Adult Day Care in Mississippi

All states: adult day services map

Mississippi adult day services at a glance

Last verified against state sources: 2026-10-21.

How is adult day care regulated in Mississippi?

Mississippi does not license adult day care centers. Instead, rules come from the money a center takes: the Division of Medicaid sets detailed standards for centers that bill its Elderly and Disabled (E&D) Waiver, and the Mississippi Department of Human Services (MDHS) sets standards for centers paid with Older Americans Act funds. Mississippi uses one service name, adult day care, and has no separate adult day health care category.

Three layers matter, and each comes from a different place:

• Licensing (none). The Mississippi State Department of Health (MSDH) Health Facilities Licensure and Certification division publishes the facility types it licenses, such as hospitals, nursing homes, home health, hospice, personal care homes and assisted living. Adult day care is not on that list. Bills to have MSDH license adult day care died in committee in 2013 (SB 2023) and 2022 (HB 48).
• Medicaid (Division of Medicaid, Office of Long Term Care). The E&D Waiver rules, 23 Miss. Admin. Code Part 208, Chapter 1 (amended June 1, 2025), cover provider enrollment, staffing, space, hours, services, records and billing for centers that serve waiver participants. Adult day care is defined in Rule 1.6 as a community program providing health, social and related support services in a protective setting during daytime and early evening hours.
• Other funding (MDHS Division of Aging and Adult Services). Centers paid through Older Americans Act Title III or an Area Agency on Aging contract follow the adult day care standard in 18 Miss. Admin. Code Part 2, Rule 2.1. The U.S. Department of Veterans Affairs also pays for adult day health care for some veterans.

Where the layers overlap, the Medicaid rules are the stricter layer for staffing, space, hours and records. The MDHS standard is more specific on some participant steps, such as assessment timing and TB screening at enrollment. A center that takes neither Medicaid nor Older Americans Act money falls under neither standard.

Do you need a license to open an adult day center in Mississippi?

No. Mississippi has no state license for adult day care, so you do not apply to a licensing agency. If you want to serve Medicaid participants, though, you must be approved as an E&D Waiver provider, and that approval has entry requirements close to a license: an orientation exam, a year in business, proof of finances and a facility inspection.

Becoming a Medicaid E&D Waiver provider. Under 23 Miss. Admin. Code Part 208, Rule 1.3, a provider must:

• Have an NPI, any license or permit that applies, and IRS and Secretary of State business registration.
• Attend the Division of Medicaid's mandatory orientation and score at least 85 on the orientation exam.
• Submit a proposal package to the Office of Long Term Care for approval.
• Have been an established business providing the service for at least one year, with a business line of credit covering at least three months of operating costs, a filed business tax return and 12 months of income and expense reports.
• Keep a physical Mississippi office, not in or on the grounds of a personal residence, for at least six months before enrolling. The office must meet ADA, zoning, fire, OSHA and health codes, and the business needs a privilege tax license.
• Pass a Division of Medicaid facility inspection, and sign a provider agreement within six months of the proposal approval letter.

The Division of Medicaid also decides which counties each center may serve, based on its location, distance and travel time.

Food permits. A Medicaid center that prepares food on site needs an MSDH kitchen permit. Otherwise it must contract with an MSDH-licensed caterer.

Fees. We did not find an application fee in the Medicaid rules.

Certificate of need. We did not find a certificate of need requirement or a moratorium for adult day care. Since there is no license, none would attach to one.

Each site. The rule text we read does not say whether each additional Medicaid site needs its own proposal. Ask the Office of Long Term Care before you open a second location.

Changes and buying a center. A change of location, supervisory staff or contact information needs Division of Medicaid approval before it is made. Changes in ownership or structure must be reported in writing within 10 business days, and after a change of ownership the provider must submit a new proposal packet within 35 days.

Renewal and inspections. Medicaid inspects the facility before enrollment, but we did not find a renewal or re-inspection cycle. Older Americans Act funded centers must post fire department and MSDH approvals, and the MDHS Office of Monitoring reviews them at least every six months.

What are the staffing rules for adult day centers in Mississippi?

For Medicaid centers, Mississippi requires at least 1 employee for every 6 attendees, or 1 for every 4 in programs serving a high percentage of severely impaired attendees. At least two people, one of them a paid employee, must be at the center at all times. Older Americans Act centers follow a looser 1:10 standard, with 1:6 stated as preferred.

