How to start a home care agency in Mississippi and reach your first client faster
Mississippi has no state license for nonmedical home care, so a private pay agency can open quickly. Medicaid is a different story. The E&D Waiver only accepts agencies that have been in business and providing the service for a year, with a commercial office in place for six months. Home health is closed to new agencies by a Certificate of Need moratorium, and new hospice licenses are frozen. We put all of it in the right order for you.
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- Christine OchimasRN, LMFT, MBA
- All three care typesNonmedical, home health, hospice
- Written to Mississippi rules23 Miss. Admin. Code Part 208, Chapter 1 (E&D Waiver)
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Mississippi requires.
Nonmedical home care for E&D Waiver members
- State license
- None for nonmedical care; Division of Medicaid E&D Waiver provider approval under 23 Miss. Admin. Code Part 208, Rule 1.3
- Who you deal with
- Division of Medicaid, Office of Long Term Care
- Must haves
- One year in business providing the service, Mississippi office open six months, orientation exam score of 85, proposal package, line of credit, qualified supervisor within 60 miles, trained attendants, fingerprint and registry checks, EVV
- Realistic time to first client
- A year or more: one year of operating history comes first
Orientation for Mississippi only. We confirm your exact path on the free call.
Three places new Mississippi agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
Opening the agency and expecting Medicaid next month
The Division of Medicaid only accepts E&D Waiver providers that have been established as a business and providing the service for at least one year, from a Mississippi office that has been in place for six months. Owners who plan their budget around Medicaid revenue in the first year find the door closed until they have that history.
What it costs: A full year of payroll and rent carried by private pay clients and your reserve before the first Medicaid visit.
An office that does not count
Part 208 requires a physical Mississippi office that is not in or on the grounds of a personal residence, with outside signage, posted weekday hours, lockable records storage and a private meeting space. The six month clock only starts once that office is open, so a home office used for the first year does not help.
What it costs: Six more months before you can even apply, on top of the one year rule.
Planning a home health or hospice agency that cannot be licensed
A federal court struck down the 40 year home health Certificate of Need moratorium in January 2026, but the Legislature reenacted it in House Bill 1622, signed March 23, 2026, and MSDH staff recommended disapproving the home health applications it reviewed in May 2026. New hospice licenses have been frozen since 2015, currently until July 1, 2027.
What it costs: Months of planning and consulting fees spent on a license that cannot be issued today.
What does a delay cost your agency?
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Home care vs home health vs hospice in Mississippi
The three sound alike and are regulated differently. The one you choose decides your regulator, staffing, startup capital and timeline.
| Topic | Nonmedical home care | Home health (skilled) | Hospice |
|---|---|---|---|
| What your staff do | Personal care, homemaker help, companionship, in home respite | Skilled nursing under an RN plus therapy, medical social services or home health aide visits, ordered by a physician or other authorized practitioner | Palliative and supportive care for people who are terminally ill, and their families |
| State license | None | MSDH home health agency license (Miss. Code Ann. 41-71-1 et seq.; MSDH Minimum Standards, Chapter 46) | MSDH hospice license (Miss. Code Ann. 41-85-1 et seq.) |
| Certificate of Need | No | Yes, and a moratorium on new agencies (41-7-191(9), reenacted 2026) | No Certificate of Need, but new hospice licenses are frozen under 41-85-7(3) |
| Main payers | Private pay, Medicaid E&D Waiver after Division of Medicaid approval | Medicare, Mississippi Medicaid and MississippiCAN plans, commercial insurance | Medicare hospice benefit, Mississippi Medicaid |
| Medicare | Not covered | Accreditation or state survey, then Medicare enrollment; check the CMS moratorium | Accreditation or state survey, then Medicare enrollment; check the CMS moratorium |
| Key staff | For the E&D Waiver: a supervisor and a director or compliance officer with two years of supervisory experience with elderly or disabled people; trained personal care attendants | Administrator, full time supervising nurse (Mississippi RN), clinical staff, trained home health aides | Administrator, medical director, RN, interdisciplinary group |
| Startup capital | Lowest, but the E&D Waiver needs a line of credit covering three months of operating costs | High: the price of buying an existing licensed agency | High: the price of buying an existing licensed hospice |
| Time to first client | Weeks (private pay); a year or more (E&D Waiver) | Closed to new agencies; depends on finding an agency to buy | Closed to new licenses until at least July 1, 2027 |
In Mississippi the sensible order is private pay first. It builds the year of operating history, the office record and the caregiver team that the E&D Waiver asks for. Home health and hospice are open today mainly by buying an existing licensed agency, which brings MSDH change of ownership steps and, for Medicare, CMS rules on ownership changes. We plan both from day one so your policies and hiring grow with you instead of being rewritten.
