How to start an IOP or PHP in Austin

Austin at a glance

Question	Austin's answer
State license	HHSC chemical dependency treatment facility license, per site (26 TAC 564)
Medicaid service area	Travis: Bastrop, Burnet, Caldwell, Fayette, Hays, Lee, Travis and Williamson counties
STAR plans	Blue Cross and Blue Shield of Texas, Dell Children's Health Plan, Superior HealthPlan
STAR+PLUS plans	Superior HealthPlan, UnitedHealthcare Community Plan
CHIP / STAR Kids	CHIP: Blue Cross and Blue Shield of Texas, Superior, Dell Children's. STAR Kids: Blue Cross and Blue Shield of Texas, Superior
Local mental health authority	Integral Care (Travis County); surrounding counties have their own, such as Bluebonnet Trails Community Services
Zoning and certificate of occupancy	City of Austin Development Services Department (start at austintexas.gov); Round Rock, Cedar Park, Georgetown, San Marcos and others each have their own
Local watch-outs	Zoning and site plan questions in a busy permit market; flash flooding; a service area that's urban and rural at once

Plan line-ups are from HHSC's managed care service areas map (revised August 2026). Counties are from HHSC's service area appendix and BCBSTX's Medicaid service area map.

The state license

Austin is the state capital, but that doesn't change the licensing: HHSC licenses every Texas SUD program as a chemical dependency treatment facility under Health and Safety Code chapter 464, and the city has no separate treatment license. As of October 2026 the fee under 26 TAC 564.408 is $1,200 plus $125 per additional site. If you'll offer mental health services only, the rules differ; see licensing a mental health IOP or PHP in Texas. For SUD programs, the forms and inspection are in our CDTF license guide and each rule is mapped to the document that proves it in 26 TAC 564 in plain English.

Zoning, permits and which city you're in

Austin is a zoned city with its own Land Development Code, and the Austin metro is really a dozen cities. Before you fall in love with an address, confirm which city's code applies, then ask that city's permit office in writing. Inside Austin, start with the City of Austin Development Services Department at austintexas.gov.

1. How does the city classify an outpatient substance use treatment program, and is it allowed in this zoning district without a special approval?
2. Does the existing certificate of occupancy cover our use and expected occupancy, or will we need a new one?
3. Will our build-out need a site plan or only building permits, and what are current review times?
4. Is the property in a mapped floodplain?
5. What does the fire marshal inspect before we open?

Austin's permit reviews can be a long pole, so start them as soon as the lease is signed, and build the wait into a lease with free rent during the build-out and a way out if zoning, the certificate of occupancy or the license falls through. The Texas IOP opening checklist lists every site step in order.

Flash floods and the emergency plan

Central Texas is known as Flash Flood Alley: heavy rain on the Hill Country can raise creeks and low-water crossings fast. Check any address on FEMA's Flood Map Service Center before you sign, and ask the city whether the site is in a regulated floodplain. Then write the response into your emergency operations plan: who decides to close or move groups to telehealth, how clients who drive low-water crossings are warned, and how you document a missed day. Comply's guides on the emergency operations plan and the hazard vulnerability analysis show what surveyors ask for.

Medicaid plans in the Travis service area

After the HHSC license, the program enrolls with TMHP and applies to each managed care plan (TMHP has said Medicaid SUD treatment may only be delivered in a licensed chemical dependency treatment facility: TMHP notice).

Program	Who it covers	Plans in the Travis service area
STAR	Most children, pregnant women and some families	Blue Cross and Blue Shield of Texas, Dell Children's Health Plan, Superior
STAR+PLUS	Adults with disabilities and adults 65 and older	Superior, UnitedHealthcare Community Plan
STAR Kids	Children and young adults with disabilities	Blue Cross and Blue Shield of Texas, Superior
CHIP	Children in families above Medicaid income	Blue Cross and Blue Shield of Texas, Superior, Dell Children's Health Plan

• Superior is the common thread. It's the one plan listed in all four programs here, so it's usually the first Medicaid application for an Austin program, adult or adolescent.
• Adults: add UnitedHealthcare for STAR+PLUS (behavioral health through Optum; see carve-outs) and BCBSTX for STAR.
• Adolescents: BCBSTX and Dell Children's Health Plan both serve children's programs here. BCBSTX's Medicaid plan is separate from its commercial network; our BCBS of Texas credentialing guide explains both.
• Plans can change. HHSC's last STAR and CHIP procurement was halted by a Travis County court injunction (Fierce Healthcare). Check HHSC's current list before you apply.

