What is the Mississippi E&D Waiver (and the IL Waiver)?
The Elderly and Disabled (E&D) Waiver is a Mississippi Medicaid 1915(c) Home and Community-Based Services (HCBS) program. It helps people who would otherwise need nursing-home-level care stay in their own home by covering services such as personal care assistance, adult day care, in-home and institutional respite, home-delivered meals, extended home health, and community transition services. It is administered by the Office of Long Term Care within the Mississippi Division of Medicaid.
There is one important catch for families: the E&D Waiver is not a self-directed program. Mississippi assigns the provider agency that delivers your personal care, so you cannot simply hire and pay a specific family member through the E&D Waiver the way you can in "consumer-directed" states. If your main goal is to be paid for caring for a relative, the E&D Waiver alone usually will not get you there.
That is where the Independent Living (IL) Waiver comes in. The IL Waiver is a separate Mississippi Medicaid waiver, administered jointly by the Division of Medicaid and the Department of Rehabilitation Services (MDRS), for people age 16 and older with severe orthopedic and/or neurological impairments. Unlike the E&D Waiver, the IL Waiver permits participant direction (also called consumer direction or self-direction) of personal care attendant services. That means the member can hire, train, schedule, and manage their own attendant, including select relatives.
So in practice, Mississippi families researching how to "get paid to care for a loved one" are usually pointed toward the IL Waiver rather than the E&D Waiver. Both are Medicaid programs that keep people out of nursing homes, both require a nursing-facility level of care, and both are limited-slot (non-entitlement) waivers that may carry a waiting list. This page covers both so you can figure out which door actually lets a family caregiver be paid.
Mississippi waiver eligibility requirements
Eligibility applies to the person receiving care, not the caregiver. The care recipient must qualify for Mississippi Medicaid, meet a nursing-facility level of care, and fit the age and disability criteria for the specific waiver (E&D or IL). The relative being paid does not have to meet income or asset limits.
Who can - and cannot - be paid as a caregiver in Mississippi
This is the most important distinction in Mississippi. Paying a relative is only possible through the Independent Living (IL) Waiver, which allows consumer direction. The E&D Waiver assigns an agency and does not let you choose a family caregiver. Under the IL Waiver, a spouse still cannot be paid, and relatives generally cannot be paid if they live in the same household as the participant.
- Adult children (sons and daughters) of the participant, under the IL Waiver
- Sons-in-law and daughters-in-law of the participant
- Siblings and grandchildren of the participant
- Other relatives who are not legally responsible for the participant and who do not live in the same home
- Friends and neighbors the participant chooses, if they pass a background check and meet minimum qualifications
- The participant's spouse (excluded under both the E&D and IL Waivers)
- A parent or legal guardian of the participant, or anyone else legally responsible for them
- A relative who lives in the same household as the IL Waiver participant
- Any paid family caregiver through the E&D Waiver, because that waiver does not allow self-direction
Mississippi caregiver pay, hours, and rules
Mississippi is one of the lowest-paying states in the country for home care, so caregiver wages here are modest compared with states like New York or California. Pay is set through the Medicaid provider or fiscal intermediary rather than negotiated freely, and the authorized hours depend on the assessed level of need.
Hourly pay
In 2026, personal care attendant wages in Mississippi generally fall in the range of about $10 to $14 per hour. Statewide averages for home care workers hover near $11 to $12 per hour, among the lowest in the nation, while Medicaid reimburses provider agencies roughly $15 to $20 per hour (the worker is paid less than the agency rate). Under the IL Waiver's participant-directed model, the member helps decide the attendant's pay within program limits, and a fiscal intermediary withholds taxes and issues W-2s. Note: starting in July 2026, states must publish their Medicaid personal care hourly rates online, so Mississippi-specific numbers should become more precise then.
Hours and scheduling
Authorized hours are based on the nursing-facility-level-of-care assessment and the participant's plan of care, not a fixed statewide amount. Personal care hours are set by the case manager to match documented ADL and IADL needs, and can be spread across more than one attendant. The IL Waiver reports an average monthly service budget in the ballpark of $1,500, which frames how many attendant hours a typical plan supports.
