Self-Direction and FMS in Mississippi
All states: self-direction map
In short: Self-direction is limited to personal care attendants on two waivers run by the Department of Rehabilitation Services, which also processes attendant payroll.
Mississippi self-direction at a glance
| Self-directed programs | Attendant care on the Independent Living (IL) Waiver and the Traumatic Brain Injury/Spinal Cord Injury (TBI/SCI) Waiver |
|---|---|
| FMS model | State-run. The Department of Rehabilitation Services (MDRS) certifies attendants, approves hours and processes payroll. |
| FMS vendors | No outside FMS vendor found |
| Who is the employer | Not confirmed. The participant chooses the attendant, but we did not find who the legal employer of record is today. |
| Can family be paid | Yes, with limits. Not a spouse or the parent or step-parent of a minor child. On the IL Waiver, not a relative who lives in the home. |
| EVV for self-directed workers | Yes. Attendant services on both waivers are EVV services. How MDRS attendants record visits is not published. |
| Budget authority | Not confirmed for either waiver |
Last verified against state sources: 2026-10-13.
Which Medicaid programs in Mississippi offer self-direction?
Mississippi offers self-direction in a narrow form on two Medicaid waivers: the Independent Living (IL) Waiver and the Traumatic Brain Injury/Spinal Cord Injury (TBI/SCI) Waiver. On both, the person receiving care chooses the personal care attendant. Both waivers are operated by the Mississippi Department of Rehabilitation Services (MDRS). We did not find a self-directed option on the Elderly and Disabled Waiver or the ID/DD Waiver.
Important: This page is shorter than most because key documents could not be read. The Division of Medicaid website could not be reached during our check, so the approved waiver applications were not opened. The Administrative Code rules cited here were read on Cornell Law School's republication of the code, not on the state's own site. Confirm details with MDRS before relying on them.
- Independent Living (IL) Waiver, Personal Care Attendant services: a 1915(c) waiver that serves people age 16 or older with severe orthopedic or neurological impairments who need a nursing facility level of care. The Division of Medicaid administers it, and the MDRS Office of Special Disability Programs operates it under an interagency agreement. The participant or a representative chooses the attendant. Budget authority is not confirmed.
- Traumatic Brain Injury/Spinal Cord Injury (TBI/SCI) Waiver, Attendant Care services: a 1915(c) waiver that serves people who have had a traumatic brain injury or spinal cord injury and need a nursing facility level of care. The Division of Medicaid administers it, and the MDRS Office of Special Disability Programs operates it. The participant chooses the attendant. Budget authority is not confirmed.
MDRS describes attendant care on both waivers as provided by an individual of the participant's choosing on its waiver programs page. Choosing the worker is the core of employer authority. Budget authority means the participant also manages a set amount of money for the service, and the sources we could open do not settle whether that exists in practice on either waiver.
For the other two waivers, the Administrative Code rule for Elderly and Disabled Waiver services (amended through June 1, 2025) describes personal care by trained attendants and has no participant-directed model. The rule for ID/DD Waiver services describes no participant-directed service either. It does let an approved family member work for a provider agency in Home and Community Supports, which is agency employment and not self-direction.
Who handles financial management services (FMS) in Mississippi?
We did not find an outside FMS vendor in Mississippi. From the sources we could open, MDRS itself does the work an FMS organization does in other states. MDRS staff certify the attendant, approve the hours and process attendant payroll. Participants do not pick among FMS vendors, because none was found to pick from.
Financial management services (FMS) is the name for the payroll and paperwork side of self-direction: enrolling the worker, checking time, paying wages and handling taxes. Here is what the sources show about how that works in Mississippi.
- Hiring steps: MDRS procedure rules say a prospective attendant must pass a Mississippi Bureau of Investigation background check and complete an employment application before the first date of service. MDRS case managers (IL Waiver) or counselors and registered nurses (TBI/SCI Waiver) certify that the attendant can do the job.
- Time and pay: the attendant turns in timesheets on set payroll dates. An MDRS counselor checks them against the assigned tasks and approved hours, and the procedure rule says the attendant is paid only for hours MDRS approved.
- Payroll: a 2025 MDRS job posting for the Office of Special Disability Programs lists fingerprinting prospective attendants and compiling, verifying and processing attendant payroll as staff duties.
- Legal employer: we did not find a current statement of who the legal employer of record is for attendants on either waiver. Ask MDRS at 1-800-443-1000.
There is one more piece that readers who know FMS should be aware of. The Administrative Code rule for the IL Waiver (Title 23, Part 208, Rule 2.6, last amended September 1, 2019) describes a Financial Management Service for Participant-Directed Personal Care. Under that rule the participant is the employer of record, handles budget and employer tasks and can negotiate attendant pay. An FMS provider acts as the employer's agent with the IRS, runs payroll and tax withholding, and reports spending each quarter. The rule says an FMS provider must hold a Medicaid provider agreement, have at least five years of billing and payroll experience, and receive participants by referral from MDRS.
