Mississippi adult foster care facility license: rules on the books, no homes listed

Two licenses for the same kind of home

Mississippi has two MSDH licenses for a home where unrelated adults live and get help with bathing, dressing and other daily activities. Most founders end up holding the second one.

• Adult Foster Care Facility. S.B. 2416 added adult foster care facilities to the state’s definition of “institutions for the aged or infirm” and told the State Board of Health to write rules for them, effective July 1, 2007 ⁠². The rules in force are Chapter 83, effective November 10, 2019 ⁠¹.
• Personal Care Home - Residential Living. This license is governed by Chapter 48, effective October 2023. It covers any place operating 24 hours a day, seven days a week that accepts people who need personal care or who may need mental health services because of functional impairments ⁠⁶.

The MSDH Health Facilities Directory dated October 12, 2026 has no adult foster care section. Its personal care home section totals 195 homes: 125 assisted living, 31 Alzheimer’s/dementia units and 70 Residential Living facilities ⁠⁷. The personal care home list includes small homes, such as MyKale Residential Living in New Albany at 10 beds and Westhaven Residential Facility in Jackson at 12 ⁠⁷. No published source says whether MSDH has ever issued an adult foster care license. The sources do not say whether MSDH currently issues Adult Foster Care Facility licenses or places small homes under Residential Living. Ask the division at (601) 364-1100 which license it would issue for your home, in writing if possible, before you spend money on a building ⁠⁸.

If your residents need help with medications or more hands-on care than personal care, look instead at the Mississippi personal care home - assisted living license. If you plan to send nurses or aides into clients’ own homes, that is a home health agency license, which requires a certificate of need.

What counts as adult foster care in Mississippi

The statute and Rule 83.5.1 define an adult foster care facility as a home setting for vulnerable adults who cannot live independently because of physical, emotional, developmental or mental impairments. It also covers adults who need emergency and continuing protective services to prevent further abuse or neglect ⁠¹⁠². Care is delivered through individual plans of care “in a protective setting, enabling participants to live in the community” ⁠¹.

Each license is issued in one of three classes ⁠¹:

The shelter class is the only place where the rule gives MSDH open waiver authority ⁠¹. A shelter-model applicant should get any waivers in writing before relying on them.

The size threshold

Section 43-11-1(a) defines an institution for the aged or infirm, which includes adult foster care facilities, as a place providing “group living arrangements for four (4) or more persons who are unrelated to the operator.” The 2024 bill reprinted this text unchanged ⁠³. Chapter 83 itself sets no minimum or maximum bed count. The license states the bed capacity, and you may not exceed it ⁠¹. Neither the statute nor Chapter 83 says how the four-person threshold applies to a traditional home with fewer than four residents, so ask MSDH whether a home that small needs a license at all.

Bills to extend licensure to homes serving one or more unrelated persons have failed twice. S.B. 2328 died in the 2024 session ⁠³⁠⁴, and S.B. 2564 died in the Senate Public Health and Welfare Committee on February 3, 2026 ⁠⁵. As of October 12, 2026 the four-or-more definition stands.

Who can run the home

Rule 83.11.1 requires a full-time employee designated as operator ⁠¹. The operator must:

• be at least 21;
• be a high school graduate or have passed the GED;
• not be one of the home’s residents; and
• have verification that they are not listed on the Mississippi Nurses Aide Abuse Registry ⁠¹.

When the operator is away, someone with the same qualifications (21 or older, diploma or GED, registry-cleared) must be on site to act for them ⁠¹.

The Residential Living rules add a step that Chapter 83 does not have. A new Residential Living operator must spend two concurrent days in a mentoring placement with MSDH, completed during their first six months of employment, at the facility’s expense ⁠⁶. Chapter 83 contains no mentoring requirement ⁠¹.

Staffing, background checks and health screening

Ratios. Staff must be “employed and on duty, awake, and fully dressed” ⁠¹:

• 1 resident attendant per 15 or fewer residents from 7:00 a.m. to 7:00 p.m.
• 1 per 25 or fewer from 7:00 p.m. to 7:00 a.m.

