How to Start a Home Care Agency in Texas: 14 Steps & Mistakes to Avoid

To start a home care agency in Texas, choose your business model, register your company, and decide which services you’ll offer: non-medical Personal Assistance Services (PAS), home health, or hospice.

Next, appoint qualified agency leaders, complete HHSC’s required training, and apply for a Home and Community Support Services Agency (HCSSA) license through TULIP, Texas’s online licensing portal.

The initial state license costs $2,625 and lasts three years. Startup timelines vary depending on the services you plan to offer and your preparedness. For a PAS-only agency, plan for roughly 2 to 6 months for business setup and state licensing.

After HHSC issues your license, you can begin serving clients under its approved service categories and prepare for the initial state survey. Home health and hospice agencies that plan to bill Medicare also need separate federal certification and enrollment.

This guide walks you through the 14 steps in order and highlights common mistakes we see new agency owners make. We also explain how home health and hospice requirements differ from those for non-medical home care (PAS). Where a step has its own detailed guide, we cover the essentials here and link to that resource.

What Are the Steps to Start a Home Care Agency in Texas?

Starting a home care business in Texas involves 14 main steps.

1. Choose your license category and how your agency will get paid.
2. Choose an independent agency or a franchise, and write a short business plan.
3. Register your business and set up banking and tax accounts.
4. Set up an office or home office that meets HHSC requirements.
5. Select your administrator, alternate administrator, and, for home health or hospice, supervising nurse.
6. Complete HHSC pre-survey training and administrator training.
7. Prepare Texas-specific policies and procedures.
8. Submit your HCSSA license application through TULIP.
9. Get insured before you serve clients.
10. Recruit and screen caregivers and any clinical staff your services require.
11. Set up scheduling, payroll, billing, and records.
12. Set your rates.
13. Build your referral network and start marketing.
14. Enroll your first clients and request the required initial survey.

Step 1: Choose Your HCSSA Service Category and Payer Model

Texas requires an HCSSA license to run a non-medical home care (PAS), home health, or hospice agency. You can apply for approval to offer one or more of these services under the same license as explained in 26 TAC §558.13.

The service category you choose affects who you need to hire, the training they need, how your agency can get paid, and what you must do before opening.

How Do PAS, Home Health, and Hospice Compare?

The four main Texas HCSSA license categories differ in the services you provide, the leaders you must hire, and the federal rules you follow.

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Source: Compiled by 123 Consulting Solutions from Texas licensing rules and HHSC’s licensing guidance.

*Some licensed home health agencies that offer only certain therapy or related services do not need a supervising nurse. See 26 TAC §558.243.

PAS has fewer staffing requirements than home health or hospice. Nursing and other clinical staff can add to your costs, so think about the team you can hire and the budget you have before selecting a category.

If you choose more than one service category, your agency must meet the requirements for each.

For a closer comparison, read PAS vs Home Health vs Hospice in Texas.

What Can a PAS Agency in Texas Do?

A non-medical home care agency in Texas helps clients with everyday tasks such as bathing, dressing, eating, and moving around.

Care can also include meal preparation, light housekeeping, errands, and companionship, depending on the client’s needs and service plan.

For the services you can offer under PAS, the limits that apply, and how to get started, read our guide on How to Start a PAS Agency in Texas.

What Can a Home Health Agency in Texas Do?

A home health care agency in Texas provides nursing care and therapy in a client’s home. Services can include help managing diabetes, blood pressure checks, or physical therapy to improve strength and movement.

Texas offers two main home health license categories:

• Licensed home health (cannot bill Medicare)
• Licensed and certified home health (can bill Medicare).

To learn more about Texas home health agency staffing, licensing, and Medicare requirements, read our guide on How to Start a Home Health Agency in Texas.

What Can a Hospice Agency in Texas Do?

A Texas hospice agency cares for people with a terminal illness. Hospice agencies in Texas focus on providing personal care, nursing care, medicines for pain & other symptoms, and medical equipment. Patients and families can also receive emotional support, spiritual care, and grief counseling.

For the services involved and how to get started, read our guide on How to Start a Hospice Agency in Texas.

