Selling a home care agency in Texas

How Texas licenses home care

Texas does not split home care across several agencies the way some states do. HHSC issues one license, the Home and Community Support Services Agency license, and the categories on that license define what you can provide: licensed and certified home health, licensed home health, hospice, and personal assistance services, with home dialysis designations available on the home health categories.

For a buyer this is useful. Diligence starts from one license record per location, and the categories on it tell an acquirer immediately whether your agency fits a personal care platform, a skilled home health platform, or both. Agencies that hold both a personal assistance services category and a certified home health category are often more interesting to strategic buyers that want to offer a continuum of care in one market.

What a change of ownership means in Texas

Under 26 TAC § 558.23, an HCSSA license cannot be transferred. When a licensure change of ownership happens, your license becomes invalid on that date and the buyer must apply for its own license. A change of ownership at a parent agency also counts as one for every branch office and alternate delivery site, so the buyer files an application and fee for each location at the same time.

After issuing the new license, HHSC inspects to confirm compliance. It may do a desk review instead of an on-site inspection when less than half of the ownership interest changed, or when every owner of the new license holder already had a disclosable interest in the old one. That detail matters in recapitalizations where you keep a meaningful stake.

Stock purchase

The buyer acquires your entity, which keeps holding the license. Whether HHSC treats it as a licensure change of ownership depends on how control changes, so counsel should confirm before signing.

Asset purchase

The buyer's entity needs its own HCSSA license for every location, and Medicare and Medicaid enrollment follow their own change of ownership rules. Build the licensing timeline into the closing date.

Medicare-certified home health

Federal rules apply on top of Texas licensing, including the CMS 36-month rule for agencies that changed majority ownership recently. See our home health guide for how buyers handle it.

Payer mix: STAR+PLUS and private pay

Most Texas Medicaid attendant care runs through STAR+PLUS, the state's managed care program for adults 21 and older with disabilities and adults 65 and older. STAR+PLUS covers personal attendant services, nursing, and other long-term services and supports, and it is administered by contracted health plans. Your Medicaid revenue therefore depends on health plan contracts, authorizations, and service coordination, not on a single state rate.

Buyers look closely at how concentrated that revenue is. An agency with contracts across several STAR+PLUS plans, a healthy private pay or long-term care insurance book, and VA referrals carries less risk than one where a single plan drives most hours. If one plan or one referral source accounts for more than about a quarter of revenue, expect a buyer to price that in or push part of the price into an earnout.

Who is buying in Texas

Texas is one of the states national consolidators already operate in. When Addus HomeCare agreed in June 2024 to buy Gentiva's personal care operations, Texas was one of the seven states in that business. Platforms with an existing Texas footprint tend to look for tuck-ins that add density in a metro they already serve, because caregiver recruiting, scheduling, and payer contracting get cheaper with scale in one area.

Private equity backed regional platforms and strategic home health operators are also active. The most competitive outcomes for a Texas owner usually come from speaking with a few buyers that each have a different reason to want the market, rather than from a single unsolicited offer.

What moves value for a Texas agency

Because Texas has no certificate of need, a buyer could in theory open its own agency in your market. What it cannot easily build is what you already have. That is what the price reflects.

Caregiver supply

Fill rate on authorized hours, turnover, and overtime load show whether a buyer can grow the census it pays for.

Plan and referral diversity

Contracts with several STAR+PLUS plans and hospital, physician, and community referral sources reduce concentration risk.

Survey and documentation history

Clean HHSC survey results and visit documentation that supports every billed hour avoid holdbacks in the purchase agreement.

Management depth

An administrator and alternate who can run the agency without you lets a buyer pay more at close and less through an earnout.