The Division of Substance Abuse and Mental Health (DSAMH) offers a variety of Long-Term Care programs ranging from residential treatment to community Continuum of Care services. Long-term care services are for adults (age 18 years and older) with severe and persistent behavioral health disorders who meet disability, duration of illness, and diagnostic criteria.
Clinical eligibility
To be clinically eligible for enrollment into the DSAMH Long-Term Care system, an individual must be:
- 18 years of age or older; and
- A U.S. citizen or have a legal resident alien status; and
- A resident of the State of Delaware; and
- Present a history of having received intensive behavioral health treatment in one or more community or institutional programs including: Delaware Psychiatric Center; DSAMH Continuous Treatment Team programs; group homes, and long-term residential substance abuse treatment facilities; and/or
- Present a history of having had multiple alcohol and other drug detoxification admissions and/or multiple intensive substance abuse treatment episodes.
Special eligibility determinations will be made for adults with developmental disabilities/mental retardation who have a severe and persistent behavioral health disorder and are in the upper mild range of mental retardation (317.0).
Recovery-supportive, community-based treatment
Contracted Assertive Community Treatment (ACT) and Intensive Case Management (ICM) teams provide a comprehensive array of supports that include: clinical and rehabilitation services, employment and educational rehabilitation and supports, 24/7 crisis response, full-time psychiatrists, housing assistance, employment help, coordination of care with other community providers such as medical doctors, and supports for families. The team approach allows individuals to remain within one service system in which all services are coordinated by the same staff.
What insurance coverage do I need to receive Long-Term Care services?
The LTC System provides services for: individuals enrolled in Medicaid; individuals with dual eligibility of Medicaid and Medicare; individuals with Medicare only coverage; individuals without insurance coverage; and those with limited insurance coverage.
How do you determine if I qualify for a residential treatment or a Community Continuum of Care program?
DSAMH will evaluate the need for these services based on a variety of criteria, such as diagnosis, history of mental illness and/or substance abuse, history of previous hospitalizations, and ability to successfully function independently in the community. DSAMH will monitor authorized services, periodically reviewing how well the program is meeting the needs of the individual to determine if additional services are required from the long-term care provider, or if the individual could be better served in a less-intensive service setting.
What types of housing programs are available?
DSAMH and its treatment providers help clients access a variety of housing programs throughout the state to assist individuals in recovery from serious mental illness with short- and long-term housing solutions. Access to, and eligibility for, supportive housing, including group homes, supervised apartments and residential treatment facilities for individuals with co-occurring mental health and/or substance abuse conditions is managed through the DSAMH Eligibility and Enrollment Unit.
What is Delaware’s approach to Community-Based Behavioral Health and Recovery Support programs?
Delaware’s takes a comprehensive, integrated recovery approach to working with people diagnosed with severe and persistent mental illness and, sometimes, a co-occurring substance use problem. By partnering with those using the service, provider staff help individuals identify goals that are meaningful in their recovery. ACT and ICM teams provide a comprehensive array of supports that includes: clinical and rehabilitation services, employment and educational rehabilitation and supports, 24/7 crisis response, full-time psychiatrists, housing assistance, employment help, coordination of care with other community providers such as medical doctors, and supports for families. Our team approach allows individuals to receive all services coordinated by the same staff.
How do I apply for Long-Term Care services?
A provider should complete this Eligibility and Enrollment application and return it via the Delaware Treatment and Referral Network to DSAMH_EEU@delaware.gov or by fax to 302-622-4168. For more information, call the DSAMH Eligibility and Enrollment Unit at 302-255-9399.
What if my provider or I need more information on the Eligibility and Enrollment process for Long-Term Care services?
The Eligibility and Enrollment Unit Procedures for detailed information about clinical eligibility, determination denials and appeals, enrollment, utilization review, transfers between providers, annual redetermination, requests for redetermination, redetermination denials and appeals and disenrollment. You may also call the DSAMH Eligibility and Enrollment Unit at 302-255-9399.