Mississippi requirements at a glance
| Nonmedical home care license | None at the state level. MSDH licenses home health agencies and hospices, not nonmedical in home care. |
|---|---|
| Medicaid route | Division of Medicaid Elderly and Disabled (E&D) Waiver: personal care services and in home respite, approved under 23 Miss. Admin. Code Part 208, Rule 1.3 (amended June 1, 2025) |
| E&D Waiver entry rules | One year in business providing the service, a Mississippi office (not in a residence) open six months, orientation exam score of at least 85, proposal package, business line of credit for three months of costs |
| Home health and hospice licensing | MSDH Health Facilities Licensure and Certification, under Miss. Code Ann. 41-71-1 et seq. (home health) and 41-85-1 et seq. (hospice) |
| Certificate of Need | Required for home health (Miss. Code Ann. 41-7-171 et seq.); the moratorium on new agencies in 41-7-191(9) was reenacted by House Bill 1622 in March 2026. Not required for hospice. |
| Hospice licensure moratorium | No new hospice licenses under Miss. Code Ann. 41-85-7(3), set to be repealed July 1, 2027 |
| Caregiver training (E&D Waiver) | Division of Medicaid training on hire with a scored exam, repeated every year, a hands on skills assessment, and current first aid and CPR |
| Background screening | E&D Waiver: fingerprint national check before hire and every two years, monthly Nurse Aide Abuse Registry and OIG exclusion checks. Licensed agencies: MSDH fingerprint check under Miss. Code Ann. 43-11-13 |
| Electronic visit verification | Required for E&D Waiver personal care through the Mississippi Medicaid EVV system |
| Entity filing | Mississippi Secretary of State |
Summary of Mississippi requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Mississippi
The order matters. The E&D Waiver clock (one year of service, six months in a qualifying office) only starts when you open, so form the business, lease the right office and begin private pay care as early as you can.
Form the business with the Mississippi Secretary of State
File your LLC or corporation, get an EIN, register for withholding with the Department of Revenue and for unemployment insurance with MDES, and get your city or county privilege license.
You do this; we give you the checklistDecide your payer mix
Private pay now, and whether to build toward the E&D Waiver. If you want Medicaid, every early choice (office, supervisor, records) should already meet Part 208. Use the path finder above.
Decided on your free consultationLease an office that meets Part 208
A physical Mississippi office outside any residence, with signage readable from the road, weekday 8 to 5 hours, a private meeting space, lockable records storage, a dedicated phone and secure email or fax. It must be in place six months before E&D enrollment.
You do this; we specify what is requiredSet up insurance and write your policies
Arrange workers' compensation, general and professional liability, and auto coverage. Adopt service criteria, emergency procedures, personnel policies, incident reporting and a training plan written to Part 208, Chapter 1, so the same manual serves private pay now and your Medicaid proposal later.
We write this for youBuild the caregiver pipeline
Run fingerprint national background checks before hire, check the Mississippi Nurse Aide Abuse Registry and the OIG exclusion list before hire and every month, train each attendant with a scored exam and a hands on skills check, and keep first aid and CPR current.
We set up the system and trackerServe private pay clients for a full year
Deliver and document personal care and respite under your own name for at least one year. This history is a condition of E&D Waiver enrollment, and it is also what your proposal and line of credit are built on.
You do this; we give you the checklistComplete orientation and submit the E&D proposal
Finish the Division of Medicaid virtual provider orientation and score at least 85 on the orientation quiz, then send the proposal package to the Office of Long Term Care with your organizational chart, itemized expense report, tax return and line of credit.
We prepare the applicationEnroll, sign the agreement and set up EVV
After proposal approval, complete Medicaid provider enrollment and sign the provider agreement within six months. Set up the Mississippi Medicaid EVV system before your first waiver visit, and pass any Division of Medicaid office inspection.
