Getting a Texas home care license isn't difficult once you understand the structure — but it takes longer than most new owners expect, and the applications that get rejected or stall almost always do so for the same small set of fixable reasons. This guide walks through every step, with the administrator requirements, document checklist, and timeline specifics that the official pages don't always present clearly.

All information is current as of June 2026. The governing regulation is Texas Administrative Code (TAC) Title 26, Part 1, Chapter 558.

What Is an HCSSA and Who Needs a License

HCSSA stands for Home and Community Support Services Agency. In Texas, any organization that provides in-home personal care, homemaker, companion, or skilled nursing services must hold a current HCSSA license issued by the Texas Health and Human Services Commission (HHSC).

The license requirement applies whether your agency:

Serves private pay clients only
Participates in Medicaid managed care programs (STAR+PLUS, STAR Kids, STAR Health)
Bills through fee-for-service Medicaid
Operates as a Medicaid waiver provider

There is no private pay exemption. If you are sending caregivers into clients' homes to provide hands-on personal assistance, you need an HCSSA license in the appropriate category.

HHSC administers HCSSA licensing through its Long-term Care Licensing division. The contact number for the HCSSA Licensure and Certification Unit is 512-438-2630.

The Four HCSSA License Categories

Texas HHSC issues HCSSA licenses in four service categories. Your category determines your administrator requirements, what services you can provide, and whether Medicare certification is available to you.

Personal Assistance Services (PAS)

The PAS license is the starting point for most new private pay home care agencies. It covers:

Personal care (bathing, dressing, grooming, toileting)
Homemaker services (light housekeeping, laundry, meal preparation)
Companion services
Respite care
Escort services

PAS does not require a licensed nurse on staff. The administrator requirements are more accessible than other HCSSA categories (detailed in the administrator section below), which is one reason this is the most common entry point for new agencies.

Key distinction: A PAS license does not authorize skilled nursing, therapy, or home health aide services. If your business model includes those services, you need a home health license.

Licensed Home Health (LHH)

A Licensed Home Health license covers skilled services — nursing, physical therapy, occupational therapy, speech-language pathology, and home health aide services delivered in the home. LHH agencies may not bill Medicare or Medicaid directly without additional certification.

Licensed and Certified Home Health (L&CHH)

The L&CHH license adds Medicare and/or Medicaid certification to the Licensed Home Health base. This is the full home health license for agencies that bill Medicare fee-for-service directly. The application process for L&CHH is substantially more complex than PAS, involves a state survey (inspection), and requires a CMS-approved administrator with clinical credentials.

Hospice

The Hospice license covers end-of-life care services delivered in the home or other residential settings. Hospice licensing involves a separate regulatory framework and is outside the scope of this guide.

Before You Apply: Prerequisites

HHSC will not accept a license application from an agency that hasn't cleared these three preconditions. Complete them before you submit anything to HHSC.

1. Register Your Business Entity

Your agency must be a registered legal entity in Texas — LLC, corporation, or similar — in good standing with both:

Texas Secretary of State (sos.state.tx.us)
Texas State Comptroller of Public Accounts (comptroller.texas.gov)

"Good standing" means your filings are current and you have no outstanding franchise tax obligations. HHSC verifies this during the application review. A lapsed registration is one of the most common reasons applications stall.

2. Complete the HCSSA Pre-Survey Computer-Based Training (CBT)

HHSC requires all applicants to complete the pre-survey CBT before submitting their application. The CBT covers the regulatory framework under 26 TAC Chapter 558, what to expect during an initial survey (inspection), and the operational requirements you'll be expected to meet.

The CBT is available through the HHSC Provider Portal at no cost. Completion is tracked and HHSC confirms completion before processing your application. Plan for several hours of coursework — the training is substantive, not a checkbox exercise.

3. Designate Your Administrator and Alternate Administrator

Every licensed HCSSA must have one designated administrator and one alternate administrator before applying. You cannot have more than one administrator — if your administrator changes, you must notify HHSC. The administrator and alternate must meet qualifications specific to your license category (detailed below).

