The Texas License Path Blueprint

1. Door 1: Adult Foster Care Home (1 to 3 residents)

Adult Foster Care is the fastest way into senior care in Texas. You care for 1 to 3 adults in your own home. There is no state license, only HHSC enrollment, and the enrollment fee is zero. Total guaranteed government fees come in under $400, and you can be open in 3 to 8 weeks.

The catch is real. You must live in the home full time, it has to be your primary residence, and residents share your common living areas. Private pay runs $1,200 to $3,500 per resident per month. Medicaid does not cover room and board here, the resident pays that from their own income, and the Medicaid AFC service rate is a small per-day amount on top.

The cap of 3 residents is a hard revenue ceiling. A 4th resident requires a full Assisted Living license, and since Texas no longer issues the old Type C license, that means Type A or Type B.

• •Capacity: 1 to 3 residents, and residents cannot be housed in a detached building
• •License: none, HHSC enrollment only, with a $0 enrollment fee
• •Guaranteed government fees: about $340 total ($300 LLC plus $39.75 background check per person)
• •Revenue: $1,200 to $3,500 per resident per month, with the top end private-pay only
• •Timeline: 3 to 8 weeks, the fastest path in Texas
• •Hard limit: you must live there full time, and 3 residents is the ceiling

2. Door 2: Boarding Home Facility (3+ residents, no state cap)

A boarding home is housing plus meals, and that is it. It serves seniors who manage their own daily activities and just need safe housing with meals. There is no state license and no state cap on residents. Houston requires a local permit, roughly $307 the first year and about $81 a year after, while many Texas cities require nothing at all.

The hard limit is care. You cannot provide personal care of any kind: no bathing, dressing, or toileting help, and no administering or supervising medication. Provide personal care to 4 or more unrelated residents and you have crossed into assisted living, whether you meant to or not, and you need a Type A or Type B license to continue legally.

• •Capacity: 3 or more, no state cap, though local jurisdictions may set limits
• •Guaranteed government fees: about $340 total, and no state license fee
• •Bedrooms: at least 70 sq ft for single occupancy, 60 sq ft per person in shared rooms
• •Revenue: $800 to $2,500 per resident per month
• •Timeline: 2 to 8 weeks
• •Hard limit: no personal care allowed at all, which limits you to independent seniors

3. Door 3: HCS Group Home (1 to 4 adults with IDD)

The HCS Group Home serves adults with intellectual or developmental disabilities through the Texas HCS Medicaid waiver. No ALF license is needed, but you need an HCS provider contract with HHSC and enrollment with your Local IDD Authority (LIDDA), which places your residents. To qualify you generally need at least 3 years of paid experience planning or providing IDD services, or a microboard, plus the HHSC Pre-Application Orientation. Contracts are awarded through open enrollment windows that are not always open, so confirm a window first.

Medicaid pays reliably, and residents never pay out of pocket. Revenue runs $3,000 to $8,000 per resident per month depending on each resident's assessed Level of Need. The hard cap is 4 residents, built into the program, and there is no private-pay option in this model.

• •Fees: no state application fee, a $750 federal Medicaid provider fee for CY2026 through PEMS, plus the $300 LLC
• •Timeline: 8 to 16 weeks
• •Home must feel like a real home under the HCBS Settings Rule, with a real backyard
• •Fair Housing protections strongly favor group homes against zoning challenges
• •Hard limit: 4 residents maximum, Medicaid-funded only, IDD population only

4. Door 4: Type A Assisted Living (4 to 16 residents)

Type A is the most common ALF license in Texas, for residents who can self-evacuate and do not need nighttime nursing help. The license is $300 base plus $15 per bed on a 3-year cycle, so an 8-bed license is $420 and a 16-bed is $540. Bedrooms must be at least 80 sq ft single or 60 sq ft per resident shared, with an 8-foot minimum width, and basements can never be resident space.

Type A carries two real cost advantages. Night staff can sleep on site instead of staying awake, and sprinklers are not required for a small facility of 16 beds or fewer, though NFPA 13D residential-grade may be installed or required by local fire code at $8,000 to $18,000. HHSC's first and second inspections are free, and a third inspection on the same application costs $25 per bed with a $1,000 minimum.

Revenue runs $3,090 to $5,250 per resident per month, and the timeline is 16 to 26 weeks. The hard limit: you cannot serve dementia or memory care residents or advertise an Alzheimer's specialization. That requires Type B.

5. Door 5: Type B Assisted Living (4 to 16 residents, memory care)

Type B covers the same 4 to 16 capacity but serves residents who need nighttime staff help or cannot self-evacuate, including dementia and Alzheimer's. The fee structure matches Type A, $300 base plus $15 per bed, plus an additional $300 per cycle for Alzheimer's certification. Bedrooms are bigger: 100 sq ft single, 80 sq ft per resident shared, and a 10-foot minimum width.

The biggest cost difference is staffing. Night staff must be awake at all times, not on call and not sleeping nearby, so budget $24,000 to $42,000 a year for that alone. In exchange, Type B earns the most of the mainstream residential licenses, $3,500 to $7,500 per resident per month, because memory care is the fastest-growing care segment in Texas. (ICF/IID can pay more per resident, but it is a specialist Medicaid path, not a mainstream residential license.) The timeline is the same 16 to 26 weeks as Type A.

6. Door 6: ICF/IID (dual licensed, typically 4 to 8 beds)

ICF/IID requires both a Texas state license and federal Medicaid certification, and it serves the highest-support IDD individuals: Level of Care I (IQ of 75 or below with a qualifying diagnosis) or Level of Care VIII (a related condition with no IQ requirement). The critical first step comes before everything else: you must secure a Medicaid bed allocation before you can even submit the license application.

The license runs $225 base plus $7.50 per bed, so $270 for 6 beds or $285 for 8, plus the $750 federal Medicaid provider fee. HHSC guarantees a 45-day review once a complete application is in, and this path carries the highest Medicaid reimbursement for IDD residential care in Texas, $4,000 to $12,000 per resident per month. It is the specialist's path: professional clinical staff are required from day one, and it carries the largest compliance burden of all six types.

7. Which door is yours

Two costs hit every one of the six paths, so build them into every model: a Texas LLC filing at exactly $300, and a fingerprint background check at $39.75 per person ($11.50 IdentoGO plus $15.00 DPS plus $13.25 FBI).

Pick the wrong door and you either leave money on the table or accidentally provide care you are not licensed to provide. Here is the quick read.

• •Want speed and you will live on site: Adult Foster Care.
• •Want housing-only with no care: Boarding Home.
• •Have IDD experience and want reliable Medicaid revenue: HCS Group Home.
• •Want mainstream assisted living: it comes down to Type A vs Type B, and the awake-night-staff cost is the hinge.
• •ICF/IID is the specialist's path. Later, not first.