Obstacles slow Texas’ effort to improve conditions at substance abuse recovery homes

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A new state law meant to ensure that more Texans recovering from substance abuse in residential facilities have uniform standards of care and living conditions may not have the effect lawmakers intended.

The 2023 law, which goes into effect in September, requires recovery homes to be accredited to receive state funding. That accreditation requires them to meet specific health standards, adhere to an established code of ethics and agree to inspections. But there aren’t enough people to inspect the nearly 600 recovery homes, the cost of becoming accredited can be cost prohibitive for some facilities and legislators haven’t earmarked enough money to subsidize the number of homes advocates say are needed.

“I don’t think there’s enough incentive for them to get accredited,” said Ralph Fabrizio, a certified recovery support peer specialist and owner of the accredited House of Extra Measures facilities in Houston. “There is just not a lot of money in recovery housing, and this is another expense some good providers can’t take on financially because they are already battling unlicensed recovery homes, setting the price point so low that it's running them out of business.”

House Bill 299, which the Texas Legislature passed in 2023, prohibits a recovery house from receiving state money if it has not participated in the “voluntary” accreditation process.

Texas Health and Human Services Commission adopted the standards established by the National Alliance for Recovery Residences (NARR) and the nonprofit Oxford House Incorporated. These accreditation organizations' standards require a community-based approach to recovery and set the bar for resident safety while educating providers on what is legally required in health care.

“A lot of people come into recovery housing from other industries with not a full understanding of the rules in health care,” said Elizabeth Henry, director of policy for RecoveryPeople, a substance use recovery nonprofit based in Texas. “Things like referral fees and bonuses and things like that are not welcomed in health care, but we have people trying to get discounts on drug testing. One of the great things that happens when they go through accreditation is they learn these things.”

In addition to Oxford House, Texas Recovery Oriented Housing Network accredits recovery houses in Texas. To start the certification process, a recovery house must pay $500 per application and $10 per bed.

To help categorize recovery residences into more specific groups, NARR distinguishes these residences based on four levels of care.

The first level is peer-run recovery residences, where residents operate the facility. Level two is for monitored recovery residences, with an administrative director overseeing operations. A level three home is a supervised recovery residence, which has more intense oversight than monitored residences and includes 24/7 support for residents. The fourth and final level is for service provider recovery residences, which are typically operated by organizations or corporations that offer clinical and administrative supervision and credentialed staff.

Each level has standards that must be met before being certified by NARR, including requirements for administrative operations, recovery support, physical environment, and even how to be a good neighbor. It also includes a rule that makes paid work agreements completely voluntary so residents don’t suffer consequences for declining work, a costly concept for recovery home providers.

Texas Recovery Oriented Housing Network is the only accreditation agency in the state that can certify all levels, as Oxford House Incorporated deals mainly with level 1 homes.

While these standards are meant to improve residents' recovery, they saddle housing providers with additional costs. Providers make most of their money from residents’ rent.

Henry said House Bill 299 was initially meant to include funding, but lawmakers removed this portion during committee hearings. “We don’t know why,” she said.

Residents’ private or public health insurance usually does not cover housing costs for recovery residences, leading to recovery homes closing or switching to more profitable care facilities..

“Currently, the conundrum that we face is that the higher the severity of illness, the lower the resources the person has available. This is because the higher the severity, the higher the care they need, which is more expensive, and insurance doesn’t pay for it,” Henry said.

The exact number of recovery homes in Texas is unknown because accreditation is voluntary. Still, advocates believe 600 to 700 recovery homes are operating in a given year. The Texas Health and Human Services Commission reports that 407 are accredited or chartered homes, with 326 of those being low-intensity resident-run homes.

Henry estimates around 300 homes lack accreditation and risk being cut off from all state funding.

The Texas Health and Human Services Commission could not provide an exact number of recovery homes that lack accreditation because no agency gathers information on every recovery home that exists.

To meet the current demand from Texans seeking to recover from substance abuse, the state needs at least 300 more dwellings and 200 more high-intensity managed care homes to be accredited, said Jason Pullin, the director of the Texas Recovery Oriented Housing Network.

