Texas Home Care Agency Insurance Requirements: HCSSA License, Bond & Costs (2026)

Why Texas HCSSA agencies place their coverage with KTL

KTL Business Insurance has been an independent commercial agency since 2002, licensed in California (0D86601), Arizona (142446), and Nevada (173532) and writing home care risks nationwide, including Texas HCSSA agencies. We shop your submission across 20+ A-rated carriers rather than quoting a single market, so the bond, liability, and workers' comp pieces come back priced against each other instead of stacked at one carrier's rate. When HHSC, a Medicaid MCO, or a hospital contract asks for proof, we issue certificates of insurance the same day — including additional insured and waiver of subrogation wording — so a start date never slips while paperwork catches up.

• •Independent agency since 2002, specializing in home care, home health, and hospice.
• •20+ A-rated carrier markets shopped on every Texas submission.
• •Same-day certificates of insurance, including HHSC and MCO contract wording.
• •Licensed producer team: CA 0D86601, AZ 142446, NV 173532.

HCSSA license Texas requirements — the short answer

HCSSA license Texas requirements start with a Home and Community Support Services Agency (HCSSA) application filed through Texas HHSC. You need a designated administrator and alternate administrator (with the required 2-year home care experience or approved coursework), a criminal background check for every owner and controlling person, a $2,624 initial license fee, HHSC-approved policies and procedures, a survey/inspection, proof of a $50,000 surety bond, and evidence of general liability, professional liability, and workers' compensation (or a non-subscriber program). The license is category-specific: Licensed Home Health, Licensed and Certified Home Health, Hospice, or Personal Assistance Services (PAS) — the Texas non-medical home care license.

DADS or HHSC? Who regulates Texas home care agencies in 2026

If you are reading older guidance you will still see DADS — the Texas Department of Aging and Disability Services. DADS was folded into Texas Health and Human Services (HHSC) during the state's health agency consolidation, and HHSC Long-term Care Regulation now issues, surveys, and renews every HCSSA license. Practically, that means the application, the $2,624 initial fee, the $50,000 surety bond filing, the administrator qualifications, and the pre-licensure survey all run through HHSC, and your certificates of insurance should name HHSC (not DADS) as the certificate holder where a filing is required. Rules still live in Texas Administrative Code Title 26, Chapter 558, and licenses renew every three years with an $2,624 renewal fee schedule tied to your license category.

• •Regulator: HHSC Long-term Care Regulation (successor to DADS).
• •Rule set: 26 TAC Chapter 558 — HCSSA licensing, administrator, and survey standards.
• •License categories: Licensed Home Health, Licensed & Certified Home Health, Hospice, and Personal Assistance Services (PAS).
• •Filings that must stay current: $50,000 surety bond, workers' comp or non-subscriber notice (DWC Form-005), and proof of liability coverage for contracted payers.

2026 Texas home care insurance cost benchmarks by agency size

Texas premiums scale almost entirely with payroll and service mix, not client count. These are the ranges KTL sees when we benchmark Texas HCSSA agencies across 20+ A-rated carriers — use them to sanity-check a renewal quote before you sign it.

• •Startup PAS agency (pre-revenue, 1–5 caregivers): $1,900–$3,400/yr for $1M/$2M GL, professional liability, the $50K bond, and non-owned auto.
• •Small PAS agency (~$500K payroll): $3,000–$6,000/yr for liability lines, plus roughly $10,000–$22,500 in workers' comp at $2.00–$4.50 per $100 of payroll.
• •Mid-size PAS/home health ($1M–$3M payroll): $7,500–$16,000/yr for liability, cyber, and abuse & molestation, plus comp on payroll and a $1M umbrella for hospital contracts.
• •Skilled home health or hospice: add roughly 30–60% to professional liability because of higher claim severity and nursing scope.
• •Non-subscriber alternative: occupational-accident plus stop-gap employer liability typically runs 40–60% of a comparable comp premium, but restores tort exposure.

PAS vs skilled nursing insurance costs: what changes when you add skilled care

The biggest pricing jump between Texas HCSSA categories comes from moving non-medical personal care to skilled nursing or therapy. PAS agencies do not need an RN supervisor and carry lower professional liability severity, while Licensed Home Health and hospice categories add clinical supervision, higher malpractice exposure, and stricter contract limits. The table below shows how a typical small Texas agency's insurance program changes between the two categories.

Texas HCSSA surety bond — $50,000 HHSC requirement

Texas HHSC requires every HCSSA licensee to maintain a $50,000 surety bond as a condition of licensure. The bond protects clients against financial loss caused by the agency's failure to perform its contractual or regulatory obligations, including misuse of client funds. The bond must be issued by a surety authorized to do business in Texas and must remain in force for the life of the license. Premiums typically range from $250–$750 per year for qualified applicants, though rates vary with credit and agency financials. KTL places the HCSSA bond alongside the agency's liability program so coverage is coordinated at renewal.

