How to start a home health agency in Texas

Texas requires a Home and Community Support Services Agency (HCSSA) license — licensed and certified home health services (L&CHHS) category from Texas Health and Human Services Commission to operate a home health agency. Fee: $2,625.

License required

Yes

License

Home and Community Support Services Agency (HCSSA) license — licensed and certified home health services (L&CHHS) category

Issuing agency

Texas Health and Human Services Commission

Fee

$2,625

Fee details

$2,625 initial license (includes CHOW); $2,625 per branch office license.

Renewal

$2,625 for a 3-year renewal or $1,750 for a 2-year renewal (same for branches); late fee is half the renewal fee.

Medicare certification

Applicants requesting the L&CHHS category must also apply to CMS; until certified they must follow 42 CFR 484 as if certified. Separately, CMS put a 6-month nationwide moratorium on new Medicare enrollment of home health agencies (including new branches and practice locations) into effect on May 13, 2026; it can be extended in 6-month increments, and CMS left any Medicaid/CHIP moratorium to each state.

Regulation

Texas Health and Safety Code ch. 142; 26 TAC ch. 558 (558.3 fees, 558.11-558.13)

1. Administrator, alternate administrator, supervising nurse and alternate complete HHSC Presurvey Training
2. Submit the application and full fee through the HHSC online portal
3. Supply any missing items within 30 days of HHSC's notice
4. Receive the initial license (licensed home health category while awaiting Medicare)
5. Apply to CMS for Medicare certification; HHSC adds the L&CHHS category once certified

Staffing

• Administrator and alternate administrator meeting 26 TAC 558.244
• Supervising nurse and alternate supervising nurse

Training

• HHSC Presurvey Training for administrators and supervising nurses before applying

Program

Texas Medicaid and CHIP (Texas Health and Human Services Commission, HHSC)

Enrollment portal

Provider Enrollment and Management System (PEMS), run by TMHP

Fiscal agent

Texas Medicaid & Healthcare Partnership (TMHP), the claims administrator for HHSC

Application fee

Under the ACA, institutional providers owe an application fee on initial applications, new practice locations, revalidation and re-enrollment. PEMS says at the end of the application whether a fee is due, and the application cannot be processed without it. Proof of a fee paid to Medicare or another state must be submitted with the application. The amount changes each calendar year. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.

Fingerprinting

Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check. The TMHP provider manual section we reviewed does not list a separate state fingerprint process.

Site visit

Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. TMHP's manual notes that moderate- and high-risk providers cannot bill for a new practice location until it is approved and added to the enrollment record.

Revalidation

Revalidation is due by the end of the enrollment period, called the 'revalidation due date'. Most providers have a five-year period, but some get shorter periods based on risk or other factors. Revalidation is filed online in PEMS only, opens up to 180 days before the due date, and repeats provider screening. It is not complete until every deficiency is resolved. If the period ends first, TMHP automatically disenrolls the provider. Group administrators can revalidate for their performing providers.

Full Texas Medicaid enrollment guide →

CON program

No

Texas certificate of need details →

Model

hybrid

State vendor

HHAeXchange (since 2023-10-01)

Services in scope

• personal care
• home health

Alternate EVV allowed

Yes

Program

https://www.hhs.texas.gov/providers/long-term-care-providers/long-term-care-provider-resources/electronic-visit-verification-evv

Texas EVV requirements →

State minimum wage

$7.25 an hour

Effective

2009-07-24

Scheduled increases

No scheduled change found in the official sources reviewed.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Home health agencies — active organization NPIs (NPPES)

12,524 (as of Sep 13, 2026)

Medicare-certified home health agencies (CMS Care Compare)

1,854 (as of May 27, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

3,915,559 (as of Jun 1, 2026)

All Texas Home health Medicaid rates, ranked →