HomeCareAtlas Team · Updated November 2026
Researched from primary state regulatory sources.
How to Start a Home Care Agency in Texas
Starting a home care agency in Texas costs roughly $45,000 - $90,000 and takes 4-6 Months. Here's every step, fee, and deadline — sourced directly from Texas Health and Human Services Commission (HHSC).
Texas puts all home-based care under one license: the HCSSA license. Non-medical agencies apply for the Personal Assistance Services (PAS) category. The rules are in 26 TAC Chapter 558 and Health and Safety Code Chapter 142. You apply only through the TULIP online portal. The initial license costs $2,625 and lasts three years. Before you apply, your administrator and alternate must finish HHSC's Presurvey Training (26 TAC 558.13), which HHSC offers as a computer-based training (CBT). A first-time administrator and alternate also need 8 hours of administrator training before they are named. You also need a real place of business where records are kept safe from loss and from people who should not see them.
To start a non-medical home care agency in Texas, you need a Home and Community Support Services Agency (HCSSA) from the Texas Health and Human Services Commission (HHSC). The application fee is $2,625 (3-year hcssa license), the process takes approximately 4-6 months, and total startup costs range from $45,000 - $90,000. You apply only through the TULIP online portal. The license costs $2,625 for 3 years. Within 6 months of licensure you must serve a client and request your initial survey.
- License Required
- Yes — Home and Community Support Services Agency (HCSSA)
- Regulatory Body
- Texas Health and Human Services Commission (HHSC)
- Application Fee
- $2,625 (3-year hcssa license)
- Timeline
- 4-6 Months (our estimate, full path)
- Total Startup Cost
- $45,000 - $90,000
- Key Requirement
- You apply only through the TULIP online portal. The license costs $2,625 for 3 years. Within 6 months of licensure you must serve a client and request your initial survey.
- Last Verified
- November 2026 against Texas Health and Human Services Commission (HHSC) regulations
Our Estimate, Full Path
This is our best guess. Check with the Texas Health and Human Services Commission (HHSC).
Residents Age 70+
Moderate Opportunity
How Texas compares to neighboring states
| State | License Fee | Timeline | Startup Cost |
|---|---|---|---|
| Texas ← | $2,625 | 4-6 Months | $45,000 - $90,000 |
| Louisiana | $600 | 90-120 Days | $50,000 - $90,000 |
| Oklahoma | $1,000 | 45-120 Days | $25,000 - $50,000 |
| New Mexico | $0 (no license) | 4-8 Weeks | $30,000 - $55,000 |
| Arkansas | $0 (no license) | 2-4 Months | $35,000 - $65,000 |
Texas Licensing Overview
The Texas Health and Human Services Commission (HHSC) oversees all non-medical agencies.Texas puts all home-based care under one license: the HCSSA license. Non-medical agencies apply for the Personal Assistance Services (PAS) category. The rules are in 26 TAC Chapter 558 and Health and Safety Code Chapter 142. You apply only through the TULIP online portal. The initial license costs $2,625 and lasts three years. Before you apply, your administrator and alternate must finish HHSC's Presurvey Training (26 TAC 558.13), which HHSC offers as a computer-based training (CBT). A first-time administrator and alternate also need 8 hours of administrator training before they are named. You also need a real place of business where records are kept safe from loss and from people who should not see them.
TULIP Portal — The Only Way to Apply
All HCSSA applications go through the TULIP online portal. HHSC does not take mailed or emailed applications. HHSC has up to 45 days to decide if your application is complete. Then it has up to 45 more days to issue the license. If something is missing, you get 30 days to fix it.
Mandatory Pre-Survey CBT
Your administrator and alternate must finish HHSC's Presurvey Training before you apply (26 TAC 558.13(a)). HHSC offers it as an online CBT. Save the certificates. You upload them in TULIP.
Physical Office Required
You need a real office where you keep client records. The rules say records must be kept safe from loss and from people who should not see them. A private office with locked files is the safest choice. Ask HHSC before you use a coworking desk or virtual office.
The 6-Month Initial Survey Rule
Within 6 months of your license date, you must admit and serve at least one client. You must also send HHSC Form 2020 to ask for your initial survey (26 TAC 558.521). Do not miss this deadline.
Administrator Certification
Every Home and Community Support Services Agency (HCSSA) must designate an administrator who has completed the 8-hour certification program.
- Training Hours:8 Hours
- Training Cost:$150 - $800
- Topics:For a first-time administrator or alternate: 8 clock hours before you are named (26 TAC 558.259). Then 16 more hours in your first 12 months. Total: 24 hours. After that, ongoing yearly training under 26 TAC 558.260. Topics include licensing rules, state and federal law, client rights, abuse and neglect, complaints, emergency plans, and infection control.
