Texas by city · free guides from Cima Consulting
Opening a program or practice in Texas: by city
Texas licenses treatment programs and clinicians statewide, so most of the work is the same in every city. What changes is the building, the Medicaid plans you contract with, and the local public system. This page sorts the two, compares the six biggest metros side by side, and links each city's own guide. From operators who run a licensed Texas PHP, IOP and outpatient program.
Updated October 24, 2026. Not legal advice. Cima Consulting isn't a law or accounting firm; plan line-ups change with HHSC's contracts, so confirm before you apply.
The short answer: the license is the same everywhere in Texas. A substance use IOP or PHP needs HHSC's chemical dependency treatment facility license, and a clinician's practice rests on their board license. Three things change by city: the building (zoning, permits and the certificate of occupancy come from the city that has jurisdiction); the Medicaid plans, because HHSC contracts managed care plans by service area; and the local partners, such as the local mental health authority, the OSAR program, the hospital district and the courts.
The six city guides
- HoustonNo zoning but deed restrictions, floodplains and hurricane plans; the nine-county Harris service area and its five STAR plans.
- DallasZoning and specific use permits, NTBHA and LifePath, and the line that splits the Metroplex into two Medicaid service areas.
- Fort WorthThe Tarrant service area (Denton included), shell-building build-outs, MHMR Tarrant and the Recovery Resource Council.
- AustinThe eight-county Travis service area, Superior across all four programs, Integral Care, and flash-flood planning.
- San AntonioBexar's 2024 STAR+PLUS changes, TRICARE near Joint Base San Antonio, and serving clients in Spanish.
- El PasoA two-county service area with a hometown plan, Emergence Health Network, Fort Bliss, New Mexico clients and Mountain Time.
The six metros side by side
Plans are from HHSC's managed care service areas map (revised August 2026). STAR covers most children, pregnant women and some families; STAR+PLUS covers adults with disabilities and adults 65 and older.
| Metro | Service area and counties | STAR plans | STAR+PLUS plans | Local authority |
|---|---|---|---|---|
| Houston | Harris: Austin, Brazoria, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Waller, Wharton | Community Health Choice, Molina, Texas Children's, UnitedHealthcare, Wellpoint | Community Health Choice, Molina, UnitedHealthcare | The Harris Center (Harris County) |
| Dallas | Dallas: Collin, Dallas, Ellis, Hunt, Kaufman, Navarro, Rockwall | Molina, Parkland, Wellpoint | Molina, Superior, UnitedHealthcare | NTBHA (six counties); LifePath Systems (Collin) |
| Fort Worth | Tarrant: Denton, Hood, Johnson, Parker, Tarrant, Wise | Aetna, Cook Children's, Wellpoint | Molina, UnitedHealthcare | MHMR of Tarrant County |
| Austin | Travis: Bastrop, Burnet, Caldwell, Fayette, Hays, Lee, Travis, Williamson | BCBS of Texas, Dell Children's, Superior | Superior, UnitedHealthcare | Integral Care (Travis County) |
| San Antonio | Bexar: Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina, Wilson | Aetna, Community First, Superior, Wellpoint | Community First, Molina, UnitedHealthcare | The Center for Health Care Services (Bexar County) |
| El Paso | El Paso: El Paso, Hudspeth | El Paso Health, Molina, Superior | El Paso Health, Molina | Emergence Health Network |
Molina and UnitedHealthcare each appear in STAR+PLUS in five of these six areas; in STAR, Wellpoint appears in four and Superior and Molina in three each. The local plans (Community Health Choice, Texas Children's, Parkland, Cook Children's, Dell Children's, Community First, El Paso Health) each appear in only one of the six. HHSC's last STAR and CHIP procurement was halted by a court injunction (Fierce Healthcare), so check the current status before you plan around any one plan.
Which service area is a suburb in?
Medicaid members enroll in a plan for the service area where they live, so the county matters more than the metro name. The surprises:
| If your site or clients are in… | The service area is | Why it matters |
|---|---|---|
| Denton County (Denton, Lewisville, Flower Mound) | Tarrant | Fort Worth's plans, not Dallas's |
| Collin County (Plano, Frisco, McKinney) | Dallas | Dallas's plans; LifePath Systems, not NTBHA, is the local authority |
| Williamson and Hays counties (Round Rock, Georgetown, San Marcos) | Travis | Austin's plans; different local authorities from Travis County |
| Comal and Guadalupe counties (New Braunfels, Seguin) | Bexar | San Antonio's plans |
| Montgomery, Fort Bend, Brazoria and Galveston counties | Harris | Houston's plans; Gulf Coast Center serves Brazoria and Galveston |
Outside these six, HHSC has more service areas, including Hidalgo, Jefferson, Lubbock and Nueces, and Medicaid rural service areas (MRSAs) for the rest of the state. The map shows each one's plans.
What's the same in every Texas city
- The program license. HHSC licenses substance use programs as chemical dependency treatment facilities under Health and Safety Code chapter 464 and 26 TAC 564. As of October 2026 the fee under 26 TAC 564.408 is $1,200 plus $125 for each additional site. See how to get a Texas CDTF license and 26 TAC 564 in plain English; mental-health-only programs follow different rules.