Decide How Your Agency Will Get Paid

Before you set your rates and budget, decide who will pay for care. An HCSSA license alone does not let you bill Medicaid or Medicare. Payer model options include:

• Private pay: Clients or their families pay your agency directly. You agree on the rates before care begins.
• Medicaid: Enroll as a Medicaid provider and complete any required contracts. For example, the STAR+PLUS Medicaid program requires your agency to pass a qualifications review and secure a provider contract with the client’s Medicaid health plan, known as a managed care organization (MCO).
• Medicare: Home health and hospice agencies must complete Medicare certification and enrollment before billing. We cover that process under Step 14. PAS-only agencies cannot bill Medicare.

Your payment model affects how you bill and when money reaches your account.

At 123 Consulting Solutions, we recommend including Medicaid enrollment and contracting in your launch plan, even if your first clients will pay privately. This is because accepting Medicaid can help your agency reach more clients.

For help choosing your payment options, read our guide to home care payers.

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Choose the Right Services for Your Home Care Business

Not sure whether PAS, home health, or hospice fits your plans? We can help you compare the care you’ll provide, the staff you’ll need, and the costs to plan for.

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Step 2: Choose an Independent Agency or a Franchise

A home care service business in Texas can operate independently or as part of a franchise. The choice comes down to how much control you want, the capital you have and the support you need.

• An independent agency gives you full control over your brand and systems, without franchise fees or royalties. You’ll need to develop those systems yourself or get help.
• A franchise gives you an existing brand, systems, and training. In return, you pay a fee upfront and ongoing fees called royalties. You also follow the franchise agreement.

Whatever option you choose, your agency still needs its own HCSSA license, administrator, and policies. Franchise support does not replace those responsibilities.

At 123 Consulting Solutions, we generally encourage new Texas home care business owners to start independently because it can require less capital upfront.

So, before searching for the best home care franchise business in Texas, first consider whether a franchise fits your budget and goals. Read our Independent Home Care vs Franchise guide to help you decide which option is right for you.

Write a Short Business Plan Before You Spend Money

A home care business plan should answer key questions such as:

• Who and what area will you serve?
• Who will pay?
• What will you charge?
• How will you find clients?
• Who are your local competitors?
• What are the likely referral sources?
• How long can you cover costs before clients start paying?

Writing a business plan will help you spot gaps you may have missed before you spend money on licensing, office space, or hiring. Lenders and investors usually ask to see a plan, too.

At 123 Consulting Solutions, we advise new home care owners to plan for more than just the licensing costs. Set aside money to market your agency, recruit caregivers, and pay staff while you find your first clients. We can help you check whether your budget would still work if getting clients takes longer than you expect.

For help putting your plan together, read our guide on how to create a home care business plan.

Step 3: Register Your Business and Set Up Banking and Tax Accounts

Register your home care company as a legal entity with the Texas Secretary of State before you apply for a license.

From our experience working with home care agency owners, most of our clients choose a limited liability company (LLC) to help protect their personal money and property from business debts and claims.

If you choose to form an LLC, file a Certificate of Formation (Form 205) with the Texas Secretary of State. The filing fee is $300, and you can submit it yourself (you do not need an attorney to file it).

After registering your business, complete these steps:

• Use consistent business details. Enter your legal business name exactly as it appears on your registration documents. If your LLC uses a different agency name, file an assumed name certificate, also called a DBA.
• Get an Employer Identification Number (EIN). This is your business’s federal tax ID. You can get it free from the IRS. You need it for payroll, taxes, and opening your business bank account.
• Open a business bank account. Keep agency money separate from personal spending. Using separate accounts for payroll, taxes, and other costs can also help you track your budget.
• Keep state reports and taxes up to date. HHSC checks your standing with the Texas Comptroller and Secretary of State. File required reports and pay any taxes due. LLCs must still file certain reports even when they owe no tax.
• Prepare for payroll taxes. Before paying staff, confirm which payroll tax accounts and payments you’ll need. Register with the Texas Workforce Commission (TWC) within 10 days of becoming responsible for Texas unemployment tax.

How to Choose a Name for Your Home Care Company

Choose a name that is easy to say, spell, and remember. Your agency name should also clearly communicate your services. Before filing your registration:

• Check state name availability with the Texas Secretary of State.
• Search online for businesses using similar names.
• Check whether a suitable website address is available.

