Mississippi Personal Care Home - Assisted Living license: MSDH rules and steps

Assisted Living or Residential Living: pick the license first

Mississippi does not use “assisted living facility” as a license name. It licenses personal care homes, and it splits them into two classes with separate rule chapters.⁠¹⁠⁴

• Personal Care Home - Residential Living (Chapter 48) is “any place or facility operating 24 hours a day, seven (7) days a week, accepting individuals who require personal care services or individuals, who due to functional impairments, may require mental health services.”⁠¹⁠²
• Personal Care Home - Assisted Living (Chapter 47) is any place or facility open on the same 24/7 basis “accepting individuals who require assisted living services.”⁠¹

The difference is the definition of assisted living. MSDH defines it as personal care plus supplemental services, including medical services such as medication procedures and medication administration, and emergency response services.⁠¹ Personal care means staff helping residents with one or more activities of daily living, such as bathing, walking, toileting, feeding, grooming and dressing.⁠¹

The rules draw a line between two kinds of help with medications. Medication assistance is handing a resident a prescribed oral medication with something to drink. Medication administration means someone other than the resident decides which medication is taken, the dose or the time.⁠¹ If your residents will need someone else to make those decisions, you are in Assisted Living territory. Chapter 47 requires a licensed nurse to be present to give prescription medication to any resident who cannot self-administer it.⁠¹

That nurse rule is the main cost difference between the two licenses. Both chapters set the same resident attendant ratios, but only Chapter 47 adds a licensed nurse on the premises eight hours a day.⁠¹⁠²

Chapter 47 sets no minimum resident count. Its definition depends only on 24/7 operation and the residents’ needs, and the license states the bed capacity you may not exceed.⁠¹ As of November 2020, the State Health Plan counted 197 licensed personal care homes of both types, with 7,628 licensed beds.⁠⁶

Other licenses you might confuse it with

• Adult Foster Care Facility. MSDH has a separate Chapter 83 for adult foster care. It also licenses by stated bed count and sets no numeric ceiling.⁠⁹ See the Mississippi adult foster care facility license guide.
• Alzheimer’s Disease/Dementia Care Unit. This is not a stand-alone license. It is a designation added to a licensed personal care home or nursing home (covered below).⁠³
• Home health agency. If you plan to send nurses or aides into private homes rather than house residents, that is a home health agency license, which requires a certificate of need. See the Mississippi home health agency license guide.

No certificate of need, but MSDH approves the site

The Fiscal Year 2022 State Health Plan states that “personal care facilities presently are not reviewable under Certificate of Need authority.”⁠⁶ The same plan notes that House Bill 1622 (2026 Regular Session) re-enacted the moratorium on skilled nursing facilities. A personal care home avoids that barrier.⁠⁶

The site still needs approval from the Health Department itself. Chapter 47 says “the proposed site for facility must be approved by the licensing agency.”⁠¹ When reviewing a site, MSDH considers:⁠¹

• closeness to medical and hospital services
• approved water supply and sewage disposal
• public transportation and community services
• service by an organized fire department
• available labor supply

Buildings may cover no more than one-third of the site unless MSDH grants special approval. If it does, the building must make up for the lost outdoor space with a living room, day room, sun room and recreation areas.⁠¹ The site cannot be next to disposal plants or railroad tracks, and the facility must be on streets or roads that are passable at all times.⁠¹

Local approvals are part of the state’s file. The site and structure must comply with local building, fire and zoning ordinances, and “proof of compliance shall be submitted to the licensing agency.”⁠¹ Water supply and sewage disposal must be approved by the county health department or the MSDH Division of Sanitary Engineering. No system may be installed or materially changed until the plans are approved and submitted to the licensing agency.⁠¹

No part of the licensed building may be rented, leased or used for any purpose unrelated to running the facility.⁠¹ That rules out sharing a house with a separate business or a tenant.

Plans and construction review

MSDH’s Fire Safety and Construction staff review architectural plans for new construction and renovation of health care facilities and carry out on-site compliance surveys.⁠⁵ Chapter 47 sets this review sequence:⁠¹

1. Preliminary plans

   Submit a plot plan (site size and shape, buildings, adjacent streets and railroads, utilities), a floor plan with every room’s size and purpose, door swings and corridor dimensions, and outline specifications of materials.

2. Working drawings

   Submit architectural, structural, mechanical (plumbing, heating, air conditioning) and electrical drawings, plus detailed specifications. You need written approval of these “prior to the beginning of actual construction.”

3. Architect

   An architect must prepare or directly supervise the drawings, supervise construction, and sign a statement that the work followed the approved plans.

4. Notice and access

   Tell MSDH in writing when construction begins, and give its inspectors access at all times. Any contract change that affects function or design needs approval before the work.

5. Six-month limit

   If construction is delayed more than six months after final plan approval, you need a new evaluation or approval.

