Delaware Medicaid, administered by the Delaware Health and Social Services (DHSS), is a health insurance program funded by federal and state dollars, providing medical and health-related services to low-income individuals, including children, pregnant women, parents, seniors, and disabled individuals.
This guide outlines the 2025 eligibility criteria, income limits, asset rules, and application process for Delaware Medicaid, based on federal and Delaware Division of Medicaid and Medical Assistance (DMMA) guidelines, with a focus on long-term care for seniors (aged 65+), as well as other eligibility groups.
Overview of Delaware Medicaid Programs
Delaware Medicaid offers coverage for various groups, with specific eligibility requirements based on income, assets, age, and medical needs. The main programs include:
- Institutional / Nursing Home Medicaid: An entitlement program covering nursing home care, hospitals, and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). Requires a Nursing Facility Level of Care (NFLOC).
- Home and Community Based Services (HCBS) Waivers: Non-entitlement programs with limited slots, offering services like in-home care, adult day care, and delivered meals to help seniors and disabled individuals avoid institutionalization. Programs like the Diamond State Health Plan Plus (DSHP-Plus) may have waiting lists.
- Regular Medicaid (Aged, Blind, and Disabled): Covers low-income elderly, blind, or disabled individuals, with less stringent medical requirements than long-term care programs.
- Medicaid for Children and Pregnant Women: Covers children up to age 19 and pregnant women with higher income limits through Delaware Healthy Children Program (DHCP).
- Medicaid for Adults (19–64): Covers low-income adults without dependent children, enabled by Delaware’s Medicaid expansion under the Affordable Care Act (ACA) since 2014.
Eligibility for Delaware Medicaid
Eligibility varies by program and population. General requirements include:
- Residency: Must be a resident of Delaware.
- Citizenship: Must be a U.S. citizen, national, permanent resident, or legal alien with qualifying immigration status (e.g., refugees, asylees, or lawful permanent residents with 5+ years in the U.S.).
- Income: Varies by program, often based on a percentage of the Federal Poverty Level (FPL) or Federal Benefit Rate (FBR).
- Assets: Limits apply for long-term care and aged/blind/disabled programs.
- Medical/Functional Need: Long-term care programs require a Nursing Facility Level of Care (NFLOC), assessed through limitations in Activities of Daily Living (ADLs) or Instrumental Activities of Daily Living (IADLs).
Categorical Eligibility
Individuals receiving Supplemental Security Income (SSI) or certain means-tested benefits are often categorically eligible for Regular Medicaid, bypassing some income and asset tests.
Income Limits for Delaware Medicaid
Income limits vary by program and household status. Below are the 2025 income limits for Delaware, based on federal guidelines and state policies, expressed as monthly amounts unless noted.
| Eligibility Category | Single | Married (Both Applying) | Children (0–18) | Pregnant Women | Adults (19–64, No Dependents) |
|---|---|---|---|---|---|
| Seniors/Disabled (Nursing Home/HCBS) | $2,901 (300% FBR) | $5,802 (300% FBR) | N/A | N/A | N/A |
| Regular Medicaid (Aged, Blind, Disabled) | $967 (100% FBR) | $1,450 (100% FBR) | N/A | N/A | N/A |
| ACA Expansion Adults (19–64) | $1,799 (138% FPL) | $2,432 (138% FPL) | N/A | N/A | $1,799 (138% FPL) |
| Children/CHIP (DHCP) | N/A | N/A | $2,787 (213% FPL) | N/A | N/A |
| Pregnant Women | N/A | N/A | N/A | $2,787 (213% FPL) | N/A |
Additional Notes on Income Limits
- Seniors/Disabled (Nursing Home/HCBS): Income above $2,901/month must go toward care costs, except for a Personal Needs Allowance ($50/month for nursing home, higher for HCBS), Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse. A Qualified Income Trust (QIT) can redirect excess income to meet eligibility.