• Licensing: no ratio specified, because there is no license.
• Medicaid (E&D Waiver): 1:6, or 1:4 for a high share of severely impaired attendees (Rule 1.3.C.2). The 1:4 ratio is tied to severe impairment in general, not to dementia.
• Other funding (MDHS, Older Americans Act): 1 staff member per 10 participants, depending on their physical abilities, with 1:6 preferred (Rule 2.1.D.4).

We did not find a separate ratio for participants with dementia in any layer, or staffing that rises with census beyond the ratio. The rules we read do not say whether the administrator or nurse counts toward the ratio.

Required Medicaid positions.

• A full-time administrator with a master's degree and one year of supervisory experience, or a bachelor's degree and three years.
• A full-time on-site program director if the administrator is not on site full time (bachelor's degree and one year, or comparable training).
• A full-time on-site activities coordinator (bachelor's degree and one year, or associate's degree and two years).
• A full-time program assistant with a high school diploma or equivalent and one year of experience with adults.
• A licensed nurse, on staff or contracted, on site at least eight hours a week during business hours and on call as needed, with one year of experience. The nurse's time in and out must be logged.
• A ServSafe-certified food employee if food is prepared on site, and drivers (if transport is not contracted) who are 18 or older with a valid license, subject to random drug testing and an annual Motor Vehicle Report.

Volunteers. Under Medicaid rules, volunteers complete orientation, work under staff supervision and record their hours. They add to required staff but do not replace them.

Training. Medicaid requires orientation at hire, at least four in-service sessions a year, and training at hire and each year on 13 listed topics, including participant rights and confidentiality, CPR and first aid, infection control, fire and disaster plans, choking prevention and abuse reporting. Required staff must hold current first aid and CPR certification. The Medicaid rule sets sessions and topics, not a number of hours. The MDHS standard requires at least eight hours of in-service training a year, plus First Aid, CPR and Heimlich training.

Background checks. Medicaid requires a fingerprint-based national criminal background check for employees and volunteers with face-to-face contact before they start and every two years, plus checks of the Mississippi Nurse Aide Abuse Registry and the federal OIG exclusion list before hire and every month. Listed felony convictions disqualify a person (Rule 1.3.B).

Health screening. Medicaid staff files must hold an annual attestation of health (Rule 1.8). The current rule has no adult day TB test requirement; an earlier 2018 version required an annual physical and TB test. The MDHS standard requires annual physical exams for staff.

MDHS staff qualifications. Older Americans Act centers need a program director with a bachelor's degree in health, social services or a related field plus one year of supervisory experience, a licensed social worker, an RN or BSN nurse with one year of experience with aged or disabled people (or nursing by contract if no RN is on staff), and an activities coordinator with a bachelor's degree and one year of experience.

What does an adult day center in Mississippi have to provide?

A Medicaid adult day center must be open at least nine continuous hours a day on weekdays and provide personal care, supervision, a meal and two snacks, limited health care, round-trip transportation and activities. It also needs at least 60 square feet of program space per attendee. Older Americans Act centers have shorter required hours and no square footage rule.

Required Medicaid services. Under Rule 1.6.A.2:

• Personal care and supervision.
• At least one meal and two snacks a day. Home-delivered meals and other government-funded meals cannot replace them.
• Limited health care, including medications while at the center.
• Round-trip transportation and escort as needed, with no ride longer than 60 minutes per trip.
• Social, health and recreational activities, and information and referral to vocational services.

Hours. Medicaid centers must be open and serving attendees at least nine continuous hours a day, Monday through Friday, 8 am to 5 pm, except state and federal holidays. MDHS centers provide services at least five days a week, four to eight hours a day.

Setting. Medicaid centers must meet federal home and community-based settings standards, including community access, privacy, dignity, choice and freedom from coercion and restraint. They may not be in or next to institutions such as nursing facilities, hospitals or intermediate care facilities.

Space. Under Rule 1.3.C.2.f, a Medicaid center needs:

• At least 60 square feet of temperature-regulated multipurpose program space per attendee.
• At least one toilet per 10 attendees, with at least one ADA compliant toilet within 40 feet of the activity area and fitted with a call button.
• A rest area, a private staff workspace with a separate staff restroom, and locked storage for toxic substances.
• At least two alarmed, ADA compliant exits with doors that swing outward.

MDHS centers must be handicapped accessible, with accessible bathrooms, drinking water from an MSDH-approved source, space to separate ill participants, and at least two exits with outward-opening doors.

