Haris Ashley
If you're looking to apply for medical insurance in Delaware, you have a few options. The state offers Medicaid, a federal-state partnership that provides low-cost health coverage. You can apply for Medicaid online at HealthCare.gov or through Delaware ASSIST, or you can fill out a paper application and mail it in. Additionally, if you have children, they may be eligible for the Children's Health Insurance Program (CHIP) even if you are not eligible for Medicaid. For those seeking Medicare assistance, the Delaware Medicare Assistance Bureau can provide information and support. The State of Delaware's website also offers resources to help you navigate enrollment and choose the best plan for your needs.
| Characteristics | Values |
|---|---|
| Website | Division of Medicaid & Medical Assistance |
| Phone Number | (866) 843-7212 |
| Address | Delaware Healthy Children Program, P.O. Box 950, New Castle, DE 19720 |
| Medicaid Enrollment | 33% higher than in 2013 |
| Medicaid Renewal | Annual renewals restarted on April 1, 2023 |
| Enrollment Options | Online, paper application by mail, or in-person at the nearest DSS office |
| Enrollment Assistance | The State of Delaware's website and Delaware ASSIST |
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What You'll Learn
Apply for Medicaid online or via Delaware ASSIST
The state of Delaware offers its residents the option to apply for Medicaid online or via Delaware ASSIST.
Applying for Medicaid in Delaware
Medicaid is a federal and state government-funded program that provides health coverage for individuals and families who meet certain income and asset limits. Delaware's Medicaid state plan is an agreement with the federal government that ensures the state will follow federal rules and may claim federal matching funds for its program activities.
Applying Online
To apply for Medicaid online, go to HealthCare.gov. Here, you can fill out an application and submit it electronically.
Applying via Delaware ASSIST
Delaware ASSIST (Application for Social Services and Internet Screening Tool) is an online application portal for Delaware residents to apply for health and social service programs, including Medicaid. ASSIST also provides a screening tool to help determine if you are eligible for benefits. To apply via ASSIST, go to assist.dhss.delaware.gov.
Other Application Methods
In addition to the online and ASSIST options, you can also apply for Medicaid in Delaware by mail or in person. To receive a paper application, call 1-800-372-2022 or 302-255-9500. To find the nearest DSS office to submit your application in person, call the same numbers.
Medicaid Renewal and Transition
It is important to keep your Medicaid coverage up to date by renewing your eligibility annually. If you lose Medicaid coverage, you have the option to transition to an employer's plan, Medicare, or an individual/family plan obtained through Delaware's exchange (HealthCare.gov). There are specific time windows for these transitions to ensure continuous coverage.
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Apply for long-term care
Delaware offers a range of long-term care programs, and applications can be submitted online at Delaware ASSIST. To apply, you must meet certain financial and functional (medical) requirements.
Firstly, to be eligible for long-term care, you must be a Delaware resident with financial limitations. The financial requirements vary depending on your marital status, whether your spouse is applying, and the specific program. For example, the 2025 income limit for Nursing Home Medicaid and Long-Term Care Community Services (LTCCS) is $2,417.50 per month. Additionally, countable assets must be under $2,000 for individuals and $3,000 for married couples where both spouses apply.
Secondly, you must meet the functional requirements. For basic healthcare coverage, you must be aged 65 or over, blind, or disabled. If you require long-term care services, Delaware Medicaid will assess your ability to perform daily activities, such as mobility, bathing, and dressing.
The Aged, Blind, and Disabled (ABD) Medicaid, also known as the Diamond State Health Plan, provides long-term care services to eligible residents. It is essential to note that ABD Medicaid applicants should be cautious about Look-Back violations, as these may impact their eligibility for other programs in the future.
Delaware's Long-Term Care Community Services (LTCCS) program supports Medicaid recipients who live in the community but are at risk of nursing home placement. LTCCS participants can reside in their own homes, with loved ones, or in adult foster care, residential care, or assisted living facilities. While LTCCS covers some long-term care benefits, it does not pay for room and board costs.
