Delaware Medicaid for Seniors & Long-Term Care

Per DMMA, the Nursing Facility Program income limit is set at 250% of the SSI income standard. If gross monthly income exceeds this limit, the applicant must establish a Miller Trust (Qualified Income Trust) to qualify. Assets cannot exceed $2,000 unless a community spouse is involved.

Delaware no longer runs a capped, waitlist-based HCBS waiver for its senior population. Instead, community-based long-term care for seniors and adults with physical disabilities is delivered through the Long Term Care Community Services (LTCCS) Program, part of the Diamond State Health Plan Plus (DSHP Plus) managed care system. Because LTCCS runs through managed care rather than a 1915(c) waiver with limited slots, it has no enrollment cap and no waiting list — anyone who meets the financial and level-of-care requirements can enroll. LTCCS can cover services such as adult day care, meal delivery, minor home modifications, respite care, personal emergency response systems, and personal care assistance, including self-directed care from a hired friend or relative.

A separate program, the Division of Developmental Disabilities Services (DDDS) Lifespan Waiver, offers community-based services as an alternative to nursing facility placement specifically for people who need an intermediate level of care for a developmental disability — this is a distinct pathway from LTCCS and is not the typical route for seniors without a developmental disability.

Delaware also operates a Community First Choice program, which provides personal attendant services to eligible Medicaid members — including people with disabilities who need help with activities of daily living. Community First Choice is a federal state plan option under Section 1915(k) that qualifies Delaware for an enhanced federal matching rate.

Contact DMMA at (866) 940-8963 (Central Intake Unit) to apply for nursing facility or community-based long-term care Medicaid.

Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. Exempt assets are not counted: the primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt, along with personal belongings and a prepaid funeral arrangement. Delaware enforces the federal 60-month (5-year) lookback period for asset transfers.

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse is entitled to keep a minimum amount of assets — the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income (the minimum monthly maintenance needs allowance, or MMMNA). The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility.

Delaware operates an estate recovery program. Per federal law and Delaware Code, DMMA may seek reimbursement from the estates of members who received nursing facility care, HCBS waiver services, or related services at age 55 or older. The family home is generally exempt during the lifetime of a surviving spouse or a blind or disabled child. Consult a Delaware elder law attorney before making asset transfers.

Delaware Medicaid covers skilled nursing facility care for seniors who meet clinical and financial criteria. Once approved, Medicaid pays the nursing home directly, and the resident contributes most of their monthly income toward the cost of care — typically all income minus the $75/month personal needs allowance. If income exceeds the institutional Medicaid limit, Delaware may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible.

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Contact Delaware Medicaid to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.