How to start an IOP or PHP in Waco

Waco at a glance

Question	Waco's answer
State license	HHSC chemical dependency treatment facility license, per site (26 TAC 564)
Medicaid service area	MRSA Central, a rural area that includes McLennan, Bell, Coryell, Brazos, Bosque, Falls and Limestone counties, among others
STAR plans	Superior HealthPlan, Wellpoint
STAR+PLUS plans	Superior HealthPlan, UnitedHealthcare
Local mental health authority	Heart of Texas Behavioral Health Network (McLennan, Bosque, Falls, Freestone, Hill and Limestone counties)
Zoning and certificate of occupancy	City of Waco Development Services (Inspection Services); county or other cities outside Waco
Local watch-outs	RightCare members moved to other plans; Wellpoint's rural network; veterans and VA Community Care; Baylor students on family plans

STAR plans from HHSC's MRSA Central STAR comparison chart (September 1, 2026); STAR+PLUS from the plans' 2026 provider manuals and the awards that took effect September 1, 2024. Check the full county list on the chart.

The license is the same as Austin's

HHSC licenses Texas substance use programs as chemical dependency treatment facilities under Health and Safety Code chapter 464 and 26 TAC 564; Waco adds no treatment license. As of October 2026 the fee under 26 TAC 564.408 is $1,200 plus $125 per additional site. The forms and order are in our CDTF license guide and the rule-by-rule proof list in 26 TAC 564 in plain English. If you're weighing a mental-health-only program instead, the rules are different: see mental health IOP licensing in Texas. The full path is how to start an IOP or PHP in Texas.

The Commercial Check and the certificate of occupancy

The City of Waco requires a certificate of occupancy for every business location, and its Development Services department offers two routes (City of Waco: starting a business or moving into a new space):

Your situation	Route	What happens
No interior alterations	Commercial Check	Requested through the city's portal. You give the business name and describe the business and its services; Development Services confirms the use fits the zoning and the space is safe, then issues the certificate.
Interior alterations (new walls, group rooms, restrooms)	Building permits	The applicable building permits and inspections; the certificate of occupancy follows the finished work.

Describe the use plainly in the Commercial Check request: "outpatient substance use disorder treatment, group and individual counseling, no overnight stay". Read the zoning ordinance's permitted uses for the district before you apply, so the answer isn't a surprise. Then ask in writing:

1. Is an outpatient substance use treatment program a permitted use in this district?
2. Can we use the Commercial Check, or does our layout need permits?
3. What will the fire inspection look for, given our group-room occupant load?

Addresses in Hewitt, Woodway, Bellmead or unincorporated McLennan County have their own rules. Lease with a contingency for the certificate of occupancy and the HHSC license; the site steps are on our Texas IOP opening checklist.

Medicaid plans in MRSA Central

After the HHSC license, enroll with TMHP, then 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 MRSA Central
STAR	Most children, pregnant women and some families	Superior, Wellpoint
STAR+PLUS	Adults with disabilities and adults 65 and older	Superior, UnitedHealthcare

• Superior is in both. Its September 2026 provider manual lists MRSA Central for STAR+PLUS, and the HHSC chart lists it for STAR. Start there: our Superior HealthPlan guide covers the application.
• UnitedHealthcare for STAR+PLUS. Its 2026 Texas provider manual lists MRSA Central for STAR+PLUS and STAR Kids, but not for STAR. See UnitedHealthcare and Optum credentialing.
• Wellpoint for STAR. In the rural service areas Wellpoint uses MultiPlan's Texas True Choice network, so the joining path differs from its metro areas; our Wellpoint Texas guide explains it.

The process is in our Texas Medicaid credentialing guide; for commercial plans, see insurance contracts for treatment centers. Our credentialing service handles the applications.

After RightCare: what changed in 2026

Baylor Scott & White Health Plan said in April 2026 that it would leave Texas Medicaid managed care on August 31, 2026, ending its RightCare STAR plan, and stop selling individual marketplace plans after December 31, 2026. It said Baylor Scott & White's hospitals and clinics would keep accepting Medicaid plans from other insurers (KWTX, April 15, 2026). For a new Waco program that means:

• Don't apply to RightCare. Former RightCare members are now in other plans, so your Medicaid credentialing in MRSA Central goes to Superior and Wellpoint for STAR.
• Check every Medicaid card at intake. Clients may still carry a RightCare card or not know their new plan. Verify eligibility on every admission; our sister site explains how to read an eligibility response.
• Commercial BSWHP coverage continues for employer groups and Medicare Advantage. If those clients matter to you, see our Baylor Scott & White Health Plan guide.

