How to start an IOP or PHP in San Antonio

San Antonio at a glance

Question	San Antonio's answer
State license	HHSC chemical dependency treatment facility license, per site (26 TAC 564)
Medicaid service area	Bexar: Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina and Wilson counties
STAR plans	Aetna Better Health, Community First Health Plans, Superior HealthPlan, Wellpoint
STAR+PLUS plans	Community First Health Plans (since September 1, 2024), Molina, UnitedHealthcare Community Plan
CHIP / STAR Kids	CHIP: Aetna, Community First, Superior, Wellpoint. STAR Kids: Community First, Superior
Local mental health authority	The Center for Health Care Services (Bexar County); surrounding counties have their own
Zoning and certificate of occupancy	City of San Antonio Development Services Department (start at sanantonio.gov); New Braunfels, Schertz, Seguin, Boerne and others have their own
Local watch-outs	The 2024 STAR+PLUS changes; TRICARE's accreditation rule; bilingual staff and materials

Plan line-ups from HHSC's managed care service areas map; counties from HHSC's STAR comparison charts. Check both before you apply; they change with HHSC's contracts.

The state license

There's no San Antonio treatment license. HHSC licenses SUD programs statewide 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, so a second location in New Braunfels or Schertz means another site on the license and another building to approve. The application and inspection are in our CDTF license guide; the full sequence is how to start an IOP or PHP in Texas.

Zoning, permits and the certificate of occupancy

San Antonio regulates land use through its Unified Development Code, and the City of San Antonio Development Services Department handles zoning questions, building permits and certificates of occupancy (start at sanantonio.gov). Cities in the surrounding counties run their own. Ask the right office, in writing, before you sign:

1. How is an outpatient substance use treatment program with group rooms classified, and is it allowed in this zoning district by right?
2. If it isn't, what approval is needed, and does it go to a hearing?
3. Does the current certificate of occupancy cover our use and expected occupancy?
4. What permits and inspections will the build-out need, and how long does review take?
5. What will the fire marshal check before we open?

Then sign a lease with a contingency for zoning, the certificate of occupancy and the license, and free rent for the build-out. The Texas IOP opening checklist has every step.

Medicaid plans in the Bexar service area

After the HHSC license, enroll with TMHP and apply to each 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 Bexar service area
STAR	Most children, pregnant women and some families	Aetna Better Health, Community First, Superior, Wellpoint
STAR+PLUS	Adults with disabilities and adults 65 and older	Community First, Molina, UnitedHealthcare
STAR Kids	Children and young adults with disabilities	Community First, Superior
CHIP	Children in families above Medicaid income	Aetna Better Health, Community First, Superior, Wellpoint

What changed in 2024. STAR+PLUS in Bexar was re-awarded. Community First Health Plans says HHSC selected it for STAR+PLUS in the Bexar service area effective September 1, 2024, and calls itself the area's only locally owned, nonprofit plan (Community First announcement). Superior says it no longer provides STAR+PLUS coverage in the Bexar service area (Superior notice), though it still serves STAR there: its 2026 STAR directory for Bexar covers the same eight counties. HHSC's STAR+PLUS plan code table shows the same dates. If you're reading an older payer list, it's probably wrong.

• Adult program: Community First is the one plan in both STAR and STAR+PLUS here, so it's a natural first application, followed by Molina or UnitedHealthcare for STAR+PLUS (UnitedHealthcare's behavioral health runs through Optum; see carve-outs) and Aetna, Superior or Wellpoint for STAR.
• Adolescent program: Community First and Superior appear in STAR, STAR Kids and CHIP.

The steps for TMHP and each plan are in our Texas Medicaid credentialing guide; for commercial plans, see insurance contracts for treatment centers and our credentialing service.

