Texas has a large and somewhat unusual residential care landscape. Unlike Washington, Oregon, or California, Texas does not have a dedicated small-home licensing category. Instead, all licensed residential care for adults falls under the “Assisted Living Facility” (ALF) umbrella, with subcategories that distinguish between facility size, evacuation capability, and resident acuity. The result is that small residential care homes in Texas operate under the same regulatory framework as larger facilities, distinguished primarily by size rather than license type.
This guide is the comprehensive family resource for understanding Texas residential care, finding a small home or facility, paying for it, and verifying its track record. For broader context, see our main board and care home guide and our comparison of adult family homes and board and care.
How Texas categorizes residential care
Texas regulates licensed residential care under the Texas Health and Human Services Commission (HHSC) through its Long-Term Care Regulation program. The main residential care categories:
Assisted Living Facility (ALF)
The primary category for licensed residential care for adults in Texas. ALFs can range from very small (4 to 6 beds) to very large (over 200 beds). Within the ALF category, facilities are subcategorized by:
Size:
- Small ALF: serves 4 to 16 residents
- Large ALF: serves 17 or more residents
Type (based on evacuation capability and resident acuity):
- Type A: serves residents who are physically and mentally capable of evacuating the facility unassisted in an emergency. Lower-acuity residents.
- Type B: serves residents who require staff assistance to evacuate, including residents with mobility impairment, dementia, or cognitive limitations. Higher-acuity residents.
- Type C: a four-bed maximum category for facilities providing services similar to family-style homes. Less common.
Specialty designations:
- Alzheimer’s certification: an additional credential for facilities serving residents with dementia or Alzheimer’s disease, with extra training and physical environment requirements
For families looking for the small-home model, the right starting point is a small Type A or Type B ALF, depending on the parent’s level of care needs. A small Type B ALF is typically what other states would call a board and care home or adult family home.
Other categories
- Day Activity and Health Services (DAHS): adult day health programs, not residential
- Home and Community Support Services Agency (HCSSA): home health agencies, not residential
- Nursing facilities: skilled nursing homes, regulated separately
For an aging parent in need of small residential care, the small ALF (Type A or Type B) is the right starting point.
Licensing and regulation
Assisted living facilities in Texas are licensed by HHSC Long-Term Care Regulation. The full regulations are codified in Title 26, Part 1, Chapter 553 of the Texas Administrative Code.
Provider and staff requirements
Assisted living facility administrators must:
- Be at least 21 years old
- Pass a criminal background check
- Have a high school diploma or equivalent
- Complete an approved administrator training program
- Pass the Texas State Examination for ALF Administrators
- Maintain annual continuing education
Direct care staff must complete pre-service training before working with residents and meet ongoing continuing education requirements. The training requirements are less extensive than Washington’s adult family home requirements but cover the basics: personal care, infection control, dementia care for facilities serving residents with cognitive impairment, abuse prevention, and resident rights.
Inspections
HHSC inspects assisted living facilities at least every two years for license renewal, with additional inspections in response to complaints, incidents, or follow-up on previous deficiencies. The inspection report documents what the surveyor observed, any deficiencies cited, the facility’s plan of correction, and the resolution.
How to search the Texas Long-Term Care Provider database
The HHSC Long-Term Care Provider Search is the official, public, free tool for searching licensed long-term care providers in Texas, including assisted living facilities. You can search by:
- Provider name
- City, county, or zip code
- License number
- Provider type (filter for “Assisted Living Facility”)
Each provider page shows current license status, address, capacity, license type (Type A, B, or C), and recent inspection records. Inspection reports are available as PDF downloads.
For families building a shortlist, the LTC Provider Search is the most important due diligence tool. Verify license status, read recent inspection reports, and look at any enforcement actions before scheduling tours. Our guide on reading inspection reports walks through what to look for.
