/neglect reporting), proof of financial solvency, and the applicable license fee. HHSC posts current ALF application fees on its licensing fee schedule, and fees vary by facility bed capacity, so confirm the current fee amount with HHSC directly rather than relying on a fixed number here, since fee schedules get updated ^[8]. 4. Pass a pre-licensing inspection. HHSC or its designated inspection contractor visits the physical site to confirm life safety code compliance, resident room setup, kitchen and bathroom requirements, and emergency systems before issuing the license. 5. Hire and train staff according to your submitted staffing plan, including required background checks through the Texas Department of Public Safety and the HHSC Nurse Aide Registry / Employee Misconduct Registry checks for anyone with direct resident contact ^[9]. 6. Get your license issued, then prepare for ongoing annual or biennial inspections and complaint-driven surveys. This is also where a lot of operators realize the paperwork burden is heavier than expected: policy manuals, staffing plans, emergency preparedness plans, and resident rights disclosures all need to exist in writing before HHSC will even schedule your inspection. A licensing kit built around actual state requirements, like our $299 State Group Home Licensing Kit, can save you the weeks it takes to draft these documents from a blank page, though you'll still need to customize it to your specific facility and confirm every detail against current HHSC rule text.

How do I start a group home for people with intellectual or developmental disabilities specifically?

If your model is a small IDD group home funded through Medicaid waiver services, the pathway runs through HHSC's Home and Community-based Services (HCS) program or Texas Home Living (TxHmL), not the standard ALF license. HCS group homes serve people with intellectual disabilities or related conditions and are licensed under 40 TAC Chapter 9, Subchapter D, with the provider also required to enroll as a Medicaid provider through HHSC and contract to deliver waiver services ^[10]. The process here has an extra layer most ALF operators don't face: you need a HCS/TxHmL contract with HHSC in addition to your facility license, and new HCS providers in many cases go through a moratorium or waitlist process tied to waiver slot availability, since HCS group home enrollment isn't simply open on demand the way ALF licensing is. Check the current status of new provider enrollment directly with HHSC's IDD services division before building a business plan around this model, because policy on new provider contracts changes. Staffing in HCS group homes is driven by each resident's individual plan of care, developed through the person-directed planning process, rather than a flat ratio, and direct support staff need specific competency-based training documented before they can work unsupervised with residents ^[11].

Does Medicare cover assisted living facilities in Texas or anywhere else?

No. Medicare does not cover the cost of room and board or personal care services in an assisted living facility, in Texas or any other state. Medicare.gov states plainly that Medicare "doesn't cover assisted living or other long-term care facility costs," though Medicare will still cover medically necessary services like doctor visits, physical therapy, or short-term skilled nursing after a qualifying hospital stay, even if the person happens to live in an assisted living facility ^[12]. This surprises a lot of families and even some first-time operators building a business model around Medicare reimbursement, so it's worth saying directly: don't build your financial plan assuming Medicare will pay for custodial assisted living care, because it won't. Medicaid is a different story. Texas offers Medicaid-funded assistance for long-term services through STAR+PLUS managed care and through HCS/TxHmL waivers for IDD populations, but this funding generally supports services, not room and board, in most residential settings, and eligibility and funding structures are complex enough that you should work through the details with HHSC's Medicaid and CHIP division or a benefits counselor before assuming any specific reimbursement rate ^[13]. See our related coverage in assisted living for a broader look at how funding sources interact with licensing across models.

What zoning and property issues come up for Texas group homes?

Texas cities regulate group homes primarily through zoning ordinances, and federal law limits how far those ordinances can go in restricting small residential care homes for people with disabilities. The Fair Housing Act (42 U.S.C. §3601 et seq.) and the Fair Housing Amendments Act of 1988 prohibit municipalities from using zoning to exclude group homes for people with disabilities in ways that treat them differently from other unrelated households of similar size, absent a legitimate, non-discriminatory reason ^[14]. In practice, this means many cities allow a small group home (often defined as six or fewer unrelated residents with disabilities) to operate in a single-family residential zone as a matter of right, similar to a family, while larger facilities may need a conditional use permit or fall under commercial zoning. But local ordinances vary block by block and city by city in Texas, so you cannot assume a zoning classification from one city applies in another. Confirm zoning classification, occupancy limits, parking requirements, and any required conditional use permit process directly with the specific city or county planning department before signing a lease or purchase agreement. Beyond zoning, the physical building has to pass a life safety inspection tied to your license type. Many Texas group home operators looking to open in a residential neighborhood underestimate how much retrofit work (fire-rated doors, sprinkler requirements above certain occupancy thresholds, accessible bathroom modifications) an older single-family home needs before it will pass. Get the fire marshal or licensing inspector's input on a property before you close on it, not after.

What staffing and training does Texas require for group home employees?