TRICARE and Military City USA

San Antonio calls itself Military City USA: Joint Base San Antonio and Brooke Army Medical Center bring active-duty families, retirees and veterans. For an IOP or PHP, that makes TRICARE worth planning for, with conditions. Since January 1, 2025, Texas has been in TRICARE's West region, so programs join through TriWest Healthcare Alliance. And TRICARE pays an IOP or PHP only under a participation agreement that requires accreditation (TRICARE Policy Manual, IOP participation agreement); programs usually use the Joint Commission, CARF or COA, but confirm the accepted list with TriWest. A brand-new program can't get there on day one, so plan the accreditation timeline with the TRICARE contract in mind. Our TRICARE credentialing guide and accreditation for new programs explain the order, and the Program Launch + Accreditation package carries a program all the way through. Veterans using VA benefits go through the VA's community care network, a separate process.

Serving clients in Spanish

Many San Antonio clients and families prefer Spanish. Texas rules already ask for it in places: under 26 TAC 564.506, the client bill of rights, HHSC's complaint information and the grievance procedure are posted in English and a second language (see 26 TAC 564 in plain English). Beyond the postings, plan for bilingual counselors or an interpreter policy, Spanish intake packets and consents, and at least one Spanish-language group if demand supports it. Accreditors look for language access in the intake and treatment-planning records.

The local landscape

Referral relationships are earned with fast admissions and honest updates, never with payment: the Texas Patient Solicitation Act and EKRA ban paying for referrals (our patient brokering guide). We don't arrange referrals.

• Hospital systems: University Health, Bexar County's public system; the Methodist, Baptist and CHRISTUS Santa Rosa systems; and San Antonio State Hospital. Case managers want your levels of care, plans and assessment times.
• The local mental health authority: The Center for Health Care Services is Bexar County's authority for public mental health and substance use services, including crisis care. Put the crisis hand-off in writing.
• OSAR: HHSC's Outreach, Screening, Assessment and Referral programs connect people to state-funded treatment; find the one for your counties on HHSC's OSAR page.
• Courts and probation: Bexar County runs specialty courts, including drug courts, under Government Code chapter 123. Reports need the client's consent under 42 CFR Part 2.

Or book a free 30-minute call about your site and payer plan.

Questions

Which Medicaid plans serve San Antonio?

HHSC's map lists Aetna Better Health, Community First, Superior and Wellpoint for STAR; Community First, Molina and UnitedHealthcare for STAR+PLUS; Community First and Superior for STAR Kids; and Aetna, Community First, Superior and Wellpoint for CHIP in the Bexar service area.

Does Superior still cover STAR+PLUS in San Antonio?

No. Superior says it no longer provides STAR+PLUS coverage in the Bexar service area; Community First took on STAR+PLUS there on September 1, 2024. Superior still serves STAR members in Bexar.

Can a new San Antonio IOP take TRICARE?

TRICARE pays IOPs and PHPs only under a participation agreement that requires accreditation (programs usually use the Joint Commission, CARF or COA), and in Texas you join through TriWest. So a new program usually contracts with TRICARE after accreditation. Plan the accreditation survey early if military families are part of your market.

Are New Braunfels and Seguin in the Bexar Medicaid service area?

Yes. The Bexar service area includes Comal (New Braunfels) and Guadalupe (Seguin, part of Schertz) counties, along with Atascosa, Bandera, Bexar, Kendall, Medina and Wilson. Each city has its own zoning and permits.

How long does opening a San Antonio IOP take?

Plan on nine to twelve months to a full caseload of insured clients, longer if TRICARE or other plans that need accreditation are central to your plan.

Other metros: Austin, El Paso, and all six on opening a program in Texas, by city.

Cima Consulting isn't a law or accounting firm. HHSC, the city, TRICARE and each health plan make their own decisions; we don't guarantee approvals, rates or dates.

Sources

• HHSC, Managed Care Service Areas map: hhs.texas.gov; STAR comparison charts (Bexar counties): hhs.texas.gov; STAR+PLUS plan codes (revision 25-5): fhb.hhs.texas.gov
• Community First Health Plans, STAR+PLUS award: communityfirsthealthplans.com; Superior, STAR+PLUS coverage update: superiorhealthplan.com; Superior 2026 STAR Bexar directory: superiorhealthplan.com
• Molina STAR+PLUS service area (Bexar counties): molinahealthcare.com
• 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; TRICARE: tricare.mil; TRICARE Policy Manual, IOP participation agreement: manuals.health.mil; HHSC OSAR: hhs.texas.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