Administrator Requirements by License Category

PAS-Only Agencies

For agencies providing Personal Assistance Services only, the administrator and alternate administrator do not need to be licensed healthcare professionals. Per 26 TAC §558.244(a)(3), PAS administrators must meet one of the following qualification standards:

Option A: High school diploma or GED, plus at least one year of experience or training in caring for individuals with functional disabilities
Option B: Two years of full-time study at an accredited college or university in a health-related field

In addition to meeting the qualification standard, first-time PAS administrators must:

Complete 8 hours of initial training before assuming the administrator role
Complete 16 additional hours of training within the first 12 months of designation

Total required training for first-time administrators: 24 hours in the first year.

The alternate administrator must meet the same qualification standards and complete the same training.

Licensed Home Health and L&CHH Agencies

Home health administrators must be licensed healthcare professionals — typically a registered nurse (RN), physical therapist, or have equivalent clinical credentials meeting HHSC's home health administrator standards. The training hours requirement also applies, but the baseline credential requirement is significantly higher than for PAS.

Why This Matters Operationally

Many new home care owners name themselves as administrator. That works — but you need to meet the qualification standards for your license category. If you plan to step away from day-to-day operations as the agency grows, your alternate administrator must be someone who genuinely understands the regulatory requirements, not just a name on a form. HHSC treats both roles seriously during surveys.

Application Documents: What You'll Need

The application form for a parent HCSSA agency is HHSC Form 2021. Branches and alternate delivery sites use separate forms. You'll need to prepare and upload:

Entity documentation:

Proof of Texas Secretary of State registration
Proof of good standing with the State Comptroller
Organizational chart showing ownership structure

Personnel documentation:

Completed criminal history checks for all administrators and owners (HHSC conducts checks through the Department of Public Safety Fingerprint program)
Administrator and alternate administrator qualifications and training records

Operational documentation:

Quality management plan — a written plan describing how your agency will monitor, measure, and improve the quality of services delivered. This is a specific HHSC requirement and is reviewed during the initial survey. A quality management plan that addresses specific service types, frequency of review, and corrective action processes performs better in surveys than a generic template.
Written policies and procedures covering at minimum: client care and assessments, emergency and disaster protocols, infection control, personnel management (hiring, training, supervision, disciplinary procedures), and client rights and grievance processes.

Financial and insurance documentation:

Proof of general liability insurance
Workers' compensation documentation (or certification of exemption where applicable)

Incomplete applications are returned without processing — HHSC does not chase missing documents. Review the current Form 2021 instructions carefully before submitting.

The Application Process: Step by Step

Step 1 — Complete pre-survey CBT Finish and receive completion credit for all required training modules before submitting your application.

Step 2 — Prepare your entity and personnel documentation Confirm Secretary of State and Comptroller registrations are current. Have criminal history checks initiated — fingerprinting appointment scheduling can add time here.

Step 3 — Draft your quality management plan and policies These documents need to be ready at application submission, not drafted after. HHSC reviewers look at them during application processing, and your surveyor will ask about them in detail during the initial inspection.

Step 4 — Submit Form 2021 with all supporting documents and pay the licensing fee Submission is through HHSC's online portal. The licensing fee is non-refundable; contact HHSC (512-438-2630) to confirm the current fee before submitting.

Step 5 — Application review HHSC reviews your application for completeness and accuracy. Deficiencies are returned to you with a request for correction. Timely responses to deficiency notices keep your application on track.

Step 6 — Initial survey Once your application is approved in principle, HHSC schedules an initial survey (on-site inspection). The surveyor reviews your policies, documents, administrator's qualifications, and operational readiness against the requirements of 26 TAC Chapter 558. The initial survey is the most common point of delay — agencies that have their documentation genuinely in order clear surveys quickly; agencies relying on placeholder documents do not.

Step 7 — License issued After a satisfactory initial survey with no outstanding deficiencies, HHSC issues your license. You may not operate as an HCSSA until the license is in hand.

Processing Timelines

Personal Assistance Services (PAS) license: Processing from complete application submission to license issuance typically takes 60 to 90 days when the application is complete and the initial survey is scheduled promptly. Delays in fingerprinting, missing documents, or corrections requested after review can extend this by weeks.

Licensed Home Health (LHH): The timeline is longer given the additional credential requirements and survey complexity. Budget 3 to 5 months for initial processing.

Licensed and Certified Home Health (L&CHH) with Medicare certification: Adding Medicare certification requires a separate CMS process that runs in parallel with or after state licensing. The combined timeline is typically 4 to 8 months from initial application.

The agencies that meet their target start dates are the ones that submit a complete application, respond to any HHSC requests within 48 hours, and have their policies and training documentation ready before they apply — not after.

