How Mississippi pays for disability services

Waiver inventory

CMS waiver factsheet confirming waiver numbers and target groups: medicaid.gov

State-only funded programs

• DMH IDD Programs (state-operated regional programs and community services). DMH operates six comprehensive IDD regional programs (North Mississippi Regional Center, Hudspeth, Ellisville State School, Boswell, South Mississippi Regional Center, Mississippi Adolescent Center). FY2025 funding-source expenditures reported by DMH: IDD Programs $33,579,694; Service Budget (Community Services) $49,181,348; Medicaid state share and bed taxes $62,882,100. These lines mix state appropriation, Medicaid state share, and special funds; DMH does not publish a clean state-only IDD figure. Source: dmh.ms.gov
• IDD Grant Services (employment related). Small state/grant-funded employment supports outside Medicaid; served 6 people in FY2025. Same source.
• Developmental Disabilities Council basic state grant, $841,886 (FY2025) is federal, not state-only. Same source.
• What I checked and did not find: a discrete, named state-general-fund IDD program with its own appropriation line comparable to other states' "state-funded family support" programs. Checked medicaid.ms.gov program pages, dmh.ms.gov service pages, DMH data reports page (https://www.dmh.ms.gov/data-reports/), and the FY2025 annual report. Mississippi Legislative Budget Office appropriation detail for DMH was not retrieved.

County / regional / local funding

None identified as a dedicated county levy or county DD board system. Mississippi has no county property tax levy analogue to Missouri's SB40 boards in the sources reviewed. DMH's service system runs through state-operated regional IDD programs, regional community mental health/IDD centers, and nonprofit community agencies (https://www.dmh.ms.gov/service-options/idd-services/). Regional community mental health/IDD commissions are organized by groups of counties and historically receive county contributions, but no document quantifying county contributions to IDD services was located.

Funding scale

• Total people receiving ID/DD services FY2025: 5,252, of whom 4,595 (87%) were served in the community and 657 in institutional settings. dmh.ms.gov
• Breakdown FY2025: 2,965 ID/DD Waiver; 1,110 1915(i) CSP and/or IDD TCM; 514 ICF/IID community homes; 6 IDD grant services. Same source.
• DMH IDD regional program census 6/30/2025: 620, down 53% from 1,324 on 1/1/2012. Same source.
• ID/DD Waiver growth: 1,831 enrolled end of FY2012 to 2,965 in FY2025, a 62% increase. FY2025 new enrollments: 206 (24 from institutions, 182 from the planning list). Same source.
• DMH FY2025 funding-source expenditures: IDD Programs $33,579,694; Service Budget (Community Services) $49,181,348; Behavioral Health Programs $105,686,545; Medicaid (state share/bed taxes) $62,882,100. Same source.
• Mississippi FMAP FY2026: 76.9% (highest-match tier). kff.org
• Waiting list ("planning list"): 2,496 people with I/DD waiting as of 2025 (2,772 in 2024; 2,779 in 2023). Secondary. kff.org
• Not found: total annual ID/DD spending all funds; ID/DD Waiver Medicaid expenditure total; state vs federal split for the waiver; spending per waiver participant; average wait time.

Residential funding detail

Mississippi funds a wide residential array through the ID/DD Waiver, all on per diem payment with acuity tiers driven by DMH support-level determination (Levels 1 through 5, expressed as low/medium/high support via TF and TG modifiers), plus a bed-size adjustment for congregate settings (UQ = 4 beds or fewer, UR = 5 or more beds). Rates below are effective 1/1/2026 unless noted.