The state may still reject your chosen name when it reviews your registration. If you’ve already ordered a logo, signs, or printed materials with that name, you may have to pay to change them.

That’s why at 123 Consulting Solutions, we recommend waiting until your business registration is accepted before paying for a logo, website design, signs, or printed materials.

Step 4: Set Up a Place of Business That Meets HHSC Rules

A Texas home care agency needs a permanent physical location in Texas where you manage its services. A mailbox or virtual address does not qualify.

According to HHSC's HCSSA FAQ, you can use your home address if the agency is actually run from there. But note that a home address cannot be used for an inpatient hospice unit.

At 123 Consulting Solutions, we encourage new PAS agency owners to consider starting from home when the space meets licensing and local requirements. If you start from home, you can save on office rent which leaves you more money for marketing, recruiting caregivers, and paying staff while you find clients.

Whether you work from home or rent an office:

• Keep client and personnel records secure.
• Make records available to HHSC surveyors, including records stored electronically.
• Provide a safe workspace where surveyors can review your records.

And for a home office, also check local zoning rules and any restrictions in your lease or homeowners association (HOA) rules.

Step 5: Appoint Your Administrator, Alternate, and Supervising Nurse

Every Texas HCSSA applicant must appoint an administrator to manage your agency and an alternate administrator to step in when that person is away. You have to name the alternate in writing and if you meet the requirements, you can fill either role.

Home health and hospice agencies usually need to hire or contract with a supervising nurse and name a qualified alternate in writing. Some home health agencies are exempt from this requirement.

Administrator Qualifications for PAS Agencies

For a PAS-only agency, the administrator and alternate must each meet at least one of these conditions under 26 TAC §558.244:

• High school diploma or GED, plus at least one year of experience or training caring for people with functional disabilities.
• Two years of full-time college study in a health-related field at an accredited college or university.
• The home health or hospice administrator qualifications listed below.

Administrator Qualifications for Home Health and Hospice Agencies

The administrator and alternate must each qualify through one of these two routes, satisfying the conditions under 26 TAC §558.244:

• Professional license plus experience: Be a licensed physician, registered nurse (RN), social worker, therapist, or nursing home administrator, with at least one year of management or supervisory experience in a health-related setting.
• High school diploma or GED plus experience: Have at least two years of management or supervisory experience in a health-related setting.

Examples of health-related settings include home care agencies, hospitals, nursing facilities, and hospices.

For hospice agencies, both the administrator and alternate must be hospice employees and meet any extra education or experience requirements set by the agency’s governing body.

Home health agencies seeking Medicare certification must also meet federal administrator requirements and have a qualified clinical manager.

Supervising Nurse Qualifications for Home Health and Hospice

Home health and hospice agencies generally need a supervising nurse, either employed directly or hired under a contract.

For agencies without a home dialysis designation, the supervising nurse and alternate must each:

• Be licensed RNs in Texas or authorized to practice in Texas through the Nurse Licensure Compact.
• Have at least one year of RN experience within the past three years (36 months).

A supervising nurse can also serve as administrator if they qualify for both jobs.

Home dialysis agencies have separate qualification requirements under 26 TAC §558.244(c).

Some agencies offering only therapy, medical social services, or nutritional counseling are exempt from the supervising nurse requirement. However, they still need an appropriate licensed professional to supervise those services. See 26 TAC §558.243(c)(3).

Other Rules for Administrators and Alternates

Both must:

• Be able to read, write, and understand English.
• Meet the training rules explained in Step 6. First-time administrators and alternates must complete eight hours of required training before appointment.
• Meet the criminal-history eligibility rules under 26 TAC Chapter 560.

A 12-month restriction may apply if someone was an agency’s administrator when violations led to certain HHSC enforcement actions, such as license revocation or suspension. Administrative or civil penalties alone do not trigger this restriction.

Check 26 TAC §558.244(b) for the full restrictions and exceptions.

Step 6: Complete HHSC Pre-Survey Training and Administrator Training

Your agency’s required staff must complete HHSC’s Pre-Survey Computer-Based Training (CBT) before you apply. First-time administrators and alternates also need separate administrator training. The CBT does not count toward those training hours.