According to the National Study of Treatment and Addiction Recovery Residences, the state currently ranks 33rd in the nation for recovery homes per capita. Most Texas counties — 218 — have no identified recovery housing, and 86% have fewer than five.

The Texas Recovery Oriented Housing Network has accredited 81 recovery homes, with 23 residences becoming newly certified through the voluntary process in fiscal year 2024. Even if the demand for accreditation increases, the Texas affiliate of the national accreditation organization will likely not meet it due to a lack of staff.

“We currently have one paid employee, myself, but we operate from El Paso to Beaumont, Amarillo to South Texas. These homes must be physically walked through as part of the accreditation process. We just don’t have the bandwidth,” said Pullin, the organization’s director.

Texas Health and Human Services Commission identified the single issue concerning accreditation is providers don’t find it financially feasible or worthwhile.

The exact amount of money a recovery home receives from the state can vary depending on the level of substance use it is meant to address, as higher-intensity programs might need medicine programs and clinical support.

State funds usually cover rent for specific residents in a recovery home, ranging from $300 to $2,000 monthly. However, this is not a reliable source of funding for most providers.

“The vast majority of recovery homes in Texas do not receive state funding,” Henry said. “Currently, approximately 15 homes under PROJECT HOMES and those supported by BeWell Texas receive state funds, and both programs require NARR accreditation. However, BeWell Texas only covers costs of residents who meet specific criteria, making the funding highly limited and inconsistent.”

In fiscal year 2024, the Texas Health and Human Services Commission spent $10 million on substance-use housing, with $4 million going to the Texas Targeted Opioid Response recovery housing program.

The majority of state funding for recovery housing goes to Oxford House, which has had a decade-long contract with the Texas health agency, with the current one being $1.6 million annually. Oxford House has accredited 326 homes, with 20 residences newly chartered in 2024.

“While this funding has provided stable support for Oxford Houses, it has also contributed to a significant gap in recovery housing options, as other recovery homes remain largely unfunded,” Henry said.

Additionally, some recovery homes occasionally receive housing vouchers from local mental health authorities, but these payments can take months to process, making them impractical options for many homes and residents.

The federal Substance Use Prevention, Treatment, and Recovery Block Grant covers 70% of all substance use services in Texas, something advocates say needs to be switched to state funds soon as federal funding can be unreliable, and the accreditation process is already a financial burden for recovery housing providers.

Pullin said the costs a recovery home can incur annually vary widely depending on whether the provider rents or owns the homes, whether transportation is provided, what programming is offered, and more.

“In my estimate as a former operator, the average budget for a recovery home would range from $50,000 on the low end to over $100,000 on the upper end,” he said. “Every provider has a unique program. There is no way to get an accurate average with a multitude of differences among providers.”

The current situation in Texas has led many recovery homes to look for other funding sources, either by leaving the industry altogether or switching to programs that have more consistent federal and state funding.

This is why recovery housing advocates and managers have asked lawmakers to send $4.3 million to level two or three accredited homes during the next two-year state budget cycle. Most level one homes already receive consistent funding, and a clinic or hospital usually supports level-four dwellings, so they don’t need additional funding, Henry said.

The recovery home industry warned lawmakers in a hearing that without rental assistance, facilities with expensive programs will continue to close or move to more profitable outpatient programs, and more dangerous, unregulated facilities will replace them.

“We are hopeful that this funding proposal will successfully move through the appropriations process and become part of the state budget, expanding access to quality recovery housing for more Texans in need,” Henry said.

What is a recovery home?

Lyndsi Taylor, a 35-year-old Pearland resident, began a downward spiral into drug abuse seven years ago when her youngest daughter died. She’s bounced around from couches to rehab programs to the streets, but this year, she is ready for a change.

“It’s a full-time job just worrying about how you’re going to get pills. And it’s so exhausting, and I’m just so tired of that; I’m so tired of that same old worrying about something that doesn’t even do anything for me and causes nothing but trouble in my life,” Taylor said.

For people like Taylor, a recovery home is a community of like-minded individuals who are there to pick you up at your lowest moments.

