Delaware State Guide for Medicaid Waivers/HCBS Care Coverage Benefits
Learn how Delaware’s Medicaid Waivers support in-home dementia care, providing families with peace of mind and access to essential daily support.
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Tendly Home Key Takeaways
Discover how Delaware’s Medicaid Waivers offer crucial support for individuals needing in-home dementia care:
- 🏠 Delaware’s Home and Community-Based Services (HCBS) waivers help seniors with dementia receive essential care at home, reducing reliance on institutional facilities.
- 🧾 These waivers cover services like personal care, respite support, meal delivery, and home modifications to ensure safety and independence.
- 👵 Eligible individuals must meet both financial and medical criteria, aiming to support lower-income seniors with significant care needs.
- 🤝 Care coordination is a key feature, connecting families with case managers to develop and manage personalized care plans.
- 💡 By offering comprehensive assistance, Delaware’s Medicaid options empower families to provide ongoing, dignified care for loved ones with dementia.
Navigating the complexities of long-term care for a loved one can be emotionally overwhelming and financially stressful. Whether you're a parent caring for a child with disabilities, a spouse supporting an aging partner, or a caregiver helping someone with chronic health needs, finding the right support system is crucial. In Delaware, the Medicaid Waivers and Home and Community-Based Services (HCBS) programs offer a lifeline—giving families the resources they need to provide dignified, compassionate care without institutionalization.
This guide is your comprehensive resource for understanding how Medicaid Waivers and HCBS work in Delaware. From eligibility and covered services to application steps and helpful contacts, we break everything down in clear, accessible language. If you're trying to care for someone at home—or you're planning for future needs—this guide can help you take confident steps toward securing reliable and compassionate care in The First State.
When people hear “Medicaid,” most think of basic health coverage. But for those with long-term care needs, traditional Medicaid often isn't enough. That's where Medicaid Waivers and HCBS programs come in. These programs are designed to provide more flexible, patient-centered care outside of hospital or nursing home facilities.
In Delaware, the Division of Medicaid and Medical Assistance (DMMA) oversees these waiver programs. The goal is simple: help eligible individuals receive medical and supportive services in their homes or community settings rather than in institutional environments.
The primary waiver program in Delaware is called the “Diamond State Health Plan Plus (DSHP Plus).” This program incorporates long-term services and supports (LTSS) through managed care organizations and is open to individuals who are eligible for both Medicaid and long-term care assistance. Services can include home health aides, adult day care, respite for caregivers, and even minor home modifications like wheelchair ramps.
Delaware also participates in specific HCBS waivers targeted to meet the needs of specialized populations, such as the Developmental Disabilities Services Waiver or the Assisted Living Waiver. These waivers fund essential services that standard Medicaid doesn’t typically cover, like caregiver training and transportation for non-medical needs.
The importance of these programs cannot be overstated. They allow people—young and old, with physical or developmental disabilities—to live more independently, maintain social connections, and enjoy a higher quality of life. At the same time, they offer essential emotional and financial relief to families and caregivers.
Understanding how these waivers function is key to accessing them. A common misconception is that you must be in dire circumstances to apply, but many who qualify are everyday people providing at-home care for loved ones with chronic conditions. Whether you’re already in the middle of caregiving or just starting to research options, understanding Delaware’s waiver programs is a vital first step.
Eligibility for Medicaid Waivers and HCBS programs in Delaware depends on a combination of financial, medical, and sometimes functional criteria. Understanding the requirements can make the difference between a successful application and unnecessary delays.
To begin with, applicants must meet the basic eligibility requirements for Delaware Medicaid: limited income, limited assets, and proof of state residency. For individuals who require long-term services and supports—like in-home care or community-based programs—the state uses a detailed assessment process to determine medical necessity.
Financial limits tend to change yearly, but as of 2024, individuals must earn no more than approximately $2,742 per month in income and have countable assets below $2,000. For married couples, these numbers vary, especially if one spouse is applying for care while the other remains healthy (thanks to spousal impoverishment protections, which ensure the non-applicant spouse retains enough resources to survive).
Once financial eligibility is determined, the state assesses your or your loved one’s level of care needed. This assessment is done through a Pre-Admission Screening (PAS), administered by state-contracted professionals. The screening evaluates things like mobility, cognition, daily living tasks (bathing, dressing, eating), and medical history. The goal is to establish whether the person would otherwise require institutional care, such as nursing home placement—because that's the benchmark for determining eligibility for home-based alternatives.