The TMHP and plan steps are in our Texas Medicaid credentialing guide. Commercial contracts usually carry a private IOP; start with insurance contracts for treatment centers, and let our credentialing service file and chase them.

Integral Care and the public system

• Integral Care is Travis County's local mental health authority, the public system for mental health, substance use and crisis services. Agree in writing how your program connects a client in crisis to its crisis services.
• Outside Travis County, other authorities serve the suburbs and rural counties; Bluebonnet Trails Community Services, for example, serves several counties around Austin. Know the authority for each county you draw from.
• OSAR: HHSC funds Outreach, Screening, Assessment and Referral programs that link people to state-funded substance use treatment, often run through the local authorities (HHSC OSAR page). Look up the OSAR for your counties there, and decide whether you'll take state-funded clients.

Hospitals, courts and other partners

Relationships with referral sources rest on good care and fast, honest communication. Paying or giving anything of value for a referral is illegal under the Texas Patient Solicitation Act and EKRA (patient brokering laws, explained). We never arrange referrals.

• Hospitals: the Ascension Seton, St. David's and Baylor Scott & White systems, Dell Seton Medical Center, and Austin State Hospital, the state psychiatric hospital. Discharge planners need your levels of care, plans and how fast you assess.
• Courts and probation: Travis County runs specialty courts, including a drug diversion court, under Government Code chapter 123. Reports go only with the client's consent under 42 CFR Part 2.
• Universities and employers: campus counseling centers and collegiate recovery programs, and employer EAPs in a large tech workforce, see students and employees who need more than weekly therapy.

Or book a free 30-minute call and we'll look at your site and timeline.

Questions

Which Medicaid plans cover Austin?

HHSC's August 2026 map lists Blue Cross and Blue Shield of Texas, Dell Children's Health Plan and Superior for STAR in the Travis service area, Superior and UnitedHealthcare for STAR+PLUS, BCBSTX and Superior for STAR Kids, and BCBSTX, Superior and Dell Children's for CHIP.

Are Round Rock and San Marcos in the same Medicaid service area as Austin?

Yes. The Travis service area includes Williamson County (Round Rock, Georgetown, Cedar Park) and Hays County (San Marcos, Kyle), plus Bastrop, Burnet, Caldwell, Fayette and Lee. Each city still has its own zoning and permit office.

Who is the local mental health authority in Austin?

Integral Care serves Travis County. The surrounding counties are served by other authorities, such as Bluebonnet Trails Community Services.

Does Austin require a special permit for an outpatient treatment program?

That depends on the zoning district and how the City of Austin classifies the use at that address. Ask the Development Services Department for a written answer before you sign, along with what the certificate of occupancy will need.

How long does it take to open an IOP in Austin?

Plan on nine to twelve months to a full caseload of insured clients. Permit review for the build-out can add time in Austin, and facility contracts with plans take about 90 days each after the license.

Other metros: San Antonio, Houston, and all six on opening a program in Texas, by city.

Cima Consulting isn't a law or accounting firm. HHSC, the city and each health plan 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; service area appendix: fhb.hhs.texas.gov; BCBSTX Medicaid service area: bcbstx.com
• HHSC OSAR: hhs.texas.gov
• Texas Health and Safety Code chapter 464: statutes.capitol.texas.gov; 26 TAC 564.408: justia.com
• TMHP, substance use disorder benefit changes: tmhp.com; STAR/CHIP procurement injunction: Fierce Healthcare
• FEMA Flood Map Service Center: msc.fema.gov
• Texas Occupations Code chapter 102: statutes.capitol.texas.gov; EKRA: law.cornell.edu; Government Code chapter 123: statutes.capitol.texas.gov; 42 CFR Part 2: ecfr.gov