Texas requires criminal background checks for anyone with direct access to residents in a licensed facility, run through the Texas Department of Public Safety, and HHSC also checks the Nurse Aide Registry and Employee Misconduct Registry to screen out individuals with substantiated findings of abuse, neglect, or exploitation ^[9]. Facilities cannot employ someone with a disqualifying criminal history or registry finding in a position with direct resident contact. For ALFs, staff providing personal care need training appropriate to their role, and administrators of Type B facilities need to meet specific qualification requirements under 26 TAC §553.51, which can include a combination of education, experience, and passing a state administrator's exam or equivalent, depending on facility type ^[15]. For HCS group homes, direct support professionals need documented, competency-based training tied to each resident's specific support needs before working unsupervised, per HHSC's IDD provider training rules ^[11]. One detail operators miss: staffing plans aren't a one-time filing. HHSC inspectors check, during routine and complaint surveys, whether actual staffing on the ground matches what you submitted at licensing. If your census grows or resident acuity changes, update your staffing plan and be ready to show documentation, more than tell the inspector your policy on paper.

What happens during a Texas group home inspection?

HHSC's Long-Term Care Regulation division conducts licensing surveys before initial licensure, then routine unannounced inspections on a periodic basis, plus investigations triggered by complaints. Inspectors check the physical plant (fire safety, room sizes, emergency equipment), resident records (care plans, medication administration records, incident reports), staffing documentation, and interview residents and staff ^[16]. Common citation areas in Texas ALFs include incomplete or outdated resident care plans, medication administration records with gaps or errors, staffing levels not matching the approved plan, and missing or expired fire inspection certificates. If HHSC finds a deficiency, the facility gets a plan of correction period; more serious or repeated violations can lead to administrative penalties, license suspension, or, in the most severe cases, license revocation. The honest advice here: treat your policy manual as a living document, not a one-time compliance exercise. Inspectors want to see that what's written matches what's actually happening in the building. A beautiful binder full of policies that nobody follows is worse than a simpler set of policies that staff can actually demonstrate on the day of inspection.

What's the real cost and timeline to get licensed in Texas?

There's no single number that applies to every Texas group home applicant, because cost and timeline depend heavily on license type, facility size, whether you're buying or leasing property, and how much retrofit work the building needs. HHSC publishes current ALF licensing fee schedules directly, and these are the only authoritative source for exact dollar amounts, since fees are revised periodically ^[8]. What you can plan around realistically: expect several months minimum from initial application submission to license issuance for a straightforward ALF application with a property that already meets life safety code, and considerably longer if the building needs construction or renovation to meet fire and accessibility standards, or if you're pursuing HCS provider enrollment, which adds a Medicaid contracting layer on top of the facility license. Budget separately for: the state license application fee, any local business license or health permit fees, background check costs per employee, life safety and fire marshal inspection fees, and the cost of any building modifications identified during your pre-licensing walkthrough. None of these numbers are trivial, and skipping the pre-application property assessment is the single most common way operators blow their budget and timeline.

Frequently asked questions

What is assisted living?

Assisted living is residential care for adults who need help with daily activities like bathing, dressing, and medication management but don't need 24-hour skilled nursing. It combines housing, meals, and personal care support in a home-like or apartment-style setting, licensed and regulated at the state level rather than by federal nursing home rules.

What is a group home?

A group home is a residential setting where a small number of unrelated residents, often people with disabilities or mental illness, live together with staff support. Texas doesn't have one single "group home license"; depending on the population and services, it's regulated as an assisted living facility, a home and community support services agency, or an IDD waiver provider (HCS/TxHmL).

What is an assisted living facility?

An assisted living facility is a licensed residential setting providing food, shelter, and personal care services to residents. Texas Health and Safety Code §247.002 defines it as an establishment housing four or more unrelated residents that also provides personal care, medication administration, or arranges home health/hospice services under a service agreement.

What is assisted living facility licensing based on in Texas?

Texas licenses assisted living facilities under Health and Safety Code Chapter 247 and 26 TAC Chapter 553, sorting them into Type A, Type B, and Type C based on residents' ability to evacuate independently and their care needs. The Texas HHSC Long-Term Care Regulation division issues and enforces these licenses.

What is assisted living vs nursing home?

Assisted living provides help with daily activities in a home-like setting for people who are largely independent; a nursing home (nursing facility) provides 24-hour skilled nursing care for people with serious medical needs. Texas regulates them under entirely different chapters: Health and Safety Code Chapter 247 for assisted living, Chapter 242 for nursing facilities.

What does assisted living provide?

At minimum, Texas assisted living facilities provide three daily meals plus snacks, housekeeping, laundry, personal care assistance, social activities, and (for Type B facilities) 24-hour awake staff supervision. Medication assistance or administration is common, governed by a facility policy and, in many cases, nurse oversight depending on the level of assistance provided.

