Last updated 2026-07-25
TL;DR
Texas regulates group homes under several categories run by the Health and Human Services Commission (HHSC): assisted living facilities, personal care homes, and HCSSA-adjacent services for IDD or behavioral health populations. Requirements vary by category but generally cover staffing ratios, background checks, fire safety, and a physical site inspection before HHSC issues a license.
What is a group home, exactly?
A group home is a residential setting where a small number of unrelated people live together and get some level of support with daily living, whether that's medication reminders, meal prep, personal care, or supervision tied to a disability or behavioral health diagnosis. It's not one legal category. It's a catch-all term the public uses for a bunch of licensed and unlicensed arrangements. In Texas, the closest thing to a formal "group home" license depends entirely on who lives there. A home for adults with intellectual or developmental disabilities (IDD) is regulated differently than a home for seniors needing help with bathing and dressing, which is regulated differently again from a recovery residence for people in addiction treatment. Texas Health and Human Services Commission (HHSC) is the umbrella agency, but the specific chapter of the Texas Administrative Code that applies to you depends on your population [1]. If you're picturing four to six residents, shared staff, and a house in a residential neighborhood, you're probably talking about one of these: an assisted living facility (ALF) license, a Home and Community-based Services (HCS) or Texas Home Living (TxHmL) provider enrollment for IDD group homes, or a licensed personal care home. Each has its own rulebook. Don't assume one license covers all of them.
What is assisted living, and what is an assisted living facility in Texas?
Assisted living is a housing and service model for people, usually older adults, who need help with daily activities like bathing, dressing, or medication management but don't need the round-the-clock skilled nursing care a nursing home provides. An assisted living facility (ALF) is the licensed building or program where that care happens. Texas defines and licenses ALFs under Texas Health and Safety Code Chapter 247, administered by HHSC [2]. The statute splits facilities into types based on the level of care residents need and how many people who need evacuation assistance live there. Type A facilities serve residents who are physically and mentally capable of following instructions in an emergency. Type B facilities serve residents who need help evacuating, including some with cognitive impairment. There's also a Type C designation for smaller, four-bed adult foster care-style homes, and HHSC further distinguishes small facilities (fewer than 17 residents) from large ones. HHSC's own consumer-facing description says an assisted living facility is "a facility that provides food, shelter, personal care and supervision to persons who need assistance with daily living activities" [2]. That's the working definition you should build your policies and staffing plan around, not the loose way the term gets used in casual conversation. If you're comparing this model to a facility assisted living setup in another state, expect the licensing categories to line up loosely but not exactly. Texas's Type A/B/C split is its own animal.
What is assisted living vs nursing home, and how is that different from a group home?
The plain difference: assisted living is for people who need help with daily tasks but not medical care around the clock, while a nursing home (skilled nursing facility) is for people who need ongoing medical treatment, rehabilitation, or nursing supervision. A group home sits somewhere in that spectrum depending on the population it serves and often looks more like a house than an institutional facility. Nursing homes in Texas are licensed separately under Texas Health and Safety Code Chapter 242 and staffed with licensed nurses on duty, because residents there often have complex medical needs, feeding tubes, wound care, IV therapy, that sort of thing [3]. Assisted living facilities are not required to have a nurse on-site at all times; staffing is built around personal care attendants, though medication aides and some nursing oversight come into play depending on facility type. A group home, in the IDD or behavioral health sense, usually isn't about medical acuity at all. It's about support for independent living skills, behavioral support plans, and community integration, licensed through Medicaid waiver programs (HCS, TxHmL) rather than Chapter 247. So when someone asks "what is assisted living vs nursing home" in the context of starting a Texas business, the honest answer is: figure out your target population first, then figure out which chapter of the Health and Safety Code and which HHSC program actually applies to you. Guessing wrong here wastes months.
What does assisted living provide day to day?
Texas rule requires ALFs to provide at minimum: three meals a day plus snacks, housekeeping, laundry, social and recreational activities, help with personal care (bathing, dressing, grooming, toileting), medication management or assistance, and 24-hour supervision appropriate to the facility type [2][4]. Type B and certain other facilities serving residents who need evacuation assistance must also meet higher staffing and fire-safety standards, because those residents can't self-evacuate in an emergency without help. HHSC's licensing rules under 26 TAC Chapter 553 spell out staffing ratios, physical plant requirements, and required services in detail [4]. If you're building a policy manual, this is the section to read line by line, not skim. What assisted living does not provide, by definition, is skilled nursing care, IV therapy, or the kind of medical monitoring a nursing home offers. If your prospective residents need that level of care, you're licensing the wrong category, and HHSC surveyors will flag it during inspection. Some operators try to serve a population that's outgrown assisted living because moving them is hard on the family. It's understandable, but it's also a regulatory violation waiting to happen.