Cost ranges in Texas
Approximate cost ranges for a private room in a small assisted living facility in Texas, with basic personal care, as of 2026:
- Houston metro area: $4,000 to $6,500 per month, with higher-end neighborhoods running $5,500 to $8,500+
- Dallas-Fort Worth metro: $4,000 to $6,500 per month, with higher-end areas running $6,000 to $9,000+
- Austin metro: $4,500 to $7,500 per month (Austin is generally more expensive than other Texas markets)
- San Antonio metro: $3,500 to $6,000 per month
- El Paso: $3,000 to $5,500 per month
- Lubbock and West Texas: $3,000 to $5,500 per month
- Smaller markets and rural areas: $2,500 to $5,000 per month
These ranges are for relatively independent residents in Type A facilities. Type B facilities (higher acuity) typically run $500 to $1,500 more per month than Type A. Memory care typically adds $1,000 to $2,500 per month.
Texas is generally one of the more affordable states for residential care, especially outside Austin. For the broader cost picture, see our cost guide.
Paying for assisted living facility care in Texas
Medicaid (STAR+PLUS)
Texas’s primary Medicaid pathway for long-term care is the STAR+PLUS managed Medicaid program. STAR+PLUS provides comprehensive services to Medicaid beneficiaries who are 21 and older, including older adults and people with disabilities. The program covers acute medical care, prescription drugs, and long-term services and supports, delivered through Managed Care Organizations contracted with the state.
For long-term care services in assisted living facilities, STAR+PLUS members can receive support if they meet medical necessity for nursing facility care and the facility is enrolled with their MCO. The program covers care services; the room and board portion is generally covered by the resident’s Social Security or SSI.
Eligibility requires meeting financial limits (Medicaid asset and income tests) and clinical limits (a medical necessity assessment). Application is through the Texas Health and Human Services intake process or through a STAR+PLUS MCO directly.
The reality for Texas families is that Medicaid coverage for assisted living facility placement is real but limited. Not every facility participates, and the application process requires patience. Our main Medicaid guide covers the broader picture.
Private pay
Most Texas assisted living facility residents are private-pay, combining Social Security, pension income, savings, and family contribution. Our seven ways to pay guide walks through the funding sources.
VA Aid and Attendance
Texas has the second-largest veteran population in the country, and VA Aid and Attendance is one of the most underused funding sources statewide. The benefit can pay over $2,700 per month toward the cost of an assisted living facility and can be combined with other funding sources.
Long-term care insurance
Most policies issued in the last twenty years cover assisted living facility care. Read the policy and call the insurer’s claims line. Our long-term care insurance guide covers how to start a claim.
How to find a good small assisted living facility in Texas
The search process follows the standard steps with Texas-specific resources.
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Define what you need. Acuity, location, budget, and specific care requirements (dementia, mobility, behavioral support). Determine whether your parent’s needs fit a Type A or Type B facility.
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Build a shortlist. Browse the AgeSong directory for homes in your county or city, or search the HHSC Long-Term Care Provider Search directly. Filter for small facilities (4 to 16 beds).
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Verify each home in the state database. Confirm active license status, capacity, license type, and any specialty designations. Read inspection reports.
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Phone-screen the shortlist. Use the questions in our tour questions guide.
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Tour three to five homes. Walk through the entire house. Meet the caregivers. Read our red flags guide.
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Visit the top one or two unannounced. Drop in at meal time.
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Read the contract carefully. Pay attention to rate increases, discharge triggers, and dispute resolution clauses.
What the Long-Term Care Ombudsman does
Texas has a Long-Term Care Ombudsman Program administered by HHSC. The ombudsman advocates for residents of long-term care settings, including assisted living facilities. The service is free and confidential.
Browse the directory
The AgeSong state directory has a section for Texas with listings organized by city. Browse to build your shortlist. Every listing links to the official HHSC record for verification.
For broader context, see our main board and care home guide and our comparison of adult family homes and board and care.
The next step
If you are searching in Texas, the most useful action this week is to identify your county and search the HHSC Long-Term Care Provider Search for small assisted living facilities in your area, filtering by Type A or Type B based on your parent’s needs. If you think Medicaid might be relevant, also call the Texas Health and Human Services intake line or your local Area Agency on Aging through the Eldercare Locator.
For the broader process, see our step-by-step guide, our questions to ask guide, and our seven ways to pay guide.
Sources and further reading: Texas Health and Human Services Commission; HHSC Assisted Living Facilities; HHSC Long-Term Care Provider Search; Texas STAR+PLUS Program; Texas Long-Term Care Ombudsman Program; Eldercare Locator.