Texas non-medical home care license — the PAS category

The Texas non-medical home care license is issued by HHSC as the Personal Assistance Services (PAS) category of the HCSSA license. PAS agencies provide non-skilled personal care, homemaker services, respite, and companion care — no nursing or therapy. HHSC still requires the full HCSSA application, administrator experience, $50,000 bond, and inspection, but insurance minimums are lower than skilled home health. Most PAS agencies carry $1M/$2M GL, $1M professional liability, non-owned & hired auto, abuse & molestation, and either workers' compensation or a non-subscriber occupational-accident program.

HCSSA categories & HHSC license minimums by provider type

HHSC licenses several distinct provider types — Home & Community Support Services Agencies (HCSSA), Personal Assistance Services (PAS), Licensed Home Health, and Hospice — each with its own coverage floor. License minimums typically start around $300K–$500K GL, but virtually every Medicaid MCO and hospital referral contract pushes the practical floor to $1M/$2M. Hospice and licensed home health agencies also face higher professional liability expectations and often need cyber liability and abuse & molestation endorsements.

Texas workers' compensation — subscriber vs non-subscriber

Texas home care agencies use NCCI workers' compensation class codes 8835 (home care aides), 8829 (home health aides), and 8854 (home health agency professional staff). In 2026, Texas rates for class 8835 commonly range from $2.00 to $4.50 per $100 of payroll, so a $500K payroll agency budgets roughly $10,000–$22,500 a year before experience mod and premium discounts. Texas is the only state where private employers may opt out of workers' compensation. Non-subscribers must file DWC Form-005 with the Texas Department of Insurance and post notices in English and Spanish; they lose statutory tort immunity and forfeit common-law defenses like contributory negligence and the fellow-servant rule. Most non-subscribers offset this with an occupational-accident policy plus a stop-gap employer liability policy. KTL runs the subscriber vs non-subscriber comparison at every renewal and models the break-even point based on payroll, claims history, and contract requirements.

General & professional liability minimums

HHSC does not mandate $1M GL, but Texas Medicaid STAR+PLUS, STAR Kids, and hospital referral contracts (Baylor Scott & White, Houston Methodist, Memorial Hermann, HCA) almost universally require $1M/$2M GL, $1M professional liability, primary & non-contributory additional insured status, and a waiver of subrogation. Larger health-system contracts can push $2M/$4M plus umbrella limits. We recommend $1M/$2M GL and $1M professional liability as the practical starting point even for small PAS agencies.

Non-owned & hired auto

Texas caregivers routinely drive personal vehicles between clients. Personal auto policies exclude business use, so an accident on the way to a shift can flow straight to the agency without non-owned & hired auto coverage. HHSC may not explicitly require this coverage, but Medicaid MCOs and hospital contracts regularly do, and it is the single cheapest way to close a large exposure gap.

Texas contract limits: what MCOs and health systems actually demand

HHSC sets the license floor, but your payers set the limits you will actually be held to. Before signing, read the insurance exhibit — it is usually stricter than anything in the HCSSA rules, and a certificate that misses one endorsement can stall credentialing for weeks.

• •Texas Medicaid STAR+PLUS and STAR Kids MCOs (Superior HealthPlan, Amerigroup, Molina, UnitedHealthcare Community Plan): $1M per occurrence / $2M aggregate GL, $1M professional liability, plus additional insured and 30-day notice of cancellation.
• •Large health systems (Baylor Scott & White, Houston Methodist, Memorial Hermann, HCA Healthcare, Texas Health Resources): $1M/$3M or $2M/$4M with a $1M–$5M umbrella on higher-acuity contracts.
• •Primary & non-contributory wording and a waiver of subrogation in favor of the payer — the two endorsements most often missing from a Texas COI.
• •Abuse & molestation with a dedicated limit (not a sublimit buried in professional liability) on nearly every MCO personal-care contract.
• •Non-owned & hired auto at $1M CSL whenever caregivers transport clients or run errands.
• •Cyber liability of $1M when the agency exchanges PHI through an MCO portal or EVV vendor.
• •Workers' compensation coverage or written disclosure of non-subscriber status — most MCOs accept a non-subscriber occupational-accident program only with stop-gap employer liability attached.

Sexual abuse & molestation coverage

Texas hospital systems and Medicaid MCOs increasingly require a dedicated abuse & molestation limit — often sub-limited or excluded on standard professional liability forms. KTL confirms whether abuse is embedded or needs a standalone endorsement on every Texas placement, and we verify that the limit responds to both client and caregiver allegations.

Cyber liability for electronic records

Any Texas home care agency that stores protected health information (PHI), Social Security numbers, or billing records electronically faces a cyber exposure. HHSC and Medicaid MCOs are paying closer attention to breach response plans and cyber coverage. A standalone cyber policy with network security and privacy liability, regulatory defense, and breach notification costs is now part of most complete Texas home care insurance programs.

