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Children with Medical Complexity

Self-Directed Attendant Care for
Children and Medicaid Pediatric Respite Services

On March 6, 2024, Delaware Health and Social Services, Division of Medicaid and Medical Assistance (DMMA) hosted a Virtual Town Hall meeting to discuss the Medicaid self-directed attendant care (SDAC) benefit for children and the Medicaid respite service for children.

Effective January 1, 2023, the Delaware Health and Social Services (DHSS), through the Medicaid program, began providing coverage of a self-directed option for parents on behalf of children receiving personal care services as well as respite services for children.  The self-directed option gives families the flexibility to hire, for example, a neighbor, friend, or family member, including a legally responsible family member as the service provider.

Please click the link below for registration information:

Virtual Town Hall Meeting - March 2024

See the links below for more information:

In compliance with Budget Epilogue Section 141 of the State of Delaware’s Legislature, 149th Generally Assembly’s act making appropriations for the expense of the State Government for the fiscal year ending June 30, 2018; specifying certain procedures, conditions and limitations for the expenditure of such funds; and amending certain pertinent statutory requirements [House Substitute No. 1 (HS1) for House Bill No. 275 (HB275)], Delaware Health and Social Services (DHSS) / Division of Medicaid and Medical Assistance (DMMA) has published a comprehensive plan for children with Medical Complexity.   CLICK HERE TO ACCESS RESOURCES FOR FAMILIES, PROVIDERS, AND OTHERS INVOLVED IN THE CARE OF CHILDREN WITH MEDICAL COMPLEXITIY

Identifying Children with Medical Complexity – A Working Definition

Children with medical complexity are a subset of children and youth with special health care needs because of their extensive health care utilization. For the purpose of this work, a child is considered medically complex if she/he falls into two or more of the following categories:

  • Having one or more chronic health condition(s) associated with significant morbidity or mortality;
  • High risk or vulnerable populations with functional limitations impacting their ability to perform Activities of Daily Living (ADLs);
  • Having high health care needs or utilization patterns, including requiring multiple (3 or more) subspecialties, therapists, and/or surgeries;
  • A continuous dependence on technology to overcome functional limitations and maintain a basic quality of life.

The Children with Medical Complexity Steering Committee developed this broad definition of children with medical complexity to aid in the development of a Delaware’s Plan for Managing the Health Care Needs of Children with Medical Complexity, as well as to assist in the work this group is continuing to embark on. This definition is not intended to serve as the basis for denying or authorizing care and/or payment for care for children served through the Delaware Medicaid Program.


Children with Medical Complexity Advisory Committee (CMCAC)

During development of Delaware’s Plan for Managing the Health Care Needs of Children with Medical Complexity (the Plan), it became evident early in the planning process that there would not be enough time to perform an in-depth analysis of the full continuum of care for children with medical complexity.  The data needed to perform a quantitative analysis is very detailed and complex.  Therefore, the first recommendation made as a result of the Plan development, was for DMMA to continue working with stakeholders to address the needs of this vulnerable population.  As a result, the Children with Medical Complexity Advisory Committee (CMCAC) was developed.  This group meets quarterly to strengthen the system of care, increase collaboration across agencies, encourage community involvement, and ultimately ensure that every child with medical complexity has the opportunity to receive the adequate and appropriate health care services they need and deserve.  These meetings are open to the public; all meeting dates, times, and locations will be posted on the State’s public meeting calendar at


CMCAC Charter and Guiding Principles


CMCAC Priorities


CMCAC Annual Reports


CMCAC Ad-Hoc Reports

CMCAC Meeting Agendas and Minutes

January 9, 2024

October 10, 2023

July 11, 2023

April 11, 2023

February 14, 2023

October 11, 2022

April 12, 2022

January 25, 2022

October 12, 2021

July 13, 2021

April 13, 2021

January 12, 2021

November 2, 2020

July 15, 2020

April 15, 2020

January 15, 2020

October 16, 2019

July 17, 2019

April 17, 2019

January 16, 2019

October 4, 2018

Strengthening Health Care Delivery Systems for Children with
Special Health Care Needs and the Role of Quality Measurement

As more states serve Children and Youth with Special Health Care Needs (CYSHCN) in Medicaid managed care, it is important to understand the unique needs of CYSHCN and how program and policy changes impact their access to high quality care. Delaware participated in a National Academy for State Health Policy (NASHP) learning collaborative focused on improving Medicaid managed care for CYSHCN. The link below will lead you to a webinar with presenters from Delaware, Rhode Island, and Massachusetts, who recently participated in this learning collaborative.

Improving Care for Children with Complex Medical Needs

DMMA Director Stephen Groff participated in an Alliance for Health Policy public briefing with other panelists to discuss factors that influence the quality, affordability, and accessibility of care for children with complex medical needs.