These are the same ratios used for Residential Living ⁠⁶. In a traditional home, this means someone must be awake overnight, even with a single resident.

Other positions the rule names. Several duties must be assigned to staff:

• An employee dedicated to meal preparation and food service ⁠¹.
• A non-resident employee appointed by the operator to store prescription medications and keep the medication list current at least every 30 days ⁠¹.
• A non-resident employee in charge of the daily activities program ⁠¹.
• Direct-care employees must be at least 18, registry-cleared, and trained every quarter on topics related to the population you serve. Document each training with a narrative of the content and attendees’ signatures ⁠¹.

Fingerprinting. Every direct-care employee needs a fingerprint-based criminal history check and a disciplinary check with any professional licensing board ⁠¹. A new hire may work temporarily once you have proof that fingerprints were submitted. The employment becomes voidable if a disqualifying record comes back ⁠¹. Disqualifying felonies include drug possession or sale, murder, manslaughter, armed robbery, rape, sexual battery, listed sex offenses, child abuse, arson, grand larceny, burglary, gratification of lust, aggravated assault, and felonious abuse or battery of a vulnerable adult ⁠¹.

MSDH may charge up to $50 per fingerprint submission, as published on 2026-10-12 ⁠¹. Within two weeks of a clean result, you must give the employee a notarized letter of suitability. Any MSDH-licensed entity can rely on that letter for two years ⁠¹.

Health and TB. Every staff member needs a health screening by a physician, nurse practitioner, physician assistant or registered nurse before employment and every year after ⁠¹. TB screening must be done before any resident contact, by either:

• an IGRA blood test, or
• a two-step Mantoux skin test.

Either test is paired with a symptom evaluation and documented in the personnel file within 7 days of hire ⁠¹.

The building: site, sprinklers and room sizes

Rule 83.1.3 says no facility may be licensed until it shows it conforms to MSDH’s fire safety standards ⁠¹. The building rules are written for a facility, not a family house, so check each one before you sign a lease or buy a property.

Site and local approvals.

• MSDH must approve the site. It weighs nearness to medical services, approved water and sewage, public transportation, community services, an organized fire department and labor supply ⁠¹.
• Buildings may cover no more than one-third of the lot without special approval ⁠¹.
• You must submit proof that the site and structure comply with local building, fire and zoning ordinances ⁠¹.
• Water supply and sewage disposal must be approved by the county health department and/or MSDH’s Division of Sanitary Engineering ⁠¹.
• No part of the property may be rented or used for anything unrelated to the facility ⁠¹.

Fire protection.

• Facilities licensed after August 13, 2005 need a supervised automatic sprinkler system under NFPA 13. A home licensed for 16 or fewer residents, with fire risks comparable to a one- or two-family dwelling, may install an NFPA 13D-style system instead ⁠¹.
• Mobile structures may not house residents ⁠¹.
• Multi-story buildings under four floors need one-hour fire-resistive construction. No resident may live in a building of three or more stories without an elevator ⁠¹.
• Smoke detectors go in every bedroom, every storage room and every hallway, no more than 30 feet apart ⁠¹.
• Each occupied story needs at least two remotely located exits ⁠¹.
• Stairs must be enclosed in one-hour construction, with handrails on both sides and a width of at least 44 inches ⁠¹.

Other room rules ⁠¹:

• Beds must be single beds with mattresses at least 4 inches thick. Cots and roll-aways are not allowed.
• No bedroom may be the only route to another bedroom or to an exit.
• No resident may sleep below ground level.

Construction and remodeling. New construction and major alterations follow a two-stage plan review: preliminary plans, then architect-prepared working drawings ⁠¹. MSDH must approve the plans in writing before work begins. Approval lapses if construction is delayed more than six months ⁠¹. Minor alterations that do not affect structure, fire safety or bed count need only a written explanation that MSDH approves ⁠¹. MSDH charges a Board-set, non-refundable user fee for plan review ⁠¹.

