How to Start an Assisted Living Facility in Texas: HHSC Type A and Type B Licenses

Starting an assisted living facility in Texas requires more than operational skill. You need to navigate state licensing through the Texas Health and Human Services Commission (HHSC), local zoning approval, fire code compliance, and detailed regulatory standards. This guide walks you through the entire process, from understanding license types to submitting your application and receiving your three-year license from HHSC.

Understanding Type A and Type B Assisted Living Licenses in Texas

HHSC divides assisted living facilities into two categories under 26 TAC Chapter 553. The type you pursue depends on the independence level of your residents and the level of care and supervision you plan to provide.

Type A facilities serve residents who can evacuate independently without hands-on staff assistance and can follow emergency directions on their own. Type A focuses on independent living with basic supportive services: medication management, meals, housekeeping, and social activities. Confirm the staffing requirements for each type in 26 TAC Chapter 553.

Type B facilities serve residents who may need staff assistance to evacuate in an emergency or who require night supervision. Type B residents can include those who need staff help to evacuate or night attendance. However, Type B residents cannot be permanently bedfast, meaning they cannot be entirely dependent on bed-based care. Type B facilities may add Alzheimer's certification (an additional cost of $300 for three years) to serve residents with Alzheimer's disease or related dementias, as long as they meet the core Type B criteria.

HHSC stopped issuing new Type C licenses, so if you plan to operate a facility, Type A or Type B is your path. Choose your type based on your target resident population and the staffing model you plan to implement.

Prerequisites and Requirements Before You Start

Before you submit anything to HHSC, you need to secure several critical elements:

Property and Zoning

Identify a suitable property in a jurisdiction that allows assisted living facilities. Check local zoning ordinances with your city or county planning department. Some municipalities restrict ALF density or size, and others require conditional use permits. Confirm that the property can accommodate your planned number of beds and meets space requirements under 26 TAC Chapter 553 (you will need specific square footage per resident, dining areas, activity spaces, and staff areas). Do not sign a lease or purchase until you have confirmed local approval.

Local Certificate of Occupancy and Approvals

Your proposed building must comply with local building codes and obtain a Certificate of Occupancy (CO) before HHSC will license it. You will need approval from the local fire marshal (who must sign off during the HHSC survey process). Some jurisdictions also require planning approval, variance approvals, or neighborhood hearings. Start these conversations early with your city or county building department.

Business Structure

Form a legal business entity. Most ALF operators choose an LLC (limited liability company) for liability protection. File a Certificate of Formation with the Texas Secretary of State for a $300 filing fee. If you plan to do business under an assumed name (a name different from your LLC name), file an Assumed Name Certificate with the Secretary of State for $25. You may also need to register as an employer with the Texas Workforce Commission if you plan to hire staff.

Initial Capital and Funding Plan

Prepare financing for renovation or construction, furnishings, staffing, and operating reserves. HHSC will not approve your license application until your facility is built and ready for occupation. Lenders often require evidence of HHSC approval or preapproval before releasing funds, so research financing options early and understand which lenders support ALF startups.

Management and Staffing Plan

Name your facility director and administrator (who must meet specific qualifications under 26 TAC 553, including certain training and experience). You will need a written plan describing your staffing model, supervision structure, and hiring timelines. HHSC will review this during plan review and survey.

Step-by-Step Licensing Process

Step 1: Attend HHSC Presurvey Training

Before submitting an application, attend HHSC's presurvey training session for assisted living facilities. This training explains the survey process, 26 TAC Chapter 553 requirements, and what HHSC inspectors will examine. Check the HHSC Assisted Living Facility page for the schedule. Register through the HHSC Assisted Living Facility page. This training is not optional if you want to succeed on survey; it prevents costly rework after submission.

