Frequently Asked Questions About Medicaid and Medical Assistance
- What is Medicaid?
- What is Medicare?
- Can I have both Medicaid and Medicare at the same time?
- Who qualifies for Medicaid?
- How can I find out if I can get Medicaid?
- How much income can I receive and still be eligible for Medicaid?
- If I have private health insurance, can I be eligible for Medicaid?
- If I don’t qualify for Medicaid, is there any other help for me or my children?
- How will I receive my medical care?
How to Apply
- What Medical Services does Medicaid cover?
- How will I receive my medical care?
- How do I join a Managed Care Organization (MCO)?
- What if I don’t choose a Managed Care Organization?
- How long will my Medicaid remain active?
Q. What is Medicaid?
A. Medicaid is a health insurance program that pays medical bills for eligible low-income families and for eligible aged, blind and/or disabled people whose income is insufficient to meet the cost of necessary medical services. Medicaid is run by the Delaware Division of Medicaid & Medical Assistance (DMMA) and pays medical bills with State and Federal tax money.
Q. What is Medicare?
A. Medicare is an insurance program that pays medical bills for people who are over 65 years old, or who are disabled. It is available to people who receive Social Security benefits regardless of how much money they have. It is run by the Federal government and is paid for with money from the Social Security Trust Fund, which most people pay into while they work. Retired and disabled people pay a monthly insurance premium for Medicare Part B. This is usually taken out of their Social Security check before they receive the check.
Q. Can I have both Medicaid and Medicare at the same time?
A. It depends. If you receive Supplemental Security Income (SSI) from the Social Security Administration, you are automatically eligible for Medicaid and often receive Medicare as well. If you receive both Medicaid and Medicare, Medicaid will pay your Medicare premium, co-payments and deductibles. If you have both Medicare and Medicaid, you should show both cards to your medical care provider each time you receive services.
Q. Who qualifies for Medicaid?
A. Citizenship and Residency - To obtain full Medicaid benefits in Delaware, you must be a Delaware resident and either a U.S. citizen or a legally residing noncitizen. Full coverage for noncitizens is dependent on the availability of state funding. However, noncitizens (residing legally or illegally) can qualify for coverage for emergencies and labor & delivery services if income requirements are met.
Income Level - Qualifying for Medicaid is also based on need. Household income must be under certain limits that depend on family size. For Long Term Care programs, financial resources must also be under a certain amount. There are also specific programs for individuals who meet certain medical or disability tests, or who qualify due to age or pregnancy. To find out more about different Medicaid and other medical assistance programs, visit DMMA Programs & Services.
Q. How can I find out if I can get Medicaid?
A. You can find out if you qualify for Medicaid or other medical assistance and social service programs by speaking with a representative at your local State Service Center. Call Medicaid Customer Relations at 1-800-372-2022 or (302)255-9500 to be directed to the appropriate office where someone can help you.
Q. How much income can I receive and still be eligible for Medicaid?
A. Income is money that you get from working, or money that someone gives you, or checks that you receive, such as a Social Security check, unemployment benefits, child support, retirement benefits, or sick pay. Whether your income level qualifies you or your family for Medicaid depends on the size of your family and the Medicaid program for which you are applying.
Income limits are set each year by the federal government to define the Federal Poverty Level for different family sizes. In general, if your household income is at or below the current 100% Federal Poverty Level for your household size, your family is likely to be eligible for Medicaid. Children from age 1 to under age 6 can qualify for Medicaid benefits when household income is at or below 133% of the Federal Poverty Level. Pregnant women and infants under age 1 qualify for Medicaid with family income at or below the 200% Federal Poverty Level, and pregnant women count as 2 (or more) family members.
See our tables of income limits for applying for DMMA programs to find out where your family income is, in relation to these income benchmarks.
Medical assistance programs other than Medicaid have different income level requirements. For example, uninsured children under age 19 who live in families with incomes at or below the 200% Federal Poverty Level are eligible for low cost health insurance under the Delaware Healthy Children Program. The Delaware Prescription Assistance Program can help pay for prescription medications for elderly and/or disabled individuals whose income is at or below 200% Federal Poverty Level, or whose prescription costs exceed 40% of annual income.