Policies and paperwork MSDH expects

Chapter 83 requires these written documents and records ⁠¹:

• Policies covering the services you provide, admission, transfer and discharge, and how qualified staff develop and revise care plans.
• A grievance policy and a residents’ rights statement. The rights statement must be posted and must ban physical and chemical restraints, confining residents against their will, and restricting a resident’s choice of pharmacy.
• An admission agreement, signed at or before admission. It must list basic charges for room, board, laundry and personal care, the period covered, extra-charge services, the refund policy for advance payments, and how you will notify the responsible party of changes. Any resident funds you hold go into a Resident’s Personal Deposit Fund. No more than one month’s charges may be drawn from it at a time.
• An Emergency Operations Plan using the “All Hazards” approach. It must address communications, resources, safety and security, staffing, utilities and clinical activities, and is reviewed by MSDH’s Office of Emergency Preparedness and Response. Written evidence of that office’s review must accompany every renewal application.
• Fire drill records, with one drill per shift per quarter, and a posted evacuation plan.

You must also report fires, explosions and natural disasters that cause avoidable deaths or serious injuries by telephone to MSDH’s Life Safety Code Division by the next working day ⁠¹.

Who you can admit

Rule 83.12.1 bars a person from being admitted, or from staying, if they ⁠¹:

• are not ambulatory;
• need physical restraints;
• pose a serious threat to themselves or others;
• need nasopharyngeal or tracheotomy suctioning, gastric feedings, IV fluids or medications, or an indwelling urinary catheter; or
• need sterile wound care or treatment of a decubitus ulcer or exfoliative dermatitis.

A resident who uses a wheelchair counts as ambulatory only if they can transfer and propel it on their own or with prompting ⁠¹. A home that does not meet ANSI accessibility standards may not accept wheelchair users. In a multi-level home, no one who cannot get down the stairs unassisted may live above the ground floor ⁠¹.

Before admission, each resident needs ⁠¹:

• a physician, nurse practitioner or physician assistant exam within 30 days, updated every year; and
• a TB symptom assessment and a chest x-ray with a written interpretation, both within the same 30 days.

You must write the resident’s plan of care at admission or within 24 hours ⁠¹.

Medications. Schedule I drugs are prohibited. The only injectables allowed are insulin and vitamin B-12, and only if residents give them to themselves or a licensed nurse does ⁠¹. Prescription medications must be kept locked, at no more than 85°F, with key responsibility assigned in writing ⁠¹.

Food. Serve three meals a day, planned a week ahead, with no more than 15 hours between the evening and morning meals ⁠¹. Game and home-canned foods are banned ⁠¹. If a physician prescribes a therapeutic diet, a licensed dietitian must plan it and visit at least every 30 days ⁠¹. A home with 16 or more residents needs an MSDH Food Service Permit. A home with 15 or fewer is held to MSDH’s Facility Inspection Report standards ⁠¹.

Applying, fees and renewal

1. Call the division first

   Health Facilities Licensure and Certification is at 143B Lefleur’s Square, Jackson, MS 39211, (601) 364-1100 ⁠⁸. The MSDH regulations page posts the Chapter 83 standards but no adult foster care application form ⁠⁹. The rule says applications are made in writing “on forms provided by the licensing agency” ⁠¹. Ask the division whether an adult foster care application form exists and how to get it.

2. Get the site approved and clear local codes

   This step needs MSDH site approval, proof of local zoning, building and fire compliance, and water and sewage approval ⁠¹.

3. Submit plans if you are building or altering the home

   Follow the two-stage plan review and pay the Board-set user fee ⁠¹.