• Supervised Living (group home), 4 beds or fewer (S5136, per diem): low support $231.87; medium $255.93; high $281.69 (high tier unchanged since 7/1/2023).
• Supervised Living, 5 or more beds (S5136, per diem): low $222.68; medium $236.43; high $250.18.
• Medical Supervised Living (S5136 TF): $472.98 per diem.
• Behavioral Supervised Living (S5136 TG): $939.49 per diem, a 73% increase over the prior $544.47.
• Shared Supported Living (H0043, per diem): low support $152.85; medium $193.14; high $249.66. Capped at 345 days/year.
• Host Home (T2016, per diem): $138.18, unchanged since 7/1/2023, and the only residential rate that did not receive the 1/1/2026 increase.
• Supported Living (S5135, per 15 minutes, 32 units/day max): 1 person $8.07; 2 person $5.04; 3 person $4.04. This is hourly supported living in a person's own home, not a licensed residence.
• In-home and family settings: Home and Community Supports (S5125, per 15 minutes) 1 person $7.20, 2 person $4.62, 3 person $3.84, unchanged since 7/1/2023. Combined S5100/T2015/T2047 capped at 138 hours per month.
• ICF/IID: facility-specific per diem set annually by the Division of Medicaid. CY2026 rates: Delta Manor $515.83; Lincoln Residential Center $474.74; Madison Court $548.50; Rehabilitation Centers Inc. (Millcreek) $474.51; Rolling Hills Developmental Center $471.19; SON Valley (Baptist Homes) $436.77. 514 people were served in ICF/IID community homes in FY2025. medicaid.ms.gov
• Crisis residential: Crisis Support ICF/IID (H0045) $1,163.09 per diem, up from $319.75; Crisis Intervention Daily (T2034) $663.88 per diem.
• Transition Assistance (T2038): $800 lifetime for people moving out of institutions, covering furnishings, security deposits, and moving costs.
• Room and board: not paid by the waiver. Federal 1915(c) rules bar waiver payment for room and board in non-provider-owned settings, and the Mississippi ID/DD Waiver fee schedule contains no room-and-board line. DMH's supervised living brochure does not address who pays housing costs, so in practice residents' SSI and other income cover room and board. Neither the fee schedule nor the DMH brochures reviewed document a state room-and-board subsidy. dmh.ms.gov
• Where people live, FY2025: home with ID/DD Waiver and CSP 49.4%; regional programs 12.5%; supervised living 20.8%; community homes (ICF/IID) 9.8%; supported living 5.3%; shared supported living 2.1%; home with employment activities 0.1%.

Comparable service rates

All rates from the Mississippi Division of Medicaid IDD Waiver Fee Schedule, sheet dated December 2025, "HCBS New Rates Effective 1/01/2026."

Official rate schedule links

• ID/DD Waiver Fee Schedule (xlsx, rates effective 1/1/2026): medicaid.ms.gov
• IDD Community Support Program 1915(i) Fee Schedule (xlsx): medicaid.ms.gov
• ICF/IID rate calculations, CY2026: medicaid.ms.gov
• ICF/IID rates, CY2025 amended: medicaid.ms.gov
• All Medicaid fee schedules index: medicaid.ms.gov
• CMS-approved ID/DD Waiver renewal effective 7/1/2023: medicaid.ms.gov

Notable features and flags

• 1/1/2026: broad ID/DD Waiver rate increase. Nearly every waiver service repriced. Largest movers: Behavioral Supervised Living $544.47 to $939.49 per diem (+73%); Crisis Support ICF/IID $319.75 to $1,163.09 (+264%); Crisis Intervention Intermittent $7.97 to $29.15 per 15 min; Behavior Support Evaluation under 6 hours $370.10 to $526.37; Support Coordination $241.55 to $271.11 per month. Host Home ($138.18) and Home and Community Supports ($7.20 per 15 min) were left at their 7/1/2023 levels, a gap worth flagging for host-home provider capacity.
• Waiver renewal approved by CMS effective 7/1/2023 (0282.R06.00), with a public-input process run jointly by the Division of Medicaid and DMH ahead of submission. dmh.ms.gov
• Continued institutional downsizing. DMH IDD regional program census fell from 1,324 (1/1/2012) to 620 (6/30/2025), a 53% reduction. South Mississippi Regional Center is down 78%, Ellisville State School down 61%.
• Waiting list is shrinking but material. 2,496 people with I/DD were waiting in 2025, down from 2,779 in 2023, while waiver enrollment rose from 2,733 to 2,965 over the same span. FY2025 saw 182 enrollments from the planning list, the highest in the 14-year series.
• Two-tier system design. The 1915(i) CSP functions as a lighter-touch, non-residential alternative to the waiver, paying materially lower rates for the same codes (for example Day Services Adult low support at $4.51 CSP versus $4.52 waiver, but Supported Living capped differently). CSP rates have not moved since 11/1/2023, unlike waiver rates.
• Self-direction: no participant-directed option is identified in the ID/DD Waiver fee schedule or DMH materials reviewed.

Confidence

Solid: the full ID/DD Waiver and 1915(i) CSP fee schedules were downloaded and parsed directly from the Division of Medicaid, so every rate, modifier, unit, and effective date above is first-party and exact. Enrollment, census, residential setting distribution, and the FY2012 to FY2025 enrollment series come straight from the DMH FY2025 Annual Report. ICF/IID per diems are from the published CY2026 rate calculation. FMAP is from KFF. Estimated or secondary: the waiting list count (2,496) is KFF's compilation, not a Mississippi document; DMH's own planning list total was not published in the annual report. Could not find: total all-funds ID/DD spending, the ID/DD Waiver's Medicaid expenditure total, state versus federal share of waiver spending, cost per waiver participant, average time on the planning list, and any legislative appropriation detail for DMH IDD by fund. Room and board treatment is inferred from federal 1915(c) rules plus the absence of a room-and-board code, not from an explicit Mississippi policy statement.

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