Does Medicare cover assisted living facilities?
No. Medicare does not cover the cost of room and board at an assisted living facility, and it generally doesn't cover custodial personal care services either. Medicare.gov is direct about this: Medicare doesn't pay for long-term care (also called custodial care) if that's the only care you need, and "most long-term care is custodial care" [5]. Medicare will still cover Medicare-eligible medical services a resident receives while living in an ALF, doctor visits, physical therapy, durable medical equipment, but it won't pay the facility's monthly rate for housing, meals, or help with daily living. That distinction trips up a lot of families and a lot of new operators who assume Medicare functions like it does for a hospital stay or skilled nursing rehab stint. Medicaid is a different story, and it's the program most group home and ALF operators actually deal with. Texas Medicaid, through HHSC's STAR+PLUS program and various 1915(c) waivers (like HCS and TxHmL for IDD populations), can cover personal care services and, in some cases, room and board offsets for eligible low-income residents [6]. Medicaid.gov confirms that home and community-based services waivers let states "provide long-term care services in home and community settings under the Medicaid state plan" as an alternative to institutional care [6]. If your business model depends on Medicaid reimbursement, you need to enroll as a Medicaid provider separately from getting your HHSC facility license. Those are two different applications, and conflating them is one of the most common early mistakes.
How to start a group home in Texas: the licensing sequence
Start by nailing down exactly which population you're serving and which HHSC license or Medicaid waiver enrollment applies, because everything downstream, your zoning research, your staffing plan, your fire marshal inspection, depends on that answer. Here's the general sequence most Texas operators follow, though your specific path should be confirmed with HHSC directly: 1. Pick your population and license category (ALF Type A/B/C, personal care home, or IDD provider enrollment through HCS/TxHmL). 2. Form your business entity and get an EIN. 3. Secure a property that meets zoning and building code requirements for group living, and confirm with your local planning or zoning office that group homes are a permitted use (confirm with your state licensing agency and municipal zoning office, since local rules vary widely and some cities have separate group home ordinances). 4. Complete any required life safety code inspection through the local fire marshal, since ALFs must meet specific fire and life safety standards under 26 TAC Chapter 553 [4]. 5. Write your policy and procedure manual: admission criteria, medication management, emergency preparedness, grievance procedures, staffing plan, and resident rights documentation. HHSC reviews this as part of the application. 6. Submit your license application to HHSC with the required fee (confirm current fee amounts with HHSC, since these are adjusted periodically and posted on the agency's licensing fee schedule). 7. Pass required background checks for owners, administrators, and staff through the Texas Department of Public Safety and the HHSC criminal history clearance process. 8. Schedule and pass the pre-licensing HHSC survey/inspection of the physical site. 9. Once licensed, maintain compliance through ongoing inspections, incident reporting, and staff training renewals. This is also the point where a lot of operators discover that the paperwork burden, policy manuals, staffing plans, emergency procedures, is bigger than the property search. If you want a structured starting point instead of building every document from scratch, GroupHomePath's $299 State Group Home Licensing Kit gives you templates built around what state agencies actually ask for, though you'll still need to fill in your state-specific numbers and confirm requirements with HHSC before you submit anything.
How do I start a group home for a specific population (IDD, mental health, recovery, seniors)?
The mechanics shift depending on who you're serving, even though the broad steps (entity formation, property, staffing, licensing, inspection) stay similar. For IDD group homes, you're typically looking at enrollment as a Medicaid HCS or TxHmL provider through HHSC, which involves a provider enrollment application, a program provider agreement, and compliance with the IDD-specific service standards in the Texas Administrative Code, separate from the ALF chapter [1]. For senior residential care, you're most likely licensing under Chapter 247 as an ALF, choosing Type A, B, or C depending on resident evacuation capability and care level [2]. For mental health and recovery residences, Texas doesn't have one single statewide license covering all sober living homes. Some recovery residences operate under voluntary certification through a recognized certifying organization rather than direct HHSC licensure, so if you're in this space, verify with HHSC and Texas Health and Human Services behavioral health division what certification or licensing actually applies to your specific service model before you assume a Chapter 247 or personal care home license is the right fit. Across all of these, the population served drives everything: staffing ratios, required training hours, physical plant standards (like grab bars and evacuation chairs for a Type B ALF versus behavioral support documentation for an IDD home), and which HHSC division reviews your application. Don't try to shortcut this by guessing based on a similar business in another state. If you're researching how assisted living facilities differ in staffing rules from IDD group homes, that comparison is worth doing early, before you sign a lease.