- Married, One Spouse Applying: Applicant’s income limit is $2,901/month; non-applicant spouse’s income is not counted. The non-applicant may receive a Minimum Monthly Maintenance Needs Allowance (MMMNA) of up to $3,948/month if their housing and utility costs exceed $793.13/month (effective 7/1/25–6/30/26).
- Children/CHIP: Limits may extend to 213% FPL ($2,787/month for one) for DHCP.
- Pregnant Women: Coverage extends 12 months postpartum.
- ACA Expansion: Delaware’s Medicaid expansion covers adults aged 19–64 with incomes up to 138% FPL, closing the coverage gap for those without dependents.
2025 Federal Poverty Level (FPL) Guidelines for Reference (48 States & D.C.)
| Household Size | 100% FPL | 138% FPL | 213% FPL |
|---|---|---|---|
| 1 | $15,650 ($1,304/month) | $21,597 ($1,799/month) | $33,335 ($2,787/month) |
| 2 | $21,150 ($1,762/month) | $29,187 ($2,432/month) | $45,050 ($3,754/month) |
| 3 | $26,650 ($2,221/month) | $36,777 ($3,064/month) | $56,764 ($4,730/month) |
| 4 | $32,150 ($2,679/month) | $44,367 ($3,697/month) | $68,480 ($5,707/month) |
Note: Use the FPL Calculator to estimate your household’s FPL percentage.
Asset Rules for Delaware Medicaid
Asset limits apply primarily to long-term care and aged/blind/disabled programs.
Long-Term Care Medicaid (Nursing Home and HCBS Waivers)
- Single Applicant: $2,000 in countable assets (e.g., bank accounts, stocks, bonds, secondary properties).
- Married, Both Applying: $3,000 total.
- Married, One Applying: $2,000 for the applicant; $157,920 for the non-applicant spouse (Community Spouse Resource Allowance, or CSRA).
- Home Equity Limit: $730,000 for the primary residence (if applicant/spouse resides there or intends to return).
Non-Countable Assets
- Primary home (if applicant/spouse resides there or intends to return)
- One vehicle
- Household goods and personal effects
- Irrevocable Funeral Trusts
- Medicaid Compliant Annuities
- Life insurance with a face value of $1,500 or less
Medicaid’s Look-Back Rule
Delaware enforces a 60-month look-back period for Nursing Home Medicaid and HCBS Waivers, reviewing asset transfers within 5 years of application. Transfers below fair market value (e.g., gifting) may result in a penalty period of ineligibility. No look-back period applies for Regular Medicaid.
Estate Recovery
Delaware’s Medicaid Estate Recovery Program seeks reimbursement for long-term care costs after a beneficiary’s death, often targeting the home if not protected. Consult a Certified Medicaid Planner to safeguard assets.
Regular Medicaid (Aged, Blind, and Disabled)
- Asset Limit: $2,000 for an individual; $3,000 for a couple.
- No home equity limit or look-back period.
Medicaid for Children, Pregnant Women, and Adults (ACA Expansion)
- No Asset Test: These programs focus solely on income.
Medical/Functional Requirements
For Nursing Home Medicaid and HCBS Waivers, applicants must demonstrate a Nursing Facility Level of Care (NFLOC), assessed through:
- Limitations in Activities of Daily Living (ADLs): Mobility, bathing, dressing, eating, toileting.
- Limitations in Instrumental Activities of Daily Living (IADLs): Cooking, shopping, managing finances.
- Cognitive or Behavioral Issues: E.g., Alzheimer’s or dementia, though diagnosis alone does not guarantee eligibility.
Regular Medicaid for the aged, blind, or disabled requires proof of disability or blindness per Social Security Administration criteria but not necessarily NFLOC.
Changes Due to Federal Policy
As of 2025, federal policy changes may affect Medicaid, though Delaware’s expansion status mitigates some impacts:
- Work Requirements (Starting January 2027): May apply to ACA expansion adults (19–64) but not to seniors, disabled individuals, pregnant women, or children.
