This article is a collection of the best answers to Delaware Medicaid’s most frequently asked questions.
Medicaid is a government-sponsored healthcare program for low-income families and individuals who fulfill specific income and resource requirements. Only the aged, blind, or disabled can access resources within the defined restrictions.
We have scoured the internet to provide all you need to know about the Delaware Medicaid Benefits.
You will learn everything you need to know about Delaware Medicaid in this article.
Table of Contents
What is the Delaware Medical Program?
Medicaid provides medical aid to qualified low-income families in Delaware as well as qualified elderly, blind, and/or handicapped people whose income is insufficient to cover the cost of necessary medical care.
Medicaid pays for doctor visits, hospital care, labs, prescription drugs, transportation, routine shots for children, chiropractic services, mental health, and substance abuse services.
Who is eligible for Delaware Medicaid?
You must be a Delaware resident, a national or citizen of the United States, a permanent resident, or a legal alien, in need of medical treatment or insurance, and have a low or very low income in order to qualify for Delaware Medicaid.
You also need to fit one of the following criteria:
- Pregnant, or
- Be in charge of a child who is younger than 18 years old, or
- Blind, or
- Have a disability or a family member who is disabled at your home, or
- Be 65 years of age or older.
Annual Household Income Limits (before taxes)
| Household Size* | Maximum Income Level (Per Year) |
| 1 | $18,075 |
| 2 | $24,353 |
| 3 | $30,630 |
| 4 | $36,908 |
| 5 | $43,186 |
| 6 | $49,463 |
| 7 | $55,741 |
| 8 | $62,018 |
*Add $6,277 for each additional member in families with more than eight persons.
How do I contact Medicaid in Delaware?
Customer Relations
(866) 843-7212
Website
https://dhss.delaware.gov/dhss/dmma/
Provider Services
(800) 999-3371
Health Benefits Manager
(800) 996-9969
What are the Medicaid plans in Delaware?
Delaware contracts with two national, for-profit plans (United HealthCare Community Plan and Delaware Physicians Care, owned by Aetna), which participate in both Diamond State Health Plan (DSHP) and DSHP-Plus programs.
Delaware uses a competitive bidding process to choose its programs.
- Low-income children, families, and adults, as well as children and individuals with disabilities and foster children are all covered by the Diamond State Health Plan (DSHP), which also provides acute, primary, and behavioral health care services.
- Delaware maintains a small fee-for-service primary care case management program called Diamond State Partners which was created in 2002 to maintain client choice when the state had only one commercial managed care organization (MCO).
- DSHP-Plus program enrolls dual-eligible beneficiaries, individuals enrolled in the Elderly and Disabled and AIDS home and community-based service (HCBS) waivers, and nursing facility residents on a mandatory basis and provides to those who qualify, LTSS and acute, primary, and behavioral health care treatments are provided.
- The amount of behavioral health and drug addiction services covered by DSHP and DSHP-Plus is limited, and any services delivered in excess of the visit restrictions are offered as fee-for-service wraparounds.
What is covered by Delaware Medicaid?
The following services are covered by Delaware Medicaid
| Dental care (up to age 21) | Medical transportation services |
| Doctor visits | Mental health services |
| Home health care | Physical therapy |
| Hospice care | Prescriptions |
| Inpatient and outpatient hospital care | Routine shots for children |
| Lab tests | Substance abuse services |
| Medical equipment and supplies | X-rays |
Copayments?
In Delaware, parents have a $15 per month cap on out-of-pocket expenses from copayments.
| Generic Drug | Preferred Brand Name Drug | Non-Preferred Brand Name Drug |
| $.50 – $3.00 | $.50 – $3.00 | $.50 – $3.00 |
Copays are not charged for the following:
- Low-income children
- Pregnancy-related care
- Smoking cessation services
Diamond State Health Plan – Delaware’s Medicaid Managed Care Program
Most Medicaid recipients are required to select a family doctor who will coordinate all of your preventive care and medical needs with a managed care organization (MCO). The following people are not covered by an MCO:
- Individuals with Medicare eligibility or entitlement
- People who reside in nursing homes or intermediate care facilities for people with intellectual disabilities.
- Individuals with Medicaid home and community-based waiver coverage.
- Illegal and illegible non-citizens (aliens)
- Active service personnel, veterans, and their dependents who are covered by military health insurance.
- People who qualify for Medicaid’s Breast and Cervical Cancer program.
- Pregnant women who are presumably eligible
Delaware Diamond State Health Plan (DSHP) 1115 Demonstration Waiver
Initial approval of Delaware’s Diamond State Health Plan (DSHP) 1115 Demonstration Waiver occurred in 1995, and it went into effect on January 1 of the following year.
The goal of the DSHP 1115 Demonstration was to compel the enrollment of eligible Medicaid beneficiaries into managed care organizations (MCOs) and to reduce costs in the Medicaid program so that more people could be covered.
Delaware Diamond State Health Plan (DSHP) 1115 Demonstration Waiver Amendment
DMMA is required to give the public the chance to comment on proposed changes to the DSHP 1115 Waiver in accordance with 42 CFR 431.408. The proposed DSHP 1115 Waiver amendment is open for public review and discussion.
- Delaware’s Current – DSHP 1115 Waiver August 2019 to December 2023
- Delaware’s Proposed – DSHP 1115 Waiver Amendment 2022
- Delaware’s Proposed – DSHP Waiver Amendment Public Notice May 2022
What is the income limit for Medicaid in Delaware?
2021 Countable Income Limits for Federal Medical Assistance Programs Related to Poverty
Delaware Healthy Children Program Monthly Premium Calculated as a Percentage of FPL of Countable Family Income
| Family Size | Monthly Income Ages 6-18 134% – 142% Premium $10 Per Family |
| 1 | 1,437 – 1,523 |
| 2 | 1,944 – 2,060 |
| 3 | 2,452 – 2,598 |
How do I apply for Delaware Medicaid?
You will need to complete an application and return it to the Division of Social Services (DSS).
If DSS is unable to electronically verify your information, you may be required to provide one or more of the following:
Evidence of citizenship and identity, evidence of immigration status, the social security number for each applicant who has one, evidence of all income you have received in the last 30 days, or your most recent tax return for applicants who are self-employed.
Go to the following website to submit an online application:
Delaware ASSIST
Call the Customer Relations Unit (CRU) at 1-866-843-7212 if you need help applying or would want an application addressed to you.
If you prefer to apply in person, visit your local office for the Division of Social Services (DSS).
You can learn more about Medicaid, the Delaware Healthy Children Program (DHCP), and other assistance programs by speaking with a DSS employee. Call the CRU at 1-866-843-7212 for assistance in locating a local office.