License Term and Renewal

HHSC issues HCSSA licenses for three-year terms (transitioned from two-year terms in recent years). Renewal requires:

Timely submission of the renewal application before the license expiration date
Payment of the renewal licensing fee
Continued compliance with 26 TAC Chapter 558 requirements

Operating with an expired license is a regulatory violation. HHSC tracks expiration dates and enforcement can follow lapsed licenses. Build your renewal process into your annual compliance calendar so it isn't handled reactively.

Any significant change to your agency — ownership, administrator, location, service categories — requires notification to HHSC. Most changes require a separate notification form and fee. Failing to notify HHSC of changes is a common citation finding during surveys.

HCSSA Licensing and EVV: The Connection

If your HCSSA serves Medicaid clients through any Texas program — STAR+PLUS, STAR Kids, STAR Health, fee-for-service Medicaid, CFC, PAS, Primary Home Care, or Community Attendant Services — Electronic Visit Verification (EVV) is a compliance requirement, not optional.

Texas uses HHAeXchange as its state EVV aggregator. All visit data, regardless of which EVV system captured it, must transmit to HHAeXchange.

Two compliance paths:

Use the state-provided HHAeXchange system (free baseline option from HHSC)
Use a home care software platform certified as a Proprietary System Operator (PSO) that transmits to HHAeXchange automatically

Agencies planning to serve Medicaid clients should build EVV into their operations from day one. The hardest EVV compliance transitions are those where agencies have to retrofit a system onto an established caregiver workforce that has been using manual workarounds.

For a complete breakdown of Texas EVV requirements, the alternative device phase-out timeline, and what to look for in EVV-compatible software, see our dedicated guide: Texas EVV Requirements 2026.

Software That Grows with Your License

Most agencies start on a PAS license and expand service offerings as they grow. What your software needs to handle evolves along the same path:

PAS-only agency: Scheduling, GPS caregiver clock-in/out, private pay invoicing, caregiver records management, basic reporting. EVV only matters if you add Medicaid clients.

Growing into Medicaid: EVV becomes essential. Your software needs to be either a certified Texas PSO or integrate cleanly with the state HHAeXchange system.

Adding home health services: Billing complexity increases — you need software that handles Medicare billing codes, home health claims, and potentially multiple payer types.

The agencies that have the hardest operational transitions are those that choose software for their current licensing tier and then have to switch platforms when the license expands. Building software flexibility into your initial decision is cheaper than a platform migration 18 months in.

Atlas Care Software for Texas Agencies →

HCSSA Licensing Checklist for 2026

Before you apply:

Business entity registered with Texas Secretary of State (good standing)
Business entity registered with Texas State Comptroller (good standing)
Pre-survey CBT completed and completion recorded with HHSC
Administrator and alternate administrator designated and qualifications documented
Criminal history checks initiated for all administrators and owners

Application documents:

HHSC Form 2021 completed accurately (Form 2023 for Medicare branches, Form 2024 for alternate delivery sites)
Quality management plan drafted and finalized
Written policies and procedures complete (client care, emergency protocols, infection control, personnel management)
Proof of Secretary of State and Comptroller registration
Insurance documentation (general liability, workers' compensation)
Licensing fee payment ready

Initial survey preparation:

All policy documents accessible and organized for surveyor review
Administrator training hours documented and records available
Operational systems in place (scheduling, caregiver records, client assessments)

If serving Medicaid clients:

EVV system selected (state-provided HHAeXchange or certified PSO)
Caregiver training on EVV clock-in procedures planned
HHAeXchange aggregator connection tested before first Medicaid visit

Additional Resources

HHSC HCSSA Licensing Unit: 512-438-2630
Texas Administrative Code Chapter 558: texreg.sos.state.tx.us — the governing regulation
Texas Secretary of State business registration: sos.state.tx.us
HHSC HCSSA provider portal: apps.hhs.texas.gov/providers/hcssa

Related Guides

Texas EVV Requirements 2026 — full breakdown of electronic visit verification for HCSSA agencies
EVV Compliance Made Easy — EVV fundamentals applicable in every state
AtlasCare vs Axxess — both are Texas companies; how their HCSSA support and EVV approaches compare
Home Care Software for Small Texas Agencies — software built around the PAS agency workflow

Texas HCSSA Licensing: A Plain-English Guide for Home Care Agencies in 2026