4. Apply and pay the license fee

   The rule sets the fee per bed of licensed capacity, with a per-home minimum, both “in an amount set by the Board.” Fees are non-refundable and payable by business check, money order or electronic means ⁠¹. The 2007 statute set the fee at $10 per bed with a $50 minimum, for both initial and renewal licenses ⁠². The Board-set amounts were not published in the sources checked on 2026-10-12, so ask the division for the current per-bed and minimum fees before you budget.

5. Pass the licensure inspection

   New facilities cannot be licensed until MSDH inspects them against Chapter 83 ⁠¹. If you are close but not finished, MSDH may issue a provisional license. It will do so only if it is satisfied you are preparing to qualify and residents will not be endangered ⁠¹.

6. Post the license

   The license states the facility name, location, licensee, class, building type, bed capacity and license number. Post it conspicuously ⁠¹. Use only the approved facility name in phone listings, stationery and advertising ⁠¹.

Every license expires on March 31 following its issue date, so a license issued in the fall runs only a few months before the first renewal ⁠¹. Renewal requires an approved application, the renewal fee and the Emergency Operations Plan review evidence ⁠¹. A license cannot be transferred to a new owner without MSDH’s written approval ⁠¹. The Residential Living rules add a Board-set late fee and treat a home as unlicensed if its renewal paperwork is more than 30 days late ⁠⁶. Chapter 83 has no equivalent provision ⁠¹.

No certificate of need requirement appears in the 2007 adult foster care law or in Chapter 83 ⁠¹⁠².

Enforcement

• Inspections. MSDH inspects licensed facilities at whatever intervals it directs and may inspect construction in progress ⁠¹.
• Ban on admissions. If MSDH finds immediate jeopardy, a ban on all admissions takes effect five calendar days after you receive notice. It stays in place until MSDH verifies your correction ⁠¹.
• Denial or revocation. You have 10 days from notice to request a hearing. A final decision can be appealed to chancery court within 30 days under Section 43-11-23 ⁠¹. Section 41-3-15 also lets MSDH revoke a license immediately and close an institution for the aged or infirm ⁠¹.
• Operating without a license. This is a misdemeanor punishable under Section 43-11-25 ⁠¹.

Medicaid

The 2007 law that created the license also authorized the Division of Medicaid to run an adult foster care services pilot ⁠². The pilot would provide social and protective services in an approved foster care facility for adults who would otherwise need long-term care. It was to run under the Elderly and Disabled waiver or an assisted living waiver, in the area of the state with the greatest need ⁠². The sources checked on 2026-10-12 do not show that the pilot was implemented or that any waiver pays for adult foster care. Ask the Division of Medicaid whether any waiver covers adult foster care, and until it confirms one, plan the business on private pay.

Sources

1. 1
   Mississippi State Department of Health, Title 15, Part 16, Subpart 1, Chapter 83: Minimum Standards for Adult Foster Care Facilities (effective Nov. 10, 2019) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Mississippi Legislature, S.B. 2416 (2007 Regular Session), Conference Report: adult foster care facilities; define for licensure purposes and authorize Medicaid pilot program Checked 12 Oct 2026 · Back to text ↑
3. 3
   Mississippi Legislature, S.B. 2328 (2024 Regular Session), as introduced: amending Section 43-11-1 Checked 12 Oct 2026 · Back to text ↑
4. 4
   Mississippi Legislature, S.B. 2328 (2024) bill history Checked 12 Oct 2026 · Back to text ↑
5. 5
   Mississippi Legislature, S.B. 2564 (2026) bill history Checked 12 Oct 2026 · Back to text ↑
6. 6
   Mississippi State Department of Health, Title 15, Part 16, Subpart 1, Chapter 48: Minimum Standards for Personal Care Homes - Residential Living (effective Oct. 2023) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Mississippi State Department of Health, Health Facilities Directory (October 12, 2026) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Mississippi State Department of Health, About the Health Facilities Licensure Division Checked 12 Oct 2026 · Back to text ↑
9. 9
   Mississippi State Department of Health, Health Facilities Regulations and Minimum Standards Checked 12 Oct 2026 · Back to text ↑

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