Overtime rules
When a personal care attendant is a W-2 employee through a fiscal intermediary, federal Fair Labor Standards Act rules apply, so more than 40 hours in a single workweek for one participant can trigger overtime at 1.5x the hourly rate. Because Mississippi budgets are limited, plans are usually structured to stay within authorized hours, and some families use more than one attendant to cover the schedule without overtime.
How to apply for Mississippi waiver home care
- Decide which waiver fits. If your goal is to be paid to care for a relative, aim for the Independent Living (IL) Waiver, which allows consumer direction. The E&D Waiver covers similar services but assigns an agency and does not let you choose a paid family caregiver.
- Call the Mississippi Access to Care (MAC) Center or the Division of Medicaid to start.
- Mississippi Access to Care (MAC) Center: 844-822-4622
- Division of Medicaid Office of Long Term Care: 800-421-2408
- Department of Rehabilitation Services (IL Waiver): 800-443-1000
- Confirm or apply for Mississippi Medicaid for the care recipient. If they are not already covered under a qualifying category, apply through the Division of Medicaid and gather proof of income, assets, residency, and identification.
- Complete the level-of-care assessment. A licensed social worker and registered nurse will evaluate ADLs, IADLs, and cognition in person to confirm the applicant needs a nursing-facility level of care, and a physician signs off.
- Get placed on the waiver (or the waiting list) and build a plan of care. Once a slot is available, a case manager develops the plan, sets authorized personal care hours, and, on the IL Waiver, sets up participant direction.
- Enroll your chosen attendant under the IL Waiver.
- Confirm the attendant is not a spouse, not legally responsible for the participant, and does not live in the home
- Complete the background check and minimum qualification requirements
- Register with the fiscal intermediary that handles payroll, tax withholding, and W-2s
- Submit timesheets and reassess annually. The fiscal intermediary processes pay each period, and the waiver is renewed each year through another assessment to confirm continued eligibility and adjust hours.
Mississippi E&D and IL Waiver frequently asked questions
Can my spouse be paid to care for me in Mississippi?
No. A spouse cannot be paid as a caregiver under either the Elderly and Disabled (E&D) Waiver or the Independent Living (IL) Waiver in Mississippi. Mississippi treats spouses (and other legally responsible people, such as a parent of a minor) as being expected to provide unpaid care, so waiver dollars are reserved for other people. The E&D Waiver does not allow you to self-direct or handpick any family caregiver at all, and the IL Waiver, which does allow consumer direction, still specifically excludes spouses. If you need a spouse to be paid for caregiving, look outside these waivers: VA Veteran Directed Care can pay a spouse in some cases if the care recipient is a veteran, and some states offer structured family caregiving that Mississippi does not currently run. For a non-spouse relative, the IL Waiver is the realistic path.
How much does a Mississippi caregiver get paid in 2026?
Mississippi is one of the lowest-paying states in the country for home care, so expect modest wages. In 2026, personal care attendants generally earn roughly $10 to $14 per hour, with statewide home care averages sitting near $11 to $12 per hour. Medicaid reimburses provider agencies more than that (roughly $15 to $20 per hour), but the individual worker is paid less than the agency rate. Under the IL Waiver's participant-directed model, the member has some say in the attendant's pay within program limits, and a fiscal intermediary withholds taxes and issues a W-2. The IL Waiver reports an average monthly service budget around $1,500, which is a useful ceiling to keep in mind. Beginning in July 2026, states are required to publish their Medicaid personal care hourly rates online, so exact Mississippi figures should become easier to verify then.
How long does it take to get approved in Mississippi?
Plan on roughly two to three months, and often longer if there is a waiting list. Federal rules give Medicaid up to 45 days to decide a standard application and up to 90 days when a disability determination is involved, but Mississippi families commonly report the full process taking around three months from start to finish. The biggest variables are how quickly the level-of-care assessment can be scheduled and whether a waiver slot is available, since both the E&D and IL Waivers are capped, non-entitlement programs that may carry a waiting list. You can speed things up by confirming Medicaid eligibility early and gathering documents in advance: proof of Mississippi residency, identification, Social Security information, proof of income and assets, and medical records that support the need for nursing-facility-level care.