Minor alterations that do not affect structure, function, fire safety or bed capacity skip formal plan review. You still need MSDH approval of a detailed written explanation.⁠¹ Applicants for initial licensure pay a Board-set user fee when MSDH must review or inspect additions, renovations, conversions and similar projects.⁠¹

Building and fire safety standards

No facility may be licensed until it shows conformance with MSDH’s fire prevention and life safety rules.⁠¹ Facilities licensed after August 13, 2005 must meet these building standards:⁠¹

• Sprinklers. A supervised automatic sprinkler system throughout, to NFPA 13. A facility licensed for 16 or fewer residents, with occupancy comparable to one- and two-family residential fire risk, may install an NFPA 13D-style system instead.
• Construction. Single-story buildings have no construction-type requirement. Multi-story buildings under four floors need a one-hour fire resistance rating under NFPA 220. Mobile structures may not house residents.
• Elevator. Residents may not live in a building of three or more stories unless it has an elevator. The rules set the minimum cab size, a 2,500-pound capacity and a two-hour shaft enclosure.
• Stairs and basements. Stairs must be enclosed in one-hour construction. No resident may be housed below ground level.

Each bedroom must open directly onto the main corridor. No bedroom may be the route into another bedroom or to a required exit.⁠¹ Beds must be single beds with mattresses at least four inches thick. Cots and roll-aways are not allowed.⁠¹ Grab bars are required at tubs, showers and commodes, and glass shower enclosures are not allowed.⁠¹ Every floor needs fire extinguishers, as do the kitchen, laundry and mechanical room. A battery-operated emergency light is also required.⁠¹

The kitchen rules change at 16 residents. A facility with 16 or more residents needs an MSDH Food Service Permit, and its commercial cooking equipment must meet NFPA 96. A facility with 15 or fewer must meet the MSDH Facility Inspection Report.⁠¹

Licensed facilities that do not meet ANSI accessibility standards may not accept wheelchair users. In a multilevel building, residents who cannot go down stairs unassisted may not be placed above the ground floor.⁠¹

The operator and your staff

Operator

Chapter 47 requires a full-time employee designated as operator, who is responsible for managing the home. The operator must:⁠¹

• be at least 21
• have a high school diploma or GED
• not be a resident of the facility
• have verification of not being listed on the Mississippi Nurses Aide Abuse Registry

When the operator is away, someone on site must represent them and be able to take on the operator’s duties. That person must meet the same age, education and registry requirements.⁠¹

New operators must also complete MSDH’s operator mentoring placement. This means two concurrent days (the rule’s wording) with the licensing agency, in its central offices or with a survey team, finished within the first six months of employment. The facility pays any costs. An operator who does not complete the placement is disqualified until they do. Operators who have done a placement before, or who used to work as MSDH surveyors, are exempt.⁠¹

Ratios and the nurse

Direct care employees must be at least 18 and cleared against the Nurses Aide Abuse Registry. Staff must be on duty, awake and fully dressed.⁠¹ The minimums are:⁠¹

Nursing work must comply with Mississippi Board of Nursing rules.⁠¹ Staff need training every quarter on topics related to the population you serve, documented with a written summary of the content and attendee signatures.⁠¹ You also need an employee dedicated to meal preparation and food service. A non-resident employee must run the activities program, and a non-resident employee appointed by the operator must handle medication storage and keep the medication list current.⁠¹

Background checks and health screening

For every new direct-care employee, you must run a disciplinary check with any professional licensing board and a fingerprint-based criminal history record check.⁠¹ Employees may start direct care temporarily once you have documented that their fingerprints were submitted. If a disqualifying record comes back and no waiver is granted, the job offer is voidable.⁠¹ Disqualifying felony convictions or pleas 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 Your hiring officer may grant waivers based on mitigating circumstances listed in the rule.⁠¹

MSDH may charge up to $50 per fingerprint check.⁠¹ When a check comes back clean, you must give the applicant a notarized suitability letter within two weeks. Any MSDH-licensed employer may accept that letter for two years without running a new check.⁠¹

Before starting work and every year after, each employee needs a health screening by a physician, nurse practitioner, physician assistant or registered nurse.⁠¹ Before any contact with residents, each employee needs a tuberculosis evaluation: either an IGRA blood test or a two-step skin test, plus a symptom assessment. The test may be done up to 30 days before hire.⁠¹

Who you can admit and keep

According to the rule, an appropriate resident is “primarily an aged ambulatory person who requires domiciliary care.” Such a resident may also need medication assistance, emergency response and physician-ordered home health services.⁠¹

Ambulatory means a resident can bear weight, pivot and walk safely, alone or with a cane, walker or wheelchair. A wheelchair user must be able to transfer and propel the chair independently or with prompting. No more than 10% of the resident census may need help during any staffing shift.⁠¹

