Delaware Medicaid / Diamond State Health Plan Plus Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. This article focuses on Delaware Medicaid Long Term Care, which is also called Diamond State Health Plan Plus and will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. These programs are different from regular Medicaid, which is for financially limited people of all ages.

 

Delaware Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Delaware Medicaid will cover the cost of long-term care in a nursing home for financially limited Delaware seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

  • Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
  • Skilled nursing care
  • Physician’s visits
  • Prescription medication
  • Medication management
  • Mental health counseling
  • Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

Delaware Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover the nursing home expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $50/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

Delaware Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

 

Home and Community Based Services (HCBS) Waivers

Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports that help financially limited Delaware seniors who are at risk of being placed in a nursing home remain living in the community instead of moving to a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for Delaware residents who live in their home, the home of a loved one, an adult foster care home, a residential care home or an assisted living facility. While Delaware’s HCBS Waivers will cover some long-term care services and supports in those settings, it will not cover room and board costs.

Delaware residents can receive HCBS benefits through the state’s Long Term Care Community Services (LTCCS) program.

Long Term Care Community Services
Delaware’s Long Term Care Community Services (LTCCS) program provides services and supports to Delaware Medicaid recipients who live in the community but are at risk of nursing home placement. LTCCS program participants can live in their own home, the home of a loved one, an adult foster care home, a residential care home or an assisted living facility. While LTCCS can cover some long-term care benefits in those settings, it will not pay for room and board costs such as mortgage payments, rent, utility bills and food expenses.

LTCCS program long-term care benefits include adult day care, home modifications, housekeeping services, specialized medical equipment and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). The state will supply a licensed caregiver to provide these benefits, but the program participant can also self-direct some of the LTCCS benefits (like personal care assistance and housekeeping services) by hiring caregivers of their choice, including friends, spouses and other family members.

These benefits will be made available depending on each individual’s needs and circumstances. Any Delaware resident who receives LTCCS benefits will also be enrolled in Diamond State Health Plan Plus (DSHP+). This is a mandatory managed care program that will also provide all of the Delaware Medicaid beneficiary’s medical and behavioral health benefits.

Unlike most HCBS Waivers, Delaware’s Long Term Care Community Services (LTCCS) program is an entitlement. This means that all eligible applicants are guaranteed by law, aka entitled, to be accepted into the program and to receive benefits.

 

Aged, Blind, and Disabled Medicaid

Delaware’s Aged, Blind and Disabled (ABD) Medicaid, which may also be called the Diamond State Health Plan, provides basic healthcare coverage and long-term care services and supports to financially limited Delaware residents who are aged (65 and over), blind or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for low-income people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive the benefits without any wait.

1. ABD Long Term Care Benefits
Eligible Delaware seniors who show a medical need for long-term care services can receive those services through ABD Medicaid. These benefits can include in-home personal care, adult day care, meal delivery, home modifications and Personal Emergency Response Systems (PERS). ABD Medicaid recipients qualify for these benefits one at a time. This is different from Nursing Home Medicaid, which makes all of its benefits immediately available for anyone who qualifies. Instead, Delaware seniors will be evaluated by the state to determine what kind of long-term care benefits they need and will receive.

2. Living Independence for the Elderly (LIFE)
Delaware residents who are age 55+ and have ABD Medicaid can cover their medical, social service and non-medical personal needs with one comprehensive plan and delivery system using the Living Independence for the Elderly (LIFE) program. The program is also known as Program of All-Inclusive Care for the Elderly (PACE). LIFE/PACE program participants are required to need Nursing Facility Level of Care, but they must live in the community and a LIFE/PACE center must be available in that community. Delaware’s LIFE/PACE programs can be used by people who are “dual eligible” for Medicaid and Medicare, and it will coordinate the care and benefits from those two programs into one plan. LIFE/PACE also administers vision and dental care, and LIFE/PACE day centers provide meals, social activities, exercise programs and regular health checkups and services to program participants. The Delaware LIFE/PACE centers are located in Milford (PACE Your LIFE) and Wilmington (Saint Francis LIFE). To learn more about LIFE/PACE, click here.

 

Eligibility Criteria For Delaware Medicaid Long Term Care Programs

To be eligible for Delaware Medicaid and the state’s Long Term Care Community Services (LTCCS) program, a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

  Just For You: The easiest way to find the most current Delaware Medicaid eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.

 

Delaware Nursing Home Medicaid Eligibility Criteria

Financial Requirements

Delaware residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through Delaware Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for a single applicant is $2,357.50/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Delaware Nursing Home Medicaid beneficiaries must give most of their income to the state to help cover the nursing home expenses. They are only allowed to keep $50/month of their income as a “personal needs allowance,” plus enough to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially limited, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for nursing home coverage through Delaware Medicaid is $3,000 combined, and the income limit is a combined $4,570/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,357.50/month for the applicant, and the income of the non-applicant spouse is not counted.

  Plan Ahead: There are alternative pathways to eligibility for Delaware Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Delaware has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for nursing home coverage through Delaware Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that can only be provided in a nursing home. The state will administer a functional assessment of applicants to determine if they do require a NFLOC. An applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, and laundry), as well as their cognitive function, are taken into consideration.

