How to Start a Home Health Agency in Texas: HHSC HCSSA License

If you want to know how to start a home health business in Texas, the license you need is a Home and Community Support Services Agency (HCSSA) license from the Texas Health and Human Services Commission (HHSC). HHSC licenses these agencies under Texas Health and Safety Code chapter 142 and the rules in 26 TAC chapter 558. You cannot provide home health services in Texas without it, so this license is the first regulatory step to plan around.

This guide walks through the steps in the order most applicants handle them, the items to gather first, the fees HHSC lists, and the mistakes that cause delays. It is informational content, not legal or tax advice. Confirm current requirements with HHSC before you file, and talk with a healthcare attorney and a CPA about your ownership structure, payer contracts, and tax position.

Choose the Right HHSC License Category

HHSC licenses several categories of HCSSA. The categories listed on the HHSC licensing page are:

• Licensed Home Health
• Licensed and Certified Home Health, which is Medicare and Medicaid certified
• Licensed Home Health with a Home Dialysis designation
• Licensed and Certified Home Health with a Home Dialysis designation
• Hospice
• Personal Assistance Services

Most new home health owners choose between the Licensed category and the Licensed and Certified category. The difference matters. A state license authorizes you to operate, but it does not by itself allow you to bill Medicare. Medicare certification is a separate federal process that sits on top of the state license. Pick your category before you file, because the application and the initial survey both depend on it. If you are unsure whether your planned services fall under home health, hospice, or personal assistance, ask HHSC before you pay any fees.

What to Gather Before You Start

Assemble these items before you open a TULIP application. Missing items are one of the most common reasons an application stalls.

• A legal entity. Many owners form a Texas limited liability company (LLC). The Certificate of Formation (Form 205) carries a $300 filing fee with the Texas Secretary of State.
• A Texas registered agent with a physical street address in Texas where the agent can be served in person during business hours. Your entity cannot serve as its own registered agent, and a post office box or mail-forwarding service alone does not qualify.
• An entity name that is distinguishable in the Secretary of State records and includes an organizational designation such as LLC. The name also cannot falsely suggest a government affiliation, so avoid words that could imply a public agency.
• An administrator and an alternate administrator, both identified in your application and both able to complete the HHSC presurvey training.
• Proof that the entity is in good standing with the Texas Comptroller and the Texas Secretary of State.
• Physical office location details and the documents listed on the HHSC application checklist for your chosen category, including policies, staffing information, and service descriptions.
• Documentation of operating funds if you plan to pursue Medicare certification. Details are in Step 3 below.
• A payment method for HHSC fees and Secretary of State filing fees.

Step-by-Step: Starting a Home Health Agency in Texas

Step 1: Form the entity and confirm the filing

File the Certificate of Formation (Form 205) through SOSDirect, the Secretary of State's online portal. The filing fee is $300. The Secretary of State does not publish a guaranteed standard turnaround. Electronic filing is the fastest route, and mailed or hand-delivered documents generally take at least one business day just to show as received. If you need guaranteed timing, the paid Texas Express tiers are the only option:

• Standard Expedite: $50 per document, typically processed in two to three business days
• Next Day Expedite: $500 per document, processed by close of business the next business day for filings received by 12:00 p.m.
• Same Day Expedite: $750 per document, processed by close of business the same day for filings received by 12:00 p.m.

Expedite fees are in addition to the filing fee. Preclearance of a draft instrument is $50. Expediting the formation does not speed up HHSC review, so do not pay for it unless you need the entity on a specific date. Check the name with the Secretary of State business search at https://www.sos.state.tx.us/corp/searches.shtml, or call (512) 463-5555 for a preliminary name availability check. If you need to hold a name while you prepare, a name reservation costs $40 and lasts 120 days.

Step 2: Establish tax standing with the Comptroller

Texas has no state income tax and no general state business license. Instead, your entity is subject to the Texas franchise tax, a privilege tax administered by the Comptroller. For the 2026 and 2027 report years, the no tax due revenue threshold is $2,650,000. An entity at or below that total revenue owes no franchise tax, but it still must file a Public Information Report, which is due May 15 each year to the Comptroller. Missing required Comptroller filings can affect the good standing HHSC expects to see, so set up your Comptroller account early and calendar the May 15 deadline. Confirm your filing status at https://comptroller.texas.gov/taxes/.

If any part of your operation involves selling taxable goods, such as supplies or equipment sold to clients, check whether you need a sales and use tax permit. The Comptroller issues the permit at no charge, and processing typically takes two to three weeks.

Step 3: Decide on Medicare certification and confirm capitalization

If you plan to become a Licensed and Certified Home Health agency, you will need to address Medicare's initial capitalization requirement. In practice, this means showing proof that you have reserve operating funds to cover the agency's startup period before Medicare payments arrive. The amount and the proof format are not settled figures in this guide. Confirm both with HHSC and with CMS before you commit money or sign a lease, and get the answer in writing where you can.

HHSC's licensing steps do not include a certificate of need. Be cautious with any consultant or vendor who tells you that a certificate of need is required for HCSSA licensure. Ask HHSC directly if you hear this.

Step 4: Complete HHSC presurvey training

The administrator and the alternate each need to complete the HHSC presurvey training before you move forward. Schedule this early. Training is a prerequisite for the application, so a delay here pushes everything else back. Keep the training certificates in your records, because you will need them when you upload documents.

