Texas home care licensing
Last updated: October 2, 2026
Texas does not use one simple “home care license” for every agency. A business providing non-medical personal care may fit the Personal Assistance Services category, while an agency providing nursing, therapy, or other home health services may need a Licensed Home Health Services category. Medicare-certified home health is a separate step again. The most important job is to classify your services correctly before you build the company, hire staff, advertise, or accept clients.
Bottom line
If your Texas business will provide home health services or personal assistance services for pay, start with the Texas Health and Human Services Commission’s Home and Community Support Services Agency, or HCSSA, licensing system. HHSC requires an HCSSA applicant to choose the service category or categories that match what the agency will actually provide.
For many non-medical home care businesses, the key category is Personal Assistance Services (PAS). For skilled home health, the key category is usually Licensed Home Health Services (LHHS). If the agency also wants Medicare certification, the Texas category and federal certification path are different. Do not advertise “home health,” “personal assistance services,” skilled nursing, or similar regulated services until you understand which category applies.
Quick start: do these checks in this order
- List every service you will sell. Separate personal care and respite from nursing, therapy, IV services, wound care, or other skilled work.
- Choose the HCSSA category. Use HHSC’s PAS, LHHS, and licensed-and-certified home health materials instead of relying on the label “non-medical.”
- Set up required personnel. PAS-only applicants follow a different staffing path from home health applicants that generally need a supervising nurse and alternate.
- Complete the Presurvey CBT. Required participants complete Modules 1 and 2 plus the module for each selected service category.
- Prepare state business records. HHSC requires the applicant to meet Secretary of State and Comptroller registration/good-standing requirements.
- Apply through TULIP. Submit the HCSSA application, documents, and payment through the state portal.
- Plan for the survey. After initial licensure, meet the first-client and initial-survey deadlines.
Texas home care licensing decision table
| What you plan to do | Main Texas path | Key agency | Action |
|---|---|---|---|
| Provide routine personal care, help with activities of daily living, respite, or permitted health-related tasks in a client’s home | Usually evaluate the HCSSA Personal Assistance Services category | Texas HHSC | Read the HHSC PAS presurvey module |
| Provide nursing, therapy, medical social services, IV therapy, or other services within the home-health definition | Evaluate Licensed Home Health Services | Texas HHSC | Read the HHSC LHHS presurvey module |
| Provide Medicare-certified home health | State HCSSA licensure plus the licensed-and-certified category and federal Medicare steps | Texas HHSC and CMS | Review the licensed-and-certified home health module |
| Submit the state HCSSA application | TULIP | Texas HHSC | Register for TULIP |
| Form or maintain a Texas filing entity | SOSPortal | Texas Secretary of State | Use the current Texas business filing route |
| Determine local office zoning, occupancy, or local business requirements | City or county process depends on the office address | Local government | Start with the Texas business license guide, then verify the exact local jurisdiction |
First decision: home health is not the same as non-medical home care
Texas puts several in-home service businesses under the HCSSA system, but the service categories are not interchangeable. The application asks the agency to select the categories it will actually provide.
Personal Assistance Services (PAS) covers routine ongoing help with activities of daily living and independent living. HHSC examples include bathing, dressing, grooming, feeding, toileting, positioning, assistance with self-administered medication, transfer, ambulation, and respite. Some health-related tasks can fit PAS when Texas delegation rules allow them.
Licensed Home Health Services (LHHS) covers services such as nursing, physical or occupational therapy, speech or respiratory therapy, medical social services, IV therapy, dialysis, certain delegated or supervised services, medical equipment and supplies, and nutritional counseling.
Do not rely on the word “non-medical”
A business marketed as “non-medical home care” can still fall within Texas PAS licensing. Classify the tasks your workers will actually perform.
Texas has specific statutory exemptions under Health and Safety Code Chapter 142. Those exemptions have conditions. A normal staffed home care agency should not assume it is exempt; verify the exact statutory criteria before relying on an exemption.
Non-medical home care: the PAS route
For an agency providing personal care and support rather than skilled home health, PAS is often the central Texas category. HHSC’s training states that providing or implying that you provide PAS without the required HCSSA license is a violation, subject to statutory exemptions.
