Starting a care business in Mississippi

Child care sits with MSDH's Bureau of Child Care Facilities Licensure, not with the Department of Human Services. MDHS enters only when you want subsidy families through the Child Care Payment Program, and it requires an MSDH license first. A home with no more than five children, counting your own, is a child care family home with a $130 application fee and a $50 license fee. Six or more unrelated children under 13 makes you a child care facility; six to twelve children in the operator's own home is a facility tier with its own rule set, and centers follow rules that took effect February 26, 2026. MSDH tells center applicants not to sign a lease or buy a building until a licensing inspector has visited it.

One child care question is not settled in the official sources. The statute and MSDH's application page start licensing at six unrelated children, yet the family home rules say a family home may not operate without meeting their standards, and the subsidy program accepts only licensed homes. If you plan a small private-pay home, ask the bureau at (601) 364-2827 whether you need a license and keep the answer in writing.

Mississippi has no license called "assisted living facility." It licenses personal care homes in two classes: Residential Living for residents who need help with daily activities, and Personal Care Home - Assisted Living, which adds medication administration and a licensed nurse on the premises eight hours a day. Neither class needs a certificate of need, and only the Assisted Living license qualifies a home for the Medicaid Assisted Living Waiver. MSDH also has rules for an adult foster care facility, but its October 2026 facilities directory lists no adult foster care homes, while small homes of 10 or 12 beds appear as Residential Living. Ask the Health Facilities division which license it would issue before you buy a house. The rules for both kinds of home leave the license fees to the State Board of Health and do not print the amounts.

A new home health agency cannot be licensed today. The license requires a certificate of need, and the Legislature reaffirmed the moratorium on new home health CONs effective April 17, 2026. The remaining way in is to buy an existing agency, which starts with a notice to MSDH's Health Planning office and a $2,500 processing fee; you keep only the counties printed on the seller's license. Medicare is also closed to new agencies under a six-month federal enrollment moratorium that began May 13, 2026, and Mississippi Medicaid pays only agencies certified for Medicare.

Adult day care and non-medical home care, such as personal care attendants and in-home respite, have no MSDH license in the sources checked. The state touches them only if you bill the Medicaid Elderly and Disabled Waiver. To enroll, you pass a mandatory orientation exam with a score of at least 85, show that your business has provided the service for at least a year, and keep an office with a physical address that is not in or on the grounds of a personal residence for six months before enrollment. Adult day centers on the waiver also need at least two people present whenever participants are there, one of them a paid employee, and a licensed nurse on site at least eight hours a week.