A person may not be admitted, or may not stay, if they:⁠¹

• need physical restraints
• pose a serious threat to themselves or others
• need nasopharyngeal or tracheotomy suctioning
• need gastric feedings
• need intravenous fluids, medications or feedings
• need an indwelling urinary catheter
• need sterile wound care
• need treatment of decubitus ulcers or exfoliative dermatitis

There is a limited exception that lets some residents age in place. If MSDH determines a resident needs skilled nursing, the resident or their responsible party may consent in writing to stay, with written approval from a physician. No home may keep more than two such residents or 10% of its residents, whichever is greater. You must send copies of the consent and the physician’s approval to MSDH within 30 days.⁠¹

Each applicant needs an examination by a physician, nurse practitioner or physician assistant within 30 days before admission, updated every year. Residents must also be screened to rule out active tuberculosis.⁠¹ Schedule II narcotics are allowed only if they are given or stored under the direct supervision of a licensed physician or nurse. Prescription drugs must be locked up and kept at or below 85°F. The medication list must be updated at least every 30 days.⁠¹

Paperwork MSDH expects to see

Chapter 47 does not list the contents of the application. It says the application must be made in writing on MSDH forms with whatever information the agency requires.⁠¹ The rule does require these documents to exist and be ready for inspection:⁠¹

• Admission agreement. A written financial agreement, signed at or before admission, covering basic charges (room, board, laundry, personal care), the period covered, services with special charges, refunds of advance payments, and your duty to tell the responsible party about changes in the resident’s status.
• Written policies on the services you provide and on admission, transfer and discharge.
• Residents’ rights and house rules in writing, given to residents, staff and sponsors and posted publicly. The rights include freedom to move about in the community and a ban on physical and chemical restraints.
• Resident records, including the medical evaluation, physician orders, medication administration records, social service and activity contacts, and any representative payee statement. If you serve as a resident’s conservator or representative payee, keep a separate bank account for that resident.
• Emergency Operations Plan. A written all-hazards plan covering communications, resources, safety and security, staffing, utilities and clinical activities. The MSDH Office of Emergency Preparedness and Response reviews it.
• Fire evacuation plan, posted, with records of drills held once per shift per quarter.

Meals follow specific rules too. You must serve three meals a day, planned a week ahead and posted. Game and home-canned foods are not allowed. If a physician prescribes a therapeutic diet, a licensed dietitian must plan the meals and visit at least every 30 days.⁠¹

From site to license: the order of steps

1. Settle the classification

   Decide whether you will give medications and need the eight-hour nurse (Assisted Living, Chapter 47) or only give personal care (Residential Living, Chapter 48).⁠¹⁠²

2. Get site approval and local sign-offs

   Get MSDH approval of the site, local zoning, building and fire compliance, and water and sewer approval from the county health department or MSDH Sanitary Engineering.⁠¹

3. Go through plan review

   Submit preliminary plans, then working drawings, and get written approval before construction. Pay the Board-set user fee for plan review.⁠¹

4. Build or convert, and notify MSDH

   Tell MSDH in writing when construction starts and keep the site open to inspectors. Install the required sprinkler system.⁠¹

5. Apply on MSDH forms with the fee

   Send the initial license application with the Board-set, non-refundable fee by check, money order or electronic payment.⁠¹ Neither Chapter 47 nor the MSDH Health Facilities pages reviewed on 2026-10-12 give the dollar amount or an application packet for personal care homes, so ask the Health Facilities Licensure division for the current fee and form before you budget.⁠¹⁠⁴

6. Hire and screen staff

   Complete fingerprint submissions, registry checks, health screenings and TB testing before staff have contact with residents.⁠¹

7. Pass the initial inspection

   “New facilities shall not be licensed without having first been inspected for compliance with these rules.”⁠¹ MSDH may issue a provisional license if it is satisfied you are preparing to qualify for a regular license and residents will not be endangered.⁠¹

8. Post the license and use only the approved name

   The license shows the licensee, classification, building type and bed capacity. It must be posted where people can see it. Only the name MSDH approved may appear in phone listings, stationery and advertising.⁠¹

9. Complete operator mentoring

   Your operator has six months from hire to finish the two-day MSDH placement.⁠¹

MSDH does not publish a processing time for personal care home applications in the sources reviewed.

