ICF/IID — Intermediate Care Facility

Dual-licensed Medicaid group home for high-support IDD individuals

Dual Licensed — Federal + State

To open a ICF/IID — Intermediate Care Facility in Texas, you need a license from Texas HHSC. It serves no state cap on residents, and the exact government fees total about $1,320 (Requires Texas state license AND federal Medicaid certification. Fee: $225 base + $7.50/bed. Must secure Medicaid bed allocation BEFORE applying). Below is every step, fee, and official link.

Reviewed by Erika Crossley, Texas senior care startup specialist · Information last verified June 2026

Path

Advanced path

Gov't fees (total)

$1,320

State license

Required

Max residents

Unlimited

Who this serves

Individuals with intellectual disability or a related condition who meet ICF/IID level-of-care criteria — Level of Care I (IQ ≤75 with a qualifying diagnosis) or Level of Care VIII (related condition, which has no IQ requirement)

Best fit: An operator with professional staff resources who wants to serve the highest-acuity IDD population with full Medicaid backing

Common questions about opening a ICF/IID in Texas

Do I need a license to open a ICF/IID in Texas?

Requires Texas state license AND federal Medicaid certification. Fee: $225 base + $7.50/bed. Must secure Medicaid bed allocation BEFORE applying.

How much does it cost to open a ICF/IID in Texas?

The exact government fees total about $1,320. On top of that, variable startup costs (insurance, any required modifications, and similar) depend on your property and market. Government fees are fixed; variable costs are estimates.

How many residents can a ICF/IID in Texas have?

A federal ICF/IID is by definition an institution of 4+ beds. Typically 4–8 for home-based facilities; beds are allocation-capped (reallocated beds are capped at 6 per facility).

How much can a ICF/IID earn per resident in Texas?

Roughly $4,000–$12,000 per resident per month, depending on private pay vs. Medicaid, acuity, and your market.

Actual Costs

Government fees are exact. Variable costs are estimates — tips show how to minimize them.

EXACT

Government Fees — You Will Pay These

ICF/IID State License (6-bed)

$225 base + $7.50 × 6 beds

$270

per 3 years

ICF/IID State License (8-bed)

$225 base + $7.50 × 8 beds

$285

per 3 years

Texas LLC Formation (SOS filing)

$300

one time

DPS Background Check

All staff and household members ($11.50 IdentoGO + $15.00 DPS + $13.25 FBI = $39.75)

$39.75

per person

HHSC Life Safety Code Inspection

No state inspection fee

one time

Federal Medicaid Certification Survey

CMS survey — no fee, but required in addition to state inspection

one time

Medicaid Bed Allocation Application

Must be approved BEFORE submitting license application

one time

Federal Medicaid provider application fee (PEMS)

Required federal institutional provider application fee for CY2026 — $750 (42 CFR §455.460). Set annually by CMS.

$750

one time

Guaranteed minimum (gov't fees)

$1,320

VARIABLE

Costs That Depend on Your Property & Choices

Life Safety Code compliance upgrades

$5,000–$25,000/one time

Depends heavily on your home's current condition — a free HHSC pre-survey tells you exactly what to fix, and we set this up with you on your intake

General liability + professional liability

$3,600–$9,600/annual

IDD-specific coverage required — we connect you with vetted insurers (Markel, GuideOne, Philadelphia Insurance) and pull quotes for you

Clinical staffing (RN, therapists per ISP)

$30,000–$80,000/annual

Required per individual service plans — this is typically your largest cost

Accessibility modifications

$3,000–$20,000/one time

Per residents' specific needs in Individual Program Plans

Physical & Building Requirements

Stories allowed

Any — residential home acceptable

Sq ft / resident (single room)

Residential standard

Sq ft / resident (shared room)

Residential standard

Bedroom min width

No minimum

Bathroom ratio

Per individual resident needs in service plans

Sprinklers

Life Safety Code — residential standards acceptable for small facilities

•Must pass HHSC Life Safety Code inspection
•Must have adequate outdoor space — we confirm this for your address when you submit your home in the roadmap
•Must meet federal HCBS Settings Rule — home-like, not institutional
•HHSC guarantees 45-day review after a complete application is submitted

Can I Use My Home?

✓

1-Story Home

✓

2-Story Home

1,600

sq ft minimum

bedrooms

→Can use an existing residential home
→Must have adequate outdoor space — we confirm this for your address when you submit your home in the roadmap
→Life Safety Code inspection required — a free HHSC pre-survey tells you exactly what to fix, and we set this up with you on your intake
→Must feel like a real home — HCBS Settings Rule

Why operators choose this

+Highest Medicaid reimbursement rate for IDD residential care in Texas
+HHSC guarantees 45-day review after complete application — faster than ALF licensing
+Placement still depends on Medicaid bed availability/allocation and a LIDDA referral
+Can operate from a residential home
+Federal + state funding = maximum stability

Know before you start

–Most complex path — federal AND state approval required
–Must secure Medicaid bed allocation first — this adds time before you can even apply
–Professional clinical staffing required from day one
–Largest compliance and documentation burden of all six types

Key Restrictions — Know These Before You Start

!CRITICAL FIRST STEP: Medicaid bed allocation must be approved BEFORE you can submit the license application — it is a prerequisite that comes first, ahead of the licensing timeline
!Residents must meet ICF/IID level-of-care criteria — Level of Care I (IQ ≤75 with a qualifying diagnosis) or Level of Care VIII (a related condition meeting adaptive-behavior criteria, with no IQ requirement)
!Requires both Texas state license AND federal Medicaid certification — two separate approvals
!Professional clinical staff required per Individual Program Plans from day one
!Must contract with your Local IDD Authority (LIDDA) for resident placement

Apply Directly

Every link goes to the exact page — no searching.