What is the difference between assisted living and nursing home in terms of who regulates them?

In Texas, both are regulated by HHSC's Long-Term Care Regulation division, but under different statutes: assisted living under Health and Safety Code Chapter 247, nursing facilities under Chapter 242. Nursing facilities have heavier staffing, physician oversight, and Medicaid/Medicare certification requirements than assisted living.

Does Medicare cover assisted living facilities?

No. Medicare.gov states Medicare doesn't cover assisted living or other long-term care facility room and board costs. Medicare can still cover medically necessary services, like doctor visits or short-term skilled nursing after a hospital stay, for someone who happens to live in an assisted living facility, but not the custodial care itself.

How do I start a group home in Texas?

Pick your population and license type (ALF, HCSSA, or HCS/TxHmL for IDD), confirm zoning with your city before leasing property, submit your license application with required policies to HHSC, pass a pre-licensing safety inspection, hire staff meeting background check and training requirements, then maintain compliance through ongoing inspections.

How do I start a group home for people with intellectual disabilities in Texas?

You'll need to enroll as an HHSC Medicaid provider under the Home and Community-based Services (HCS) or Texas Home Living (TxHmL) program, licensed under 40 TAC Chapter 9, Subchapter D, in addition to any facility license. New HCS provider enrollment can be affected by waiver slot availability, so confirm current enrollment status with HHSC's IDD division directly.

How many residents trigger assisted living licensing in Texas?

Texas Health and Safety Code §247.002 sets the threshold at four or more unrelated residents receiving personal care, medication administration, or contracted home health/hospice services in exchange for food and shelter. Homes with three or fewer residents may fall outside this specific licensing category, but confirm with HHSC since other rules can still apply.

What background checks does Texas require for group home staff?

Texas requires criminal history checks through the Department of Public Safety for anyone with direct resident contact in a licensed facility, plus checks against the Nurse Aide Registry and Employee Misconduct Registry. Anyone with a disqualifying criminal record or substantiated abuse/neglect/exploitation finding cannot work in a direct care role.

How long does it take to get a Texas assisted living license?

Timelines vary by facility readiness and property condition; there's no fixed statewide guarantee. A straightforward application for a building that already meets life safety and accessibility code moves faster than one requiring construction. Budget several months minimum and confirm current processing timelines directly with HHSC Long-Term Care Regulation.

Sources

1. Texas HHSC, Long-Term Care Regulation: HHSC licenses residential care settings under categories including ALF, HCSSA, and IDD waiver provider enrollment
2. Texas HHSC, HCS and TxHmL Program Information: HCS and TxHmL are the Medicaid waiver programs covering IDD group home services in Texas
3. Texas Administrative Code, Title 26, Chapter 553: Assisted living facility licensing rules including facility types and staffing are set in 26 TAC Chapter 553
4. Texas Health and Safety Code §247.002: Definition of assisted living facility as housing four or more unrelated residents with personal care or medication services
5. Texas Administrative Code §553.2, Definitions: Assisted living facility types A, B, and C are distinguished by resident evacuation capability and facility size
6. Texas Health and Safety Code Chapter 242: Nursing facilities are regulated under Chapter 242, a separate statute from assisted living's Chapter 247
7. Texas Administrative Code §553.261, Staffing Requirements: Type B assisted living facilities must have awake staff on duty 24 hours a day with staffing sufficient for resident needs
8. Texas HHSC, Long-Term Care Provider Licensing Fees: HHSC publishes current assisted living facility license application fee schedules, which vary and are updated periodically
9. Texas HHSC, Employee Misconduct Registry: HHSC requires checks against the Employee Misconduct Registry for direct care staff in licensed facilities
10. Texas Administrative Code, Title 40, Chapter 9, Subchapter D: HCS group homes are licensed under 40 TAC Chapter 9, Subchapter D, requiring both facility licensing and Medicaid provider contracting
11. Texas HHSC, HCS Provider Training Requirements: HCS direct support staff need documented, competency-based training before working unsupervised with residents
12. Medicare.gov, Long-term care coverage: Medicare doesn't cover assisted living or other long-term care facility room and board costs
13. Medicaid.gov, Home & Community-Based Services: Medicaid HCBS waivers can fund services in residential settings but generally do not cover room and board
14. U.S. Dept. of Justice, Fair Housing Act statute, 42 U.S.C. §3601 et seq.: The Fair Housing Act restricts municipalities from using zoning to exclude group homes for people with disabilities in a discriminatory manner
15. Texas Administrative Code §553.51, Administrator Qualifications: Type B assisted living facility administrators must meet specific education, experience, or exam qualifications under state rule
16. Texas HHSC, Long-Term Care Regulation Survey and Enforcement: HHSC conducts licensing surveys, routine inspections, and complaint investigations of licensed long-term care facilities