Delaware Medicaid Definition
Medicaid in Delaware is a managed care program and is called the Diamond State Health Plan (DSHP), and long-term care Medicaid in Delaware is referred to as Diamond State Health Plan Plus (DSHP Plus). The Delaware Division of Medicaid & Medical Assistance (DMMA) administers the Medicaid program in Delaware.
Medicaid is a wide-ranging health insurance program for low-income individuals of all ages. Jointly funded by the state and federal government, it provides health coverage for various groups of Delaware residents, including pregnant women, parents and caretaker relatives, adults with no dependent children, disabled individuals, and seniors. However, the focus of this page is solely on Medicaid eligibility for Delaware elders, aged 65 and over, and specifically for long term care, whether that be at home, in an adult foster care home, in a nursing home, or in an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Delaware seniors may be eligible. These programs have slightly different financial and functional (level of care need) eligibility requirements, as well as varying benefits. Further complicating eligibility are the facts that the requirements vary with marital status and that Delaware offers multiple pathways towards Medicaid eligibility.
1) Institutional / Nursing Home Medicaid – this is an entitlement program. This means anyone who meets the eligibility requirements will receive assistance, which is provided only in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – with these programs, there are a limited number of participant enrollment slots. Therefore, wait lists may exist. Benefits are provided at home, adult day care, an adult foster care home, or in assisted living. To avoid confusion, it is important to mention that the state’s Medicaid Waivers for the elderly were absorbed by the state’s managed care program.
3) Regular Medicaid / Aged and Disabled – this is an entitlement program, which means meeting the eligibility requirements guarantee assistance will be provided. Benefits are provided at home or adult day care.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from a Delaware Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible for Delaware Medicaid. More.
|2020 Delaware Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$1,957.50 / month*||$2,000||Nursing Home||$2,937.50 / month*||$3,000||Nursing Home||$1,957.50 / month for the applicant*||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$1,957.50 / month||$2,000||Nursing Home||$2,937.50 / month||$3,000||Nursing Home||$1,957.50 / month||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$783 / month||$2,000||None||$1,175 / month||$3,000||None||$1,175 / month||$3,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, Veteran’s benefits, pension payments, Social Security Disability Income, Social Security Income, Supplemental Security Income, IRA withdrawals, and stock dividends.
When only one spouse of a married couple is applying for nursing home Medicaid or home and community based services Medicaid, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. For married couples with one spouse applying for regular Medicaid, income is calculated differently. In this case, the income of both spouses, even if only one spouse is an applicant, is counted towards the income limit. Learn more about how Medicaid counts income.
For married couples in which just one spouse is an applicant for nursing home Medicaid or a Medicaid waiver, there is a Minimum Monthly Maintenance Needs Allowance (MMMNA) to ensure the non-applicant spouse has sufficient income from which to live. Put differently, the MMMNA is intended to ensure non-applicant spouses do not become impoverished. Basically, if the non-applicant spouse, also called a community spouse, well spouse, or non-recipient spouse, has income under $2,155.00 / month, as of 7/1/20 (this figure changes each year in July), he or she is entitled to a portion of the applicant spouse’s income. If the well spouse has income equivalent to $2,155.00 / month or income in excess of this amount, one might be entitled to a greater monthly income allowance based on one’s shelter and utility costs. As of 1/1/20, the maximum monthly maintenance needs allowance a community spouse can receive is $3,216 / month. (This figure is set to change 1/1/21). This spousal impoverishment rule is not relevant for married couples with one spouse applying for regular Medicaid.
*While there is an income limit above for a senior to be eligible for nursing home Medicaid, a beneficiary is not able to keep monthly income up to this level. Instead, all of a senior’s income except for a small personal needs allowance of approximately $44 / month and a spousal maintenance needs allowance (if applicable) must be applied towards his or her cost of nursing home care.
What Defines “Assets”
Countable assets, also called resources, include cash, stocks, bonds, investments, annuities, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility, there are many assets that are not counted. In other words, they are exempt from the asset limit. Exemptions include personal belongings, such as clothing, household furnishings, an automobile, up to $1,500 for burial, an irrevocable funeral trust (limited to $10,000 in 2020), and life insurance with a combined face value of $1,500. In addition, one’s primary home, given the Medicaid applicant lives in the home (or has the intent to return to it), is exempt if his / her equity interest in the home is not greater than $595,000 (in 2020). (The amount of the home’s value owned by the applicant equals the applicant’s equity interest). The house is also exempt if a non-applicant spouse lives in it. This holds true regardless of where the applicant spouse lives and his / her equity interest in the home.