We prepare and manage it
Personal care attendant training and background checks
Mississippi sets no training standard for private pay nonmedical caregivers. If you plan to serve E&D Waiver members, 23 Miss. Admin. Code Part 208, Rule 1.3 sets the standard, so train to it from the first hire. Licensed home health agencies follow MSDH Chapter 46 instead.
- Attendant basics: At least 18, a high school diploma or GED or the ability to read assignments and write required forms, a valid state ID, reliable transportation, and the ability to lift and transfer.
- Training and exam: Division of Medicaid required training on hire covering topics such as the Vulnerable Persons Act, HIPAA, activities of daily living and the E&D Waiver, with a scored exam passed before the attendant provides services. Repeated every year.
- Skills and certifications: A hands on skills assessment by the agency before the first visit, current first aid and CPR, and a yearly health self attestation.
- Supervisors: Two years of supervisory experience with elderly or disabled people, plus a related bachelor's degree, RN or LPN licensure, or a high school diploma with four years of direct experience. One supervisor may oversee no more than 20 full time attendants.
- Fingerprint background checks: A national criminal background check with fingerprints before employment and every two years for every employee and volunteer with face to face contact. Felonies such as drug possession or sale, abuse of a vulnerable adult and listed violent and sex offenses disqualify.
- Registry checks: The Mississippi Nurse Aide Abuse Registry and the OIG exclusion database before employment and every month after.
- Licensed home health agencies: MSDH runs fingerprint checks for direct care staff of licensed home health agencies and hospices under Miss. Code Ann. 43-11-13, at $50 per applicant through the SAFER portal. Aides complete an MSDH approved training program before their first home visit.
Six mistakes that slow Mississippi agencies down
We look for every one of these in the first week of an engagement.
Running the agency from home for the first year
- What it costs
- Part 208 does not accept an office in or on the grounds of a residence, so the six month office clock has not started.
- How we prevent it
- Your first call sets the office requirements so your lease counts toward Medicaid from day one.
Applying to the Division of Medicaid too early
- What it costs
- Without a full year of providing the service, the proposal cannot be approved, and the work has to be redone later.
- How we prevent it
- We time your orientation and proposal to the quarter after your one year mark.
Hiring a supervisor who does not qualify
- What it costs
- A supervisor without two years of supervisory experience with elderly or disabled people fails the E&D Waiver standard.
- How we prevent it
- We check every supervisor and compliance officer against Part 208 before you hire.
Promising care beyond 60 miles
- What it costs
- E&D personal care is limited to counties within 60 driving miles of the office unless a supervisor has a designated worksite nearby.
- How we prevent it
- We map your service area and any designated worksite before you market to new counties.
Letting monthly registry checks and two year fingerprints lapse
- What it costs
- Missing checks in personnel files can lead to a corrective action plan, suspension or termination.
- How we prevent it
- A tracker that flags registry checks, fingerprint renewals, yearly training and CPR dates for every caregiver.
Assuming the 2026 court ruling opened home health
- What it costs
- The Legislature reenacted the moratorium in House Bill 1622, and new home health applications reviewed in May 2026 were recommended for disapproval.
- How we prevent it
- We check the current Certificate of Need status on your first call and plan around what is actually open.
In a free 30 minute call we confirm your Mississippi path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Mississippi launch packages
Three fixed price packages, matched to the path you choose. Your exact price is quoted in writing after your free call, before any work starts.
Private pay launch
For nonmedical agencies serving families who pay privately.
- Mississippi path and a dated launch plan
- Policy and procedure manual written to 23 Miss. Admin. Code Part 208, Chapter 1 (E&D Waiver)
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
E&D Waiver ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to E&D Waiver requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for the Division of Medicaid Office of Long Term Care
- Survey and audit readiness
- Mississippi city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to MSDH rules and the Medicare Conditions of Participation
- License application and inspection readiness
- Accreditation survey preparation
- Medicare and Medicaid enrollment support
Every package: one fixed price agreed in writing · you own 100% of your agency · no franchise fees or royalties.