HHSC Pre-Survey Computer-Based Training

This online course explains licensing rules and helps your agency prepare for its initial survey.

• PAS-only agencies: The administrator and alternate administrator must each complete it.
• Home health and hospice agencies: The administrator, alternate administrator, supervising nurse, and alternate supervising nurse must each complete it.

Everyone takes Modules 1 and 2, plus the module for each service category the agency will offer:

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Allow about 30–60 minutes per module. Each participant must score at least 80%, then print and sign their certificates. Upload the signed certificates with your TULIP application and keep copies for your records. Start through HHSC’s CBT page.

Administrator and Alternate Administrator Training Hours

First-time administrators and alternates in all license categories must each complete:

• 8 clock hours before appointment: Complete these during the 12 months immediately before appointment.
• 16 additional clock hours by the end of their first 12 months in the position: These can also be completed early, during the 12 months before appointment.

Together, these make up the 24-hour initial training requirement under 26 TAC §558.259.

After the first year, administrators and alternates must each complete 12 clock hours of continuing education every 12 months, under 26 TAC §558.260.

123 Consulting Solutions offers online training for Texas HCSSA administrators, including the 8-hour and 16-hour initial courses.

Step 7: Prepare Texas-Specific Policies and Procedures

Your agency needs written policies and procedures that meet 26 TAC Chapter 558 and match the services you will provide. These should explain how your staff will run the agency and care for clients.

Start preparing them before you apply. Generic templates written for other states often miss Texas requirements, which can lead to survey deficiencies.

What Policy Documents Should You Prepare for the Application?

Prepare these documents alongside your application:

• Organizational chart or written description: Show who manages the agency, who reports to whom, and who is responsible for each service.
• Orderly transfer-of-care plan: Explain how clients will continue receiving care if your agency closes or cannot provide their services.
• Continuing education plan: Explain how your management staff will complete their required ongoing training.

Follow the document requirements shown in TULIP for your application.

What Should Your Full Policy Manual Cover?

Your manual should cover areas such as:

• client admission, rights, complaints, and discharge
• client assessments, care plans, and service delivery
• infection control and emergency preparedness
• reporting and investigating suspected abuse, neglect, or exploitation
• hiring, background checks, orientation, and staff training
• personnel records, client records, and confidentiality
• supervision, after-hours support, and backup care
• quality checks and improvement

Home health and hospice agencies also need policies for their clinical services, including nursing care and medication management. Agencies seeking Medicare certification must also address the applicable federal Conditions of Participation.

Step 8: Submit Your HCSSA License Application Through TULIP

Apply for a Texas HCSSA license through TULIP (the Texas Unified Licensure Information Portal). The initial parent-agency license costs $2,625 and lasts three years. The fee is generally non-refundable. HHSC does not begin reviewing your application until TULIP shows “payment received.”

What Should You Have Ready Before Applying?

Before you apply, have the following ready:

• Business records: Registration and good standing with the Texas Secretary of State and Comptroller.
• Agency leaders: Your administrator, alternate, and any required supervising nurses, with their qualifications documented.
• Training records: Signed Pre-Survey CBT certificates for every required person and module, plus applicable administrator training certificates.
• Policy documents: The plans, organizational information, and other documents requested in your application.
• Agency details: Your selected service categories, ownership information, and place-of-business address.

Upload every document TULIP requires for your application. First-time administrators and alternates need their initial 8-hour training before appointment; the remaining 16 hours are due by the end of their first year.

What Happens After You Submit?

HHSC has up to 45 days after submission and payment receipt to check whether your application is complete and accurate.

If information is missing or incorrect, HHSC sends a notice through TULIP explaining what you must correct. You must submit the requested information within 30 days after the notice date.

Once your application is complete and all licensing requirements are met, HHSC has up to another 45 days to issue the license. These review periods are explained in 26 TAC §558.31.

Step 9: Arrange Insurance Before Serving Clients

Arrange insurance for the services your agency will provide before serving clients. Discuss general liability, professional liability, and any bonding needs with an insurance adviser who understands home care companies.

