Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Assisted Living Facilities

12/01/2003

In Texas, assisted living is a service delivery model not an architectural model. It is defined as a housing plus services arrangement for persons who, because of a physical or mental limitation, are unable to live their own homes. Assisted living settings provide food, shelter and personal care services to four or more persons who are unrelated to the proprietor of the establishment.

There are five types of licensed ALFs, but there are two primary licensing designations, which are based on residents' physical and mental ability to evacuate the facility in an emergency, and whether nighttime attendance is necessary.8 They are:

  • Type A facilities, whose residents must be capable of evacuating the facility unassisted, who must not require routine attendance during night time hours, and who must be capable of following directions under emergency conditions. This may include persons who are non-ambulatory but mobile, such as persons in wheelchairs or who use electric carts, and have the capacity to transfer and evacuate themselves in an emergency.

  • Type B facilities, whose residents may require staff assistance to evacuate, may not be able to follow directions, who require attendance during the night, and who, while not permanently bedfast, may require assistance in transferring to and from a wheelchair. Facilities that advertise, market, or otherwise promote their capacity to provide personal care services for people with dementia must be certified as a Type B facility.9

Only licensed facilities may use the term assisted living, and the statute requires careful monitoring to detect and report unlicensed facilities. An assisted living facility must be licensed to participate in the CBA waiver program.


  1. Type C facilities are Adult Foster Care Homes with four or more beds. In 1999, when personal care facilities were renamed assisted living facilities, the state required AFC homes with four or more beds to be licensed as an assisted living facility. Type D facilities are operated by the Department of Mental Health and Mental Retardation for persons with serious mental illness and developmental disabilities. Type E facility residents are the same as Type A except that they do not require assistance with ADLs, but only with medication administration.

  2. Use of advertising terms such as "medication reminders or assistance," "meal and activity reminders," "escort service," or "short-term memory loss, confusion, or forgetfulness" will not trigger a requirement for certification as an Alzheimer's facility. (Source: Texas Administrative Code, Title 40, Chapter 92)

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