On your own vs a franchise vs Lunaria
| Topic | On your own | Home care franchise | With Lunaria |
|---|---|---|---|
| Who owns the business | You | You, under the franchisor's brand and rules | You, 100% |
| Ongoing fees | None | Royalties and brand fees, usually a share of revenue | None. One fixed project fee |
| Knowing what Mississippi requires | Pieced together from manuals and forums | A national playbook, adapted | Confirmed on your first call, then in writing |
| Policy manual | A template, often from another state | The franchisor's standard manual | Written to 23 Miss. Admin. Code Part 208, Chapter 1 (E&D Waiver) |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for the Division of Medicaid Office of Long Term Care prepared together |
| Your brand and marketing | Up to you | The franchisor's brand, with territory limits | Your brand, plus local search set up for you |
The Mississippi home care startup checklist
Every Mississippi step in order: business setup, your payer path, policies, caregiver screening and training, Medicaid enrollment and getting found. The items to start first are starred.
- Choose your care type and payer mix (private pay now, E&D Waiver later, or both)
- Form your LLC or corporation with the Mississippi Secretary of State
- Get an EIN, register for withholding with the Department of Revenue and for unemployment insurance with MDES
- Get your city or county business privilege license
- Lease a Mississippi office outside any residence, with road signage and weekday hours
- and 15 more steps
Christine Ochimas, RN, LMFT, MBA
Christine founded Lunaria Care Consulting to give nurses and caregivers a direct route from "I want my own agency" to a compliant business with clients. She reads state requirements the way a reviewer does and writes policies the way a nurse would actually use them.
- We serve owners in all 50 states and DC, with a plan written for Mississippi
- We help through enrollment and survey readiness, not just the application
- We tell you what we cannot promise: no one can guarantee a state or health plan decision
Have these ready for your consultation
- The care you want to provide and the clients you want to serve
- The Mississippi cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, E&D Waiver, Medicare
- Your target opening month and rough budget
No client or patient records. We never need them for a first call.
What it costs to start a home care agency in Mississippi
| Item | Notes |
|---|---|
| State license | None for nonmedical care. Home health and hospice license fees are set by MSDH; Miss. Code Ann. 41-85-7 sets a hospice fee of $1,000 per site. Check current fees with MSDH. |
| Entity formation | The Secretary of State fee schedule lists $50 for an LLC Certificate of Formation or Articles of Incorporation, plus any local privilege license |
| Commercial office | Rent for an office outside any residence, open at least six months before E&D Waiver enrollment |
| Background and registry checks | Fingerprint national checks at hire and every two years. MSDH charges $50 per applicant for licensed agency staff. |
| Training, first aid and CPR | Yearly attendant training and exam, skills assessment and certifications |
| Line of credit | The E&D Waiver requires a business line of credit covering at least three months of operating costs |
| Insurance | Workers' compensation, liability and auto coverage |
| Scheduling and EVV | Scheduling software, and any EVV integration you choose beyond the state's system |
| Operating reserve | Covers payroll and rent through the year of history needed before Medicaid revenue begins |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Mississippi
Weeks, once the business, insurance and hiring process are in place.
A year or more: one year of providing the service and six months in a qualifying office come first, then orientation, proposal review, enrollment and the provider agreement.
New agencies are blocked today by the home health Certificate of Need moratorium and the hospice licensure moratorium. Buying an existing agency depends on the sale, MSDH change of ownership steps and Medicare rules.
Mississippi demand follows its population centers: the Jackson area (Hinds, Madison and Rankin counties), the Gulf Coast, DeSoto County near Memphis, Hattiesburg and Tupelo. Much of the state is rural, including the Delta, where long drives make reliable staffing your selling point. The E&D Waiver's 60 mile service area rule means an agency based in one city cannot simply cover the whole state, so office and supervisor locations shape where you can grow. Families often search by town and county, which makes a complete Google Business Profile and clear county pages matter.
Frequently asked questions
Do you need a license to start a nonmedical home care agency in Mississippi?
No. MSDH licenses home health agencies, which provide skilled nursing, and hospices, but not nonmedical in home care. You still need business registration, tax accounts and insurance, and Division of Medicaid approval to serve E&D Waiver members.
Can a new agency bill Mississippi Medicaid right away?
Not for E&D Waiver personal care. Part 208 requires that the agency has been established and providing the service for at least one year, from a Mississippi office that has been open for six months, before it applies. Orientation, the proposal review and enrollment follow.
Who approves E&D Waiver providers in Mississippi?
The Division of Medicaid's Office of Long Term Care. Agencies complete a virtual provider orientation, score at least 85 on the orientation quiz, submit a proposal package, then enroll and sign a provider agreement within six months of approval.
Can I open a new home health agency in Mississippi now?
