How to Start a Home Health Agency in Mississippi: MSDH Licensure and Certificate of Need

If you want to start a home health agency in Mississippi, you face two hurdles that can stop a project cold: a state license from the Mississippi State Department of Health (MSDH), and a Certificate of Need (CON) question that is unsettled right now. This guide covers how to start a home health agency in Mississippi in the order that protects your money. Check CON status first, because it decides whether the rest of the plan is worth funding.

Disclaimer: This article is informational content, not legal or tax advice. Rules, fees and agency practices change, and every figure below is one we could verify. Confirm each one with the agency named before you spend money. Talk with a Mississippi health care attorney and a CPA before you sign a lease, a payroll contract or a loan.

What Counts as a Home Health Agency in Mississippi

MSDH defines a home health agency as one that provides skilled nursing under the direction of a registered nurse (RN), at a physician's written direction, in the patient's home, plus at least one other service such as therapy or aide care. The licensing statute is Miss. Code Ann. 41-71-1 et seq., and the MSDH Division of Health Facilities Licensure and Certification administers it.

That definition decides what you are actually opening. A company that provides only non-medical companion care, meaning help with errands, meals, companionship and housekeeping with no skilled services, appears to fall outside it. Do not assume that exemption. Ask MSDH Licensure in writing whether your specific service model needs a license before you describe your business as exempt.

What You Need Before You Start

• A written business plan that states which services you will provide, who will provide them, and which patients you will serve
• A business name that you have checked against the Mississippi Secretary of State business search
• A Mississippi street address for your registered office, plus a registered agent with a physical Mississippi address
• A federal Employer Identification Number (EIN) from the IRS
• Licensed clinical staff: at least one RN to supervise skilled care, and a plan for how physician orders will be obtained and documented
• Written policies, a patient rights process, a clinical record system and an emergency plan
• Enough working capital to cover payroll, insurance and filing costs for several months, since licensing and certification take time
• Contact details for the MSDH Division of Health Facilities Licensure and Certification and the MSDH Health Planning office

Step 1: Get a Written Answer on Certificate of Need Status

Do this before anything else. Mississippi's CON status for a new home health agency is unsettled. On January 28, 2026, a federal judge in the Southern District of Mississippi (Slaughter v. Edney) held the statutory moratorium on new health facilities, which had run for about 40 years, to be unconstitutional. The same ruling upheld the CON law. The Legislature then reaffirmed the moratorium in HB 1622, approved March 23, 2026, and MSDH's State Health Plan states that the moratorium continues.

In practical terms, the state may not approve a new agency without a CON, and the rules could change again. Contact MSDH Health Planning (CON) and ask three questions in writing: whether a CON is required for your specific service area and service mix, whether a moratorium currently blocks new agency applications, and what the review timeline looks like. Keep the reply. Do not sign a lease, buy equipment or hire staff until you have that answer.

Step 2: Form Your Entity With the Secretary of State

Most owners form a Mississippi limited liability company (LLC). File the Certificate of Formation (Form F0100) through the Secretary of State's Business Services online filing portal at corp.sos.ms.gov. The filing fee is $50. Online filings paid for are normally approved and filed immediately, and filings that need staff review are normally returned filed within 24 hours. The Secretary of State lists no expedite fee for formation filings.

The LLC name must contain the words 'limited liability company,' or the abbreviation 'L.L.C.' or 'LLC.' It must also be distinguishable on state records from any registered corporation, nonprofit, limited partnership, limited liability partnership or LLC. Search the name at the Secretary of State business search before you file. If you need time, you can reserve the name for 180 days for a $25 fee.

A corporation is also possible, using Articles of Incorporation (Form F0001) for the same $50 filing fee. Most small agencies choose an LLC because it is simpler to run. Your tax choice matters more than the entity label, so discuss it with a CPA.

Step 3: Appoint a Registered Agent and Keep a Mississippi Office

Every Mississippi LLC must keep a registered office in the state and a registered agent for legal papers. The agent must be an individual Mississippi resident, or a business entity authorized to operate in Mississippi, and the agent's business office must match the registered office. The office needs a physical Mississippi street address, so a post office box will not work.

Mississippi recognizes two kinds of agents. A commercial agent files a listing statement with the Secretary of State for $100, appears on the state website, and must accept or decline each representation within 14 days. A noncommercial agent needs no state registration, but you must have that person's permission before you list them. Commercial agents cost money every year, while a family member or manager may serve for free, but you need a reliable person who will accept legal service without delay.

Step 4: Register Your Business Name, Tax Status and Local License

If your agency will operate under a name other than the exact LLC name, such as a trade name for your home care brand, register it as a fictitious (assumed) business name. File Form F0070 with the Secretary of State's Business Services Division for $25. Do not file it with the county.

Mississippi has no single state general business license. Registering an LLC with the Secretary of State is a registration, not a license. Instead, every city, town and village issues its own privilege license under Miss. Code Ann. 27-17. Counties issue privilege licenses only to businesses located outside municipal limits. Ask your city clerk for the exact fee and renewal rules, because the amounts vary by municipality and this guide does not list them.

