How to start an IOP or PHP in The Woodlands or Conroe

Montgomery County at a glance

Question	Montgomery County's answer
State license	HHSC chemical dependency treatment facility license for each site (26 TAC 564)
Medicaid service area	Harris: Austin, Brazoria, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Waller and Wharton counties
STAR plans	Community Health Choice, Molina, Texas Children's Health Plan, UnitedHealthcare Community Plan, Wellpoint
STAR+PLUS plans	Community Health Choice, Molina, UnitedHealthcare Community Plan
Local mental health authority	Tri-County Behavioral Healthcare: Montgomery, Liberty and Walker counties
Building and covenant approvals	The Woodlands: Township Covenant Administration and the Development Standards Committee, plus the county's requirements. Conroe and other cities: that city's permit office
Local watch-outs	Commercial covenants; mapped floodplains; hurricane season (June 1 to November 30); clients from north Harris County

Plans from HHSC's managed care service areas map (revised August 2026), as listed in our Houston guide; counties from HHSC's STAR Kids plan codes appendix. Check before you apply.

The state license

Under Health and Safety Code chapter 464 and 26 TAC chapter 564, HHSC licenses the program as a chemical dependency treatment facility before it treats anyone. Neither the Township nor Conroe issues a treatment license. As of October 2026 the fee under 26 TAC 564.408 is $1,200 plus $125 for each additional site, so a Houston program opening a Woodlands office adds a site to its license, with that site's own approvals and inspection.

The forms are in our Texas CDTF license guide, the proof list is 26 TAC 564 in plain English, and the full sequence is how to start an IOP or PHP in Texas. Expanding an existing program is covered in adding a level of care and relocating a treatment program.

The Woodlands: covenants on top of codes

The Woodlands isn't a city. It's governed by The Woodlands Township, and its land carries recorded Residential and Commercial Covenants that the Township enforces. For a program, that means a layer of private-style rules on top of building and fire codes:

• Covenant Administration reviews permit applications. The Township's Covenant Administration department handles residential and commercial permit applications, reviews them and enforces the covenants; applications go through its online portal.
• The Development Standards Committee decides changes to existing commercial property. The DSC reviews requests for improvements on existing commercial properties, is the only committee that can grant variances, and meets on the first and third Wednesdays of each month. A build-out that changes signs, exterior, parking or layout may need its approval, so put its meeting dates on your calendar.
• New construction is the developer's call. The Township says initial construction on undeveloped land is reviewed by the developer, Howard Hughes, not the Township board or the DSC.
• The county's requirements still apply. Because there's no city building department, ask Montgomery County and its fire marshal which permits and inspections a change of use needs.

Ask your landlord for the covenants and any use restrictions in the lease, and have your attorney read them before you sign. A landlord's "no problem" isn't a covenant review.

Conroe and the rest of the county

Conroe, the county seat, has its own permit office, as do Shenandoah, Oak Ridge North and the county's other cities. Unincorporated addresses go through the county. Confirm the jurisdiction from the address, then ask that office in writing:

1. How is an outpatient substance use treatment program with group rooms classified at this address, and is it allowed there?
2. Does the existing certificate of occupancy (or the county's equivalent) cover our use and headcount?
3. What permits, plan review and inspections will the build-out need, and how long is review taking?
4. Is the property in a mapped floodplain, and would our build-out trigger floodplain review?
5. What will the fire marshal check before we open?

Then lease with a contingency for the approvals (covenant, certificate and license) and free rent during the build-out. Every site step is in our Texas IOP opening checklist.

Floodplains and storms

Montgomery County sits in the San Jacinto River basin, and parts of it flood. Look up every candidate address on FEMA's Flood Map Service Center and ask the permit office whether floodplain rules apply to your build-out.

• Insure the contents and the income. Ask about flood coverage for furniture, computers and records, and business-interruption coverage; a standard commercial policy may exclude flood.
• Write the storm plan into your emergency plan. The Atlantic hurricane season runs June 1 to November 30. Comply's guides cover the emergency operations plan and the hazard vulnerability analysis accreditors ask for.
• Don't let a closure end the license. HHSC retires a site's license when services stop there for more than 60 days unless you've asked for inactive status (26 TAC 564.406).

Medicaid plans in the Harris service area

For Medicaid, Montgomery County is Houston: the same nine-county service area and the same plans. After the HHSC license, enroll with TMHP and credential with 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 Harris service area
STAR	Most children, pregnant women and some families	Community Health Choice, Molina, Texas Children's Health Plan, UnitedHealthcare, Wellpoint
STAR+PLUS	Adults with disabilities and adults 65 and older	Community Health Choice, Molina, UnitedHealthcare
STAR Kids	Children and young adults with disabilities	Texas Children's Health Plan, UnitedHealthcare, Wellpoint
CHIP	Children in families above Medicaid income	Community Health Choice, Molina, Texas Children's Health Plan, UnitedHealthcare, Wellpoint

• Adult program? Community Health Choice, Molina and UnitedHealthcare are in both STAR and STAR+PLUS. Community Health Choice is part of the Harris Health System and has limited new network applications to set windows before; see our Community Health Choice guide before you plan around it. UnitedHealthcare's behavioral health runs through Optum (UnitedHealthcare and Optum guide).
• Adolescent program? Texas Children's Health Plan is in STAR, STAR Kids and CHIP here.
• Clients cross the county line. A Woodlands program draws from Spring and north Harris County too. Because the whole area is one Medicaid service area, the same plans cover them; commercial networks don't split this way either.

