Delaware Medicaid

Medicaid is a government health insurance program that helps certain people get health care services at a lower cost. There are different Medicaid programs in Delaware for different groups of people.

What does Delaware Medicaid cover?

Delaware Medicaid pays for routine and acute health care services. This includes:

• Visits to health care providers (including physicians and nurse practitioners)
• Inpatient and outpatient hospital services
• Early and periodic screening, diagnostic, and treatment services
• Preventive care (e.g., vaccinations)
• Lab tests and X-rays
• Dialysis services
• Mental health services
• Substance use treatment
• Rural health clinic services
• Medical transportation
• Long-term care (e.g., nursing facility care, home health services)

Most states also cover optional services such as:

• Physical, respiratory, and occupational therapy
• Home- and community-based care
• Case management
• Prescription drugs
• Dental and vision care
• Hearing services
• Podiatry services
• Hospice care

Since the program serves those with limited income and resources, people with Delaware Medicaid pay few to no out-of-pocket costs for their benefits. To get coverage once you are enrolled, you must go to health care providers that take part in the Delaware Medicaid program.

In Delaware, Medicaid is administered by the Division of Medicaid and Medical Assistance. Call them at 1-866-843-7212 to learn more about the coverages provided.

How do I know if I qualify for Medicaid in Delaware?

In general, to be eligible for Medicaid, you must:

• Be a Delaware resident
• Be a U.S. citizen or a qualified non-citizen
• Meet the income and/or asset limit for your coverage group

What are the different Medicaid programs in Delaware?

You may be able to get health coverage if you fall into one of the following categories:

Nursing Home Medicaid

Nursing Home Medicaid in Delaware covers health care and support services in a nursing home or other medical facility. It may cover room and board as well as nursing care, rehabilitation services, and social services. You may be able to get this coverage if you have limited income and resources. You must also have a medical condition that requires the skills of a licensed nurse on a regular basis.

Medicaid Waiver for the Elderly and Disabled

This Delaware Medicaid program provides health care and support services so that you can stay in your own home to avoid having to move into a nursing home. It can help take care of your daily needs by providing services like personal care, meals, homemaking, and case management.

How do Medicare and Medicaid work together?

If you get Medicare, you may also be able to get help from Delaware Medicaid. This is called being “dual eligible.” Medicaid pays for some services not covered by Medicare such as eyeglasses, hearing aids, and dental care.

If you have Medicare and qualify for full Medicaid coverage, the state will pay your Medicare Part B (Medical Insurance) monthly premiums.

Depending on the level of Delaware Medicaid you qualify for, the state might also pay for:

• Your share of Medicare costs, like deductibles, coinsurance, and copayments
• Part A (Hospital Insurance) premiums, if you have to pay a premium for that coverage

In addition, if you are dual-eligible for Medicare and Medicaid:

• You will automatically be signed up for the Low-Income Subsidy (LIS)/Extra Help program through Medicare Part D (prescription drug coverage). This program helps people with low income pay for their medicines.
• You may be able to get your coverage through a Medicare Advantage Special Needs Plan (SNP) instead of having original Medicare with separate Medicaid coverage. This plan can help you manage the health care services you need. SNPs may also offer more benefits than what you already get from original Medicare. In some cases, you may have no monthly premiums and/or you may pay lower co-payments. All SNP plans are different, so check with the plans to see what they cover and if you can enroll.

Note: SNPs are not available in every community. To find out if there is an SNP in your area, visit the Medicare website or call 1-800-633-4227 or 1-877-486-2048 (TTY).

How do I prepare to apply for Medicaid in Delaware?

When you apply for Medicaid in Delaware, you’ll be asked for important information to help determine if you qualify for benefits.

Before you start, gather some basic information to make your application process easier: 

• A document that shows your age, such as your birth certificate or driver’s license
• Your Social Security card
• Pay stubs for anyone in your household who has earned income
• Documentation that shows any other form of income, such as letters from Veterans Affairs (VA) or the Social Security Administration (SSA)
• Information about your financial assets, such as bank account or investment account statements

How do I apply for Medicaid in Delaware?

There are a few different ways you can apply for Medicaid in Delaware. Read below to learn more about which option might be right for you.

APPLY ONLINE

The quickest and easiest way to apply for Medicaid in Delaware is online through the Delaware ASSIST website. All your personal information is kept 100% confidential and protected by special security technology. 

Apply through Delaware ASSIST

APPLY IN-PERSON OR BY MAIL

Contact or visit your nearest DSS Service Center to request a Medicaid application.

How can I get help with my Delaware Medicaid application?

There are a few ways to get help filling out your Medicaid application:

• Contact your local DSS Service Center.
• Call the Delaware Aging and Disability Resource Center at 1-800-223-9074 (toll-free).
• Visit a Benefits Enrollment Center (BEC), if there’s one near you. See if there’s one in your area.

NCOA also has a HelpLine you can call to get free support. To get started today, call  1-800-794-6559