In addition to the DSHP Plus waiver, Delaware also offers specialized options for people with particular conditions. For example:
- Children with developmental disabilities may qualify for supports through the Division of Developmental Disabilities Services (DDDS), which offers its own assessment and approval processes.
- Older adults with moderate needs may qualify for lighter-touch services through the Delaware State Plan LTSS programs, even if they don’t meet strict institutional care requirements.
It’s important to note that slots for certain waiver programs can be limited. However, Delaware has made efforts in recent years to reduce waitlists through expanded managed care and streamlined application systems. Starting the process early—and with a complete, accurate application—can greatly improve your chances of timely approval.
Don’t get discouraged by the paperwork. Many families find that while the eligibility process is rigorous, it’s manageable with the right support and information. And the reward—access to genuinely helpful, life-enhancing care—is more than worth it.
Once eligibility is established, the next big question is: What services are actually covered? Fortunately, Delaware’s approach to Medicaid Waivers and HCBS is broad and person-centered, designed to customize care based on individual needs.
Under the DSHP Plus program, Delaware uses managed care organizations (MCOs)—currently AmeriHealth Caritas Delaware and Highmark Health Options—to deliver services under an integrated care model. These MCOs work with families to develop individualized care plans, monitor progress, and coordinate necessary services.
Covered services can include:
- Personal care assistance: For help with bathing, dressing, toileting, and grooming.
- Skilled nursing: For in-home medical care, including medication administration, wound care, or chronic disease management.
- Adult day programs: Offering social engagement alongside medical oversight for those who can live at home but need daytime supervision.
- Respite care: Temporary relief for family caregivers, which can range from a few hours to several days.
- Home modifications: Such as installing grab bars, stair lifts, or wheelchair ramps to improve safety and accessibility.
- Transportation: To and from medical appointments or community programs.
- Case management: To ensure services are cohesive, accessible, and responsive to changing needs.
For populations served under the Developmental Disabilities Services Waiver, additional supports may be available, including behavior therapy, job coaching, and transition services for young adults moving from school to independent living.
One standout feature of Delaware’s HCBS model is the option for self-direction. This means eligible recipients or their families can choose to hire and manage their own care providers—sometimes even paying family members to offer care (a deeply valued flexibility among many households).
Families also benefit from Delaware’s emphasis on integrated care. For those receiving both Medicare and Medicaid (often called “dual eligibles”), DSHP Plus coordinates services across both programs, reducing duplication, billing headaches, and coverage gaps.
The range of covered services makes these programs not just an alternative to institutional care, but often a more attractive, personalized solution. With the right supports in place, many people can thrive at home—staying connected to loved ones, preserving independence, and enjoying a higher quality of life.
Applying for Medicaid Waivers or HCBS assistance in Delaware involves several key steps, but knowing what to expect can make the process much smoother. Whether you’re applying for yourself or a loved one, the path typically includes eligibility screening, documentation, interviews, and follow-up assessments.
Step 1: Apply for Medicaid.
Start by applying through the Delaware ASSIST website (https://assist.dhss.delaware.gov/). This platform is your central application portal for Medicaid and other public assistance programs, including food and cash benefits. If you're already enrolled in Medicaid, you can skip to the next step.
Step 2: Request a Health Screening.
For long-term care services, including those under the DSHP Plus waiver, a Pre-Admission Screening (PAS) is required. You—or a caseworker—can initiate this by contacting the Delaware Aging and Disability Resource Center (ADRC) at 1-800-223-9074. Be prepared to provide medical documentation and a detailed explanation of the care needs.
Step 3: Choose a Managed Care Plan.
Assuming eligibility is approved, you'll need to enroll in one of Delaware’s participating Managed Care Organizations: AmeriHealth Caritas Delaware or Highmark Health Options. These organizations will assign a care coordinator to help develop an individualized plan that fits your needs.
Step 4: Review and Begin Services.
After enrollment and approval, services can begin—often within weeks of finalizing the care plan. Your assigned coordinator will help you understand what services are covered, how to schedule them, and who to contact if needs change.
For specialized waiver programs, such as those offered through the Division of Developmental Disabilities Services (DDDS), a separate application must be initiated. Contacting the DDDS at (302) 744-9600 can help begin this process. Note that children, in particular, may be subject to different pathways and waiting lists, though Delaware has made efforts to minimize delays through early screening at school or pediatric levels.
One final piece of advice: Document everything. Keep copies of medical evaluations, financial documentation, and communications with state agencies or MCOs. Being organized not only simplifies the process but gives you peace of mind during a stressful time.
