Starting a care agency in Texas? You need one license, and the category you choose on the application decides what you’re allowed to do. Pick the wrong one and you either can’t offer the services you planned, or you pay for staffing and a survey you didn’t need.
One license: the HCSSA
Every home care, home health and hospice provider in Texas needs a Home and Community Support Services Agency (HCSSA) license from the Texas Health and Human Services Commission (HHSC). The rules are in Health and Safety Code Chapter 142 and 26 Texas Administrative Code Chapter 558.
Texas is one of the most accessible states to launch in. There’s no Certificate of Need, and HHSC accepts new applications all year round through the TULIP online portal.
The four categories
- Personal Assistance Services (PAS). Non-medical help with daily living: bathing, dressing, meals, companionship. No nurses required on staff.
- Licensed Home Health Services (LHHS). Skilled nursing and therapy under physician orders, for clients who don’t use Medicare home health. State-licensed only, not federally certified.
- Licensed and Certified Home Health Services (L&CHHS). The HCSSA license plus CMS certification, so you can bill Medicare and Medicaid managed care plans such as STAR+PLUS.
- Hospice. End-of-life palliative care, with or without Medicare certification.
Which one fits you?
- Non-medical care, private-pay clients, no nurses: PAS.
- Skilled nursing or therapy, paid privately or by non-Medicare payers: Licensed Home Health.
- Skilled care billed to Medicare or Medicaid: Licensed and Certified.
- End-of-life care: Hospice.
Many owners start with PAS because it’s the fastest, lowest-overhead route, then add a skilled category once the business is running.
What it costs
The initial HCSSA license fee is $2,625, and it covers a full three-year term. It’s the same for all four categories. With business formation, insurance and a possible surety bond, most new Texas agencies budget about $3,500 to $6,000 to open. See the full Texas cost breakdown.
Who you need on the team
- An Administrator and an alternate. For PAS, a high school diploma or GED plus a year of experience or training in caring for people with functional disabilities can qualify. For home health and hospice, the Administrator needs either a clinical or nursing home administrator license with a year of supervisory experience, or a diploma plus two years of supervisory experience in a health setting.
- A supervising nurse and an alternate for home health and hospice agencies.
- HHSC Pre-Survey Computer-Based Training. Everyone in those roles must pass each module with at least 80%, and the signed certificates go in with your application.
You don’t need to be a nurse to own the agency. More on that in our ownership guide.
From application to survey
- Get your entity in order. Register with the Texas Secretary of State and make sure you’re in good standing with the Comptroller. HHSC won’t process your application otherwise.
- Apply through TULIP with Form 2021 and your documents. HHSC has up to 45 days to review a complete application. If it finds deficiencies, you have 30 days to respond or the application is denied.
- Admit your first client. Once licensed, you must admit at least one client and submit Form 2020 (Notification of Readiness for Initial Survey) within six months.
- Pass the initial survey. HHSC checks client records, personnel files, policies and actual care against Chapter 558.
That six-month clock is the most common early failure in Texas. It doesn’t pause, and HHSC won’t survey you without an active client.
The Medicare step
If you want to bill Medicare (L&CHHS or Medicare hospice), there’s an extra step. HHSC is not conducting initial Medicare certification surveys right now, so in practice you’ll need a CMS-approved accreditor such as ACHC, CHAP or The Joint Commission. One combined survey from an accreditor can satisfy both the state survey and Medicare certification. You’ll also need to have served at least 10 skilled patients, with seven active on survey day.
New Medicare enrollment for home health and hospice has also been frozen nationally since May 13, 2026, with the freeze scheduled to end November 13 unless CMS extends it. Here’s how to use that window.
How long it takes
Plan for about 3 to 6 months from application to active license for PAS and Licensed Home Health. Medicare certification adds roughly 2 to 4 months, so 5 to 10 months in total for L&CHHS or a Medicare hospice.
How we help in Texas
We handle the full HCSSA application, filing and survey preparation at a fixed price: PAS $2,495, Licensed Home Health $3,495, Licensed and Certified $4,495 and Hospice $4,995. Our Texas licensing guide has the full detail.
Not sure which category fits? Book a free discovery call, tell us the services you plan to offer, and we’ll tell you which HCSSA category you need.
This article is general information, not legal advice. Texas rules and fees change; we confirm the current requirements as part of every project.
