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Long Term Care Medicaid Programs

Services

The Division of Social Services provides the following Long Term Care services:

The Nursing Facility Program

Individuals wishing to apply for this program should contact either the DSS PreAdmission Screening (PAS) unit in New Castle County or the DSS PAS unit in Kent and Sussex County .

An individual applying for the Nursing Facility program must be a Delaware resident and must be willing to enter a nursing facility and accept Medicaid coverage.

The medical criteria for this program are as follows: the applicant must be in need of skilled or intermediate level of care as defined by Delaware Medicaid criteria. In other words, the individual must require the level of care provided by a nursing facility. If his gross monthly income exceeds the income limit for this program (set at 250% of the Supplemental Security Income - SSI - standard), he will need to establish a Miller Trust in order to qualify. His assets cannot exceed $2,000, unless he has a spouse.

The program pays for the cost of care provided in nursing facilities in Delaware that have contracts with Delaware Medicaid. These nursing facilities provide room, board, and nursing services to persons who are elderly, infirm, or disabled.

Payment issues:

  • Medicaid may only pay for covered services after all other coverage has been exhausted. Examples of other coverage are Medicare, employment related health insurance, Union Health & Welfare Funds, workmen's compensation, and no-fault automobile coverage. This is based on Federal Regulation (42SFR 433 Subpart) and State Law (Medical Care Subrogaties Law - Chapter 5, Title 31, Section 52). When a recipient receives payment from an insurance carrier, court settlement, etc. for any medical services paid by Medicaid, the recipient is obligated to reimburse the program for those related services. All such cases must be referred to the Third Party Liability Unit at the Medicaid State Office.
  • A Medicaid nursing facility resident may keep $44.00 of his monthly income for his personal needs. This "Personal Needs Amount" is set by the Delaware Legislature. The rest of his income must be paid to the facility unless an amount has been protected for:
    • The needs of a community spouse under the Spousal Impoverishment provision,
    • medically necessary medical equipment and services not covered by Medicaid (e.g. eye glasses,  dentures, hearing aids...), and/or private health insurance premiums.
  • If a patient in a Medicaid enrolled nursing facility runs out of private funds and converts to Medicaid payment, the nursing facilitycannot discharge him if there is an available Medicaid certified bed.
  • Federal law prohibits nursing facilities from charging Medicaid residents or their families for items and/or services that are covered by Medicaid. Nursing facilities must provide a list of what items and services are included in the basic Medicaid rate and what items or services would require an extra charge.
  • Nursing facilities that accept Medicaid cannot ask Medicaid residents for contributions as a condition of admission or charge fees to supplement the Medicaid rate.

Medicaid nursing facility rates are based on  the facilities' annual costs reports .

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Last Updated: Friday November 09 2012
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