What staffing does Texas require in a group home or ALF?
Staffing requirements in Texas ALFs are tied to facility type and resident count, and they cover both the number of staff on-site and their required training. Under 26 TAC Chapter 553, facilities must maintain sufficient staff, awake or asleep depending on type, to meet resident needs and evacuation requirements at all times [4]. Type B facilities, since they serve residents needing evacuation assistance, generally require staff to be awake and on duty overnight, more than on-call, because evacuation-dependent residents can't wait for someone to wake up during a fire. Type A facilities have more flexibility since residents there are expected to self-evacuate. Administrators of licensed ALFs in Texas must hold a specific administrator license or provisional license issued through HHSC, and that credential requires its own application, training hours, and sometimes an exam, separate from the facility license itself. Direct care staff typically need documented training in first aid, CPR, resident rights, abuse/neglect reporting, and infection control before they can work unsupervised. Exact hour requirements and renewal cycles should be confirmed directly with HHSC's Long-Term Care Regulation division, since these get updated through rule amendments. For IDD group homes under HCS/TxHmL, staffing standards come from a different rule set focused on direct support professional (DSP) training curricula and staff-to-resident ratios tied to each resident's individual service plan, not a flat facility-wide ratio.
What zoning rules apply to a Texas group home?
Zoning is where a lot of otherwise well-prepared applicants get stuck, because it's governed by your city or county, not by HHSC, and Texas municipalities are not uniform about how they treat group homes. Federal fair housing law offers real protection here. The Fair Housing Act, as amended, prohibits municipalities from using zoning to exclude group homes for people with disabilities from residential neighborhoods in ways that don't apply to other unrelated households of similar size, and courts have repeatedly struck down zoning ordinances that singled out group homes for disabled residents [7]. That protection matters, but it doesn't mean zoning boards roll over. Many cities still require a special use permit, occupancy limits, parking minimums, or spacing requirements (sometimes called "dispersal" rules) that require group homes to be a certain distance apart. Before you sign a lease or make an offer on a property, call your city or county planning department and ask directly: is a licensed group home (specify ALF, IDD provider home, or recovery residence) a permitted use in this zoning district, and is a special use permit or variance required? Get the answer in writing if you can. This single phone call, made early, saves more headaches than almost anything else in this process. Confirm with your local zoning authority and with HHSC's facility licensing division whether your specific use classification triggers additional local requirements, since this varies by city and even by neighborhood overlay district.
What does the HHSC inspection process look like?
Before HHSC issues an initial license, it sends a surveyor to inspect the physical site for compliance with the applicable chapter of the Texas Administrative Code, life safety code standards, and your submitted policies. This isn't a drive-by. Surveyors check physical plant items (exits, fire extinguishers, smoke detectors, accessible bathrooms), review resident records and staff files, and interview staff about emergency procedures. After licensure, ALFs and other licensed group homes go through periodic unannounced inspections, and HHSC also investigates complaints as they come in. Deficiencies get documented on a statement of deficiencies, and facilities must submit a plan of correction with a timeline. Repeated or serious violations can lead to enforcement action, including administrative penalties or license revocation, under the enforcement provisions tied to Chapter 247 [2]. If you want a sense of what inspectors focus on before you ever open your doors, HHSC publishes its licensing standards and survey guidance publicly, and reading through a recent statement of deficiencies for a comparable facility (these become public record) is one of the more useful, underused prep exercises an operator can do.
Frequently asked questions
What is assisted living?
Assisted living is housing paired with support services, meals, help with bathing and dressing, medication management, and supervision, for people who need daily living assistance but not full-time skilled nursing care. In Texas, this is licensed as an assisted living facility under Health and Safety Code Chapter 247, administered by HHSC [2].
What is a group home?
A group home is a residential setting, usually a house, where a small number of unrelated residents live together with staff support tied to a shared need: aging, intellectual or developmental disability, mental health, or recovery from addiction. In Texas there's no single "group home license"; the applicable rule depends on the population served [1][2].
What is an assisted living facility?
