How to start a home care agency in Texas

Updated October 14, 2026 · CensusDesk research

Texas at a glance

Fees and forms change. Check HHSC’s “How to Become a Licensed HCSSA Provider” page before you pay anything.

Step 1. Decide what kind of agency you are

Most new agencies in Texas start non-medical: help with bathing, dressing, meals, light housekeeping, errands, and companionship. That’s the Personal Assistance Services category. If you plan to offer skilled nursing or therapy, you’re a home health agency instead, with more requirements (a supervising nurse among them). This guide covers the non-medical path.

Decide one more thing early: private pay, Medicaid, or both. Private-pay families pay you directly. Billing Medicaid is a separate enrollment with the state after you’re licensed. Many owners start private pay because the money comes in faster and the paperwork is lighter.

Step 2. Form your business

HHSC requires your business to be registered and in good standing with both the Texas Secretary of State and the Texas Comptroller of Public Accounts. Most owners form an LLC, get a federal EIN from the IRS, and open a business bank account before they apply. Talk to an insurance agent about liability and workers’ compensation coverage now, too. You will want it in place before your first caregiver starts.

Step 3. Finish the presurvey training

HHSC’s presurvey training is a free online course. For a Personal Assistance Services agency, your administrator and your alternate administrator both complete it. Modules 1 and 2 are required for everyone, and Module 3 covers Personal Assistance Services. Print and sign the certificate for each module. HHSC will not accept your application without them.

Step 4. Apply through TULIP

HHSC’s own checklist for a license:

1. Complete the presurvey training (Step 3).
2. Fill out the license application in TULIP, completely.
3. Upload every required document, including your training certificates.
4. Pay the license fee.
5. Be registered and in good standing with the Comptroller and the Secretary of State.
6. Receive approval from HHSC’s Licensure and Certification Unit.

Once a complete application arrives, HHSC has up to 45 days to process it. If something is missing, you get 30 days to answer, or the application is denied. Complete is the fastest path.

Step 5. Serve your first client, then request your survey

After your license is issued, you can start serving clients. When you take on your first person, you notify your HHSC regional office and request your initial health survey using HHSC Form 2020. You have six months from the day your license is issued to do it.

What it costs to get licensed

Getting your first clients

A license doesn’t bring families to you. Here’s what the research says about where clients come from, and what that means for a new Texas agency.

• Referrals lead. Current and past clients are the top referral source for private duty home care, followed by discharge planners, home health, hospice, and rehab. A new agency has no past clients yet, so the referral engine starts slow.
• Families search first. Most families looking for senior care start with a generic search like “home care near me,” and few search an agency by name. If your agency has no website, those families find someone else.
• Directories charge per lead. Lead directories and paid search often run $50 to $150 per lead, and the family may be shopping three agencies at once.
• Speed wins. On average about a third of home care inquiries become clients. A family coming home from the hospital may have only a day or two to decide.

What one client is worth in Texas

That’s why the first thing a new agency needs after its license is a front door that works when you can’t pick up the phone: a real website, a way for families to get answers at night, and every inquiry in your inbox the minute it happens.

Sources

• Texas HHSC, “How to Become a Licensed HCSSA Provider” (license steps, fees, processing times, Form 2020 survey request), read October 14, 2026
• Texas HHSC, “Computer-Based Trainings” (HCSSA presurvey training, PAS modules), read October 14, 2026
• Texas HHSC, Home and Community Support Services Agencies (HCSSA) provider page (Licensing and Certification Unit phone)
• CareScout Cost of Care Survey 2025, median hourly cost of non-medical in-home care by state
• HCAOA Private Duty Benchmarking, via Activated Insights (referral sources)
• Caring.com search behavior figures, via CoreCubed (generic search)
• Home Care Pulse, via Home Health Care News (inquiry conversion benchmarks)
• Sagapixel (directory and paid search cost per lead estimates)