How to start an IOP or PHP in Fort Worth

Fort Worth at a glance

Question	Fort Worth's answer
State license	HHSC chemical dependency treatment facility license, per site (26 TAC 564)
Medicaid service area	Tarrant: Denton, Hood, Johnson, Parker, Tarrant and Wise counties
STAR plans	Aetna Better Health of Texas, Cook Children's Health Plan, Wellpoint
STAR+PLUS plans	Molina, UnitedHealthcare Community Plan
Local mental health authority	My Health My Resources (MHMR) of Tarrant County; the other five counties have their own
OSAR	Recovery Resource Council, the designated OSAR for 12 North Texas counties including Tarrant, Denton and Parker
Zoning and certificate of occupancy	City of Fort Worth development services (start at fortworthtexas.gov); Arlington, Denton and the other cities each have their own
Local watch-outs	The Dallas/Tarrant service-area line; new shell buildings that need a full build-out; spring storms

Where the Tarrant service area starts and stops

HHSC lists the Tarrant service area as Denton, Hood, Johnson, Parker, Tarrant and Wise counties (STAR+PLUS service area by county; Aetna's 2026 STAR member handbook uses the same six). Two consequences for planning:

• Denton County is on this side. A program in Denton, Lewisville or Flower Mound contracts with the Tarrant-area Medicaid plans, even though many people think of those cities as "Dallas." Collin County, next door, is in the Dallas service area with different plans. Our Dallas guide covers that side.
• Arlington and Grand Prairie sit near the line. Clients enroll in a plan for the county where they live, so a program on the Tarrant–Dallas border may see Medicaid clients from both service areas. Decide whether you'll credential with both sets of plans before you promise anyone in-network care.

The state license

Fort Worth doesn't issue a treatment license; HHSC does, 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 at a separate address. The application, the six-month window to show compliance and the inspection are in our CDTF license guide; the whole sequence is in how to start an IOP or PHP in Texas; and the counselor and director roles HHSC expects are in IOP staffing requirements in Texas.

Zoning, permits and the certificate of occupancy

Fort Worth and its neighbors are zoned cities, so the first question about any address is whether its zoning district allows an outpatient treatment program. Start with the City of Fort Worth's development services (from fortworthtexas.gov), or the permit office of whichever city the address is actually in.

1. How does the city classify an outpatient substance use treatment program, and is that use allowed in this zoning district by right?
2. If not by right, what approval would it need, how long does that take, and is there a hearing?
3. Does the current certificate of occupancy cover our use and headcount, or do we need a new one?
4. What plan review, permits and inspections will the build-out need?
5. When and how does the fire marshal inspect?

New buildings need the most work. Fast-growing parts of the county have plenty of new retail and office "shell" space. A shell has no interior walls, restrooms or finished rooms, so you'd pay for the full build-out and go through every permit and inspection before a certificate of occupancy. Budget the time: in our roadmap the build-out alone is about six weeks after the lease, and the certificate and fire inspection about three more. Negotiate free rent for that period, and a way out of the lease if zoning, the certificate or the license falls through. Every site step is on the Texas IOP opening checklist.

Medicaid plans in the Tarrant service area

Once the HHSC license is issued, the program enrolls with TMHP and then applies to each managed care plan separately (TMHP has said Medicaid SUD treatment may only be delivered in a licensed chemical dependency treatment facility: TMHP notice). Line-ups below are from HHSC's managed care service areas map (revised August 2026).

Program	Who it covers	Plans in the Tarrant service area
STAR	Most children, pregnant women and some families	Aetna Better Health of Texas, Cook Children's Health Plan, Wellpoint
STAR+PLUS	Adults with disabilities and adults 65 and older	Molina, UnitedHealthcare Community Plan
STAR Kids and CHIP	Children with disabilities; children above Medicaid income	Check HHSC's current map. Aetna's 2025–2026 provider manual says it offers STAR Kids in the Tarrant and Dallas service areas.