- Reduced Retroactive Coverage (Starting January 2027): Medicaid will cover only 2 months prior to application (down from 90 days), increasing potential medical debt for late applicants.
- More Frequent Eligibility Checks (Starting December 2026): Beneficiaries must renew eligibility every 6 months, requiring regular documentation to avoid coverage gaps.
- New Out-of-Pocket Costs (Starting October 2028): Non-exempt beneficiaries may face up to $35 per visit for specialist services or procedures, but primary care and preventive services remain free.
Options if Over the Income or Asset Limit
If your income or assets exceed the limit, consider:
- Qualified Income Trusts (QITs): Redirect excess income to meet limits for Nursing Home or HCBS Waivers. The trust is irrevocable, and Delaware Medicaid must be designated as the beneficiary upon the recipient’s death.
- Irrevocable Funeral Trusts (IFTs): Pre-paid funeral and burial expenses are exempt from asset limits.
- Spend Down: Convert countable assets into exempt ones (e.g., home repairs, purchasing a vehicle, or paying off debt).
- Certified Medicaid Planners: Professionals can help with financial strategies to achieve eligibility, such as Medicaid Compliant Annuities or asset restructuring.
Application Process
To apply for Delaware Medicaid:
- Online: Use the Delaware ASSIST portal at assist.dhss.delaware.gov. Check eligibility with the Medicaid Eligibility Calculator.
- Phone: Call the Delaware Medicaid Customer Relations at 1-800-372-2022 for assistance.
- In-Person or Mail: Complete and submit an application to a local DHSS Office. Download the application from dhss.delaware.gov.
- Assistance: Contact the Division of Medicaid and Medical Assistance or a local Area Agency on Aging for program-related questions. Call 1-800-223-9074 for long-term care support.
Required documents include proof of income, assets, residency, citizenship, and medical records (for long-term care or disability programs). An interview may be required.
Processing Time
- Standard applications: Up to 45 days (90 days for disability-based applications).
- Expedited processing: May apply for urgent cases (e.g., pregnant women via presumptive eligibility for outpatient care).
Frequently Asked Questions
How do I apply for Medicaid in Delaware?
Apply online at assist.dhss.delaware.gov, by phone at 1-800-372-2022, in person at a DHSS Office, or by mail with a downloaded application from dhss.delaware.gov.
What are the 2025 Medicaid income limits for Delaware?
For seniors/disabled (Nursing Home/HCBS), the limit is $2,901/month (single) or $5,802/month (couple). Regular Medicaid (aged, blind, disabled) is $967/month (single) or $1,450/month (couple). Children and pregnant women qualify up to 213% FPL ($2,787/month for one). ACA expansion adults qualify up to 138% FPL ($1,799/month for one).
Are there asset limits for Delaware Medicaid?
Yes, for long-term care and aged/blind/disabled programs: $2,000 (single), $3,000 (couple, both applying), or $157,920 for a non-applicant spouse. No asset tests for children, pregnant women, or ACA expansion adults.
What is the Medicaid look-back period in Delaware?
A 60-month look-back period applies to Nursing Home Medicaid and HCBS Waivers, penalizing asset transfers below fair market value. No look-back for Regular Medicaid.
Can I qualify for Medicaid if my income or assets are too high?
Yes, through Qualified Income Trusts (QITs), Irrevocable Funeral Trusts (IFTs), or spending down assets on exempt items. Consult a Certified Medicaid Planner for assistance.
How does Delaware’s Medicaid expansion affect eligibility?
Delaware’s ACA expansion since 2014 covers adults aged 19–64 with incomes up to 138% FPL, with no asset test, closing the coverage gap for those without dependents.
This guide is based on 2025 federal and Delaware Department of Health and Social Services guidelines. Verify details with the Delaware Medicaid program for accuracy.