Step 2: Prepare Your Application Package

Gather the following documents:

• Completed HHSC Form 3720 (Application for License for Assisted Living Facility)
• Detailed building floor plans showing all resident rooms, common areas, staff areas, bathrooms, emergency exits, and square footage calculations
• Proof of property ownership or lease agreement
• Local zoning approval or variance approval letter
• Organizational chart and résumés of the facility director and other key staff
• Written policies and procedures for resident care, emergencies, medication management, and abuse prevention
• Evidence of financing or funding plan
• Proof of business formation (LLC Certificate of Formation)
• Local fire marshal preliminary approval (if available at this stage)

HHSC reviews your application to ensure completeness. Incomplete applications are rejected and sent back for resubmission, delaying your timeline by weeks.

Step 3: Submit Application Through TULIP

Submit your completed Form 3720 and supporting documents through TULIP (Texas Unified Licensing Information Portal), HHSC's online filing system. Verify that you have uploaded all required documents. You will receive a confirmation and an application number. Save this number for all future correspondence with HHSC.

Step 4: Plan Review by HHSC

HHSC reviews your building plans and written policies against 26 TAC Chapter 553 standards. The reviewer will check room sizes, bathroom ratios, emergency exit routes, common area requirements, and staffing plan adequacy. If deficiencies are found, HHSC sends a deficiency letter listing what must be corrected. You then resubmit revised plans and documentation. Plan review time varies, and resubmissions add time.

Step 5: Complete Construction or Renovation

Once plan review is approved (you will receive written approval from HHSC), complete all building work to match the approved plans. Do not deviate from approved plans without requesting a formal modification. Document your progress with photos and keep receipts. HHSC inspectors will verify that the built facility matches the approved plans during the survey.

Step 6: Obtain Local Fire Marshal Inspection and Approval

Schedule an inspection with your local fire marshal. The facility must comply with the Life Safety Code and Texas Fire Code. The fire marshal will examine emergency exits, fire suppression systems, alarm systems, evacuation routes, and storage of hazardous materials. The fire marshal must sign off on your facility before HHSC will conduct its final survey. The time this takes depends on your local fire marshal.

Step 7: Notify HHSC That You Are Ready for Survey

Once construction is complete and the fire marshal has approved the facility, notify HHSC through TULIP that you are ready for the Life Safety Code survey and health inspection. HHSC will schedule a survey date.

Step 8: HHSC Life Safety Code and Health Survey

An HHSC surveyor visits your facility to inspect physical plant, staffing, policies, emergency procedures, and resident safety measures. The surveyor interviews staff, reviews documentation, tests emergency systems, and verifies that your facility meets every requirement in 26 TAC 553. The surveyor will document any deficiencies found.

Step 9: Address Deficiencies (if any)

If the surveyor identifies deficiencies, HHSC sends a deficiency report. You have a set timeframe, stated in the deficiency report, to respond in writing, explaining how you will correct each deficiency or why the deficiency citation is incorrect. Some deficiencies can be corrected immediately (policy clarification, staff training documentation). Others require physical changes or time to implement. HHSC may conduct a follow-up survey to verify correction of serious deficiencies.

Step 10: Receive Your License

Once all deficiencies are resolved (or determined to be already corrected), HHSC issues your assisted living facility license. HHSC has up to 45 days to issue the license. Your license is valid for three years from the issuance date.

Costs to Budget for Your ALF License

HHSC licensing fees are tiered by bed count:

• Base fee: $300 (three-year license)
• Per-bed fee: $15 per bed
• Maximum cap: $2,250 total (three-year license)

Example: A 10-bed facility pays $300 plus (10 beds × $15) = $300 + $150 = $450 for a three-year license. A 130-bed facility would normally pay $300 + (130 × $15) = $2,250, but the fee is capped at $2,250, so it also pays $2,250.

If you add Alzheimer's certification (for Type B facilities), the additional certification fee is $300 for three years.

Beyond HHSC fees, budget for:

• Building and renovation: Varies widely with property condition and bed count
• Legal and consulting: attorney, licensing consultant and architect fees
• Business formation: $325 (LLC formation $300, assumed name $25 if needed)
• Local permits and inspections: varies by jurisdiction
• Furniture, equipment, and supplies: depends on size
• Initial staffing and training: depends on your staffing model

Total startup costs depend heavily on property and local factors, and larger facilities will cost substantially more.

