[1] Until federal regulations changed in July 2020, it was considered one of the seven regional accreditation organizations dating back 130 years.

It accredits nearly 600 institutions, primarily in Delaware, Washington, D.C., Maryland, New Jersey, New York, Pennsylvania, Puerto Rico, and the U.S. Virgin Islands.

Its traditional region includes the U.S. states of New York, New Jersey, Pennsylvania, Delaware, and Maryland, and Washington, D.C. and the American territories and commonwealths of Puerto Rico, and the U.S. Virgin Islands that wish to participate in Federal "Title IV" student loan programs.

[2][3] The commission conducts business in 48 states; the two exceptions are Montana and North Dakota, two U.S. territories, Puerto Rico and the U.S. Virgin Islands, and Washington, D.C..

MSCHE grew out of the Middle States Association of Colleges and Schools (MSA), an organization established in 1887 to improve education using evaluation and accreditation.