Vehicles. Medicaid vehicles must be accessible, carry a phone, fire extinguisher, first aid kit and seat belt cutter, and be inspected by a certified mechanic before use and twice a year. Contracted transport must come from a licensed, ADA compliant provider.

Written policies. Medicaid providers must keep written criteria for providing services (including handling emergency service requests), emergency procedures, policy and procedure manuals, personnel policies on recruiting, hiring, training, retention and termination, job descriptions, a training plan, an organizational chart and employee list, and a written plan of operation approved by the governing board. They must also hold a quarterly advisory committee meeting with agendas, minutes and at least 24 hours public notice, and keep records of quarterly fire and inclement weather drills and an annual fire department safety inspection. MDHS centers need written emergency and evacuation plans with drills, personnel rules on prohibited behavior and grievances, a written evaluation plan and a posted monthly activity calendar.

What rules protect participants in Mississippi adult day centers?

Medicaid centers must keep a medical history or exam from within six months of admission, an individualized service plan reviewed each year, and daily time sheets signed by the participant or representative. Abuse, neglect and exploitation must be reported to the Division of Medicaid within 24 hours. Older Americans Act centers have their own assessment and care plan timelines.

Who can enroll through Medicaid. E&D Waiver participants must be 21 or older, need nursing facility level of care on a long-term services assessment, and qualify financially through SSI or institutional eligibility rules. People living in a nursing facility or personal care home cannot enroll (Rule 1.2).

Medicaid participant record. Under Rule 1.8, each record includes a medical history or exam completed within six months of admission, an annual nutritional assessment, an Individualized Service Plan reviewed each year, and the approved Plan of Services and Supports. That plan is written by a conflict-free case manager and reviewed at least every 12 months, when needs change a lot, or when the participant asks. Changes need the participant's documented consent (Rule 1.13).

Older Americans Act participants. MDHS serves people 60 or older (or a disabled spouse under 60) who score at levels II to III on the Consumer Information Form. A medical report from an exam within six months before admission, including TB screening, is required. An interdisciplinary assessment is done within eight days of starting and no later than 30 calendar days, followed by a plan of care with measurable goals, quarterly progress notes and an annual review of goals. MDHS highly recommends an enrollment agreement, and clients must be entered in the state client tracking system within 10 working days.

Discharge. A Medicaid participant who is an imminent danger to self, caregiver or provider may be discharged right away. When waiver services are reduced or ended, the case management agency sends a Notice of Action by certified mail with appeal rights (Rule 1.11). We did not find other discharge reasons a center may use or a notice period in days.

Attendance records. Medicaid centers keep daily activity or time sheets showing the date, arrival and departure times, and activities, signed by the participant or representative to confirm services. Nurse visits are logged with dates, times and services, signed by the administrator or program director.

Incidents. Medicaid providers must report all abuse, neglect and exploitation, including unauthorized restraint, restrictive interventions and seclusion, to the Division of Medicaid and other agencies required by law within 24 hours of the event or of learning about it (Rule 1.5.C). Unresolved complaints are reported after seven days. We did not find an incident reporting rule in the MDHS standard.

What we did not find. We did not find a record retention period in the adult day rules, required contents for a Medicaid enrollment agreement, or provider discharge notice rules. Families should ask the center for its written policies, and operators should ask the Division of Medicaid what it expects.

How does Medicaid pay for adult day in Mississippi?

Mississippi Medicaid pays for adult day care through the Elderly and Disabled (E&D) Waiver, run by the Division of Medicaid's Office of Long Term Care. Centers bill in 15-minute units for the time a person is at the center, and payment is the lesser of the units billed or a daily cap. We could not confirm the current rate, cap amount or billing code.

The E&D Waiver. The E&D Waiver (waiver 0272.R07.00) is a 1915(c) home and community-based services waiver that also operates under a 1915(b)(4) authority. Its current approval took effect July 1, 2023. It serves adults 65 and older, and people 21 to 64 with physical disabilities, who need nursing facility level of care. Adult day care is a listed service.

• Billing unit: 15 minutes, for time actually served from arrival at the facility to departure. Transport time is not billable.
• Daily cap: payment is the lesser of the daily cap or the units billed (Rule 1.6.A.2.c).
• One line per day: each day is billed as its own line item. Span billing is not allowed.
• Timing: adult day care may be billed no sooner than the first day of the month after the month of service (Rule 1.10).

Transportation. Round-trip transportation is a required part of the Medicaid service, but the time spent in transit is not billable. We did not find whether transportation is paid separately or built into the rate under the current rule. Ask the Division of Medicaid.

