How do you start a group home in Texas?

What counts as a group home in Texas?

Texas law does not have a single "group home" license. The word covers several regulated settings, and each one has its own license, contract, or rule chapter. Pick the setting first, because it decides who regulates you.

For adults with an intellectual disability or a related condition, the main Medicaid waiver setting is an HCS residence. HCS is a Texas Medicaid waiver, and a residence where HCS residential support or supervised living is provided is certified under the HCS rules in 26 TAC Chapter 565.

HHSC defines an assisted living facility as an establishment that furnishes food and shelter to four or more people who are unrelated to the proprietor, and provides personal care services, medication administration, or both. Assisted living facilities are licensed under Texas Health and Safety Code Chapter 247 and 26 TAC Chapter 553.

Homes for children are a separate world. HHSC Child Care Regulation defines a general residential operation as a child care facility that provides care for seven or more children for 24 hours a day. Its minimum standards are in 26 TAC Chapter 748.

• HCS residence (adults and children with IDD, Medicaid waiver): HHSC contract plus HCS certification, 26 TAC Chapter 565
• Intermediate care facility (ICF/IID): state license plus an allocation of Medicaid beds, 26 TAC Chapter 551
• Assisted living facility (four or more unrelated people with personal care): state license, 26 TAC Chapter 553
• General residential operation (seven or more children, 24-hour care): HHSC Child Care Regulation license, 26 TAC Chapter 748

Which path fits an IDD group home?

For a new IDD group home, the usual path is to become an HCS program provider and run three-person or four-person residences. An ICF/IID is a licensed facility that needs Medicaid beds, and HHSC says there has been no additional funding for ICF/IIDs for several years.

HHSC says an ICF/IID must be licensed to operate in Texas, and that an applicant "must have an allocation of Medicaid beds" to be considered for licensure. Licensing is governed by Health and Safety Code Chapter 252 and 26 TAC Chapter 551.

HCS works differently. The individual lives in a home in the community, and the program provider delivers residential services there under its HHSC contract and the HCS certification standards.

If you plan to serve people who are not in HCS, or more people than an HCS residence allows, ask HHSC which license applies before you sign a lease. This guide is not legal advice.

What are the rules for an HCS three-person or four-person residence?

An HCS residence is a home the program provider owns or leases. A three-person residence serves no more than three people, and a four-person residence serves no more than four. A four-person residence also needs a fire inspection and written HHSC approval before residential support starts there.

Under 26 TAC §565.3, the people counted are those receiving residential support, supervised living, respite, or a similar non-HCS service. The only other people who may live there are a service provider and the service provider's spouse or partner. If four people live in a four-person residence, at least one of them must receive residential support.

Under 26 TAC §565.23 and §565.43, a four-person residence must pass an inspection by the local fire marshal (or the Texas State Fire Marshal's Office where there is no local one) and get written HHSC approval. HHSC answers within 14 calendar days after it receives the documents. The fire certification is renewed every year, and a copy of the latest inspection stays in the home.

Residential support and supervised living differ in staffing. Our guide to the HCS program explains the difference in plain words.

What does HHSC check inside an HCS home?

HHSC checks that the home is safe, clean, accessible, and ready for an emergency. The residential rules in 26 TAC §565.23 cover hot water, bedroom locks, smoke alarms, escape routes, fire extinguishers, fire drills, emergency plans, infection control, and medication storage.

Hot water at sinks and baths may not exceed 120 degrees Fahrenheit, unless a yearly skills assessment shows every individual in the home can regulate it. Each individual's bedroom door needs a lock the individual can operate, not paid for by the individual.

Each residence needs two means of escape, working smoke alarms in and just outside each bedroom, and a fire extinguisher on each level. The provider runs at least one fire drill every 90 days and four every 365 days, with two during sleeping hours. Each staff member joins a fire drill within 90 days of hire and at least once a year after.

The program provider inspects each residence on site before services start and every year after, under 26 TAC §565.25. Items it finds must be fixed before an individual moves in, or within 30 days if someone already lives there. HHSC also makes an unannounced visit to each residential support and supervised living residence at least once a year.

How do you get the HCS contract?

You enroll in Texas Medicaid, complete HHSC's Provider Applicant Training and exam, and apply to HHSC for a contract. HHSC awards a provisional contract and surveys the agency within 120 calendar days after it approves the first individual's enrollment. Our HCS provider guide walks through every step.

The step-by-step, including the documents in the application packet and the program manager's experience requirement, is in our guide on how to become an HCS provider in Texas.

Plan growth with the interest list in mind. HHSC announced in May 2026 that it will not release HCS interest list reduction slots starting in May 2026, and it has not given a date to resume. Our guide to the 2026 slot pause explains what that means for new providers.

Is a host home an alternative to running a group home?

Yes. With HCS host home/companion care, the individual lives in a home the host home provider or the individual owns or leases, and the provider lives there too. The program provider does not own or lease that home, and no more than three people in it receive the service.

A host home provider does not hold an HHSC contract. The provider works with an HCS program provider as a staff member or contractor, and the program provider inspects the home before services start and every quarter after.

Our guide to HCS host home requirements covers who qualifies, what the home needs, and how the weekly Form 4122 log works.

What must be in place before the first individual moves in?

Before the first individual moves in, you need screened and trained staff, written policies, a registered nurse arrangement, emergency plans for the home, and a record system. HHSC reviews all of it at the first certification survey.

Staff screening under 26 TAC §565.9 means a criminal history check before hire, the Employee Misconduct Registry and Nurse Aide Registry before hire and every 12 months, and the federal and Texas exclusion lists before hire and every month.

Written policies must cover transportation (only staff with a valid driver's license and insurance), conflicts of interest, financial impropriety, abuse, neglect, and exploitation, communicable disease control, and preventing unauthorized access to medications.

Nursing matters from the first day. Under 26 TAC §565.13, a registered nurse performs a nursing assessment before an unlicensed service provider performs a nursing task, unless a physician delegated it. Staff who give medications must be trained and delegated by an RN.

Records matter too. Under the HCS Program Billing Requirements, each service log is written after the service, signed with the staff member's title, and made within 14 calendar days. HHSC publishes Form 4119 as an example log for residential support and supervised living.

• Staff screened and trained on each individual before service
• Written policies for transportation, finances, abuse, neglect, and exploitation, infection control, and medications
• An RN for nursing assessments and delegation
• Emergency plans, posted emergency numbers, and a fire drill schedule for each home
• A record system for service logs, the MAR, incidents, fire drills, and staff files

How does Sereniq help a new group home?

Sereniq is the operations and EHR platform for IDD group home and host home providers. DSPs write notes on their phones, and Sereniq turns them into the Form 4119 service delivery log, the MAR, fire drill records on Form 4719, and the individual binder a surveyor asks for.

Sereniq was born in Texas on HHSC forms and adapts forms, terms, and time zones for other states. Texas is live today. It keeps the records behind your billing and does not submit claims.

This guide is not legal advice. Confirm every license, contract, and residence requirement with HHSC before you open.