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ICF/IID — Intermediate Care Facility

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

Dual Licensed — Federal + State

Time to open

2–3 months (after Medicaid bed allocation)

Gov't fees (total)

$570

State license

Required

Max residents

Unlimited

Who this serves

Individuals with intellectual disability or related conditions at the highest support level (Level of Care 8, IQ ≤ 75)

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

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 ($9.95 IdentoGO + $31.50 state/FBI fee)

$41.45

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

Guaranteed minimum (gov't fees)

$570

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 — request a pre-survey from HHSC

General liability + professional liability

$3,600–$9,600/annual

💡 IDD-specific coverage required — Markel, GuideOne, Philadelphia Insurance

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 800 sq ft minimum outdoor space
•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 800 sq ft outdoor space (a real backyard)
→Life Safety Code inspection required — get a pre-survey first
→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
+No waiting list — any eligible resident can be placed
+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: Apply for Medicaid bed allocation BEFORE submitting license application
!Residents must have intellectual disability (IQ ≤ 75) at Level of Care 8 (highest support)
!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

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