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Mississippi - Assisted Living Facility — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Mississippi State Department of Health licenses congregate residential care under the Personal Care Home - Assisted Living (PCH-AL) designation, which the Division of Medicaid reimburses through the 1915(c) Assisted Living Waiver. Prospective providers must secure this PCH-AL license and pass a distinct Division of Medicaid facility inspection before submitting an enrollment application through the MESA portal.

Medicaid reimbursement is restricted to facilities that maintain the specific Assisted Living tier of licensure, as the lower-tier Residential Living license does not permit the retention of non-ambulatory residents or meet the waiver's medical supervision requirements. Approval requires demonstrating compliance with Title 15, Part 16 of the Mississippi Administrative Code for licensure and Title 23, Part 208 for Medicaid waiver enrollment.

1. Service Definition and Scope

In Mississippi, Assisted Living is defined as a Personal Care Home - Assisted Living (PCH-AL) facility operating 24 hours a day, seven days a week, accepting individuals who require assisted living services. These facilities provide personal care and supplemental services, including medication administration and emergency response.

The 1915(c) Assisted Living Waiver covers personal care, homemaker, chore, attendant care, and medication oversight provided in a licensed PCH-AL setting. Room and board costs are explicitly excluded from Medicaid reimbursement and must be covered by the resident.

2. Regulatory and Oversight Agencies

The Mississippi State Department of Health (MSDH) serves as the primary regulatory body for facility licensure, conducting initial and annual surveys. The Division of Health Facilities Licensure and Certification within MSDH processes all PCH-AL applications and architectural plan reviews.

The Mississippi Division of Medicaid (DOM) manages the Assisted Living Waiver and provider enrollment. DOM utilizes the Medicaid Enterprise System Assistance (MESA) portal for all provider applications, claims, and revalidation activities.

3. Gatekeeping Prerequisites: Who Can Even Apply

Mississippi requires prospective Assisted Living Waiver providers to hold an active, unencumbered Personal Care Home - Assisted Living license from MSDH before initiating Medicaid enrollment. There is no Certificate of Need (CON) requirement for PCH-AL facilities in Mississippi, as CONs are reserved for skilled nursing and other specific institutional facilities.

Before DOM accepts a Medicaid enrollment application, the licensed facility must successfully pass a distinct facility inspection conducted by a Division of Medicaid inspector. Facilities operating solely under a Residential Living license are structurally barred from applying for the Assisted Living Waiver.

4. Licensure and Certification Requirements

PCH-AL licensure requires compliance with Title 15, Part 16, Subpart 1 of the Mississippi Administrative Code. Applicants must submit architectural plans for review and approval by MSDH prior to any construction or renovation, and water/sewerage systems must be approved by the local county health department.

Facilities must maintain an approved Emergency Operations Plan (EOP) reviewed annually by the Office of Emergency Preparedness and Response. Initial and renewal licensure applications require a fee set by the Board of Health, and licenses must be renewed annually.

5. Medicaid Provider Enrollment

Providers submit their enrollment application through the MESA Portal for Providers using the appropriate taxonomy code for Assisted Living. The application must include a copy of the active PCH-AL license and proof of the successful DOM facility inspection.

All additional documentation, including the Additional Enrollment Requirements Checklist, must be uploaded in the Attachments section of the MESA portal. Providers can track their enrollment status using their Application Tracking Number (ATN).

6. Staffing, Training and Background Checks

PCH-AL facilities must designate a full-time operator to manage the facility and maintain specific direct care staffing ratios based on the time of day. Additionally, PCH-AL facilities must have a licensed nurse on the premises for eight hours a day to oversee medical services and medication administration.

All staff must undergo criminal background checks, as regulations list several crimes that preclude employment. Staff assigned to Alzheimer's-dementia units require specific orientation and quarterly in-service training on at least three of eight mandated topics.

7. Documentation, Policies and Records

Facilities must maintain comprehensive resident records, including annual re-examinations by a physician, nurse practitioner, or physician assistant. Medication administration records must be strictly maintained, as only licensed personnel are permitted to administer medication.

Operational policies must include written on-call personnel schedules for emergency shifts. Facilities must also strictly adhere to the official name approved by the licensing agency in all advertising and telephone listings.

8. Billing, Rates and Claims

Claims for the Assisted Living Waiver are submitted electronically through the MESA portal using standard HCBS procedure codes. Reimbursement rates are established by the Division of Medicaid and published in the DOM Fee Schedule and Rates document.

Medicaid reimbursement covers only the waiver services; room and board must be billed separately to the resident. Providers must verify beneficiary eligibility and waiver enrollment status via MESA prior to rendering services.

9. Approval Sequence and Timeline

The approval process begins with submitting architectural plans to MSDH, followed by construction and local health department sanitation approval. Once the physical plant is approved, MSDH conducts an initial licensure survey to issue the PCH-AL license.

After licensure, the provider requests a DOM facility inspection. Upon passing the DOM inspection, the provider submits the Medicaid enrollment application via MESA, which is processed by Gainwell Technologies.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied if architectural plans are not approved prior to construction or if construction is delayed beyond the six-month approval limit. Medicaid enrollment will be rejected if the provider fails the DOM facility inspection or uploads an incorrect licensure tier.

Common survey deficiencies include failure to maintain the required daytime or nighttime staffing ratios, lack of a licensed nurse on premises for the required eight hours, and expired Emergency Operations Plan approvals.

11. Key Contacts and Resources

The Mississippi State Department of Health and the Division of Medicaid provide essential resources for prospective Assisted Living providers. Providers should utilize the MESA portal for all Medicaid-related transactions and inquiries.

Gainwell Technologies serves as the fiscal agent for DOM and handles provider enrollment questions. The Office of Appeals manages any disputes regarding Medicaid enrollment or claims.

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