Tell your adviser what services you offer and whether you use employees or contractors. Check your payer and referral agreements for required coverage types and limits.

Texas does not require workers’ compensation for most private employers. However, your agency’s contracts may require it.

Before buying a policy, ask what it covers, what it excludes, and when coverage starts. Include insurance premiums in your ongoing operating budget.

Step 10: Recruit and Screen Your First Caregivers and Clinical Staff

Use the HHSC application review period to recruit staff for the areas you plan to serve. Ask applicants where they can travel, which hours they can work, and what care tasks they have experience providing.

What Checks Must You Complete Before Staff Serve Clients?

Complete the screening required for each person’s position. Your hiring process should include:

• Criminal history checks: Review the results for convictions that bar employment under Texas Health and Safety Code §250.006. A search credit on the Texas DPS secure website costs $1, plus processing fees when paying by card.
• Registry checks: Search the Search Engine for Multi-Agency Reportable Conduct (SEMARC) and the Nurse Aide Registry (NAR) separately through TULIP before hire. Repeat the required searches at least every 365 days and keep dated results.
• Orientation and training: Explain your agency’s policies, confirm staff can perform their assigned tasks, and document the required training.

Follow HHSC’s SEMARC guidance when setting up your registry checks.

Additional Requirements for Home Health and Hospice Staff

Home health and hospice agencies also need qualified clinical staff for the services they offer. Verify each clinician’s license and authority to practice in Texas.

Home health and hospice aides must meet the training and competency requirements that apply to your agency. These include the relevant Texas rules and, for Medicare-certified agencies, federal requirements.

For hiring methods and places to advertise, read how to recruit caregivers for a home care business. For office staffing, see when and who to hire first.

Step 11: Set Up Scheduling, Payroll, Billing, and Records

Before your first client, you need a reliable way to schedule visits, track hours, pay staff, collect payments, and keep records. Texas home care companies with clear systems from day one make fewer errors and are better prepared for HHSC surveys.

What Systems Does Your Home Care Business Need?

• Scheduling and timekeeping: Assign caregivers, record hours worked, and arrange backup coverage when someone is unavailable.
• Payroll and taxes: Set pay dates and arrange wage calculations, deductions, and tax filings. Register with the Texas Workforce Commission when your agency becomes required to pay state unemployment tax.
• Client intake and care planning: Prepare forms for client information, assessments, service agreements, and care plans.
• Incident reporting: Give staff a clear way to report concerns. Identify who will notify HHSC and track reporting deadlines. Suspected abuse, neglect, or exploitation of a client by agency staff must be reported immediately, meaning within 24 hours.
• Billing and payments: Set up invoices or insurance claims, payment tracking, and follow-up on unpaid balances for each payer you accept.
• Client and personnel records: Organize files so authorized staff can find what they need while keeping confidential information secure.

Additional Systems for Medicaid, Home Health, and Hospice

If your Medicaid services require Electronic Visit Verification (EVV), arrange an approved system to record and verify visits. Texas offers a state-provided system or approved proprietary systems. Complete the required setup before providing EVV-required services.

Home health and hospice agencies also need systems for recording clinical assessments, care plans, orders, and visit notes.

Home health agencies seeking Medicare certification must also prepare to collect and submit required OASIS patient assessments under the federal Conditions of Participation. Choose a documentation system that supports this work.

Test Your Process Before Your First Client

Walk through a sample case from the first inquiry to intake, scheduling, visit records, payroll, and billing. Check that each person knows their responsibilities and that information reaches the next person who needs it.

Step 12: Decide How Much to Charge for Your Services

For private-pay services, set your rates before accepting your first client. Start by working out what each hour of care costs your agency.

Include:

• caregiver wages
• employer payroll taxes and benefits
• caregiver recruitment and training
• insurance
• software, marketing, and other office expenses

Divide your monthly insurance, software, marketing, and office costs by the client hours you expect to bill that month. Include that amount in your hourly rate, then add enough to make a profit. Be sure to compare your proposed rates with local agencies offering similar services. Pricing too low hurts the agency's survival, and pricing too high slows client growth.

Rate setting works differently for Medicare.