The local landscape

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

• Heart of Texas Behavioral Health Network is the local mental health and IDD authority for Waco and McLennan County plus Bosque, Falls, Freestone, Hill and Limestone counties (HHSC LMHA directory). It runs 24-hour crisis services and a crisis center on Imperial Drive in Waco (its crisis services brochure), and its own outpatient substance use program. Agree on crisis hand-offs, and know when a client belongs there instead.
• OSAR. HHSC's Outreach, Screening, Assessment and Referral programs link people to state-funded treatment; find your region's provider on HHSC's OSAR page.
• Hospitals. Baylor Scott & White and Ascension Providence discharge patients who need a step down. Case managers want your levels of care, accepted plans and assessment times.
• Veterans. Waco is home to the Doris Miller VA Medical Center. A program can see veterans through the VA's Community Care Network once it's in network; see our VA Community Care guide.
• Students. Baylor students often carry a parent's employer plan from another city or state, with a different network or a behavioral health carve-out. Verify before admission.
• Courts and probation. If the county runs a drug court or other specialty court under Government Code chapter 123, reports go only with the client's consent under 42 CFR Part 2.

Legal marketing is in how to market a treatment center.

The order of work in Waco

Step	Waco detail	Typical time in our roadmap
1. Program model and budget	Levels of care and payers, with MRSA Central's short plan list in mind. Run the break-even calculator.	1–2 months
2. Site search	Zoning district, Commercial Check or permits, jurisdiction	about 30 days
3. Lease with a contingency	Out if the certificate of occupancy or license fails; free rent for the build-out	about 3 weeks
4. Build-out	Permits if you alter the space; skip to the Commercial Check if you don't	about 6 weeks
5. Certificate of occupancy and fire inspection	Keep both for HHSC and the accreditor	about 3 weeks
6. HHSC license and inspection	The statewide process	about 2–3 months
7. Facility contracts	TMHP, then Superior, Wellpoint or UnitedHealthcare, then commercial plans and VA Community Care	about 90 days each

The times are the planning figures in our own launch roadmap, not promises. On that roadmap the first admission comes about 6 months after kickoff. Costs are in how much it costs to start an IOP.

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Questions

Which Medicaid plans serve Waco?

McLennan County is in MRSA Central. HHSC's September 2026 chart lists Superior and Wellpoint for STAR; the STAR+PLUS plans are Superior and UnitedHealthcare. RightCare from Baylor Scott & White left Medicaid on August 31, 2026.

What is a Commercial Check in Waco?

It's the City of Waco's route to a certificate of occupancy when you move into a space without interior alterations. You request it through the city's portal, describe the business, and Development Services confirms the zoning and safety before issuing the certificate.

Who is the local mental health authority in Waco?

Heart of Texas Behavioral Health Network, for McLennan, Bosque, Falls, Freestone, Hill and Limestone counties. It runs crisis services and its own substance use program.

Is Waco in the Dallas or Austin Medicaid service area?

Neither. McLennan County is in the Medicaid Rural Service Area Central, with its own plan list, separate from the Travis (Austin) and Dallas service areas.

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

Plan on nine to twelve months to a full caseload of insured clients. The license and the certificate of occupancy are usually faster than credentialing, so start the plan applications as soon as the license is in hand.

Other Texas cities: Austin, Dallas, Tyler, Lubbock, and every city on opening a program in Texas, by city.

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

Sources

• HHSC, MRSA Central STAR comparison chart (September 1, 2026): hhs.texas.gov; Managed Care Service Areas map (revised August 2026): hhs.texas.gov
• Superior HealthPlan provider manual (September 2026): superiorhealthplan.com; UnitedHealthcare 2026 Texas Care Provider Manual: uhcprovider.com
• KWTX, Baylor Scott & White Health Plan to exit Texas Medicaid managed care, April 15, 2026: kwtx.com
• City of Waco, starting a business or moving into a new space: waco-texas.com
• HHSC, local mental health authority directory: resources.hhs.texas.gov; Heart of Texas Behavioral Health Network crisis services: hotbhn.org; OSAR: hhs.texas.gov
• Texas Health and Safety Code chapter 464: statutes.capitol.texas.gov; 26 TAC 564.408: justia.com; TMHP SUD notice: tmhp.com
• 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