Applying for Medicaid Waivers and HCBS support can feel overwhelming, especially when you’re already emotionally stretched. But you don’t have to go it alone—local advocacy groups, healthcare providers, and the ADRC are ready to guide you every step of the way.
Caring for a loved one is a responsibility filled with deep love, but it can also bring exhaustion, confusion, and worry—especially when it comes to financing and coordinating long-term care. Thankfully, Delaware’s Medicaid waiver and HCBS programs offer practical, affordable, and compassionate solutions for families just like yours. From assisting elders with mobility to empowering young adults with disabilities to live with independence, the support available is both diverse and life-changing.
Understanding these programs takes time, but once you’re equipped with the right information, you’ll find that support is within reach. You’re not alone—and your family’s well-being is worth the time it takes to explore these options fully.
Take the first step today: apply through Delaware ASSIST, call the ADRC, or reach out to a local care advocate. Your journey toward dignified, empowering care doesn’t have to wait.
Frequently Asked Questions
To qualify for a Medicaid waiver in Delaware, individuals must meet both general and program-specific criteria. Generally, applicants must be Delaware residents, U.S. citizens or qualified non-citizens, and meet financial requirements related to income and assets. Additionally, the applicant must require a level of care typically provided in a nursing home or institutional setting. Each waiver program, such as the Elderly and Disabled Waiver or the Developmental Disabilities Waiver, may have its own specific clinical and functional criteria. It’s important to provide medical documentation and undergo an assessment to determine eligibility.
To qualify for Medicaid waivers or Home and Community-Based Services (HCBS) in Delaware, individuals must meet certain income, asset, and functional need criteria. Typically, applicants must be Delaware residents, U.S. citizens or qualified immigrants, and require a level of care usually provided in a nursing facility. For financial eligibility, there are income and asset limits that vary by waiver type, but many individuals may qualify through Delaware’s "waiver income trust" if they exceed income thresholds. Additionally, a medical or functional assessment is required to confirm the need for HCBS support.
Delaware HCBS waivers offer a broad range of services that help individuals live independently in their homes or communities instead of in institutional settings. Covered services often include personal care, skilled nursing, case management, home modifications, respite care, and adult day services. The specific services available depend on the waiver program an individual is enrolled in, such as the Diamond State Health Plan Plus or the Lifespan Waiver for individuals with developmental disabilities.
To apply for a Medicaid waiver in Delaware, individuals should first contact the Division of Medicaid & Medical Assistance or the applicable agency handling the specific waiver, such as the Division of Services for Aging and Adults with Physical Disabilities. An initial screening will assess eligibility, including income, assets, and care needs. If the individual appears eligible, a more comprehensive application and assessments will be required. It is recommended to gather all supporting documents and be prepared for an in-home evaluation or interview.
Yes, some Medicaid waiver programs in Delaware may have waiting lists, particularly those that serve people with intellectual and developmental disabilities or individuals requiring extensive in-home supports. The availability of services often depends on state funding and the number of waiver slots approved by the Centers for Medicare & Medicaid Services (CMS). Even if a person is eligible, they may be placed on a waitlist until an opening becomes available. It's advisable to apply early and maintain contact with the administering agency for updates.
Home and Community-Based Services (HCBS) Medicaid waivers in Delaware are designed to provide long-term care supports in a person’s home or community setting rather than in institutions like nursing homes. While both HCBS and institutional care require a similar level of medical need, HCBS offers greater flexibility by tailoring services to help individuals maintain independence and quality of life in more integrated settings. Institutional Medicaid, by contrast, typically involves full-time care in a licensed facility with less personal autonomy.
Dr. Alan Lee is a board-certified geriatrician specializing in neurodegenerative conditions including Alzheimer’s disease, Parkinson’s, and Lewy Body dementia. With more than two decades in clinical practice and research, Dr. Lee is a trusted authority in personalized care planning for aging adults. He serves as a medical reviewer for several national caregiving organizations and frequently lectures on aging in place and ethical dementia care.
Emily Sanders is a Dementia Practitioner and educator who trains in-home caregivers and family members in person-centered dementia care. With a background in occupational therapy and caregiver training, Emily creates practical tools and care plans that improve everyday life for people living with Alzheimer’s and related conditions. She is passionate about preserving identity, dignity, and connection in home-based settings.
Maria Torres is a social worker with a focus on elder care, family systems, and caregiver mental health. She has worked in both hospice and community health settings and currently supports family caregivers navigating long-term care decisions. Maria brings an empathetic lens to her writing and advocates for proactive planning, emotional resilience, and equitable access to home care resources.