The filing order is in our Texas Medicaid credentialing guide, commercial contracts are in insurance contracts for treatment centers, and our credentialing service files and follows every application.

Tri-County and the local landscape

Earn referrals with fast assessments and honest level-of-care calls. Paying or giving anything of value for referrals is illegal under the Texas Patient Solicitation Act and federal EKRA (patient brokering laws, explained). We never arrange referrals.

• Tri-County Behavioral Healthcare is the community center for Montgomery, Liberty and Walker counties, serving people with serious mental illness, intellectual disabilities and substance use disorders, with a board appointed by each county's commissioners court (Community Impact). It offers its own substance use treatment, so learn where your program fits next to it and how crisis hand-offs work.
• OSAR. HHSC funds Outreach, Screening, Assessment and Referral programs in every region to link people to state-funded substance use treatment (HHSC OSAR page). Find the current provider for Montgomery County there.
• Hospitals. The Houston systems' Woodlands and Conroe hospitals discharge patients who need a step-down level of care; their case managers want your levels of care, plans and assessment times.
• Courts and probation. Drug courts run under Government Code chapter 123; reports go only with consent that meets 42 CFR Part 2.
• Therapists, EAPs and school counselors refer people who need more than weekly therapy. Legal marketing is in how to market a treatment center.

The order of work in Montgomery County

Step	Montgomery County detail	Typical time in our roadmap
1. Program model and budget	Pick levels of care and payers. Use the break-even calculator.	1–2 months
2. Site search	Township, city or county; covenants; floodplain; the five questions above	about 30 days
3. Lease with a contingency	Out if the covenant review, certificate or license fails; free rent for the build-out	about 3 weeks
4. Covenant review and build-out	Covenant Administration and, for changes, the DSC (first and third Wednesdays); county or city permits	about 6 weeks, plus DSC timing
5. Certificate of occupancy and fire inspection	Keep both for HHSC and the accreditor	about 3 weeks
6. HHSC license and inspection	File when the site, policies and staff files are nearly ready	about 2–3 months
7. Facility contracts	TMHP, the Harris-area plans you chose, commercial plans	about 90 days each

The times are planning figures from our own launch roadmap, not promises. What it costs is in how much it costs to start an IOP.

Or book a free 30-minute call and tell us the address you're looking at.

Questions

Does The Woodlands require permits for a treatment program?

The Woodlands isn't a city, so there's no city building department, but commercial properties are bound by the Township's covenants. Covenant Administration reviews permit applications, and the Development Standards Committee reviews changes to existing commercial properties. Ask Montgomery County and its fire marshal which county permits and inspections apply.

Is Montgomery County in the same Medicaid service area as Houston?

Yes. HHSC's Harris service area includes Montgomery County, so the plans are the same as Houston's: Community Health Choice, Molina, Texas Children's, UnitedHealthcare and Wellpoint for STAR, and Community Health Choice, Molina and UnitedHealthcare for STAR+PLUS.

Who is the local mental health authority for Conroe and The Woodlands?

Tri-County Behavioral Healthcare, which serves Montgomery, Liberty and Walker counties. The Harris Center serves Harris County, next door.

When does The Woodlands Development Standards Committee meet?

The Township says the DSC meets on the first and third Wednesdays of each month. It reviews improvements to existing commercial properties and is the only committee that can grant variances.

How long does it take to open an IOP in The Woodlands or Conroe?

Plan on roughly nine to twelve months from first decisions to a full caseload of insured clients. Covenant review can add a few weeks to the build-out, and the facility contracts usually take longest.

Other Texas cities: Houston, Plano and Frisco, Killeen–Temple, and every city guide on opening a program in Texas, by city.

Cima Consulting isn't a law or accounting firm. HHSC, The Woodlands Township, the county, the cities and each health plan make their own decisions; we don't guarantee approvals, rates or dates. We aren't affiliated with any health plan named here.

Sources

• HHSC, Managed Care Service Areas map (revised August 2026): hhs.texas.gov; STAR Kids plan codes and Harris service area counties: fhb.hhs.texas.gov
• The Woodlands Township, Covenant Administration: thewoodlandstownship-tx.gov; Development Standards Committee: thewoodlandstownship-tx.gov
• Community Impact, Montgomery County commissioners extend contract with Tri-County Behavioral Healthcare: communityimpact.com
• FEMA Flood Map Service Center: msc.fema.gov
• HHSC OSAR: hhs.texas.gov; TMHP, substance use disorder benefit changes: tmhp.com
• Texas Health and Safety Code chapter 464: statutes.capitol.texas.gov; 26 TAC 564.406 and 564.408: 564.406, 564.408
• 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