If you need help with medical payments, you may qualify for one of many other medical assistance programs. If you don’t know which program you need, a good first step would be to call the Delaware HelpLine toll-free at 1-800-464-HELP (4357).
Q. If I have private health insurance, can I be eligible for Medicaid?
A. It depends. If your income is low, and you have minor children, you and your children can have private health insurance and still be eligible for Medicaid. Certain Medicaid qualifying programs require that you not have any other health insurance in order for you to get Medicaid. If you have both private health insurance and Medicaid, you should show both your Medicaid card and your private health insurance card to your medical provider each time you receive services.
Q. If I don’t qualify for Medicaid, is there any other help for me or my children?
A. Yes. Many organizations in Delaware are dedicated to the principle that health care should never be beyond the reach of those who need it. If you need health care, but do not have insurance coverage, the people at the Delaware HelpLine have a wealth of information about organizations that provide health care at reduced rates for uninsured individuals. Call the Delaware HelpLine toll-free at 1-800-464-HELP (4357) from Monday – Friday from 8:00 a.m. to 5:00 p.m. (If calling from outside Delaware, the toll-free number is 1-800-273-9500.) The Delaware Helpline service is also available in Spanish. Additional information about the support provided by the Delaware Helpline can also be found by visiting www.delawarehelpline.org.
For example, you may qualify to receive discounted medical services through the Community Healthcare Access Program (CHAP). CHAP helps connect uninsured individuals with affordable health care from primary care doctors, medical specialists, and other health providers including prescription programs, laboratory and radiology services. To find out more about this program, visit the website for the Community Healthcare Access Program, or call 1-800-996-9969 for eligibility guidelines.
You can read about CHAP and other healthcare resources for uninsured individuals in the Delaware Healthcare Resource Guide – (text-only version). This guide is also available in Spanish: Guía de Recursos de Salud – (Spanish text-only version).
Your minor child may qualify for the Delaware Healthy Children program. There is a small monthly premium for this health insurance program that ranges from $10 to $25 per month depending on your income. Your children would receive all the benefits that most private plans provide. For more information, please click the link above.
If your child does not qualify for Medicaid or the Delaware Healthy Children Program, you may find the help you need through the Nemours financial assistance program. The financial counselors at the Nemours/Alfred I. duPont Hospital for Children can help families who have no insurance or too little insurance. Some families may be able to get free care for their children, while others may pay less than the regular fees. Nemours offers pediatric primary care at locations in all Delaware counties and the finest specialty care at the Alfred I duPont Hospital for Children in Wilmington. Please call 1-800-252-0040 to find out how Nemours can help.
The Delaware Prescription Assistance Program can help pay for prescription medications for elderly and/or disabled individuals who cannot afford the full cost of filling their doctor's prescriptions. Visit the preceding link or call 1-800-996-9969 for more information about eligibility and how to apply.
The Nemours Health Clinic offers low-cost dental, vision, and hearing care for Delaware senior citizens within certain income limits. Residents of New Castle County can obtain all services at the clinic on Rockland Road in North Wilmington. Residents of Kent and Sussex counties can obtain vision and hearing services at the clinic in Milford, and dental services from a network of participating dentists in their area. For more information, visit the Nemours Health Clinic online, or call the Patient Services Department at (302) 651-4405 for Wilmington, or 1-800-763-9326 in Milford.
Q. How will I receive my medical care?
A. In Delaware, Medicaid benefits are provided mainly through a managed care organization, or MCO, under contract with the state. Managed care is an organized way to ensure that people receive the quality medical care they need in the most cost-effective manner. Some Medicaid recipients in Delaware – those who also receive Medicare and those in Long Term Care Medicaid programs such as the Nursing Facility program – do not receive their medical care through a managed care organization.
DMMA provides a choice of managed care organizations so you can select the MCO plan that is best for you and your family. Delaware contracts with two managed care plans – UnitedHealthCare Community Plan and Highmark Health Options.