EVV compliance for Texas home care agencies

Texas Medicaid MCOs and HHSC require Electronic Visit Verification (EVV) for most personal care services under the 21st Century Cures Act. EVV systems capture caregiver arrival, departure, and task data — often storing PHI with a third-party vendor. If your EVV vendor has a breach or outage, the agency can still be named in a Medicaid compliance or privacy complaint. We package cyber liability with network security, regulatory defense, and breach notification so your EVV data exposure is covered.

Caregiver classification

Texas does not have an AB 5-style test, but the IRS 20-factor test and DOL enforcement still make 1099 caregivers risky. Misclassification triggers back workers' comp premium (or non-subscriber losses), wage claims, and license risk. Plan for W-2 classification when budgeting your Texas insurance program and avoid payroll structures that carriers will surcharge or non-renew.

2026 HHSC compliance reminders every agency should review

HHSC enforcement and Medicaid MCO credentialing standards have tightened heading into 2026. Agencies should treat the following as a practical compliance checklist before renewal or re-credentialing:

• •Confirm your $50,000 HHSC surety bond is active and matches the legal entity name on your HCSSA license exactly.
• •Renew administrator and alternate administrator credentials before expiration; HHSC can suspend intake if either lapses.
• •Run background checks on every new owner or controlling person and document the results in the personnel file.
• •Align your insurance effective dates with your license renewal so the HHSC renewal packet shows no gap.
• •Verify EVV (Electronic Visit Verification) data security practices — MCOs increasingly ask for cyber coverage proof when EVV vendors store PHI.
• •Request COIs with primary & non-contributory additional insured wording at least 30 days before any contract start date.

Inside the HHSC packet: fees, surveys, and category-specific rules

HCSSA requirements change with the category you apply under, and most denials come from category-specific details rather than the insurance itself. Here is the granular version of what HHSC Long-term Care Regulation checks:

• •Initial license fee is $2,624 per category — an agency licensed for both PAS and Licensed Home Health pays per category, not once.
• •Licensed Home Health and Licensed & Certified categories require a qualified clinical supervisor (RN) in addition to the administrator and alternate administrator, which raises professional liability severity and premium.
• •PAS-only agencies do not need an RN supervisor, but HHSC still requires documented service delivery plans, supervisory visits, and complaint procedures under 26 TAC §558.
• •Administrator qualifications: 2 years of management experience in a licensed health-related setting within the last 5 years, or an approved 24-hour HCSSA administrator training course plus 8 hours of continuing education annually.
• •Every owner, controlling person, and administrator clears a criminal history check and is screened against the HHSC Employee Misconduct Registry and Nurse Aide Registry — a hit on either can block licensure.
• •Initial licenses are issued for a 12-month period; after the first on-site survey the license moves to the 3-year renewal cycle, and the $50,000 bond and insurance must show no gap across that transition.
• •Parent agencies adding a branch or alternate delivery site file separately, and each site must appear by address on your certificates of insurance before an MCO will credential it.

Step-by-step: getting HCSSA licensed and insured in Texas

Most Texas startups lose weeks because insurance and bond paperwork trails the HHSC application instead of moving with it. This is the order we walk new PAS and home health agencies through:

• •Week 1 — Form the entity, register with the Texas Secretary of State, and lock the exact legal name you will use on the license, bond, and every certificate of insurance.
• •Week 2 — Name your administrator and alternate administrator and gather proof of the 2 years of qualifying experience or approved coursework HHSC requires.
• •Week 2–3 — Bind the $50,000 HHSC surety bond and the liability program together so effective dates match; carriers can issue both in a few business days once financials are in hand.
• •Week 3 — Submit the HCSSA application with the $2,624 initial fee, background checks for owners and controlling persons, and HHSC-approved policies and procedures.
• •Week 4–12 — Prepare for the pre-licensure survey; HHSC reviews complete packets in roughly 60–90 days, and missing bond or administrator documents are the most common delay.
• •After licensure — Send MCO and hospital credentialing packets with COIs carrying primary & non-contributory additional insured wording and a waiver of subrogation.

What Texas home care agency insurance costs

For a small Texas PAS agency (under ~$500K payroll), a typical program runs roughly $1,200–$2,500 a year for $1M/$2M general liability, $900–$2,000 for professional liability, $250–$750 for the $50,000 HHSC surety bond, $400–$900 for non-owned & hired auto, and $700–$1,500 for cyber. Workers' compensation is the largest single line — Texas home care payroll (NCCI class 8835) commonly prices between $2.00 and $4.50 per $100 of payroll, so a $500K payroll agency should budget roughly $10,000–$22,500 a year, or less under a non-subscriber occupational-accident program. Skilled home health and hospice agencies pay more because of higher professional liability severity. Actual pricing depends on payroll, services offered, claims history, and Medicaid mix — KTL benchmarks Texas agencies across 20+ A-rated carriers before quoting.