How to start an assisted living facility in Mississippi

Mississippi requires a Personal care home–assisted living license (personal care home–residential living is a separate license for residents who walk independently); optional Alzheimer's/dementia care unit designation from Mississippi State Department of Health, Health Facilities Licensure and Certification to operate an assisted living facility.

License required

Yes

License

Personal care home–assisted living license (personal care home–residential living is a separate license for residents who walk independently); optional Alzheimer's/dementia care unit designation

Issuing agency

Mississippi State Department of Health, Health Facilities Licensure and Certification

Medicaid waiver coverage

HHS's 2015 compendium reported a Medicaid 1915(c) Assisted Living Waiver covering personal care home–assisted living for people 65+ and adults 21–64 with disabilities; dementia care units were not covered.

Regulation

MSDH Minimum Standards for Personal Care Homes–Assisted Living

Program

Mississippi Medicaid (Mississippi Division of Medicaid, DOM)

Enrollment portal

Medicaid Enterprise System Assistance (MESA) Provider Portal

Fiscal agent

Gainwell Technologies (DOM fiscal agent; sends recredentialing notices and does revalidation site visits)

Application fee

DOM charges institutional provider taxonomies on its list (e.g., home health, hospice, ASCs, ESRD, FQHCs, mental health centers, rehab facilities) $750 for 2026. The fee applies at initial enrollment, reactivation, revalidation or re-enrollment, ownership changes and new practice locations, and is paid by check to the Division of Medicaid (marked with the application tracking number) and mailed to Gainwell. Providers that already paid Medicare or another state are exempt. Federal rule (42 CFR 455.460): the state must collect the CMS application fee from institutional providers that are newly enrolling or re-enrolling; individual physicians and non-physician practitioners are exempt, as are providers already enrolled in (or that already paid the fee to) Medicare or another state's Medicaid/CHIP. CMS set the fee at $750 for calendar year 2026.

Fingerprinting

Revalidating providers may have to submit fingerprints as part of screening. Federal rule (42 CFR 455.434, 455.450(c)): providers the state places in the 'high' categorical risk level, and anyone owning 5% or more of such a provider, must submit fingerprints for a criminal background check.

Site visit

Revalidating providers may need a site visit, done by Medicaid's fiscal agent. Federal rule (42 CFR 455.432, 455.450(b)-(c)): the state must do site visits before and after enrollment for providers in the 'moderate' or 'high' risk levels, and any enrolled provider must allow unannounced on-site inspections.

Revalidation

DOM restarted revalidation on October 1, 2023, mailing notices to providers enrolled five years or more; revalidation is done in the MESA Provider Portal. DOM published a Medicaid Provider Revalidation Roadmap in August 2026. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Mississippi Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need

Agency

Mississippi State Department of Health, Office of Health Policy and Planning (Health Planning & Resource Development)

Services covered

• nursing home care services (skilled nursing and ICF)
• ICF/IID and nursing care for persons with developmental disabilities
• pediatric skilled nursing facilities
• acute psychiatric, chemical dependency and psychiatric residential treatment beds
• obstetrical and neonatal special care services
• comprehensive medical rehabilitation
• ambulatory surgery
• home health agencies / home health services
• end stage renal disease facilities
• general acute care hospitals and beds, swing beds, long-term care hospitals
• MRI, PET, digital angiography, therapeutic radiation, stereotactic radiosurgery, cardiac catheterization, open-heart surgery
• major medical equipment and capital expenditures above indexed thresholds; changes of ownership

Moratoria

Long-standing legislative moratoria (first imposed in 1990) bar new or expanded nursing home beds, ICF and ICF/IID beds, and new home health agencies. Effective April 17, 2026, the Legislature re-enacted and reaffirmed the nursing facility / ICF / ICF-IID moratorium (HB 1622, 2026 Regular Session, §2) and the home health agency moratorium.

Mississippi certificate of need details →

State minimum wage

$7.25 an hour

Effective

2009-07-24

Scheduled increases

No scheduled change found in the official sources reviewed.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Assisted living facilities — active organization NPIs (NPPES)

145 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

584,125 (as of Jun 1, 2026)

All Mississippi Home care Medicaid rates, ranked →

• Assisted Living Waiver (1915(c))
• Elderly and Disabled (E&D) Waiver (1915(c))
• IDD Community Support Program (CSP) (1915(i))
• Intellectual Disabilities and Developmental Disabilities (ID/DD) Waiver (1915(c))
• Independent Living Waiver (1915(c))
• Traumatic Brain Injury and Spinal Cord Injury Waiver (1915(c))

Mississippi waivers and waiting lists →