Sales tax is a separate question. The Department of Revenue issues a sales tax permit with no fee, although a bond may be required for applicants without a permanent Mississippi location. Most home health agencies make no retail sales, so this may not apply to you. If you sell taxable goods, such as durable equipment or supplies, register through the Department of Revenue registration page. The state sales tax rate is 7%, and city levies apply only in Jackson and Tupelo, with no county add-on. Confirm the current rules with the Department of Revenue.

On taxes for owners, an LLC normally passes income through to its members, who report it on their Mississippi personal returns. For tax year 2026, Mississippi personal income tax is 0% on the first $10,000 of taxable income and 4% above that. The franchise tax applies to corporations, not to an LLC taxed as a partnership. An LLC that elects corporate tax treatment pays corporate income tax and the franchise tax. For 2026 the franchise tax is $0.50 per $1,000 of capital above $100,000, with a $25 minimum. That tax steps down for 2027 and is repealed effective January 1, 2028. Confirm with a CPA which treatment fits your ownership.

Step 5: Apply for the MSDH Home Health License

Once the CON question is answered in writing and your entity exists, apply through the MSDH Division of Health Facilities Licensure and Certification. Find the current application packet on the MSDH website, since forms and fee schedules change. Confirm the license fee and application fee with MSDH directly. This guide does not list a figure for them.

Ask MSDH Licensure which documents the application requires, such as your policies, governing documents, administrator and RN supervisor details, and proof of insurance, and whether a survey or inspection comes before a license is issued. Do not advertise skilled services, take patients or bill anyone until the license is in hand. Operating before licensure is the most expensive mistake on this list.

Step 6: Plan Medicare and Medicaid Separately

A state license does not make you eligible for Medicare payment. Medicare certification is a separate process with its own application, survey and enrollment steps. Most agencies that depend on Medicare need that certification to bill it. Plan Medicaid enrollment and any managed care contracts as separate projects. Ask MSDH and your payer contacts which steps must be complete before you accept referrals that you plan to bill.

Step 7: Build Your Staffing and Payroll Plan

Mississippi has no state minimum wage law, so federal wage and hour rules govern pay for covered employees. Build your staffing budget around the wages you actually intend to pay, the licensing requirements for each role, and the cost of training and supervision. Confirm your payroll withholding, unemployment and workers' compensation registrations with the state agencies that administer them when you hire your first employee.

Cost Summary

Item	Amount	Where to Confirm
LLC Certificate of Formation (F0100)	$50	Secretary of State
Name reservation (180 days)	$25	Secretary of State
Fictitious business name (F0070)	$25	Secretary of State
Commercial registered agent listing statement	$100 (only if you use a commercial agent)	Secretary of State
LLC annual report (F0108)	$0	Secretary of State
Sales tax permit (only if you make retail sales)	No fee, bond possible	Department of Revenue
City, town or village privilege license	Set locally	Your city clerk
MSDH home health license	Not listed here	MSDH Licensure
Certificate of Need	Status unsettled	MSDH Health Planning

Expected Results

Owners who sequence these steps carefully usually end up with a clean entity record, a documented licensing path and fewer surprises at the survey stage. Those outcomes depend on your application quality, your staffing and your local market, so treat them as possibilities rather than guarantees. Do not expect a fast launch. The CON question alone can change your timeline, so build a schedule with a long buffer and reassess after MSDH answers.

Common Mistakes to Avoid

• Skipping the CON answer. Signing a lease or buying equipment before MSDH confirms the CON position can strand the money.
• Assuming companion care needs no license. Any skilled service, such as wound care or medication administration, can bring the agency under MSDH rules. Get a written answer.
• Treating the Secretary of State filing as the whole process. The $50 LLC filing is a registration. It does not replace the city privilege license or the MSDH license.
• Filing a fictitious name with the county. The $25 fictitious name filing goes to the Secretary of State.
• Using a registered agent without a Mississippi address. The office must be a physical Mississippi street address.
• Ignoring the April 15 annual report. The LLC annual report is due April 15 each year and must be filed online. It carries no state fee, but failing to file can lead to administrative dissolution.
• Billing before licensure or certification. Revenue collected before the license is issued creates refund and compliance exposure.

Annual Upkeep

Calendar the LLC annual report for April 15 every year. You may file it on or after January 1, and it must be filed online through the Secretary of State. Renew your city privilege license on the local schedule, keep your MSDH license current under its renewal rules, and confirm your registered agent is still willing and able to serve.

Next Steps and Free Help

Start with the written CON inquiry to MSDH Health Planning, then form the entity, then apply for the MSDH license once the CON position is clear. The Mississippi Small Business Development Center Network, a statewide program with 19 locations led by the University of Mississippi, can help you organize the plan and check your filings. For official entity records and forms, use the Mississippi Secretary of State Business Services page. For tax questions, start with the Mississippi Department of Revenue.

Because this business combines licensing, Medicare and tax issues, plan to have a Mississippi health care attorney review your structure and a CPA review your tax elections before you commit capital. A few hours of professional review at the start costs far less than correcting a filing after MSDH has issued a notice.