A PAS-only agency designates an administrator and alternate administrator. HHSC lists education or experience routes for those roles. PAS-only agencies do not have to designate a supervising nurse solely because they hold PAS.
That does not remove nursing-delegation rules. If unlicensed workers perform health-related tasks, the agency must follow applicable Board of Nursing delegation rules and written agency policy. PAS agencies also need staffing and supervision policies, client service plans, records of delivered services, and required QAPI processes.
If the planned service list includes skilled nursing or therapy within the home-health definition, PAS alone is not enough.
Skilled home health: the LHHS route
An agency providing skilled home health should evaluate the Licensed Home Health Services category. HHSC’s LHHS training covers nursing, therapy, medical social services, and other services within the Texas home-health definition.
HHSC says an LHHS agency generally must have a supervising nurse and alternate supervising nurse. A narrow exception applies to agencies providing only certain therapy, medical social, or nutritional services, where an appropriate qualified licensed professional may supervise instead. The administrator and alternate administrator must also meet HCSSA qualifications.
If the business wants to provide both PAS and home health, select and comply with the categories needed for both. Adding skilled services is not merely a marketing change.
How the Texas HCSSA application works
- Choose the service categories. Decide whether the agency needs PAS, LHHS, Licensed and Certified Home Health Services, or another HCSSA category.
- Complete the Presurvey CBT. Required participants take Modules 1 and 2 plus each applicable category module: Module 3 for PAS, Module 4 for LHHS, and Module 5 for licensed-and-certified home health.
- Pass and document training. HHSC requires an 80 percent minimum on required module quizzes and signed completion certificates.
- Confirm business standing. HHSC requires registration and good standing with the Texas Comptroller and Secretary of State.
- Submit through TULIP. Upload required material and pay the current licensing fee.
- Become operational and survey-ready. A new agency generally must admit at least one client, start services, and request the initial survey within six months of the initial license, subject to applicable accreditation or certification rules.
HHSC may survey licensed agencies and investigate complaints after the initial process, so build compliant records from the first client forward.
Staffing, caregiver checks, and records
HCSSA licensing requires an operating staffing system, not just an application. Written policies address qualifications, orientation, training, performance, discipline, criminal-history checks, and registry searches for unlicensed personnel.
HHSC says agencies must search the Employee Misconduct Registry and Nurse Aide Registry before hiring covered unlicensed people and annually thereafter. They may not employ a person listed as unemployable. Initial criminal-history checks also apply to covered unlicensed employees, volunteers, and contractors with face-to-face client contact.
Keep documentation of the checks and required personnel records available for survey.
2026 portal change
HHSC moved employability-status checking into TULIP during 2026. The TULIP login page says the Employee Misconduct Registry migration was effective June 29, 2026. Update hiring checklists that still point to an older registry route.
Your office, service area, and local city or county rules
Care happens in clients’ homes, but the agency still has a place of business. HHSC licenses each place of business and regulates service areas, location changes, branches, and related license information.
The HCSSA license does not erase local rules. The city or county where the office sits may control zoning, home occupation, occupancy, building, fire, signs, or a general local business registration. Verify the exact office address before signing a lease or using a residence as the administrative office.
Use the city, county, and state registration guide to separate these layers, then use the correct local government’s current zoning and occupancy pages.
Entity, tax, and employer layers are separate from the HCSSA license
An LLC or corporation is not the HCSSA license. See Business License vs LLC vs DBA vs Seller’s Permit if you need to separate the filings.
Texas Secretary of State
Texas launched SOSPortal on September 29, 2026, replacing SOSDirect and SOSUpload for business filings, searches, and orders. Use the current Secretary of State route when forming or maintaining a filing entity.
Texas Comptroller
HHSC requires the applicant to meet Comptroller registration and good-standing requirements. A sales and use tax permit is separate and is not automatic just because the business holds an HCSSA license; the Comptroller ties that permit to taxable goods, taxable services, and other taxable activity.
Employers
If you hire, check Texas Workforce Commission unemployment-tax duties and Texas new-hire reporting. Because unemployment-tax systems have been in a 2026 modernization transition, use TWC’s current program page to reach the live system rather than a saved legacy portal link.