Fees as published

Chapter 47 does not print dollar amounts. Initial and renewal license fees, the plan review user fee and the renewal late fee are all “in an amount set by the Board” (the State Board of Health), and all fees are non-refundable.⁠¹ The only figure in the rule is the fingerprint charge of up to $50 per check, as published on 2026-10-12.⁠¹ The sources reviewed do not say whether the license fee is charged per facility or per bed; ask MSDH for the current fee schedule.⁠¹⁠⁴

Memory care: the Alzheimer’s unit designation

If you want to market dementia care, Chapter 50 lets a licensed personal care home set up a separate Alzheimer’s Disease/Dementia Care Unit (A/D Unit). Once approved, the designation is printed on the license.⁠³ Its rules apply on top of Chapter 47, and they are much stricter:⁠³

• 3.0 hours of nursing care per resident per 24 hours, with licensed nurses and aides both counting
• a registered nurse or licensed practical nurse on every shift
• at least two staff on the unit at all times
• only staff with the required orientation and quarterly in-service training may work on the unit
• social services provided by a licensed social worker, licensed professional counselor or licensed marriage and family therapist
• a separate multipurpose room of at least 40 square feet per resident, never smaller than 320 square feet
• a secured outdoor walking path at least 4 feet wide
• solid fencing at least 6 feet high
• security controls on all entrances and exits

Residents must have a primary diagnosis of Alzheimer’s disease or dementia. In a personal care home, they must still meet the home’s own admission criteria.⁠³ Because of the nurse-on-every-shift requirement, an A/D Unit is a much bigger staffing commitment than the base license.

Getting paid through the Medicaid Assisted Living Waiver

Mississippi Medicaid pays for assisted living services through its Home and Community-Based Services Assisted Living Waiver. To become a waiver provider, a home must:⁠⁷

• submit a provider enrollment packet
• hold a current Personal Care Home - Assisted Living license
• pass a facility inspection by a Division of Medicaid inspector
• meet the general Medicaid provider enrollment requirements

The rule names the Assisted Living license specifically, so a Residential Living home does not meet this requirement.⁠⁷ Covered waiver services include personal care, homemaker services, attendant care, medication oversight or administration within staff licensure scope, and therapeutic, social and recreational programming. Case management is done by a licensed social worker with at least two years of full-time experience with elderly and disabled people.⁠⁸

Inspections, renewal and enforcement

MSDH conducts routine surveys in all licensed facilities, with follow-up visits to verify corrections of cited deficiencies.⁠⁵ Every license expires on March 31 after it is issued. Renewal requires an approved renewal application, the renewal fee, and continued compliance with the standards.⁠¹

If renewal documents arrive after the expiration date, MSDH charges a late fee. If they are not in within 30 days after expiration, the home is considered unlicensed and MSDH moves to terminate the license.⁠¹ Every renewal application must include written evidence that the MSDH Office of Emergency Preparedness and Response has approved or reviewed your Emergency Operations Plan.⁠¹ Chapter 47 also requires you to give residents influenza information by September 1 each year.⁠¹

You may not exceed your licensed bed count. The license cannot be transferred to anyone else without MSDH’s written approval.⁠¹ You must report fires, explosions and natural disasters, and any resulting deaths or serious injuries, by phone to MSDH’s Life Safety Code Division by the next working day.⁠¹ If MSDH finds immediate jeopardy, it bans all admissions starting five calendar days after you receive the notice, and the ban lasts until compliance is verified.⁠¹ Running a personal care home without a license is a misdemeanor under Miss. Code Ann. § 43-11-25.⁠¹

Sources

1. 1
   Mississippi State Department of Health, Title 15, Part 16, Subpart 1, Chapter 47: Minimum Standards for Personal Care Homes - Assisted Living (effective October 2023) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Mississippi State Department of Health, Title 15, Part 16, Subpart 1, Chapter 48: Minimum Standards for Personal Care Homes - Residential Living (effective October 2023) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Mississippi State Department of Health, Title 15, Part 16, Subpart 1, Chapter 50: Minimum Standards of Operation for Alzheimer's Disease/Dementia Care Unit Checked 12 Oct 2026 · Back to text ↑
4. 4
   Mississippi State Department of Health, Health Facilities Regulations Checked 12 Oct 2026 · Back to text ↑
5. 5
   Mississippi State Department of Health, About the Health Facilities Licensure Division Checked 12 Oct 2026 · Back to text ↑
6. 6
   Mississippi State Department of Health, Fiscal Year 2022 Mississippi State Health Plan Checked 12 Oct 2026 · Back to text ↑
7. 7
   Mississippi Division of Medicaid (text via Cornell Legal Information Institute), 23 Miss. Admin. Code Pt. 208, R. 3.3: HCBS Assisted Living Waiver, Provider Enrollment Checked 12 Oct 2026 · Back to text ↑
8. 8
   Mississippi Division of Medicaid (text via Cornell Legal Information Institute), 23 Miss. Admin. Code Pt. 208, R. 3.6: HCBS Assisted Living Waiver, Covered Services Checked 12 Oct 2026 · Back to text ↑
9. 9
   Mississippi State Department of Health, Title 15, Part 16, Subpart 1, Chapter 83: Minimum Standards for Adult Foster Care Facilities (effective November 10, 2019) Checked 12 Oct 2026 · Back to text ↑

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