Starting a care business in Texas

Child care permits scale with headcount and location. Caring in your own home for one to three unrelated children makes you a listed family home, four or more requires registration (up to 6 children plus 6 after school), and HHSC describes a licensed child care home as care for 7 to 12 children; no home may have more than 12 children in care at once, the caregiver's own included. Registered and licensed homes need the HHSC pre-application class first, and a licensed home's primary caregiver must qualify as a child care director. The home permit guide covers all three tiers. Seven or more children under 14 cared for somewhere other than the operator's residence, for at least two hours a day on three or more days a week, takes a child care center license, which starts with a mandatory orientation and fire marshal and sanitation inspections.

Texas has no separate license for small residential care homes. Giving food, shelter and personal care or medication administration to four or more unrelated people requires an assisted living facility license, Type A or Type B, whether the building is a six-bed house or a large complex. A facility licensed for 16 or fewer residents counts as small and gets lighter rules: its manager needs only a high school diploma or GED, and a small Type A manager may run up to four homes with no more than 16 residents in total. A home with three or fewer residents falls below the definition, but it may not call itself assisted living, and HHSC can count several homes with shared ownership or staff as one establishment. Since September 1, 2025, operating an unlicensed assisted living facility is a Class A misdemeanor, and a repeat offense is a third-degree felony.

Adult day care is licensed as a Day Activity and Health Services facility, required once you serve, by day only, four or more unrelated people who are 65 or older or have a disability. It is a health model: each facility needs a director, a licensed nurse on site at least 8 hours a day and an activities director, and no one person may hold all three roles. The license costs $75 for three years, and HHSC issues a traditional DAHS license only after the building passes its Life Safety Code inspection and a later health survey. Medicaid, Title XX and STAR+PLUS contracts can be sought only after licensure.

Agencies working in clients' homes all hold one license type, the HCSSA license, with categories for the services offered. Paid hands-on personal care such as bathing, dressing or toileting needs the Personal Assistance Services category; sitter, companion and chore services with no personal care are exempt. Sending nurses, therapists or home health aides needs the Licensed Home Health or Licensed and Certified Home Health category. The fee, $2,625 per parent or branch office for three years as published on 2026-10-12, is the same no matter how many categories you hold. Key staff must finish HHSC's Presurvey computer-based training before you apply, and within six months of licensure you must serve a first client and request the initial survey on Form 2020.

Several changes matter in 2026. CMS stopped enrolling new home health agencies in Medicare nationwide on May 13, 2026, for an initial six months; HHSC still issues the state license, but its web page saying Texas has no moratoria dates from 2019. Since January 1, 2026, the statute requires child care homes and centers to carry $100,000 of liability insurance per occurrence instead of $300,000, though the minimum standards have not yet been amended, and since September 1, 2025 a center's initial license lasts 12 months. HCSSAs have had to check the SEMARC search engine before hiring since August 3, 2026, and HHSC began enforcing the HB 3595 power-outage rules for assisted living on September 1, 2026.