If you accept Medicaid, review the applicable program rates or your managed care organization (MCO) contract rates. Check that those payments can cover the cost of providing care.

Medicare pays home health and hospice agencies under its own payment systems. For those services, plan around the expected payments and cost of care rather than setting a private-pay hourly rate.

For Texas rate ranges and help calculating your prices, read how much your home care agency should charge clients in Texas.

Step 13: Build Your Referral Network and Start Marketing

Use HHSC’s application review period to prepare your marketing materials and identify potential referral sources. Have your outreach plan ready so you can begin promoting your services once your license is issued.

What Can You Prepare Before Licensure?

• Draft your website pages, brochures, and service descriptions.
• List potential referral contacts, including hospital discharge planners, rehab centers, senior living communities, and case managers.
• Prepare a clear explanation of your planned services, service area, payment options, and referral process.

How Should You Market Your In-Home Care Business After Licensure?

Publish your website and begin contacting the referral sources on your list. Explain whom your agency serves, where you can provide care, and how to refer a client. 

For home health and hospice, include physicians’ offices, hospitals, and other clinical providers in your outreach.

Keep a record of each contact, your conversations, and when to follow up. Track where inquiries come from and which sources lead to clients.

At 123 Consulting Solutions, we recommend that new owners spend roughly 70%–80% of their time on marketing and business development in the early months. Make outreach a regular part of your week.

Once you are serving clients, ask satisfied families for honest reviews.

For help planning your outreach, read our guide to marketing home care services. For specific ways to find your first paying client, see how to get your first private-pay home care client.

Step 14: Enroll Your First Client and Request the Initial Survey

Once HHSC issues your license, you can begin serving clients under its approved service categories.

For a PAS-only agency, complete these steps within six months of the initial license’s effective date:

1. Admit at least one client.
2. Provide services to that client.
3. Request your initial survey using HHSC Form 2020, Notification of Readiness for Initial Survey.

Home health, hospice, and agencies with multiple categories must meet the client-service requirements for their categories. Qualifying accredited agencies may be exempt from the HHSC survey, but must submit accreditation documentation within the required deadline.

See 26 TAC §558.521 for the requirements that apply to your agency.

What Will HHSC Review?

The initial survey checks whether your agency follows Texas rules in practice. Surveyors review:

• agency policies and procedures
• personnel qualifications, screening, and training records
• client assessments, care plans, and service records
• how staff deliver and supervise care

Before requesting the survey, run an internal practice review. Check your files and ask staff to explain how they handle client care, complaints, and incidents.

In our experience, gaps can include incomplete quality assessment and performance improvement (QAPI) records, missing emergency preparedness documents, and unfinished background or registry checks. Review these areas carefully before requesting your initial survey.

What Does Medicare Certification Add for Home Health and Hospice?

A Texas HCSSA license alone does not authorize Medicare billing. Home health and hospice agencies must also complete Medicare enrollment and certification and meet the applicable federal Conditions of Participation.

Current Medicare enrollment restriction: Centers for Medicare & Medicaid Services (CMS) imposed a nationwide pause on new home health and hospice Medicare enrollment effective May 13, 2026. Check CMS’s current moratorium guidance before applying or committing money to certification.

When enrollment is available, the process generally includes:

• obtaining an organizational National Provider Identifier (NPI)
• applying through PECOS or the CMS-855A enrollment application
• completing the required certification survey and approval process
• for home health, documenting the initial reserve operating funds required by 42 CFR §489.28

HHSC currently states that it is not performing initial Medicare certification surveys. Coordinate the applicable process with HHSC and a CMS-approved accrediting organization.

Newly enrolling Texas hospices are also subject to CMS’s provisional period of enhanced oversight, which includes medical review of claims and can last from 30 days to one year.

How Long Does It Take to Start a Home Care Agency in Texas?

Starting a PAS-only agency in Texas can take several months. Most first-time PAS owners should plan for about 2 to 6 months from forming the business to holding an HCSSA license.

Certified home health and hospice agencies take longer because Medicare certification starts only after the state license has been received.

Texas Home Care Startup Timeline

This table shows how long it takes to start a home care agency in Texas:

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How Much Time Can Application Corrections Add?