Source: 26 TAC §558.259(c) · Checked Oct 2026
Estimated Startup Costs (2026)
Budget for $45,000 - $90,000 to ensure 3-6 months of runway.
| Category | Low Est. | High Est. |
|---|---|---|
| HHSC HCSSA Fee (3-Year) | $2,625 | $2,625 |
| Administrator/Alternate Training (8 hrs pre-app + 16 hrs Year 1) | $150 | $800 |
| Commercial Office Deposit/Rent | $1,500 | $4,500 |
| Gen/Prof Liability Insurance | $3,000 | $6,000 |
| NPI Registration (free from NPPES) | $0 | $0 |
| Full Policy & Procedure Manual | $500 | $1,500 |
| Initial Marketing & CRM | $2,000 | $5,000 |
| Working Capital (6 Mo) | $35,000 | $65,000 |
We map every cost and file your Texas license for you.
The Texas Critical Path to Licensure
1-2 Weeks
Entity Formation & NPI
File your LLC with the Texas Secretary of State. Get your National Provider Identifier (NPI) for billing.
1 Week
Administrator Training (8 Hours Pre-Application)
A first-time administrator and alternate must each finish 8 clock hours of training in the 12 months before they are named (26 TAC 558.259). Private trainers sell this course. Prices vary. Then 16 more hours are due in the first 12 months on the job (24 hours total).
1 Week
HHSC Presurvey CBT
Your administrator and alternate must finish HHSC's Presurvey Training (26 TAC 558.13(a)). It is offered online as a CBT. It does not count toward the 24 administrator hours. Save the certificates for the TULIP portal.
2-4 Weeks
Office Setup & Compliance
Lease a space with a private office where you can keep client records safe. A private suite in a shared office building is fine. Set up locked file cabinets for records. Ask HHSC before you use a coworking desk or virtual office.
2 Weeks
TULIP Application Submission
Submit your HCSSA application through the TULIP online portal. Include your full policy manual, proof of insurance, training certificates, and the $2,625 fee.
4-10 Weeks
HHSC Review
HHSC has up to 45 days to decide if your application is complete, then up to 45 more days to issue the license (26 TAC 558.31). It also checks the background of owners and controlling persons. HHSC says that if it asks for fixes, you have 30 days to reply.
Milestone
License Issuance & Soft Launch
Your license is issued. Now you can legally market and take clients.
Within 6 Months
The Initial Survey
Admit and serve your first client. Send HHSC Form 2020 within 6 months of your license date (26 TAC 558.521). Then get ready for the survey.
We can do all of them for you in Texas.
New 2026 Legal Mandates
No Services or Ads Before Licensure (Health & Safety Code 142.002)
You may not provide personal assistance services, or tell the public you do, until HHSC issues your license.
Electronic Visit Verification (EVV)
Current - Federal law requires states to use EVV for Medicaid personal care (42 U.S.C. 1396b(l)), so Texas requires it. This includes STAR+PLUS. You need an EVV system to get paid.
Criminal History + EMR/NAR Checks (Health & Safety Code Ch. 250)
Before hire, run a DPS criminal history check (name-based) and check the Employee Misconduct Registry (EMR) and Nurse Aide Registry (NAR). Repeat the EMR and NAR checks at least every 12 months. You cannot hire anyone listed on the EMR. Immediate Survey Deficiency
Administrator Training (26 TAC 558.259)
For first-time administrators and alternates: 8 clock hours before you are named. 16 more hours in the first 12 months. 24 hours total. After that, yearly continuing education (26 TAC 558.260).
Our Texas licensing team tracks the law so you do not have to.
Caregiver Mandates
Important Warning
Some people talk about using 1099 contractors. When your agency sets the schedule and directs the work, caregivers are usually employees. Ask a lawyer or CPA before you use 1099s.
- Criminal History Check (Ch. 250): A DPS criminal history check before hire. It is name-based, not fingerprint-based. Some crimes bar employment.
- EMR/NAR Check: Check the Employee Misconduct Registry and Nurse Aide Registry before the first client contact, and at least every 12 months.
- Orientation: Each new worker must get an orientation to your agency and its rules.
- Emergency Preparedness: Staff must know your emergency plan for things like tornadoes, floods, and hurricanes.
Regional Billing Snapshots
*Regional rates vary by specialized care needs (Dementia, Parkinson's) and local competition.*
We launch Texas home care agencies start to finish.
Regional Market Opportunities
Most Texans live in the big metros: Houston, Dallas-Fort Worth, San Antonio, and Austin. Texas has about 4.7 million adults 65 and older, the 3rd most of any state. That group grew about 20% from 2020 to 2025, the 6th fastest of any state (Census, July 2025). The middle pay for home health and personal care aides is $11.65 an hour (BLS OEWS May 2025, series OEUS480000000000031112008). Private-pay agencies often pay more to hire. The billing rates below are our estimates. Real rates depend on the metro, the care, and who pays.
Houston Metro
Home to the Texas Medical Center, a big source of hospital referrals.
Key: Get to know hospital social workers and discharge planners.
Dallas-Fort Worth
A very spread-out metro with large suburbs, like Collin and Denton counties.