 

Delaware Home and Community Based Services (HCBS) Waivers Eligibility Criteria

Financial Requirements
Delaware residents have to meet an asset limit and an income limit in order to be financially eligible for Home and Community Based Services (HCBS) Waivers. For a single applicant in 2024, the asset limit for HCBS Waivers in Delaware is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for a single applicant is $2,357.50/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for HCBS Waivers in Delaware is $3,000 combined, and the income limit is $4,570/month combined. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

  Plan Ahead: There are alternative pathways to eligibility for Delaware HCBS Waivers applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Delaware has a Look-Back Period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Home and Community Based Services (HCBS) Waivers through Delaware Medicaid is being at risk of nursing home placement. To determine if HCBS Waiver applicants are at risk of nursing home placement, Delaware’s Division of Medicaid & Medical Assistance Pre-Admission Screening team will conduct a functional assessment. Applicants who need help with at least one of the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) are considered to be at risk and meet the functional criteria for HCBS Waivers in Delaware.

 

Delaware Aged, Blind, and Disabled Medicaid Eligibility Criteria

Financial Requirements
Delaware residents have to meet an asset limit and an income limit in order to be financially eligible for Aged, Blind, and Disabled (ABD) Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for a single applicant is $943/month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.

For married applicants, the 2024 asset limit for Delaware ABD Medicaid is $3,000 combined, and the income limit is $1,415/month combined. This applies to married couples with both spouses applying or with just one spouse applying.

  Plan Ahead: There are alternative pathways to eligibility for Delaware ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While Delaware has a Look-Back Period of five years for Nursing Home Medicaid and HCBS Waivers applicants to make sure they don’t give away their assets to get under the limit, the Look-Back Period does not apply to ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, or an HCBS Waiver, and those programs will deny or penalize the applicant for giving away assets.

Functional Requirements
The only functional requirements to receive basic healthcare coverage through Delaware ABD Medicaid are being aged (65 or over), blind, or disabled. For ABD Medicaid applicants who require long-term care services and supports, Delaware Medicaid will conduct an assessment of their ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications) to determine what kind of benefits the applicant needs and the state will cover.

 

How Delaware Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

  • If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
  • If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
  • If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.

These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status.

Nursing Home Medicaid applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Delaware and how you can protect your home from it, click here.

 

Applying For Delaware Medicaid Long Term Care Programs

The first step in applying for Delaware Medicaid Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

The second step is determining if you or your loved one meets the financial and functional criteria, also discussed above, for that program. Applying for Delaware Medicaid when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Delaware Medicaid applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Delaware residents can apply for Medicaid online at Delaware ASSIST. Or they can begin the application over the phone or in person by contacting their local Delaware Health and Social Services office.

For a comprehensive guide that will take you through the application process for all three types of Medicaid Long Term Care, click on the program you want: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

 Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.

Choosing a Delaware Medicaid Nursing Home

After being approved for nursing home coverage through Delaware Medicaid, you or your loved one needs to choose which Medicaid-accepting nursing home best meets your needs. Even though Nursing Home Medicaid is an entitlement, not all nursing homes accept Medicaid, and those that do might not have any available spaces. Finding the right nursing home can be a task, especially if you live in a small state like Delaware.

There are approximately 40 nursing homes in Delaware that accept Medicaid. About a dozen are located in Wilmington, and there are five more facilities in nearby Newark. The southern part of the state has fewer options, with nine nursing homes spread out from Lewes on the coast to Delmar in the southwest corner.

Residents in many Delaware communities may cross state lines regularly into New Jersey, Pennsylvania and Maryland for personal and business reasons, including healthcare. Medicaid coverage, however, does not cross state lines. So anyone with Delaware Nursing Home Medicaid will not be covered in a nursing home in Philadelphia, for example, or Denton, Maryland, even if those facilities might be more convenient than any in Delaware.

  TOOLS: Delaware residents can find a licensed nursing home near them using Nursing Home Compare, which is a federal government website that has information about more than 15,000 nursing homes across the country. They can also use this Delaware Health and Social Services webpage.

Once you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by overall rating, health inspections, staffing and quality measures, which can be a helpful place to start. The healthcare professionals who work with you are a great resource. And the Delaware Aging & Disability Resource Center is another good source of information.

After doing your research, you or someone you trust should also visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive prepared with a list of questions. Some things you might ask are: Does the residence coordinate social activities? Does it provide transportation? What are the meals like? How will the residence provide access to oral and eye care? Who are the staff doctors? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

According to data from the Centers for Medicare & Medicaid Services (CMS), there are 41 nursing homes in Delaware that accept Medicaid. An impressive 13 of them received five-star overall rating, the best possible score, which is based on health inspections, staffing, quality measures and more. Another 7 Delaware nursing homes received four-star ratings. However, CMS data also showed that Delaware nursing homes averaged 39.2 health deficiencies that led to citations from 2019-2022, which was well above the national average of 25.7.