If HHSC uses both full 45-day review periods and you use the full 30-day correction window, those stages total 120 days, or about 17 weeks, after submission and payment receipt.

Using the same four-week preparation example:

• Without a correction period: 28 days + 90 days = 118 days, or about four months.
• With the full correction period: 28 days + 120 days = 148 days, or about five months.

These are planning calculations, rather than required waiting periods or guaranteed approval dates. Delays beyond the standard periods are possible under the rules.

How Much Longer Does Medicaid Take?

Medicaid enrollment and contracting add separate steps. TMHP states that enrollment can typically take up to 60 days after it receives all necessary information, with some applications taking longer.

Managed care organization credentialing and contracting can add more time. Confirm the process with each health plan; Medicaid enrollment alone does not establish every required provider contract.

What About Medicare-Certified Home Health and Hospice?

State licensure and Medicare approval have separate requirements. Plan both processes early rather than waiting until your state license arrives to investigate certification.

Since May 13, 2026, new Medicare enrollment has been restricted by a nationwide home health and hospice enrollment moratorium. CMS can extend the restriction, so a fixed Medicare launch timeline would be misleading.

Check CMS’s current enrollment restrictions before committing to a Medicare-dependent launch date. The restriction concerns Medicare enrollment; PAS-only agencies do not bill Medicare.

How Much Does It Cost to Start a Home Care Agency in Texas?

We recommend planning around $10,000–$15,000 for a small, independent PAS agency that starts lean. This assumes you keep expenses low, such as working from a home office that meets HHSC rules and handling administration yourself if you qualify.

Your budget may need to be higher if you rent an office, pay for software, hire an administrator, or need more money to cover payroll while you wait for client payments. Home health and hospice agencies also have clinical staffing and other costs to consider.

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We help our clients keep their start-up costs low by providing them with software for hiring, training, and onboarding at no cost. We also advise them on which tasks to delegate or outsource, so they can spend more time finding clients and building referral relationships.

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Business Registration and Licensing Fees

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The LLC filing and initial HCSSA license alone total $2,925 before processing fees. You will still need to budget for screening, training, insurance, and other startup expenses.

What Else Should Your Budget Cover?

Include money for:

• Policies and training: Texas-specific policies, administrator training, and any professional help you use.
• Insurance: Coverage suited to your services and contracts.
• Office and software: Equipment, secure records, scheduling, payroll, and billing.
• Marketing: Your website, marketing materials, and finding your first clients.
• Recruitment: Finding, screening, and training caregivers.
• Working capital: Cash to pay staff and other bills while you build your client base and wait for payments.

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Start Your PAS Agency With 123 Consulting Solutions

With 123 Consulting Solutions, you can start a non-medical home care business for as little as $10,000 to $15,000. How do we do this? We help our clients keep their start-up costs low by providing them with software for hiring, training, and onboarding at no cost. And with our pay-to-play strategy, we show you how to use paid leads to find your first clients while building referral relationships.

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What Adds to Home Health and Hospice Startup Costs?

PAS agencies can start with lower overhead because they do not require a supervising nurse or Medicare certification. Home health generally adds an RN supervising nurse and clinical staff. Hospice also needs a broader clinical team to care for patients and support their families.

New home health agencies entering Medicare must also show enough reserve funds for three months of operation, excluding expected Medicare payments. The Medicare contractor determines the amount, and at least half must be non-borrowed funds.

The funds must remain available from application through enrollment and for three months after Medicare billing privileges are granted, under 42 CFR §489.28.

For a fuller breakdown of setup expenses and the cash you’ll need after launch, read our Texas home care startup cost guide.

What Mistakes Should You Avoid When Starting a Home Care Agency in Texas?

As you work through the 14 steps above, it helps to know where things can go wrong. Some mistakes can delay your license; others can leave you short of staff or money when clients arrive.