Key: Drive time adds up. Keep each caregiver's clients close together.
San Antonio / Austin
San Antonio has many military retirees. Austin is growing fast.
Key: In San Antonio, learn how VA benefits like Aid and Attendance can help families pay.
Cost of care in Texas
What agencies charge clients vs. what caregivers earn in Texas. The difference is the agency's gross margin per billable hour — before overhead like insurance, admin, marketing, and compliance costs.
$28
Avg. hourly rate charged to clients
$17.97
Avg. caregiver hourly wage
$10.03
Gross margin per hour
36%
Gross margin %
What this means for agency owners
In Texas, agencies keep roughly $10.03 per billable hour after paying the caregiver. That's a 36% gross margin.
This is a typical margin for the industry. You will need to manage overhead carefully, but profitability is achievable with good operations.
Sources: Avg. hourly rate from CareYaya and CareScout 2025 surveys (averaged). Caregiver wage from Care.com. Gross margin is before overhead costs like insurance, admin, marketing, and compliance.
Texas Medicaid Programs
STAR+PLUS
Texas Medicaid managed care for adults 65 and older and adults with disabilities. You contract with the health plans (MCOs) that serve your area. Ask HHSC or each plan which plans serve your counties.
Agency Angle: You need a Medicaid provider number, an NPI, and EVV to bill.
Community First Choice (CFC)
A Medicaid benefit that pays for personal assistance and habilitation at home for people who meet its rules. Ask HHSC or the health plan if a client qualifies.
Becoming a Provider
Essential 2026 Tech Stack for Owners
Tiles outlined in teal are areas HomeCareAtlas covers in our platform.
Texas Licensing FAQ
Can I use a virtual office address for my HCSSA license?
Not really. You need a real office where client records are kept safe. A private office inside a shared office building can work. Ask HHSC before you use a coworking desk or virtual office.
How much administrator training is needed before I can apply?
A first-time administrator or alternate needs 8 clock hours before being named. Then 16 more hours in the first 12 months (24 hours total). Both the administrator and alternate must do this. The HHSC Presurvey Training is separate and does not count toward these hours.
What is the TULIP portal?
TULIP is HHSC's online portal for HCSSA license applications. All forms, documents, and training certificates go through TULIP. HHSC does not take mailed or emailed applications.
How long does the NPI number take to get?
It is free from NPPES. Online applications are often done in 1-2 weeks, but times vary.
What happens during the initial survey?
After you admit your first client and send Form 2020, HHSC surveys your agency. Surveyors look at client records and how you follow the HCSSA rules. Have staff files, policies, and records ready.
Is a surety bond required for HCSSA licensure?
No. A surety bond is not part of HCSSA licensing. Some Medicaid MCO contracts may ask for one. Check with each MCO if you plan to serve Medicaid clients.
Starting in a Nearby State?
Licensing requirements vary a lot between states. Compare your options:
Louisiana
$600 fee · 90-120 Days
Oklahoma
$1,000 fee · 45-120 Days
New Mexico
No state license required · 4-8 Weeks
Arkansas
No state license required · 2-4 Months
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Home care agencies in Texas
Want to see the competition up close? Look at who is already open, city by city.
- Home care agencies in Houston
- Home care agencies in Dallas
- Home care agencies in San Antonio
- Home care agencies in El Paso
- Home care agencies in Garland
Looking for care for a family member? Find agencies near you
Ready to get started?
We broke the Texas licensing process into simple steps. Walk through each one with free guides, checklists, and links to official forms.
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Where our numbers come from
We check each fact against Texas's own rules. Tap a source to read it yourself.
- License needed?YesTex. Health & Safety Code §142.002(a)· Oct 2026
- Who oversees itTexas Health and Human Services Commission (HHSC)26 TAC §558.521· Oct 2026
- License nameHome and Community Support Services Agency (HCSSA)26 TAC Ch. 558· Oct 2026
- The rules26 TAC §55826 TAC §558.3· Oct 2026
- First license fee$2,62526 TAC §558.3(a)(1)· Oct 2026
- License lasts3 years26 TAC §558.19(a)· Nov 2026
- BondNone26 TAC Ch. 558· Sep 2026
- Owner/manager training8 hours26 TAC §558.259(c)· Oct 2026
- Caregiver trainingNo state minimum26 TAC Ch. 558· Sep 2026
- Background checksDPS criminal history check, plus Employee Misconduct Registry and Nurse Aide Registry searches before hireTex. Health & Safety Code §§250.003, 253.008· Oct 2026
- How long it takes4-6 MonthsBest guess — not confirmed yet
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This guide is for informational purposes only and does not constitute legal, regulatory, or business advice. Licensing requirements, fees, and regulations change frequently. Always verify current requirements with your state's licensing agency before making business decisions. HomeCareAtlas is not responsible for the accuracy or completeness of this information.
Researched and reviewed by
John Helmy, Founder of HomeCareAtlasBuilding tools and resources to help home care agency owners navigate licensing, compliance, and growth.