How to Choose an Assisted Living Facility in Texas

Assisted living in Texas costs an average of $4,570 per month in 2026, though that number swings a lot depending on where you are. Houston runs closer to $5,000, while San Antonio averages around $3,600. If your loved one is on Medicaid, the STAR+PLUS HCBS waiver can cover the care services in assisted living, but there's a catch: Medicaid doesn't pay room and board.

This guide covers what you'll actually pay, what Medicaid covers (and doesn't), how to check a facility's track record, and what to look for when you tour.

In This Guide

• Key Takeaways
• Assisted Living Costs in Texas by City
• What Services Are Included
• Does Medicaid Pay for Assisted Living in Texas?
• How to Choose an Assisted Living Facility
• How to Check a Facility's Record
• Your Rights as a Resident
• Frequently Asked Questions
• Next Steps

Key Takeaways

• Average cost is $4,570/month statewide. Houston is the priciest major city ($4,750-$5,355), San Antonio the most affordable (~$3,599).
• Medicaid HCBS waiver covers care services (bathing, meals, medication help) but not room and board in assisted living.
• HHSC inspects facilities at least every two years. Check any facility's record at apps.hhs.texas.gov/LTCSearch.
• Texas law protects resident rights including privacy, dignity, participation in care planning, and freedom from abuse.
• Ask for the Disclosure Statement (Form 3647) before signing anything. It spells out exactly what you're paying for.

Assisted Living Costs in Texas by City

These are base rates. Most facilities charge extra for higher levels of care. If your parent needs memory care, medication management, or help with multiple activities of daily living, expect to add $500 to $2,000 per month on top of the base rate. Always ask for a detailed breakdown of what's included and what costs extra.

How to Pay for Assisted Living

• Private pay is the most common method. Savings, retirement accounts, Social Security, and pension income.
• Long-term care insurance may cover some or all of the cost, depending on the policy.
• VA Aid and Attendance can provide up to $2,874/month for a veteran with a spouse, which can offset a big chunk of the cost.
• Medicaid HCBS waiver covers care services only (see below).
• Bridge loans and life insurance conversions are options some families use for short-term funding.

What Services Are Included

Texas assisted living facilities are required to provide personal care services, which means hands-on help with daily activities. A typical facility includes:

• Personal care: Help with bathing, dressing, grooming, toileting, and eating
• Medication management: Reminders, administration, or supervision depending on the facility
• Meals: Three meals a day, usually with dietary accommodations available
• Housekeeping and laundry
• Social activities and recreation
• 24-hour staff presence (though not 24-hour nursing in most facilities)

What assisted living does not typically include: skilled nursing care around the clock, physical or occupational therapy (usually brought in separately), and intensive medical care. If your loved one needs that level of care, a nursing facility or home health combined with assisted living may be a better fit.

Assisted Living vs. Personal Care Homes

In Texas, these are different. An assisted living facility (ALF) is licensed by HHSC, can house more residents, and may offer medication administration and some health services. A personal care home is a smaller residential setting (4+ residents) that provides non-medical personal care. Personal care homes have fewer regulatory requirements, usually cost less, and feel more like a private home. Both are valid options depending on your loved one's needs.

Does Medicaid Pay for Assisted Living in Texas?

Partly. Through the STAR+PLUS HCBS waiver, Texas Medicaid covers the care services in an assisted living facility. That includes personal care assistance, nursing services, therapy, adaptive aids, medical supplies, and medical transportation.

What Medicaid does not cover: Room and board. The room and board cost is the resident's responsibility. The amount is based on the SSI federal benefit rate minus an $85 personal needs allowance. For 2026, that works out to roughly $882/month for room and board.

The catch: The STAR+PLUS HCBS waiver has an interest list (waitlist). Not everyone who qualifies can access it immediately. See our guide to Texas HCBS waivers for current interest list numbers and how to apply.

If your loved one isn't on the waiver, base STAR+PLUS Medicaid covers medical services and limited personal care but doesn't specifically cover assisted living as a residential option. Community First Choice (CFC) and Community Attendant Services (CAS) can provide home-based attendant care as an alternative to assisted living.