• No plan is in both STAR and STAR+PLUS here, unlike Houston or Dallas. An adult program that wants broad Medicaid reach needs at least one plan from each list, for example Aetna or Wellpoint for STAR and Molina or UnitedHealthcare for STAR+PLUS.
• Cook Children's Health Plan serves mostly children, so it matters most to an adolescent program.
• Watch the contract status. Cook Children's Health Plan, Wellpoint, Superior and Texas Children's Health Plan sued over HHSC's last STAR and CHIP procurement, and a Travis County court injunction stopped the new contracts (Fierce Healthcare). The 2025 Legislature didn't cancel the procurement (Texas Managed Care Alliance recap), so check where it stands before counting on a STAR plan's future in this area.

The steps for TMHP and each plan are in our Texas Medicaid credentialing guide. For commercial plans and Aetna's commercial side, see insurance contracts for treatment centers and credentialing with Aetna in Texas.

MHMR Tarrant and the Recovery Resource Council

• My Health My Resources (MHMR) of Tarrant County is the county's local mental health authority: public mental health services, crisis services and services for people with intellectual and developmental disabilities. Agree in writing how your program hands a client in crisis to them, and put it in your crisis policy.
• Recovery Resource Council describes itself as the designated Outreach, Screening, Assessment and Referral (OSAR) program for 12 North Texas counties, including Tarrant, Denton and Parker (its OSAR page). OSAR screens people and connects them to state-funded substance use treatment (HHSC OSAR page). If you won't take state-funded clients, OSAR is where you send the people you can't serve.

Hospitals, courts and other partners

Build relationships on quick assessments, clear level-of-care decisions and good updates, and never on anything of value: the Texas Patient Solicitation Act and EKRA forbid paying for referrals (see patient brokering laws). We don't arrange referrals for anyone.

• Hospital systems: JPS Health Network, Tarrant County's public system; Cook Children's for adolescents; and the large private systems across the county. Case managers want your levels of care, plans, hours and assessment times on one page.
• Courts and probation: Tarrant County runs specialty courts, including drug courts, under Government Code chapter 123. Progress reports go only with the client's written consent under 42 CFR Part 2.
• Therapists, EAPs and detox units across Tarrant and Denton counties refer clients who need more structure than weekly therapy.

Our guide to marketing a treatment center legally covers directories, ads and LegitScript.

Or book a free 30-minute call before you sign a lease.

Questions

Is Fort Worth in the same Medicaid service area as Dallas?

No. Fort Worth is in HHSC's Tarrant service area (Denton, Hood, Johnson, Parker, Tarrant and Wise counties). Dallas is in the Dallas service area (Collin, Dallas, Ellis, Hunt, Kaufman, Navarro and Rockwall). The Medicaid plans differ between them.

Which Medicaid plans serve Fort Worth?

HHSC's August 2026 map lists Aetna Better Health, Cook Children's Health Plan and Wellpoint for STAR, and Molina and UnitedHealthcare for STAR+PLUS. Check HHSC's current list before you apply, and ask each plan whether its behavioral health network is open.

Who is the OSAR for Tarrant County?

Recovery Resource Council describes itself as the designated Outreach, Screening, Assessment and Referral program for 12 North Texas counties, including Tarrant, Denton and Parker. HHSC's OSAR page lists the programs statewide.

Does Fort Worth require a city permit to open an IOP?

The city doesn't license the treatment, but it controls zoning, building permits for the build-out and the certificate of occupancy, and the fire marshal inspects. Get the zoning answer in writing before you sign a lease.

How long does opening a Fort Worth IOP take?

Roughly nine to twelve months to a full caseload of insured clients. A shell building adds build-out time, and the facility contracts with plans, about 90 days each after the license, usually take the longest.

Other metros: Dallas, Austin, 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; STAR+PLUS service area by county: fhb.hhs.texas.gov
• Aetna Better Health of Texas, 2026 STAR member handbook (Tarrant counties): aetnabetterhealth.com; provider manual 2025–2026: aetnabetterhealth.com
• Recovery Resource Council, OSAR: recoverycouncil.org; 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; 2025 session recap: Texas Managed Care Alliance
• 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