Attendance documentation. Claims are supported by paper or equivalent time sheets with start and end times, activities, and the participant's or representative's signature (Rule 1.8). The electronic system named in the rule applies to personal care and in-home respite, not to adult day care, and we did not find an electronic attendance requirement for adult day.

Older Americans Act units. For centers paid through MDHS, one unit is attendance of at least four hours and less than 24 hours, starting at pickup if the center provides transport. Partial days are prorated by hours attended.

Can a private-pay adult day center operate in Mississippi without Medicaid?

Yes. Because Mississippi has no adult day license, a center that serves only private-pay participants needs no adult day license. The Medicaid and MDHS standards apply only to centers that take those funds. Local and general permits may still apply, so check with your city or county before you open.

What still applies. We did not check whether general state food service, fire or building codes require separate permits for a private-pay center. A center that cooks on site should ask MSDH about a food permit, and every center should ask its local fire and zoning offices what they require.

Protections for private-pay participants. We did not find state consumer protections written for private-pay adult day participants, such as required contract terms or fee disclosures. Families should ask for the center's written policies, fees and staffing in writing.

Older Americans Act funding. MDHS and the Area Agencies on Aging fund adult day care for people 60 and older through Older Americans Act Title III contracts. In those centers, clients may contribute toward costs, but no one may be denied service for not contributing, and only licensed health professionals may provide nursing, medical services or medication (18 Miss. Admin. Code Part 2, Rule 2.1). Your local Area Agency on Aging can tell you whether adult day care is funded in your area.

Veterans. The U.S. Department of Veterans Affairs offers Adult Day Health Care to enrolled veterans who meet clinical criteria, at VA medical centers, State Veterans Homes or community organizations. A copay may apply. We did not find which Mississippi centers hold VA contracts.

The market. Since there is no license, there is no state list or count of adult day centers, and we did not find a state association with a website of its own.

What is changing next for adult day in Mississippi?

As of our last check on October 21, 2026, we did not find an upcoming change to Mississippi's adult day rules or Medicaid adult day payment. The most recent change, a rewrite of the E&D Waiver rules, is already in effect. A renewal of the waiver itself is expected before its current approval period ends.

• E&D Waiver rules amended, June 1, 2025. The Division of Medicaid amended Part 208 effective June 1, 2025. The changes raised required adult day hours to nine continuous weekday hours (8 am to 5 pm), set a 60-minute limit on each ride, and rewrote provider enrollment and staffing rules (Rule 1.6).
• Waiver renewal ahead. The current approval period for the E&D Waiver is listed as running through mid-2028, so Mississippi will likely need to renew it before then. No renewal terms have been published, and a renewal could change adult day rules or payment. Watch the Division of Medicaid for public notice.

Mississippi adult day sources

• Mississippi State Department of Health: Health Facilities Licensure and Certification
• Mississippi Legislature: HB 48 (2022) bill history, adult day care licensure
• 23 Miss. Admin. Code Part 208, Rule 1.3: E&D Waiver provider enrollment and requirements
• 23 Miss. Admin. Code Part 208, Rule 1.6: E&D Waiver covered services (Adult Day Care)
• 23 Miss. Admin. Code Part 208, Rule 1.8: E&D Waiver documentation and records
• 23 Miss. Admin. Code Part 208, Rule 1.5: E&D Waiver provider reporting
• 18 Miss. Admin. Code Part 2, Rule 2.1: MDHS Adult Day Care service standards
• Medicaid.gov: Mississippi Elderly and Disabled Waiver (0272)
• U.S. Department of Veterans Affairs: Adult Day Health Care

Related reading

• The Compliance Curve: Why Adult Day Services Should Learn from Home Care Before They Have To
• Effective Transportation Tracking for Elder Day Centers
• Simplifying Payments with Electronic Billing for Adult Day Care
• Podcast: How Adult Day Services Let You Serve 50 Clients with Just 8 Staff
• Adult day services in every state (map)
• Adult Day Care Services and Reference Guide

Other states with no state adult day license

Alabama, Alaska, Colorado, Connecticut, District of Columbia, Idaho, Illinois, Indiana, Kentucky, Maryland, Massachusetts, Michigan, New Jersey, New York, North Dakota, Ohio, Oregon, South Dakota, Vermont, Washington, West Virginia, Wisconsin. See every state on the adult day services map.

Page history

• October 21, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for adult day centers, covering attendance, care plans, transportation and billing. If you would like to talk about running your center, contact Ankota or read more about Ankota's adult day care software.