We could not confirm that this service operates today, and we did not find any provider enrolled in that role. We did not find an FMS provision in the TBI/SCI Waiver rules we opened. If you are an FMS organization or a family trying to learn whether the Rule 2.6 option is available, ask the MDRS Office of Special Disability Programs or the Division of Medicaid.
Who can be a paid caregiver under self-direction in Mississippi?
Relatives can be paid attendants on both waivers, but only with limits and a documented reason. A spouse cannot be paid, and neither can the parent or step-parent of a minor child. On the IL Waiver, a relative who lives in the participant's home is also excluded.
- Independent Living Waiver: Rule 2.3 (last amended September 1, 2019) allows a family member to be a paid attendant only if that person is not legally responsible for the participant. It excludes a spouse, the parent or step-parent of a minor child, and a relative living in the participant's home. It also requires adequate justification, such as a remote area with no other qualified attendant.
- TBI/SCI Waiver: Rule 4.5 (last amended January 1, 2017) allows a family member to provide attendant care if that person is not legally responsible for the participant (not a spouse, and not the parent or step-parent of a minor child), meets provider standards, is certified competent and has documented justification.
- MDRS procedure: the MDRS procedure rules repeat that payment is not made for services from a person who is legally responsible for the individual, and that spouses and parents of minor children cannot be paid attendants.
Two cautions apply. The rule text we read may not be the latest version, and we could not confirm whether the IL Waiver's limit on relatives who live in the home is still in force after the waiver's 2023 renewal. We also did not find a published cap on weekly hours for attendants. For a specific family situation, ask the participant's MDRS case manager or counselor, or call MDRS at 1-800-443-1000.
Does EVV apply to self-directed workers in Mississippi?
Yes. Attendant services on both waivers are on Mississippi's list of services that require electronic visit verification (EVV). The state's EVV system is run through HHAeXchange. What we did not find is how attendants working through MDRS record their visits.
- Services covered: a Division of Medicaid rule effective December 1, 2025 (Rule 1.14) lists IL Waiver Personal Care Attendant services, and TBI/SCI Waiver Personal Care Attendant, In Home Companion Respite and In Home Nursing Respite, as EVV services.
- Self-directed services included: the Division of Medicaid's EVV page for personal care providers says the EVV scope for these waivers covers both agency and participant-directed services. We read that page in an archived copy.
- Claims: Rule 1.14 requires claims for EVV services to reach the state's fiscal agent through the state EVV system unless the Division of Medicaid authorizes otherwise in writing.
Three points could not be confirmed. We did not find which EVV tool MDRS attendants use or who sets it up for them. We did not find a published EVV exemption for live-in caregivers. And we did not find a statement on whether an attendant's own paycheck is held when a visit is not verified. The claims rule above is about Medicaid claims, not about a worker's pay. For any of these, ask MDRS at 1-800-443-1000.
What is changing next for self-direction in Mississippi?
We did not find an upcoming change to self-direction in Mississippi as of our last check on October 13, 2026. No new program, FMS procurement or change to the paid family rules was found in the sources we could open. Because the Division of Medicaid website could not be reached, a change posted only there could have been missed.
One EVV item is worth checking. HHAeXchange's Mississippi information page says its HHAeXchange+ mobile app would become required to complete EVV in late summer 2026. That timing has passed, the page still words it as a future event, and we did not find a state source confirming that it took effect. Treat it as unconfirmed and ask the Division of Medicaid or HHAeXchange for the current rule.
The larger open question is not a scheduled change but an unsettled fact: whether the Financial Management Service described in the IL Waiver rule is in use. The currently approved waiver applications should answer that, and we were not able to open them.
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Who to ask about self-direction in Mississippi
Questions about self-direction in Mississippi are best put to the state. Start with Mississippi Department of Rehabilitation Services, Home and Community Based Waiver Programs. Published contact: 1-800-443-1000 (MDRS).
Mississippi self-direction sources
- Mississippi Department of Rehabilitation Services: Home and Community Based Waiver Programs
- Mississippi Administrative Code Title 23, Part 208, Rule 2.3: IL Waiver covered services (Cornell LII republication)
- Mississippi Administrative Code Title 23, Part 208, Rule 2.6: IL Waiver Financial Management Service (Cornell LII republication)
- Mississippi Administrative Code Title 23, Part 208, Rule 4.5: TBI/SCI Waiver covered services (Cornell LII republication)
- Mississippi Administrative Code Title 32, Part 1, Rule 1.15.6: MDRS attendant timesheets and pay (Cornell LII republication)
- Mississippi Secretary of State: Division of Medicaid Rule 1.14, EVV (effective December 1, 2025)
- Mississippi Division of Medicaid: EVV for personal care service providers (archived copy)
- MDRS Office of Special Disability Programs job posting, Rehabilitation Associate I (2025)
- HHAeXchange: Mississippi information hub
Related reading
- Self-Directed Medicaid Home Care Services in 2026
- Understanding Self-Direction and FMS
- Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
- 5 Big Challenges in Self-Directed Care And How FMS Providers Can Solve Them
- Self-direction in every state (map)
- Mississippi EVV requirements
Other states with state-run payroll and no FMS vendor
Nebraska. See every state on the self-direction map.
Page history
- October 13, 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 FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.