“The girls are great. There’s a sisterhood and a bond because we’re all going through the same thing,” Taylor, who is currently staying in a recovery home in Houston, said. “We hold each other accountable. But we’re there for each other when you need it, too. You need that community because you can’t do it alone.”

For many Texans, leaving rehab is just the start of the recovery journey, not the end.

“You are pretty much going from the street to 30 days in treatment and then right back home,” said Sarah Saidock, who was a resident of a recovery home in 2021. “Those addictive behaviors are still going to be engraved in you.”

Saidock said her time at a recovery home allowed her to regulate her emotions again after years of numbing them with drugs.

“If I hadn’t been sent to that recovery home, I wouldn’t have had that time to heal and grow and be a responsible parent for my daughter that I still am today; that made a world of difference for me,” said Saidock, who has worked at House of Extra Measures, a recovery housing program in Houston since her treatment.

Recovery housing benefits individuals by reinforcing a substance-free lifestyle and providing direct connections via support groups, participating in house meetings, peer support, job training, and more.

“You must learn many little things, like keeping the house clean and pushing in your chair. At first, I thought that was stupid, and then I started to like taking care of the house, taking care of myself, and being respectful,” said Kimberly Ham, who has been a Hoskins House for Women resident in Houston for the past three months.

However, for many who are searching for help with their addiction, finding a quality recovery home can be a challenging task.

“I’ve been to awful places. I mean roach infestations, people still doing drugs all the time and stealing,” said Taylor. “There are a lot of places like that, but this place is completely different.”

Why is accreditation important?

Studies show that recovery homes with enforced standards are a key step in recovery and preventing relapses. Still, the quality can vary from place to place since the accreditation process is voluntary in Texas.

“Anybody can open up a recovery home, put some beds in it, put utilities on it, market it, and put some bodies in there,” said Fabrizio.

This has led to a problem where tracking what recovery home is open or closed can be challenging.

“Since undergoing accreditation is a voluntary process, HHSC cannot confirm the total number of operating recovery homes in Texas,” said James Rivera, spokesperson for the state health agency.

States cannot simply close down unlicensed houses because doing so would violate the Federal Fair Housing Act and Americans with Disabilities Act.

“Other recovery homes will say they will give you grace but want their money immediately. They want their money, and it’s almost impossible to focus on recovery when stressed about finding a job just to get a bed,” said Stephanie Paris, who had been abusing opioids and heroin since the age of 11.

Paris, 46, decided she was ready for a change after being released from rehab in early 2024. However, she knew the grim options that awaited someone with her financial means.

“It’s virtually impossible, especially in today’s economy, to start from scratch all over again without some kind of support and assistance,” she said. “You are pretty much homeless once you leave a rehab program.”

When Paris thought she had no other options and would have to continue her court mandated probation on her own, she learned about the House of Extra Measures. This accredited recovery housing organization offered services to people with little to no income.

“It was a game changer. It allowed me to make my recovery the most important thing in my life, and that set a routine and foundation for me. All of this can be hard to do when you have to worry about paying rent or end up back on the street,” she said.

What is the solution?

Recovery housing advocates say more money from the state will save taxpayer dollars.

“We are currently spending a bunch of money on people with some pieces of addiction. We’re spending on the justice system. We are spending it on child removals and spending it on human trafficking prevention. It touches every area that we taxpayers pay for,” said Cynthia Humphrey, executive director of the Texas Association of Substance Abuse Programs.

Advocates want $2 million of the $4.3 million requested from the state to be used on implementing and administering accreditation programs.

“Additional funds would allow us to increase staff and our ability to develop more training materials for providers who want to get into operating a recovery home,” Pullin said. “There is not a lack of interest in this purpose. It’s a lack of resources.”

Advocates also propose using some of these funds to create rental assistance programs for accredited providers, easing some of the financial burden created by trying to provide quality service.

“My husband is one of the do-gooders who started a recovery home in the early 2000s, and it lasted about two years after pouring so much money into the home,” Humphrey said. “We need to do something for our providers and those seeking help.”

Danielle Villasana contributed to this story.

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