State licensure is not Medicare certification or Medicaid contracting
HHSC says HCSSA licensure is mandatory while Medicare certification is optional. A PAS-only private-pay agency is not a Medicare home health agency, and an LHHS license alone is not federal Medicare certification. The appropriate licensed-and-certified category and federal enrollment steps apply when Medicare certification is the goal.
Medicaid and other HHSC program contracts are another layer. Program enrollment, rates, electronic visit verification, managed-care rules, and contracts are separate from basic HCSSA licensure. Confirm those program rules before building a reimbursement model around them.
State license cost and timing
HHSC’s presurvey materials list a $2,625 initial fee for a three-year parent agency or branch license. Because a broad Chapter 558 rulemaking package is pending in fall 2026, confirm the fee displayed in TULIP immediately before paying.
The license term is not a promised startup timeline. Missing information, training certificates, or business-standing problems can delay an application. After the initial license, the agency generally has six months to admit a client, begin services, and request the initial survey.
Medicare certification, accreditation, local occupancy work, insurance, payroll, staff screening, and program contracting can add separate costs.
Texas home care changes to know in 2026
SOSPortal replaced older business filing systems
Texas launched SOSPortal on September 29, 2026, replacing SOSDirect and SOSUpload for business filings, searches, and orders. This matters because HCSSA applicants must meet Secretary of State registration and good-standing requirements when applicable.
HHSC moved employability checks into TULIP
HHSC’s 2026 training directs providers to the TULIP-based Employee Misconduct Registry and Nurse Aide Registry process. Update older hiring instructions accordingly.
Proposed HCSSA amendments are not current law
HHSC published a large proposed Chapter 558 amendment package on September 18, 2026, including place-of-business and online-portal provisions. The earliest possible adoption date listed is October 18, 2026. As of October 2, these are proposed rules. Recheck final rule status before relying on them.
Three realistic Texas examples
Private-pay personal care
Caregivers help with bathing, dressing, toileting, transfers, ambulation, and respite, without skilled nursing or therapy. The business should closely evaluate PAS, administrator requirements, caregiver screening, supervision, and client service plans.
Nursing and therapy at home
The agency provides nursing, wound care, physical therapy, or other skilled services. That is not a PAS-only model; evaluate LHHS, supervising-nurse requirements, and skilled-service policies.
Medicare home health
The founders want to bill Medicare for skilled home health. They need the correct Texas licensed-and-certified category plus federal enrollment and certification. State licensure alone is not Medicare certification.
Common mistakes
- Calling PAS “unlicensed non-medical care.” Texas regulates PAS unless a specific exemption applies.
- Adding skilled nursing informally. Service categories control what the agency may offer.
- Assuming an LLC is the license. Entity formation and HCSSA licensure are separate.
- Hiring before screening is ready. Registry, criminal-history, qualification, and training records matter.
- Using old portal links. SOSPortal and TULIP changes make older checklists risky.
- Ignoring the office address. The agency place of business can face state and local requirements.
- Confusing licensure with Medicare or Medicaid. Certification and contracting are separate layers.
- Waiting until month six to prepare for survey. Build survey-ready records from the first client.
Texas home care compliance checklist
- List every client service and match it to the correct HCSSA category.
- Verify any claimed statutory exemption instead of assuming it.
- Identify the administrator and alternate administrator.
- For categories that require them, identify the supervising nurse and alternate.
- Complete Modules 1 and 2 plus each service-category Presurvey CBT module.
- Keep signed training certificates and confirm state business standing.
- Prepare and submit the HCSSA application through TULIP.
- Build staffing, supervision, QAPI, client-care, complaint, emergency, and recordkeeping policies.
- Set up current EMR/NAR and criminal-history screening before client assignment.
- Verify local zoning and occupancy for the agency office.
- Track the first-client and initial-survey deadline after licensure.
- Treat Medicare or Medicaid participation as a separate project.
What to ask HHSC before you apply
If your model sits near the PAS/home-health line, describe the actual tasks to HHSC before filing under the wrong category.