Timeline: How Long Does Licensing Take?

The licensing path has several stages, and each takes as long as the property, contractors and agencies require:

• Property acquisition and local approvals: varies by property and city
• Application preparation: varies
• HHSC plan review: time varies (plus additional time if deficiencies require resubmission)
• Construction and renovation: time varies (depending on scope and contractor performance)
• Fire marshal inspection: time varies
• HHSC survey and final approval: time varies (including any deficiency follow-up), with the license issued within 45 days

Licensing does not happen overnight, so plan for a long runway.

Tips and Common Mistakes to Avoid

Mistakes That Delay Licensing

Submitting an incomplete application: HHSC will reject it and send you back to start. Checklist every item on HHSC's application guidance before uploading to TULIP.

Skipping the presurvey training: This training teaches you exactly what surveyors will examine. Skipping it often results in deficiencies that could have been prevented.

Building without approved plans: If you construct areas that do not match HHSC's approved plans, the surveyor will cite deficiencies and may require changes. Work strictly to the approved plans.

Hiring staff who do not meet qualifications: Your facility director and administrator must have specific education and experience under 26 TAC 553. Hiring unqualified staff and then trying to correct it after survey creates delays.

Ignoring local requirements: HHSC licensing is only one approval. Local fire codes, building codes, and zoning must be met first. Assuming state approval is enough is a costly mistake.

Tips for Success

Start with a licensing consultant: A consultant familiar with Texas ALF rules can review your plans before submission and identify issues early, saving weeks.

Schedule fire marshal inspection early: Do not wait until the end of construction. Involve the fire marshal during planning so you build to code the first time.

Document everything: Keep detailed records of all policies, staff training, maintenance, and facility improvements. Surveyors expect evidence.

Check current regulations: A Texas Register proposal in September 2026 proposed amendments to 26 TAC Chapter 553. Verify the current rule text with HHSC before finalizing your plans, as rules may have changed.

Engage legal counsel: An attorney experienced in healthcare licensing can structure your business entity and ensure your policies meet legal standards.

Expected Results and Next Steps After Licensing

Once you receive your HHSC license, you can legally admit residents to your facility. Your license authorizes you to operate for three years. Before expiration, you must submit a renewal application to maintain your license. Expect HHSC to conduct unannounced surveys during your license period to monitor ongoing compliance. Any violations found may result in deficiency citations, and serious violations can lead to enforcement action up to license suspension.

Your business must also comply with ongoing state and federal requirements: filing annual Public Information Reports with the Texas Comptroller (required even if you owe no franchise tax), maintaining a registered agent in Texas, and obtaining any local business permits required by your city or county.

Legal and Tax Disclaimer

This article is informational only and does not constitute legal, tax, or business advice. Starting an assisted living facility involves complex regulatory, legal, and financial considerations that vary based on your specific situation, location, and business structure. Before proceeding, consult with a Texas-licensed attorney experienced in healthcare facility licensing, a certified public accountant familiar with healthcare businesses, and any relevant local authorities. Rules and fees are subject to change; verify all current requirements with the Texas Health and Human Services Commission, your local fire marshal, and your city or county building department before finalizing your business plan.

Key Contacts and Resources

• Texas Health and Human Services Commission (HHSC): For assisted living facility licensing forms, requirements, and presurvey training information. Visit the HHSC website and search for "Assisted Living Facility" or contact your local HHSC regional office.
• TULIP (Texas Unified Licensing Information Portal): Submit your license application through this online portal.
• Texas Secretary of State: For business formation and assumed name filing. Visit https://www.sos.state.tx.us/corp/index.shtml
• Local city or county planning and zoning department: For zoning approval and certificate of occupancy requirements.
• Local fire marshal: For Life Safety Code and fire code compliance inspection.
• Texas Comptroller of Public Accounts: For franchise tax registration and filing. Visit https://comptroller.texas.gov/taxes/
• Texas Workforce Commission: For employer registration if hiring staff.