Start a Home Care Agency in Texas

Starting a non-medical home care agency in Texas requires understanding the state’s licensing process, regulatory structure, and administrative requirements before providing services.

Texas is considered a fully regulated state, meaning agencies must obtain approval from the state before operating, especially if providing personal care services.

This guide explains Texas requirements in clear, simple terms so you know what to expect.

1️⃣ Understand Texas Home Care Licensing Requirements

In Texas, most non-medical home care agencies fall under:

Home and Community Support Services Agencies (HCSSA)

These agencies are regulated by the:

Texas Health and Human Services Commission (HHSC)

If your agency provides:

• personal care (bathing, dressing, grooming)
• assistance with activities of daily living (ADLs)
• supervision related to health conditions

you will be required to obtain a license before operating.

2️⃣ Choose Your License Type

Texas offers different license categories under HCSSA.

For non-medical home care agencies, the most common is:

Personal Assistance Services (PAS)

This covers services such as:

• bathing and grooming assistance
• mobility support
• meal preparation
• medication reminders
• companionship (when combined with care)

3️⃣ Complete Business Setup Requirements

Before applying for a license, you must:

• register your business (LLC or Corporation)
• obtain a Federal EIN
• secure general liability insurance
• establish a physical business address
• prepare administrative policies and procedures

4️⃣ Prepare Your Policy & Procedure Manual

Texas requires agencies to submit a comprehensive policy and procedure manual as part of the licensing process.

This manual must include:

• agency policies and administrative structure
• client care procedures
• caregiver training and supervision
• emergency preparedness
• infection control policies
• quality assurance processes

The manual must align with Texas HCSSA regulations.

5️⃣ Submit Your Application to HHSC

Once your documentation is prepared, you will:

• submit your HCSSA application
• pay the required licensing fees
• provide all supporting documentation

Incomplete or poorly structured applications can delay approval.

6️⃣ Pass the State Survey

Texas requires a pre-licensure survey (inspection) before approval.

During this process, the state will review:

• your policy and procedure manual
• client and employee documentation
• administrative processes
• compliance readiness

You must demonstrate that your agency is prepared to operate in accordance with state regulations.

7️⃣ Begin Operations After Approval

You may only begin providing services after:

• your license has been approved
• all requirements have been met
• your agency is fully compliant

Medicaid Pathway in Texas

Texas allows home care agencies to participate in Medicaid programs, but this typically occurs after initial licensure and may require additional approvals and contracts.

Texas Home Care Startup Checklist

✔ Register your business entity
✔ Obtain EIN and insurance
✔ Prepare policy & procedure manual
✔ Create client and caregiver forms
✔ Submit HCSSA application
✔ Prepare for state survey
✔ Receive license approval

Prepare Your Home Care Agency Documentation

Starting a home care agency in Texas requires extensive administrative preparation.

Wise Caregiving® provides home care startup template bundles designed to help organize the documentation commonly required for licensing and operation.

These templates can help you prepare:

• policy and procedure manuals
• client intake forms
• caregiver documentation
• operational forms

Explore Home Care Startup Bundle →

Last Updated: October 2026