- The order of work. Plan, form the business, find a site, build out, certificate of occupancy and fire inspection, HHSC license, then facility contracts. On our Texas SUD program roadmap, the first admission comes about 6 months after kickoff; the full sequence is how to start an IOP or PHP in Texas and the opening checklist.
- Staffing and credentials. Counselor qualifications, supervision and director roles come from state rules, not the city: IOP staffing requirements in Texas.
- Medicaid enrollment. TMHP enrollment is statewide; TMHP has said Medicaid SUD treatment may only be delivered in a licensed chemical dependency treatment facility (TMHP notice). Only the plans after it are local: Texas Medicaid credentialing.
- The referral laws. The Texas Patient Solicitation Act and federal EKRA apply in every city: never pay or give anything of value for referrals (patient brokering laws, explained).
What changes by city
| Local factor | What to do |
|---|---|
| Zoning and permits | Confirm which city or county has jurisdiction, then get a written answer on whether your use is allowed and what the certificate of occupancy needs, before you sign a lease. Houston has no citywide zoning, but deed restrictions still apply. |
| Medicaid plans | Pick the plans in your service area that cover the people you'll serve: STAR and STAR+PLUS for adults, STAR Kids and CHIP for adolescents. |
| Local authority and OSAR | Know the local mental health authority's crisis services and the OSAR program for state-funded clients, and write the hand-offs into your policies. |
| Hazards | Floods and hurricanes on the coast, flash floods in Central Texas, storms and freezes in North Texas, heat in El Paso. Put them in your emergency plan and hazard vulnerability analysis. |
| Military families | Near Fort Bliss or Joint Base San Antonio, plan for TRICARE, which requires IOPs and PHPs to be accredited. See TRICARE credentialing in Texas. |
| Language | Spanish-speaking staff and materials matter everywhere in Texas and most in San Antonio and El Paso; 26 TAC 564.506 already asks for postings in English and a second language. |
Practices and sober living homes
- A private practice runs on the clinician's own board license, so the city matters less: the office needs a certificate of occupancy that covers offices, some cities want a business permit, and the Medicaid plans you can join depend on your service area. See how to start a private practice in Texas, a group practice, a psychiatric NP practice or an LCDC practice.
- A sober living home is housing, not treatment, so city rules and fair housing law decide more than any license does. Start with how to open a sober living home in Texas.
How to read HHSC's service area map
- Open HHSC's managed care service areas map and check the revision date in the corner.
- Find the county your site is in, then the counties your clients come from. Each county belongs to one service area.
- For each service area, read the STAR, STAR+PLUS, STAR Kids and CHIP lists. Programs serving adults care most about STAR and STAR+PLUS; adolescent programs about STAR, STAR Kids and CHIP.
- Cross-check with HHSC's health plans by service area list, then ask each plan whether its behavioral health network is open for your provider type.
Opening a program anywhere in Texas?
Our IOP / PHP Program Launch takes a program from plan to first admission for a flat $24,500, including the site checklist for your city and facility credentialing with the plans in your service area.
Or book a free 30-minute call and tell us the city and address.
Questions
Do Texas cities license treatment programs?
No. HHSC licenses substance use programs statewide. Cities control zoning, building permits, the certificate of occupancy and fire inspections, which decide whether a building can be used.
Why do Medicaid plans differ by city in Texas?
HHSC contracts Medicaid and CHIP managed care plans by service area, groups of counties. Each area has its own list of plans for STAR, STAR+PLUS, STAR Kids and CHIP, and a program credentials with the plans in the areas where its clients live.
Is Dallas or Fort Worth the same Medicaid area?
No. Dallas is in the Dallas service area (Collin, Dallas, Ellis, Hunt, Kaufman, Navarro, Rockwall) and Fort Worth is in the Tarrant service area (Denton, Hood, Johnson, Parker, Tarrant, Wise), with different plans.
Which Texas city is easiest to open an IOP in?
None is easy, and the license is the same everywhere. A smaller service area with fewer plans, like El Paso, means fewer Medicaid applications; a zoned city adds a zoning question Houston doesn't have, but Houston adds deed restrictions and floodplains. Pick the city where your clients and staff are.
Cima Consulting isn't a law or accounting firm. HHSC, cities and health plans make their own decisions; we don't guarantee approvals, rates or dates.
Sources
- HHSC, Managed Care Service Areas map (revised August 2026): hhs.texas.gov; Health Plans by Service Areas: hhs.texas.gov
- HHSC service area county lists: STAR+PLUS service area by county; service area appendix; STAR comparison charts; STAR Kids comparison charts
- HHSC OSAR: hhs.texas.gov
- Texas Health and Safety Code chapter 464: statutes.capitol.texas.gov; 26 TAC 564.408: justia.com; TMHP: tmhp.com
- STAR/CHIP procurement injunction: Fierce Healthcare
- Texas Occupations Code chapter 102: statutes.capitol.texas.gov; EKRA: law.cornell.edu
Tell us the city and the address.
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