An assisted living facility is a licensed building or program providing food, shelter, personal care, and supervision to people who need help with daily living activities but not continuous nursing care. Texas HHSC licenses these under Chapter 247 and classifies them as Type A, B, or C based on resident evacuation capability [2].
What is the difference between assisted living and a nursing home?
Assisted living helps residents with daily tasks like dressing and medication reminders; nursing homes provide continuous skilled nursing care for people with significant medical needs. Texas licenses nursing homes separately under Health and Safety Code Chapter 242, with required licensed nursing staff on-site, unlike most assisted living facilities [2][3].
Does Medicare cover assisted living facilities?
No. Medicare does not pay for room, board, or custodial care at an assisted living facility. Medicare.gov states plainly that Medicare doesn't cover long-term custodial care when that's the only care needed, though it still covers separate Medicare-eligible medical services a resident receives [5].
How do I start a group home in Texas?
Identify your target population and matching HHSC license category first (ALF, IDD provider enrollment, or another applicable license), then form your business entity, secure a zoning-compliant property, write required policies, pass background checks, and complete HHSC's pre-licensing inspection before the license is issued. Confirm each step's current requirements directly with HHSC.
What does assisted living provide that home care doesn't?
Assisted living bundles housing with meals, housekeeping, laundry, social activities, and on-site staff supervision, all under one roof and one license. Home care sends an aide into a person's own home for specific tasks but doesn't include the housing, dining, or continuous on-site supervision an ALF provides [2][4].
Do I need a special license for an IDD group home in Texas versus a senior assisted living home?
Yes. Senior-focused residential care in Texas is licensed under Health and Safety Code Chapter 247 as an assisted living facility. IDD group homes typically operate through Medicaid HCS or TxHmL provider enrollment with HHSC, governed by separate service standards, not the ALF chapter [1][2].
What staffing ratio does Texas require in an assisted living facility?
Texas rule (26 TAC Chapter 553) requires sufficient staff to meet resident needs and safe evacuation at all times, with specifics tied to facility type; Type B facilities generally need awake overnight staff because residents need evacuation help. Exact ratios should be confirmed with HHSC's current rule text [4].
Can a group home be denied a permit because of local zoning?
Not simply because it's a group home for people with disabilities; the Fair Housing Act bars zoning that singles out disabled residents' group homes for exclusion from residential districts [7]. Cities can still require special use permits, occupancy caps, or spacing rules, so confirm requirements with your local zoning office before committing to a property.
Does Texas Medicaid pay for group home or assisted living costs?
Texas Medicaid can cover personal care and support services through programs like STAR+PLUS and HCS/TxHmL waivers, and in some cases contributes to room and board costs for eligible low-income residents, but the facility license and Medicaid provider enrollment are separate applications [6].
How long does it take to get an assisted living facility license in Texas?
There's no single fixed timeline; it depends on application completeness, background check turnaround, and inspection scheduling. HHSC does not publish a guaranteed processing time, so build in several months and confirm current timelines directly with HHSC's Long-Term Care Regulation division before setting an opening date.
What's the difference between assisted living Type A, Type B, and Type C in Texas?
Type A facilities serve residents capable of following instructions and self-evacuating in an emergency. Type B facilities serve residents who need help evacuating, including some with cognitive impairment, and require higher staffing. Type C generally refers to smaller, four-bed adult foster care-style homes under the same chapter [2][4].
Sources
- Texas Health and Human Services, IDD service standards overview: IDD group homes are regulated through HCS/TxHmL Medicaid waiver enrollment, separate from ALF licensing
- Texas Health and Safety Code, Chapter 247 (Assisted Living Facilities): Definition, licensing authority, and facility type classifications for assisted living facilities in Texas
- Texas Health and Safety Code, Chapter 242 (Convalescent and Nursing Facilities): Nursing homes are licensed under a separate chapter with required licensed nursing staff
- Texas Administrative Code, Title 26, Chapter 553 (Licensing Standards for Assisted Living Facilities): Staffing, physical plant, and required service standards for licensed ALFs by facility type
- Medicare.gov, Long-Term Care coverage page: Medicare does not cover custodial long-term care such as assisted living room and board
- Medicaid.gov, Home & Community-Based Services page: Medicaid HCBS waivers allow states to provide long-term care services in home and community settings as an alternative to institutional care
- U.S. Department of Justice, Fair Housing Act group homes guidance: The Fair Housing Act restricts zoning that excludes group homes for people with disabilities from residential areas