The federal government, through Centers for Medicare and Medicaid Services (CMS), is requiring all states to conduct off-cycle screening and revalidation of providers in their networks by June 5, 2028. High Risk providers, as defined in CFR 42 C.F.R. § 455.450, will be prioritized in this effort and will be contacted first. This requirement is for Fee-for-Service (FFS) providers, Managed Care providers, and Managed Care-Only Providers (MCOPs).

Providers will be contacted if the following apply:

• The provider did NOT successfully revalidate June 6, 2025, through July 5, 2026. In other words, if the provider successfully revalidated between June 6, 2025, and July 5, 2026, they will not be asked to revalidate as part of this effort.
• The provider’s record(s) with Delaware Medicaid has incomplete, inaccurate, or outdated information.
• Additional information is required to complete the screening and revalidation effort.

Next steps for providers:

• Providers will receive a mailed letter from Delaware Medicaid before their revalidation date. The letter will include instructions, deadlines, and requirements.
• Providers MUST respond by the deadline listed in the notice. Failure to complete the screening and revalidation on time may affect ability to participate in Delaware Medicaid or receive payment for services.
• Moderate Risk and High-Risk providers have a site visit requirement as part of their screening and revalidation process. High Risk Providers have additional criminal fingerprint check and background check requirements. For more information, see 42 C.F.R. § 455.450.

Questions?

Contact the provider enrollment team, call 1-800-999-3371 (TTY 711) and select Option 0 followed by Option 4.