For married couples, as of 2020, the community spouse (the spouse of a Medicaid nursing home applicant or a HCBS waiver applicant) can retain half of the couples’ joint assets (up to a maximum of $128,640), as the chart indicates above. If the non-applicant spouse’s half of resources is under $25,728, a portion of the applicant spouse’s resources can be taken to bring the non-applicant spouse’s resources to $25,728. This is referred to as the Community Spouse Resource Allowance (CSRA), and like the MMMNA, is intended to prevent the non-applicant spouse from becoming impoverished. Also like the spousal income allowance, the spousal asset allowance does not apply for non-applicant spouses of those applying for regular Medicaid.
It is vital that one does not give away assets or sell them for less than fair market value in an attempt to meet Medicaid’s asset limit. This is because Delaware has a Medicaid Look-Back Period, which is a period of 60 months (5 years) that backdates from one’s Medicaid application date. During this time frame, Medicaid checks all past transfers to ensure no assets were sold or given away for less than they are worth. If one is found to be in violation of the look-back period, one will be penalized with a period of Medicaid ineligibility.
Qualifying When Over the Limits
For Delaware elderly residents (65 and over) who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Qualified Income Trusts (QIT’s) – QIT’s, also referred to as Miller Trusts, are for Medicaid applicants who are over the income limit, yet still cannot afford the cost of their long-term care. This type of trust offers a way for individuals over the Medicaid income limit to still qualify for long-term care Medicaid, as money deposited into a QIT does not count towards Medicaid’s income limit. In simple terms, one’s excess income (over the Medicaid limit) is directly deposited into a trust, in which a trustee is named, giving that individual legal control of the money. The account must be irreversible, meaning once it has been established, it cannot be changed or canceled, and upon death of the Medicaid participant, any remaining funds must be paid to the state of Delaware. In addition, the money in the account can only be used for very specific purposes, such as paying long term care services / medical expenses accrued by the Medicaid enrollee.
Unfortunately, Miller Trusts are not helpful if one has assets over the Medicaid eligibility limit. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above option cannot assist one in reducing their extra assets. However, one can “spend down” assets by spending excess assets on non-countable ones, such as home modifications (wheelchair ramps, roll-in showers, and stair lifts), vehicle modifications (wheelchair lifts, adaptive control devices, and floor modifications to allow one to drive from a wheelchair), prepaying funeral and burial expenses, and paying off debt. To learn more about asset “spend down”, click here. Remember, Medicaid has a look-back period, which if one violates, can result in Medicaid ineligibility. Therefore, it is extremely important not to give away assets or sell them for less than they are worth for 60-months immediately preceding one’s Medicaid application.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific Delaware Medicaid Programs
Diamond State Health Plan Plus (DSHP-Plus) – this managed care program is broken into two sub-programs; the Nursing Facility Program and the Long Term Community Services (LTCCS) Program. DSHP-Plus provides supportive services to program participants living at home, in assisted living, adult foster care, and nursing homes. Benefits may include adult day care, home health services, meal delivery, private duty nursing, home modifications, respite care, and more. Self-direction of personal care assistance is an option for those living outside of a residential facility.
How to Apply for Delaware Medicaid
Persons wishing to apply for Delaware Medicaid may do so online at Delaware ASSIST. Alternatively, individuals can contact Delaware Health and Social Services (DHSS). Contact information is available here. One’s local Area Agency on Aging might also be helpful with providing program information and application assistance.
Prior to submitting an application for Delaware Medicaid, senior applicants should be positive that all eligibility requirements are met (as discussed above) for the program in which they are applying. Having income and / or assets greater than the limits(s), or being uncertain if eligibility criteria are met, can result in a denial of Medicaid benefits. Persons in these situations should seriously consider Medicaid planning for the best chance of acceptance into a Medicaid program. To learn more about applying for Medicaid, click here.