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Learn how Delaware is working to make health care better. You'll get a chance to discuss with a panel of experts the things that matter most to you. Like evening and weekend doctors' hours, making sure medications and medical records are tracked and managed, coordinating your care with a team, and even how your neighborhood can help you get and stay healthy. Learn More
A new opportunity available on our website. The Division of Medicaid & Medical Assistance (DMMA), under the direction of DHSS, has created a Medicaid/Children's Health Insurance Program (CHIP) Accountable Care Organization Program (Medicaid ACO Program) for the purpose of improving health outcomes while reducing costs through value based purchasing (VBP) arrangements which include downside financial risk for ACOs. The Medicaid ACO program is part of the strategies DMMA is pursuing to advance the adoption of participating Medicaid VBP models and total cost of care (TCOC) strategies. This Medicaid ACO Program builds off of the responses and information we received in response to a request for information on the design and development of Medicaid ACOs in Delaware.
The Medicaid ACO Program has been designed to allow qualified provider organizations to apply to become Medicaid ACOs and subsequently contract directly with our Medicaid managed care organizations (MCOs) in a TCOC payment arrangement. DMMA believes that by working together, Medicaid ACOs and MCOs can better coordinate care for Delaware's Medicaid and CHIP members, providing better health outcomes and lower costs. We have implemented the program pursuant to section 80000 of Division of Social Services Manual (DSSM), Authorization and Regulation of Medicaid/CHIP Accountable Care Organizations. Under the statutory authority of 42 CFR 438.6(c)(i) and 29 Del.C. 7931, this regulation sets forth standards for the authorization and regulation of ACOs for Medicaid/CHIP beneficiaries in the State of Delaware.
We encourage you to review the application and if interested/meet requirements, submit a completed application following the instructions provided within the application. The application period will close at 1:00pm ET on April 24, 2020. Additional information on the opportunity and program is available within the application. We are excited to work with you to implement our Medicaid ACO program beginning with the calendar year 2021 MCO contract period.
DE ACO Application Appendix Participating Primary Care Provider Template
Senate Substitute 1 for Senate Bill 92, enacted in 2019, directs the Division of Medicaid and Medical Assistance (DMMA) to establish an adult dental benefit. Adult dental coverage is optional for state Medicaid programs, but most offer at least an emergency dental benefit. It has been a long-standing priority of DMMA to offer preventive and restorative dental treatment for our adult population to address negative health outcomes associated with the lack of oral health care. The benefit will enable Medicaid-enrolled adults to receive up to $1,000 of dental care per year. An additional $1,500 may be available for qualifying emergency or supplemental care when medically necessary.
Unfortunately, we will be unable to meet the April 1, 2020, implementation date included in the legislation. We are working closely with the Centers for Medicare and Medicaid Services, but estimate an additional six months will be needed to receive all the necessary federal approvals and complete the subsequent administrative tasks necessary to begin the program. The projected implementation date is now October 1, 2020. The full benefit will be available upon the implementation of the program.
We apologize for the inconvenience this will cause to our beneficiaries who are waiting for these critically needed services and assure you that we will continue to move forward as quickly and expeditiously as possible.
We want to express our appreciation for the continued support and collaboration of Governor Carney, Lt. Governor Hall-Long, members of the General Assembly, the Dental Society, and other stakeholders.
If you have questions you can reach us by emailing: MedicaidInfo@delaware.gov
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. Apply for Medicaid | Learn about Medicaid
The Delaware Healthy Children Program (CHIP) features the same high-quality coverage you'd get with some of the best private insurance plans. Apply for CHIP | Learn about CHIP
Delaware Prescription Assistance Program has been reinstated as of January 1, 2019 and is currently accepting applications.
The Chronic Renal Disease Program (CRDP) was established to provide assistance to Delaware residents diagnosed with End Stage Renal Disease (ESRD). Contact our Office | Learn about CRDP
Customer Relations provides general information, referrals and assistance to DMMA and Division of Social Services applicants, clients, staff and others inquiring about Medicaid benefits and services. (302) 571-4900 or (866) 843-7212.
Provider Relations helps Delaware Medical Assistance Program (DMAP) Providers enroll in the Medicaid program, receive and respond to provider inquiries, verify client eligibility and aid in submitting electronic claims. (800) 999-3371.
The Delaware Aging and Disability Resource Center can help eligible individuals find dental care and many other services. If you need a dentist for a child, use this Dentist Locator to find a dentist near you who sees children and accepts Medicaid and CHIP.
Delaware's Medicaid state plan is an agreement between the state and the federal government that describes how Delaware administers its Medicaid program. The plan gives an assurance that the state will abide by federal rules and may claim federal matching funds for its program activities. The state plan sets out groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed and the administrative activities underway in the state.
Find monthly enrollment totals for Medicaid and CHIP plus other reports and information.
The Medicaid Health Benefits Manager helps you enroll in a Managed Care Organization (MCO) and understand your benefits and prescriptions. (800) 996-9969.
Customer Relations: (866) 843-7212
Provider Relations: (800) 999-3371
Health Benefits Manager: (800) 996-9969
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