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

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 Evaluation Design

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Delaware Diamond State Health Plan (DSHP) 1115 Demonstration Waiver Amendment

In compliance with the State's Administrative Procedures Act (APA - Title 29, Chapter 101 of the Delaware Code) and under the authority of Title 31 of the Delaware Code, Chapter 5, Section 512, Delaware Health and Social Services (DHSS) / Division of Medicaid and Medical Assistance (DMMA) intends to submit a request to the Centers for Medicare and Medicaid Services (CMS) to immediately amend Delaware’s Section 1115 Diamond State Health Plan (DSHP) Demonstration Waiver to address Medicaid coverage of substance use disorder (SUD) treatment services when provided in a setting that qualifies as an institution for mental diseases (IMD).

The purpose of this posting is to provide public notice and receive public input for consideration regarding Delaware's proposed 1115 Waiver Amendment.

• Delaware Section 1115 Waiver Approval
• Diamond State Health Plan 1115 Waiver Extension and Amendment – Full Public Notice
• Diamond State Health Plan 1115 Waiver Draft Substance Use Disorder Amendment
• Delaware's Current DSHP 1115 Waiver

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Delaware Diamond State Health Plan (DSHP) 1115 Demonstration Waiver Extension

In compliance with federal public notice requirements of 42 U.S.C. §1315(d) and 42 CFR Part 431, Subpart G, as well as the State's Administrative Procedures Act (APA - Title 29, Chapter 101 of the Delaware Code), and under the authority of Title 31 of the Delaware Code, Chapter 5, Section 512, DHSS / DMMA also gives notice of its intent to file an application with CMS to request a five year extension of the DSHP 1115 Demonstration Waiver, which is currently approved through December 31, 2018. The requested extension period is from January 1, 2019 through December 31, 2023. DHSS/DMMA is not currently requesting any changes to the DSHP 1115 Demonstration Waiver for the extension period, with the exception of the amendment described below.

The purpose of this posting is to provide public notice and receive public input for consideration regarding Delaware’s Diamond State Health Plan (DSHP) 1115 Waiver extension request.

• Diamond State Health Plan 1115 Waiver Extension and Amendment – Full Public Notice
• Diamond State Health Plan 1115 Waiver Draft Extension Request
• Delaware's Current DSHP 1115 Waiver

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Delaware 1115 Waiver Interim Evaluation Report-June 2018

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 Interim Evaluation Report. The report will be submitted to the Centers for Medicare & Medicaid Services (CMS). This evaluation reviews Delaware’s progress for the period of September 30, 2013 to December 31, 2017.

• Delaware 1115 Waiver Interim Evaluation Report-June 2018

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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.

• 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

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.