The Medicaid MCO provides almost all of the care for Medicaid members who join their plan. Prescription and non-emergency medical transportation services are covered directly by Medicaid, not through the MCO. Medicaid recipients need to show their Medicaid card to pharmacies and transportation providers when receiving these services.
How to Apply
Q. Where do I go to apply for Medicaid?
A. There are several ways to apply for Medicaid and other medical assistance programs:
- On the internet, you can use ASSIST to check your eligibility for several different assistance programs by completing a self-screening questionnaire. ASSIST then allows you to apply online.
- You may also print an Application for Health Insurance/Medicaid. The application form is also available in Spanish/en Español.
- By phone, you can contact Medicaid Customer Relations at 1-800-372-2022 or (302)255-9500 to be directed to the Division of Social Services (DSS) office closest to where you live. DSS staff members will help you find out more about eligibility for Medicaid and other assistance programs. Then the appropriate information and application forms will be mailed to you. Complete, sign and date the application form in ink and mail it to the address provided.
- For Long Term Care applications, please call the Long Term Care Medicaid Unit listed for the county where you live.
Q. What documents will I need to provide when I apply?
A. You will need to provide verification of your income. You do not need to provide proof of your assets or resources (bank accounts, cars, stocks, etc.) or come into our offices to be interviewed unless you are applying for one of the Long Term Care Medicaid programs (the Nursing Facility Program, or Home and Community Based Services).
If you are pregnant, you will need to provide proof that you are pregnant. If you are not a U.S. citizen, you will need to provide proof of your alien status. For example, you can provide a copy of your green card.
If you apply online using ASSIST, a web page at the end of the application will tell you exactly what documents must be sent by mail to support the application you are submitting, and the appropriate mailing address.
Q. What Medical Services does Medicaid cover?
A. The Delaware Medicaid program pays for many medical services to keep you healthy and to treat you when you are sick. The major services are:
- Doctor visits
- Inpatient and Outpatient hospital care
- Lab tests
- Home health care
- Hospice care
- Medical equipment and supplies
- Medical Transportation services
- Dental care (up to age 21)
Covered services for the Delaware Healthy Children Program are listed on the DHCP Benefits page.
Q. How will I receive my medical care?
A. In Delaware, Medicaid benefits are mainly provided through a Managed Care Organization, or MCO, under contract with the State. Managed Care is an organized way to ensure that people receive the quality medical care they need in the most cost-effective manner. Some Medicaid recipients in Delaware do not receive their medical care through a Managed Care Organization – those who also receive Medicare and those in Long Term Care Medicaid programs, such as the Nursing Facility program.
DMMA provides a choice of different Managed Care Organizations so that you can select the MCO plan that is best suited to your family’s needs. As of July 1, 2007, Delaware contracts with three Managed Care plans – Delaware Physicians Care, Inc., UnitedHealthCare Community Plan, and Diamond State Partners.
The Medicaid MCO provides almost all of the care for Medicaid members who join their plan. Prescription and non-emergency medical transportation services are covered directly by Medicaid, and not through the MCO. Medicaid recipients need to show their Medicaid card to pharmacies and transportation providers when receiving these services.
Q. How do I join a Managed Care Organization (MCO)?
A. After being notified that you are eligible for Medicaid (or certain other medical assistance programs), you will receive in the mail a packet of information about the different MCO plan options for receiving your Medicaid benefits. You may choose any plan described in this mailing. You probably want to choose a Managed Care Organization (MCO) to which your doctor belongs. If you need help making this decision, call the Health Benefit Manager at the phone number in the mailing.
Q. What if I don’t choose a Managed Care Organization?
A. Medicaid benefits are provided through a Managed Care Organization (MCO). If you do not choose an MCO in the time allotted, the Health Benefit Manager will assign you to one. However, it is best if you choose your own Managed Care Organization.
Q. How long will my Medicaid benefits remain active?
A. Medicaid is based on month to month eligibility. However, your benefits are redetermined on a yearly basis by DMMA to confirm whether you still remain eligible for the program you are receiving. Certain Medicaid programs require you to report changes in your situation within 10 days of the change. One example of a change that must be reported is new employment.