How to Choose an Assisted Living Facility

Questions to Ask During a Tour

Tour at least three facilities. Visit at different times of day, including mealtime. Ask:

• What's included in the base monthly rate, and what costs extra?
• What happens when my parent's care needs increase? Is there a higher level of care available in the same building?
• What's the staff-to-resident ratio during the day? At night?
• How do you handle medication management?
• Can residents keep their own doctors, or do they have to use the facility's physicians?
• What's the discharge policy if my parent needs more care than you can provide?
• Do you accept Medicaid for the care services portion?

Understanding the Contract

Before signing, request the Assisted Living Disclosure Statement (HHSC Form 3647). Texas law requires facilities to provide this before or at admission. It outlines:

• All services included and their costs
• Additional fees and how they're calculated
• Notice requirements for rate increases
• Discharge and refund policies

Read it carefully. Ask about anything that's vague. Have a family member or elder law attorney review it if the contract is complex.

How to Check a Facility's Record

Before choosing a facility, check its inspection history and complaint record.

1. HHSC Provider Search: Visit apps.hhs.texas.gov/LTCSearch to look up any licensed facility. You can see inspection results, deficiency findings, and enforcement actions.
2. Ask the facility directly. Texas law requires facilities to make inspection reports available on-site for public viewing.
3. File or check complaints: Call 800-458-9858 (toll-free) or use the online TULIP portal. HHSC investigates complaints about care quality, abuse, neglect, and safety.

HHSC inspects each facility at least every two years, with additional visits for complaints or follow-ups. A facility with no recent deficiencies is a good sign, but no inspection record is perfect. Look for patterns, not single incidents.

Your Rights as a Resident

Texas law gives assisted living residents specific protections. These include:

• Privacy and dignity in all aspects of care
• Participation in care planning and the right to make decisions about your own living arrangements and services
• Freedom from abuse, neglect, and exploitation
• The right to manage your own finances unless you've designated someone else
• The right to file complaints without retaliation from the facility
• Access to your medical records and care plan
• The right to receive visitors at reasonable times

If you believe a resident's rights are being violated, contact the HHSC complaint line at 800-458-9858 or the Long-Term Care Ombudsman. The Ombudsman advocates for residents in long-term care facilities and can investigate concerns independently.

How much does assisted living cost in Texas?

The statewide average is approximately $4,570 per month in 2026. Houston is the most expensive major city ($4,750-$5,355/month), while San Antonio is more affordable (~$3,599/month). Costs vary by facility, room type, and level of care needed.

Does Texas Medicaid cover assisted living?

Partly. The STAR+PLUS HCBS waiver covers care services (personal care, nursing, medication management) but not room and board. The resident pays room and board, which is roughly $882/month based on the SSI rate. The waiver has a waitlist, so access isn't immediate for everyone.

How do I check an assisted living facility's inspection record?

Use the HHSC Long-Term Care Provider Search at apps.hhs.texas.gov/LTCSearch. You can also ask the facility to show you inspection reports on-site. To report concerns, call 800-458-9858.

What's the difference between assisted living and a nursing home?

Assisted living provides personal care (bathing, meals, medication help) in a residential setting for people who need some daily help but not around-the-clock medical care. Nursing homes (skilled nursing facilities) provide 24-hour nursing care for people with more complex medical needs. Assisted living costs less and feels more homelike, while nursing homes provide a higher level of medical supervision. See our guide to Texas nursing homes for more details.

Next Steps

• Compare costs by requesting fee schedules from at least three facilities in your area.
• Check inspection records at apps.hhs.texas.gov/LTCSearch before scheduling tours.
• Tour in person. Visit during mealtime and ask the questions listed above.
• If Medicaid might help, read our HCBS waiver guide and ask about the interest list.
• For help paying, explore VA Aid and Attendance if the resident is a veteran, or see our guide to paying for senior care for all options.
• Considering other care types? Compare memory care, home care vs home health, and nursing homes to find the right fit.

Find personalized help choosing senior care options at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Medicaid rules vary by state and change frequently. Always verify eligibility and benefits with your state Medicaid agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.