How to Choose Assisted Living in Texas: Costs, Medicaid, Vetting

To choose an assisted living facility in Texas, do three things before you sign. Confirm the facility is licensed, look up its inspection record, and match it to your loved one's real care needs. Start with the Texas Health and Human Services Commission (HHSC), which licenses every assisted living facility in the state and posts each one's inspection history online. In 2026, the median cost of assisted living in Texas is about $5,600 per month.1 If your loved one is on Medicaid, the STAR+PLUS Home and Community Based Services (HCBS) program can cover the care services in assisted living, but not room and board.2

This guide walks you through what you'll pay, what Medicaid covers (and doesn't), how to check a facility's official track record, and what to ask before you sign.

In This Guide

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

How Assisted Living Is Licensed in Texas

There is no federal license for assisted living. Every state built its own rules, so the same kind of care is named and regulated differently from one state to the next. In Texas, the Texas Health and Human Services Commission (HHSC) licenses and regulates assisted living facilities under 26 Texas Administrative Code (TAC) Chapter 553.3 A facility must hold a current HHSC license to legally provide assisted living in Texas, and HHSC inspects each one about every two years, with extra visits for complaints and follow-ups.

The practical takeaway: before you tour, confirm the facility is HHSC-licensed and look up its inspection history. A clean license and a clear inspection record are the floor, not a bonus. Facilities that also care for residents with Alzheimer's or other dementias must be certified by HHSC for that care and provide an Alzheimer's Disclosure Statement (HHSC Form 3641) in addition to the standard one.4

What Assisted Living Costs in Texas

The most current statewide figures come from the CareScout (formerly Genworth) 2025 Cost of Care Survey, released in 2026. In Texas, the median cost of assisted living is about $67,200 per year, or roughly $5,600 per month, a 7% increase since 2024 and below the national median of $74,400 per year ($6,200 per month).1 Here is how assisted living compares with the other main care options in Texas.1

These are median base rates, and they vary by metro area within the state. Most facilities charge a base rate plus add-on fees for higher levels of care.1 If your loved one needs memory care, medication management, or help with several activities of daily living, expect those add-ons to push the bill well above the base rate. Always ask for a detailed, written breakdown of what's included and what costs extra. For a fuller comparison across every care setting, see our guide to the cost of senior care in Texas.

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 per month for a veteran with one dependent in 2026, which can offset a large share of the cost.5
• Medicaid HCBS covers care services only (see below).
• Bridge loans and life insurance conversions are options some families use for short-term funding.

For a full walkthrough of every funding path, see our guide to how to pay for assisted living in Texas.

What Services Are Included

Texas assisted living facilities provide individualized personal care in a homelike setting, with an emphasis on dignity, autonomy, independence, and privacy.4 A typical facility includes:

• Personal care: Help with bathing, dressing, grooming, toileting, and eating
• Medication management: 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 skilled nursing in most facilities)

What assisted living does not typically include: around-the-clock skilled nursing, 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. See our comparison of home care versus home health in Texas if you're weighing in-home options.

Does Medicaid Pay for Assisted Living in Texas?

Partly. Through the STAR+PLUS HCBS program, Texas Medicaid covers the care services in a contracted assisted living facility, including personal care assistance, nursing, therapy, adaptive aids, and medical supplies.2

What Medicaid does not cover: Room and board. That charge is the member's responsibility, and Texas sets it at the Supplemental Security Income (SSI) federal benefit rate minus an $85 personal needs allowance.2 With the 2026 SSI federal benefit rate at $994 per month for an individual, room and board works out to about $909 per month.6

The catch: The STAR+PLUS HCBS program has an interest list (waitlist). A person becomes an applicant only when released from that list, so access is not immediate for everyone who qualifies.2 See our guide to Texas Medicaid HCBS waivers for how the interest list works and how to apply.

If your loved one isn't released from the interest list, Community First Choice (CFC) and Community Attendant Services (CAS) can provide home-based attendant care as an alternative to assisted living.

How to Check a Facility's Inspection Record

This is the step generic checklists skip, and it's the one that turns a brochure into real due diligence. Before you tour, look up the facility's inspection history and complaint record.3

HHSC inspects each facility about every two years, with additional visits for complaints and follow-ups. A facility with no recent deficiencies is a good sign, but look for patterns over time, not a single incident.

How to Choose an Assisted Living Facility in Texas

Match the Facility to the Need

The single most useful move is to match the facility to your loved one's actual care needs, today and as they change. Ask what happens when needs increase: can the same facility legally provide more care, or will your parent have to move? A facility licensed and staffed for higher-acuity or dementia care can keep a resident who would otherwise have to relocate. Confirm the answer in writing before you commit.

Questions to Ask During a Tour

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

• What's included in the base monthly rate, and what costs extra?
• What happens when my parent's care needs increase? Is a higher level of care available here?
• What's the staff-to-resident ratio during the day? At night?
• How do you handle medication management?
• Can residents keep their own doctors?
• What's the discharge policy if my parent needs more care than you can provide?
• Do you accept Medicaid (STAR+PLUS HCBS) for the care services portion?

Understanding the Contract

Before signing, request the Assisted Living Disclosure Statement (HHSC Form 3647).4 Texas requires facilities to provide this before or at admission, and operators must explain all applicable disclosure statements to anyone who asks. It should outline the services included and their costs, additional fees, notice requirements for rate increases, and discharge and refund policies. Read it carefully, ask about anything vague, and have a family member or elder law attorney review it if the contract is complex.

Your Rights as a Resident

Texas assisted living residents retain specific protections.4 These include:

• Privacy, dignity, and respect in all aspects of care
• Participation in their own care and decisions about their living arrangements
• Freedom from abuse, neglect, and exploitation
• The right to make complaints without retaliation from the facility

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, who advocates independently for residents in long-term care facilities.3

Next Steps to Choose Assisted Living in Texas

• Check inspection records at apps.hhs.texas.gov/LTCSearch before you schedule any tours.
• Compare costs by requesting written fee schedules from at least three facilities in your area.
• Tour in person. Visit during a mealtime and ask the questions listed above.
• If Medicaid might help, read our HCBS waiver guide and ask HHSC about the STAR+PLUS interest list, or contact HHSC directly at 800-458-9858.2
• For help paying, explore VA Aid and Attendance if the resident is a veteran, or see our guide to paying for senior care in Texas.
• Considering other care types? Compare memory care, home care vs home health, and nursing homes.

Learn More

These related Texas guides go deeper on cost, coverage, and care types, including how the STAR+PLUS HCBS program covers care services but not room and board.2

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. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.