Not as a new agency at present. A federal court struck down the home health Certificate of Need moratorium in January 2026, but House Bill 1622, signed March 23, 2026, reenacted it with new legislative findings. Buying an existing licensed agency is the practical route. The law or the courts could change this.
Can I start a new hospice in Mississippi?
Not with a new license today. Miss. Code Ann. 41-85-7(3) bars MSDH from processing new hospice license applications, apart from narrow exceptions, until the provision is repealed on July 1, 2027, unless the Legislature extends it. Hospice does not need a Certificate of Need.
Is the CMS Medicare moratorium still in effect?
CMS began a six month nationwide moratorium on new Medicare enrollment of home health agencies and hospices on May 13, 2026. It runs to about November 13, 2026 and may be extended in six month steps, or may have ended. Check the CMS provider enrollment moratoria page before planning Medicare enrollment.
Do caregivers need certification in Mississippi?
Not a state certificate for private pay work. E&D Waiver attendants complete Division of Medicaid training with a scored exam on hire and every year, pass a hands on skills assessment and keep first aid and CPR current. Home health aides complete an MSDH approved training program.
Is a franchise a better way to start a home care agency in Mississippi?
A franchise gives you a brand and playbook in exchange for fees and ongoing royalties. Starting independently with Lunaria costs one fixed price, and you own 100% of your agency with no franchise fees or royalties.
How much does Mississippi home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay, the E&D Waiver, or buying a home health agency. You receive the price in writing after a free 30 minute consultation. There are no hourly charges.
Do you only work in Mississippi?
No. Lunaria works with owners in all 50 states and DC, so you can expand into a second state with the same team.
Sources checked for this guide (28)
- 23 Miss. Admin. Code R. 208-1.3, E&D Waiver provider enrollment, amended 6/1/2025 (Cornell LII)
- 23 Miss. Admin. Code R. 208-1.6, E&D Waiver covered services, amended 6/1/2025 (Cornell LII)
- 23 Miss. Admin. Code Part 208 chapter list (Cornell LII)
- 23 Miss. Admin. Code R. 208-2.3, Independent Living Waiver providers (Cornell LII)
- Division of Medicaid, HCBS Waiver Providers page (Internet Archive copy of June 13, 2026)
- Division of Medicaid, Training Required for E&D Providers of ADC, PCS and IHR (Internet Archive copy of May 16, 2026)
- MSDH Health Care Facility Regulations and Minimum Standards
- MSDH Minimum Standards of Operation for Home Health Agencies (Chapter 46)
- MSDH Minimum Standards of Operation for Hospices
- MSDH Background Checks (health care employment, $50 per applicant, SAFER portal)
- MSDH Certificates of Need
- MSDH The Certificate of Need Process
- MSDH CON Staff Analyses 2026 (home health applications)
- MSDH Staff Analysis, Simpson General Hospital home health CON, May 4, 2026 (cites Slaughter v. Edney and HB 1622)
- MSDH Staff Analysis, Memorial Hospital at Gulfport home health CON, May 4, 2026
- Mississippi Legislature, House Bill 1622, 2026 Regular Session, as sent to Governor
- Mississippi Legislature, HB 1622 history (approved by Governor 03/23/2026)
- Mississippi Legislature, House Bill 294, 2021 (Miss. Code Ann. 41-85-7 hospice moratorium to July 1, 2027)
- Slaughter v. Edney, No. 3:20-CV-789-CWR-ASH (S.D. Miss. Jan. 28, 2026), order
- CMS Provider Enrollment Moratoria (HHAs and hospices, May 13, 2026; last modified August 27, 2026)
- Federal Register 2026-09717, nationwide moratorium on Medicare enrollment of HHAs
- Federal Register 2026-09718, nationwide moratorium on Medicare enrollment of hospices
- CMS EVV compliance letter to Mississippi, December 29, 2023
- Mississippi Secretary of State business fee schedule
- MDES employer registration
- CMS accreditation and approved accrediting organizations
- 42 CFR Part 484, home health Conditions of Participation (Cornell LII)
- 42 CFR Part 418, hospice care (Cornell LII)
This guide is general information and reflects Mississippi requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Mississippi Division of Medicaid, the Mississippi State Department of Health and CMS before filing. Lunaria Care Consulting provides professional consulting services and does not provide legal advice.
Other states: see all state guides. What we do: licensing, compliance, Medicaid enrollment and local search marketing.