Mississippi Personal Choices Program — Self-Directed Medicaid Home Care

What Self-Directed Care Looks Like in Mississippi

Most Mississippi Medicaid home care runs through agencies. The family selects a provider agency from the state-approved directory, and the agency sends a worker; the family has limited say over who shows up or when. For some families, especially those in rural counties with few agency options, this model doesn't work.

The Personal Choices program is Mississippi's alternative. Available exclusively through the Independent Living (IL) Waiver, it shifts control from the agency to the participant. Your parent — or an authorized representative — becomes the employer of record, choosing who provides care, setting schedules, and managing the day-to-day relationship directly.

How Personal Choices Works

The participant receives an individualized budget based on their approved plan of care. Instead of the state paying an agency, the funds flow through a Fiscal Management Service (FMS) — a third-party intermediary that handles payroll, tax withholding, workers' compensation insurance, and compliance reporting.

The participant's role:

• Recruit and hire personal care attendants, including family members like adult children or grandchildren
• Set schedules that match actual daily needs rather than agency availability
• Train workers on the specific care routines the parent requires
• Terminate workers who aren't meeting the care standard

The FMS's role:

• Process payroll and issue paychecks or direct deposits
• Withhold and remit federal and state employment taxes
• Maintain workers' compensation coverage
• Report to the Division of Medicaid

This split is important: the participant makes care decisions, the FMS handles administrative compliance. The participant never touches Medicaid funds directly.

Who Qualifies

Personal Choices is only available through the IL Waiver. You cannot access it through the E&D Waiver or the TBI/SCI Waiver. The E&D Waiver — Mississippi's largest home care program — does not offer any self-directed option.

To use Personal Choices, your parent must:

1. Meet the IL Waiver's clinical eligibility (nursing-facility level of care, typically driven by severe physical disability)
2. Meet Medicaid financial eligibility ($2,982 income cap, $4,000 asset limit)
3. Demonstrate the ability to direct their own care, or designate a representative who will manage hiring, scheduling, and supervision

If your parent primarily needs care due to age-related decline rather than a specific physical disability, the IL Waiver likely isn't the right path — the E&D Waiver is the standard program for elderly Mississippians.

Hiring Family Members: The Rules

One of Personal Choices' biggest draws is the ability to hire relatives as paid caregivers. But Mississippi places conditions on this:

Eligible family caregivers: Adult children and grandchildren can be hired as personal care attendants through the FMS, subject to the program's restrictions.

Restrictions:

• Family members who live in the same household. The caregiver must reside at a separate address from the participant.
• Spouses and legally appointed guardians or conservators. The E&D Waiver bars these roles; confirm the current Personal Choices rules with the IL Waiver or FMS before relying on such an arrangement.

Each hired caregiver must pass a background check and complete any training the FMS or the state requires.

Personal Choices vs. Agency-Delivered Care

The Practical Trade-Off

More control comes with more responsibility. Under Personal Choices, if a caregiver calls in sick, the participant arranges backup care — there's no agency staffing desk to call. If a caregiver needs to be let go, the participant handles the termination. Families with a reliable local support network find this manageable. Families relying on a single caregiver in a rural county may find agency-delivered care more sustainable.

Our Mississippi Home Care Guide covers both the self-directed and agency models, with the eligibility criteria, application contacts, and the practical decision framework for choosing between them.

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