Here are the mistakes to watch for and what you can do to avoid them:

• Submitting an incomplete TULIP application. Check required uploads, signatures, ownership details, and training certificates before submitting.
• Missing a deficiency notice. Check TULIP regularly. If HHSC requests corrections, provide complete and correct information within 30 days of notification, or your application will be denied.
• Choosing an unqualified administrator or alternate. Both must meet Texas administrator qualifications. First-time administrators and alternates also need the required 8-hour training before designation. Training alone does not qualify them.
• Paying for an unsuitable business address. A virtual mailing address alone is not enough. Confirm that your location meets HHSC rules before paying for an address service or signing a lease.
• Relying on generic policies. Your policies must meet Texas requirements and match your services. Before your survey, check that staff understand them and that your records show they are being followed.
• Accepting clients before confirming caregiver availability. We’ve seen owners accept cases, then struggle to serve them because their caregivers lived too far away. Before promising a start date, confirm that a qualified caregiver can reliably reach the client. Factor in travel time and costs so the case still leaves room for profit.
• Spending your entire budget getting licensed. Keep cash available for recruitment, payroll, and other bills while you build your client base and wait for payments.
• Leaving marketing out of your budget. We recommend setting aside $500–$1,000 a month for marketing. Plan for advertising, paid leads, or relevant community events so you can keep finding clients after launch.

If you’re unsure about your application, staffing plan, or budget, get guidance before you commit more money or promise a client a start date.

Should You Hire a Consultant for Your Home Care Agency in Texas?

You can start a home care business in Texas without a consultant. Consider hiring one if you want hands-on help with your application, Texas-specific policies, and preparing your agency to serve clients. A home care consultant can help you avoid common HHSC application mistakes. 

For example, we serve as home care consultants in Texas and help new agency owners get it right from the start. For example, our home care startup program can help your new PAS agency:

• Prepare your TULIP application and required documents.
• Put Texas-specific policies in place and complete administrator training.
• Prepare for your initial survey.
• Work through Medicaid enrollment and MCO contracting requirements.
• Plan how to find clients and build referral relationships.

We also help you identify what can set your agency apart locally. That means deciding who you want to serve, what those clients need, and why families or referral sources should choose your agency.

Here’s what Jasmine, one of our consulting clients, had to say after successfully launching her PAS agency:

"Working with Shae and his team at 123 Consulting Solutions was incredibly helpful. They guided me through licensing, policies, and operations with clear, practical direction. Every conversation was focused and honest. Their support was key to helping me get my agency off the ground, and it made the entire process far more manageable." — Jasmine Castle, San Antonio, TX

To learn more about how Texas home care consultants can help you, read what home care consultants do and how much home care consultants cost.

Frequently Asked Questions

Do you need a license to provide non-medical home care in Texas?

Generally, yes. An agency providing personal assistance services (PAS), such as help with bathing and dressing, needs an HCSSA license from HHSC. Limited exemptions apply, including certain companionship-only services that involve no personal care or health-related tasks.

Can you start a home care agency in Texas without healthcare experience?

Yes. You can own a home care company without a healthcare background. Your administrator and alternate must meet HHSC qualifications for your services. If you plan to serve as administrator yourself, you must meet those qualifications and the applicable training requirements.

Can you run a home care business from your house in Texas?

Yes, if your home is the permanent physical location from which you direct agency services. It must meet HHSC’s place-of-business requirements, including providing a reasonable, safe workspace for surveyors. A virtual office does not qualify.

Can a non-medical home care agency in Texas accept Medicaid?

Yes. A licensed PAS agency can accept Medicaid after completing separate provider enrollment and any required program or managed care contracts. The agency must also meet applicable billing and Electronic Visit Verification (EVV) requirements. An HCSSA license alone does not authorize Medicaid billing.

Can a PAS agency give clients their medications?

PAS caregivers can help clients take their own medications through reminders or help opening containers. Certain medication-administration tasks may also be allowed under RN delegation, with the required assessment, caregiver training, and supervision. Follow the Texas Board of Nursing’s delegation requirements.

What is the difference between home care and home health in Texas?

Home care usually means non-medical PAS, such as help with bathing and dressing. Home health provides skilled services, such as nursing and therapy. Both fall under Texas HCSSA licensing, but agencies must hold the appropriate category for their services.

Do you need Medicare certification to start a home health agency in Texas?

No. Texas makes Medicare certification optional. A licensed home health agency can operate without it, but cannot bill Medicare. Medicare billing requires federal enrollment and certification, along with the licensed and certified home health category.