Step 5: Create your TULIP application and organize documents

Apply through TULIP, the HHSC online system used for licensing applications. Create the account, select your license category, and enter the entity, ownership, administrator, and location information. Before you upload anything, build a folder with every document on the checklist for your category, labeled by requirement. Accurate, consistent names across the Secretary of State filing, the Comptroller record, the TULIP application, and your lease or office documents prevent the most common review questions.

Step 6: Upload documents and pay the fees

Upload each document through TULIP and pay the required fees. The HHSC page lists the initial three-year license fee at $2,625 for a parent or branch office. An alternate delivery site costs $1,000. These figures are from the HHSC HCSSA page as of 2026. Fees change, so reconfirm the current amounts on the HHSC page before you pay.

Step 7: Wait for HHSC processing

HHSC has up to 45 days to process a complete application. The 45-day window applies to a complete application, so a missing item or unanswered question can extend your timeline. Check TULIP regularly, respond to requests quickly, and keep your contact information current. Do not sign leases, hire staff, or make large purchases that depend on the license date until you have an approval in hand.

Step 8: Request the initial survey within six months of licensure

After licensure, you must request an initial survey within six months. Use that window to get ready. Confirm that your policies, clinical record templates, staff files, and emergency plans match the services you described in your application. A survey is far easier when the records already exist and the staff know their roles.

Step 9: Launch operations under the license

Once licensed, operate exactly as your application described. Hire staff who meet the requirements for their roles, keep personnel and clinical records current, and track any changes that HHSC requires you to report. Changes in ownership, administration, or location can require HHSC action, so check with HHSC before you make them.

Common Mistakes to Avoid

• Choosing the wrong license category. A category change after filing can mean starting over on parts of the application.
• Using a post office box as the registered office. The registered office must be a physical street address in Texas.
• Naming the entity as its own registered agent. This is not allowed.
• Ignoring the Public Information Report. Entities under the $2,650,000 threshold still must file it by May 15, even though they owe no franchise tax.
• Filing an assumed name with the county clerk. Since September 1, 2019, registered filing entities such as LLCs file an assumed name certificate (Form 503) only with the Secretary of State, for $25. Sole proprietors and general partnerships file with the county clerk instead.
• Submitting an incomplete application. The HHSC 45-day review starts with a complete application, so gaps cost time.
• Assuming Medicare certification follows the state license. Plan certification as a separate project with its own capitalization proof and survey.
• Paying fees before confirming them. Check the HHSC page on the day you pay.
• Training only one administrator. Make sure both the administrator and the alternate complete presurvey training.
• Waiting until licensure to prepare for the survey. The six-month survey request window closes faster than most owners expect.

Costs at a Glance

Item	Amount	Agency
Certificate of Formation (Form 205)	$300	Texas Secretary of State
Standard Expedite (optional)	$50 per document	Texas Secretary of State
Name reservation (120 days)	$40	Texas Secretary of State
Assumed name certificate (if you use a different name)	$25	Texas Secretary of State
Initial three-year HCSSA license, parent or branch	$2,625	HHSC
Alternate delivery site	$1,000	HHSC
Franchise tax, if revenue is at or below $2,650,000 for 2026 and 2027	No tax due, but the Public Information Report is still required by May 15	Texas Comptroller
Medicare initial capitalization (certified path)	Confirm with HHSC and CMS	HHSC and CMS

Professional fees for an attorney, a CPA, or a consultant are not included here, and they vary widely. Budget for them separately.

What Results to Expect

A complete, well-organized application gives you the best chance of moving through HHSC review without repeated requests. HHSC has up to 45 days to process a complete application, but that is a ceiling, not a guarantee of a faster or slower outcome. Once licensed, you will still need to pass the initial survey, so your readiness on the day of the survey will shape how the early months go. Owners who prepare policies and records before licensure often find the survey and the first months of operation more manageable, though results depend on your services, staffing, and local conditions.

Realistic Timeline

1. Entity formation: days to weeks, depending on whether you expedite the Secretary of State filing
2. Comptroller and tax setup: ready before you file the HHSC application
3. HHSC presurvey training for the administrator and alternate: schedule early in the process
4. HHSC application review: up to 45 days after a complete application
5. Initial survey request: within six months of licensure

Questions to Confirm With the Agencies

• HHSC: current fees, the complete document checklist for your category, and whether your services fall under home health, hospice, or personal assistance
• HHSC and CMS: the amount and format of Medicare initial capitalization proof for the certified path
• Texas Comptroller: your franchise tax reporting status and whether any sales tax permit applies to your operation
• Texas Secretary of State: name availability and any filing requirements for the entity and any assumed name

When to Bring in Professionals

Talk with a healthcare attorney before you choose an ownership structure, sign a lease, or sign payer or referral agreements. A CPA can help you plan for franchise tax filings, Medicare cost reporting, and startup funding. Many owners also use an experienced home health consultant to review the application and survey readiness. Treat these as cost-saving steps, because correcting a filing error is usually more expensive than getting it right the first time.

Useful Official Resources

• Texas Secretary of State: https://www.sos.state.tx.us/corp/index.shtml
• SOSDirect online filing: https://direct.sos.state.tx.us/acct/acct-login.asp
• Texas Comptroller of Public Accounts: https://comptroller.texas.gov/taxes/
• Texas Small Business Development Center Network: https://www.sbdctexas.org/
• Texas Health and Human Services Commission: search the HHSC site at hhs.texas.gov for Home and Community Support Services Agencies and the HCSSA licensing page

Disclaimer

This article is informational content, not legal or tax advice. Requirements, fees, and deadlines change. Verify every figure on the agency pages listed above before you file or pay, and consult a qualified Texas attorney and CPA about your specific situation.