Delaware Medicaid

Medicaid furnishes medical assistance to eligible low-income families and to eligible aged, blind and/or disabled people whose income is insufficient to meet the cost of necessary medical services. Medicaid pays for: doctor visits, hospital care, labs, prescription drugs, transportation, routine shots for children, mental health and substance abuse services. Apply for Medicaid.

• Delaware Medicaid providers may access the Delaware Medical Assistance Provider manual at: https://medicaid.dhss.delaware.gov/.

Eligibility

• You can have a car, bank account, and a home and still qualify for Medicaid. DMMA does not look at any of your resources when determining your eligibility for Medicaid.
• You can work and still qualify for Medicaid.
• Some persons can have other insurance and still receive Medical Assistance.
• Low-income uninsured adults between the ages of 19 and 65 may qualify for Medicaid.
• Certain children living with stepparents, grandparents, or siblings with income may receive Medicaid.
• Needy families with children may be eligible for Medicaid if they are part of Temporary Assistance for Needy Families.
• When a family getting a welfare check starts working and leaves welfare they still may receive Medicaid.
• Low-income pregnant women and children under age 19 may qualify for Medicaid.
• Most women of child bearing age may be eligible for birth control and family planning services for up to 24 months after their regular Medicaid stops.
• You may qualify for retro-eligibility click Here!

Most people receiving Medicaid are enrolled with one of the managed care plans under the Diamond State Health Plan.

To apply for Delaware Healthy Children's Program click here.

 

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Diamond State Health Plan - Delaware's Medicaid Managed Care Program

The majority of people receiving Medicaid must choose a family doctor who, along with a managed care organization (MCO), will provide or arrange for all your preventive care and medical needs.  The following individuals are not enrolled with a MCO:

• Individuals entitled to or eligible to enroll in Medicare
• Individuals residing in a nursing facility or intermediate care facility for Individuals with Intellectual Disabilities (ICF/IID).
• Individuals covered under the Medicaid home and community based waiver programs.
• Non lawful and non qualified non citizens (aliens).
• Individuals who have military health insurance for active duty, retired military, and their dependents.
• Individuals eligible for the Medicaid Breast and Cervical Cancer program.
• Presumptively eligible pregnant women.

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Delaware Diamond State Health Plan (DSHP) 1115 Demonstration Waiver

Delaware's Diamond State Health Plan (DSHP) 1115 Demonstration Waiver was initially approved in 1995 and implemented beginning January 1, 1996. The DSHP 1115 Demonstration was designed to mandatorily enroll eligible Medicaid recipients into managed care organizations (MCOs) and create cost efficiencies in the Medicaid program that could be used to expand coverage.

• Delaware's DSHP 1115 Waiver Approval Letter 2024
• 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

As required by 42 CFR 431.408, DMMA must provide opportunity for public comment on proposed DSHP 1115 Waiver amendments, extensions, and renewals. The public is invited to review and comment on the proposed DSHP 1115 Waiver extension.

• Delaware's DSHP 1115 Waiver Approval Letter 2023
• Delaware's Proposed - DSHP 1115 Waiver Extension Public Notice November 2022
• Delaware's Final - DSHP 1115 Waiver Extension 2022
• Delaware's DSHP 1115 Demonstration Interim Evaluation 2022
• Delaware's DSHP 1115 SUD Demonstration Interim Evaluation 2022

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Delaware Diamond State Health Plan (DSHP) 1115 Demonstration Waiver 2022 Annual Report

In compliance with the Special Terms and Conditions of the Diamond State Health Plan (DSHP), Section 1115 Demonstration, the State of Delaware (Delaware Health and Social Services/Division of Medicaid and Medical Assistance (DMMA)) publishes this most recently approved Annual Report.

• Diamond State Health Plan 1115 Waiver 2022 Annual Report

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Delaware Diamond State Health Plan (DSHP) 1115 Demonstration Waiver Evaluation Design

In compliance with the Special Terms and Conditions of the Diamond State Health Plan (DSHP), Section 1115 Demonstration, the State of Delaware (Delaware Health and Social Services/Division of Medicaid and Medical Assistance (DMMA)) publishes this Approved Evaluation Design.

• Diamond State Health Plan 1115 Waiver Approved Interim Evaluation Report April 2024
• Diamond State Health Plan 1115 Waiver Approved Evaluation Design April 2024

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