What training does a Mississippi personal care attendant need?
There is no requirement to be a licensed nurse, a Certified Nursing Assistant (CNA), or a Home Health Aide to be a personal care attendant under the Independent Living (IL) Waiver. The attendant does have to meet the program's minimum qualifications and pass a background check before being enrolled, and they must be able to safely perform the personal care tasks in the participant's plan (help with bathing, dressing, transferring, toileting, eating, meal prep, and light housekeeping). Under the participant-directed model, the member or their representative trains the attendant on their specific needs and preferences. Basic onboarding through the fiscal intermediary typically includes employment paperwork, tax forms, and instructions for submitting timesheets. This makes the IL Waiver accessible to relatives who have already been providing informal care and now want to be paid for it.
What is the difference between the E&D Waiver and the IL Waiver?
Both are Mississippi Medicaid home care waivers for people who would otherwise need nursing-home-level care, but they differ in a way that matters a lot for family caregivers. The Elderly and Disabled (E&D) Waiver serves people 65 and older and adults 21-64 with a physical disability, and it delivers personal care through an assigned provider agency. It does not allow self-direction, so you cannot choose and pay a specific relative through it. The Independent Living (IL) Waiver serves people 16 and older with severe orthopedic and/or neurological impairments and does allow consumer direction, letting the member hire, train, and pay their own personal care attendant, including certain relatives. If being paid to care for a loved one is your goal, the IL Waiver is almost always the correct program, and the E&D Waiver is better thought of as agency-delivered care.
Can a relative who lives with me be paid under the IL Waiver?
Generally no. Mississippi's Independent Living (IL) Waiver allows you to pay relatives such as adult children, sons- and daughters-in-law, siblings, and grandchildren as your personal care attendant, but there is a specific restriction: the relative usually cannot live in the same household as the participant. Live-in relatives are excluded from being paid attendants, along with spouses and anyone legally responsible for you. This surprises many families, because the person already caring for a loved one is often the one who lives with them. If that describes your situation, it is worth calling the Department of Rehabilitation Services (800-443-1000) or the Division of Medicaid (800-421-2408) to talk through your specific circumstances, because household composition and who else is available to provide care can affect what is allowed.
Does getting the waiver change my other Medicaid benefits?
No. Enrolling in the Elderly and Disabled Waiver or the Independent Living Waiver does not take away the care recipient's regular Mississippi Medicaid benefits. They keep their doctor visits, hospital coverage, prescription drugs, durable medical equipment, and other covered services. The waiver is an additional layer of home and community-based services that sits on top of the standard Medicaid benefit and is specifically designed to keep someone out of a nursing facility. If the person is dually eligible for Medicare and Medicaid, Medicare continues to cover acute care such as hospital stays, doctor visits, and short-term skilled home health, while Medicaid covers the long-term personal care and support services through the waiver. The two programs coordinate rather than cancel each other out, so adding a waiver does not put existing coverage at risk.
Who runs these waivers and who do I call first?
The Elderly and Disabled (E&D) Waiver is administered by the Office of Long Term Care within the Mississippi Division of Medicaid. The Independent Living (IL) Waiver is administered jointly by the Division of Medicaid and the Mississippi Department of Rehabilitation Services (MDRS). A good first call for either waiver is the Mississippi Access to Care (MAC) Center at 844-822-4622, which helps people find the right long-term-care option and start the process. You can also call the Division of Medicaid Office of Long Term Care directly at 800-421-2408, and for the IL Waiver specifically, the Department of Rehabilitation Services at 800-443-1000. Because both waivers have limited slots and may carry a waiting list, it is worth calling early, confirming Medicaid eligibility, and asking specifically about consumer direction if your goal is to have a relative paid as the personal care attendant.
See also: Mississippi caregiver guide
For all the ways to get paid to care for a family member in Mississippi — including E&D Waiver, VA programs, long-term care insurance, and more — read the full Mississippi guide.