Agency script
“I am starting a Texas agency that will provide these services: [list services]. We will use [employees / contractors / both], and our office will be at [city and type of location]. Which HCSSA category or categories should cover these services, which personnel must complete presurvey training, and which current TULIP application path should we use?”
What if the classification still is not clear?
Do not copy another agency’s category. Compare your service list against the PAS and LHHS modules, then ask HHSC to clarify before marketing the service. For exemption questions, read the statutory exemption and get case-specific legal guidance when the facts are close.
For zoning or occupancy, use the city or county that controls the agency office address; HHSC cannot replace that local check.
Official Texas and federal resources
- Texas HHSC HCSSA Presurvey CBT and service-category modules
- Texas Unified Licensure Information Portal registration
- HHSC Module 3: Personal Assistance Services
- HHSC Module 4: Licensed Home Health Services
- HHSC Module 5: Licensed and Certified Home Health Services
- TULIP login and current registry resources
- Texas Secretary of State business filings and SOSPortal
- Texas Comptroller franchise tax account status
- Texas Comptroller online tax registration
- Texas Workforce Commission unemployment tax
- Texas Workforce Commission new-hire reporting
- IRS Employer Identification Number information
- September 18, 2026 proposed HCSSA rule amendments in the Texas Register
About this BLG guide
This page focuses on the Texas HCSSA layer for home health and non-medical home care. For broader entity, tax, and local-license issues, use the Texas business license guide and the official agency sources for your facts.
Related business license guides
Start with the closest next-step guides, then explore other BLG location and licensing resources.
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FAQ
Do I need a license to start a non-medical home care agency in Texas?
Often, yes. A staffed agency providing personal assistance services for pay will usually need to evaluate the Texas HCSSA Personal Assistance Services category. Texas has specific statutory exemptions, so confirm whether an exemption truly applies before operating without an HCSSA license.
Is a PAS license the same as a home health license in Texas?
No. PAS covers personal assistance and permitted health-related tasks under its rules, while Licensed Home Health Services covers nursing, therapy, medical social services and other services within the Texas home-health definition. The staffing and supervision requirements are different.
Does a PAS-only agency need a supervising nurse?
Texas HHSC says an agency licensed only for PAS does not have to designate a supervising nurse and alternate supervising nurse. The agency still needs proper supervision policies, and nursing-delegation rules can apply when unlicensed workers perform health-related tasks.
Where do I apply for a Texas HCSSA license?
Use the Texas Unified Licensure Information Portal, or TULIP. Required personnel must first complete the applicable HCSSA Presurvey CBT modules, and HHSC also requires the applicant to meet its business-registration and good-standing requirements.
Does a Texas HCSSA license let me bill Medicare?
No. State HCSSA licensure and Medicare certification are separate. An agency seeking Medicare home health certification must use the appropriate licensed-and-certified category and complete the federal enrollment and certification steps in addition to Texas licensure.
Do I need a Texas sales tax permit for a home care agency?
Not automatically just because you have an HCSSA license. The Texas Comptroller ties sales-tax registration to selling or leasing taxable goods, providing taxable services, or other taxable activity. Check the agency’s actual sales and services before applying for a permit.
Can I run the agency office from home?
Do not assume so. HHSC licenses an agency place of business, and local zoning, home-occupation, lease, HOA, occupancy, and other rules may affect the address. HHSC also proposed new place-of-business language in September 2026, but those proposed rules were not yet effective on October 2, 2026.
Update note
Last updated: October 2, 2026
Next review: December 31, 2026
This guide checked Texas HCSSA service categories, PAS and licensed home health distinctions, Presurvey CBT and TULIP steps, staffing and employability checks, initial-survey timing, business-standing requirements, local office layers, Medicare separation, the September 29, 2026 SOSPortal launch, the 2026 TULIP employability migration, and the September 2026 proposed HCSSA rule package. Proposed Chapter 558 amendments are not presented as current law.
Disclaimer
This guide is for general information only and is not legal, tax, employment, healthcare, or licensing advice. Texas HCSSA rules, application systems, fees, service categories, local zoning rules, and federal certification requirements can change. Confirm the current requirements with Texas HHSC and the other official agencies that control your exact services and business location before you apply, advertise regulated services, hire staff, sign a lease, or begin serving clients.