The Nursing Facility Program, on the other hand, covers the cost of care in contracted nursing facilities in Delaware. These facilities provide room and board services to the elderly, infirm, or disabled.
For more information or assistance, you can contact the Delaware Division of Medicaid and Medical Assistance at 1-800-372-2022 or visit their website: https://dhss.delaware.gov/dhss/dmma/contact.html.
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Medicaid eligibility and enrollment
The Division of Medicaid and Medical Assistance in Delaware provides healthcare coverage to individuals with low incomes and those with disabilities. The purpose is to ensure access to high-quality, cost-effective, and appropriate medical care and supportive services.
Medicaid Eligibility in Delaware
Delaware's Medicaid eligibility criteria include adults under the age of 65 with incomes up to 138% of the federal poverty level (FPL). Additionally, children from birth to one year with family incomes up to 217% of the FPL, children aged 1-5 with family incomes up to 147% of FPL, and children aged 6-18 with family incomes up to 138% of FPL are eligible. Pregnant women with family incomes up to 217% of FPL are also covered, and their coverage continues for 12 months after the baby is born.
Enrollment Process
To apply for Medicaid in Delaware, you can use either of the following methods:
- Apply online at HealthCare.gov or through Delaware ASSIST.
- Fill out a paper application and return it by mail. You can call 1-800-372-2022 or 302-255-9500 to request an application form and have it mailed to you.
- Call 1-800-372-2022 or 302-255-9500 to be directed to the nearest DSS office.
- For long-term care, contact the Medicaid Central Intake Unit at 1-866-940-8963 or reach out to the Nursing Facility Program Medical Eligibility Unit in your county.
Maintaining Coverage
It is important to keep your contact information up to date with Delaware Medicaid to maintain coverage. This includes updating any name changes, mailing addresses, email addresses, and phone numbers. You can make these updates by logging into your Delaware ASSIST account or calling the Change Report Center at (302) 571-4900, Option 2.
Special Enrollment Period
The federal government has authorized a Special Enrollment Period for the Health Insurance Marketplace to assist individuals who lose Medicaid coverage. Those who lose insurance through Medicaid or the Delaware Children's Health Insurance Program (CHIP) between March 31, 2023, and July 31, 2024, will be eligible for this special period. Once eligible, they will have 60 days to choose a plan, and their coverage will begin the first day of the month after selecting a plan.
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Delaware Healthy Children Program
The Delaware Healthy Children Program (DHCP) is a low-cost health insurance program for Delaware's uninsured children. The program offers the same high-quality coverage as some of the best private insurance plans. It is a partnership between the federal and state governments, providing low-cost health coverage to children in families that earn too much money to qualify for Medicaid.
The Children's Health Insurance Program (CHIP) is a part of the DHCP and covers medical and dental care for uninsured children and teens up to the age of 19. CHIP qualifications differ in every state, and generally depend on income. If your income is too high for Medicaid, your child may still qualify for CHIP.
To apply for Medicaid or CHIP, you must be a resident of the state of Delaware. You can apply by creating an account with the Health Insurance Marketplace and filling out an application. If it appears that anyone in your household qualifies, your information will be sent to your state agency, which will then contact you about enrollment.
The Delaware Medicaid state plan is an agreement between the state and the federal government, outlining how Delaware administers its Medicaid program. The plan ensures that the state will abide by federal rules and may claim federal matching funds for its program activities. It also sets out the groups of individuals to be covered, the services provided, the methodologies for provider reimbursement, and the administrative activities underway in the state.
The Division of Medicaid and Medical Assistance (DMMA) and the Division of Social Services (DSS) conduct Medicaid eligibility renewals. The DMMA also supports Home and Community-Based Services (HCBS), including attendant care, companion services, homemaker services, home health aide, respite, and chore services.
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Delaware's Medicaid state plan
The Division of Medicaid and Medical Assistance (DMMA) in Delaware is responsible for providing healthcare coverage to individuals with low incomes, disabilities, or insufficient resources to cover necessary medical services. DMMA does not consider an individual's resources when determining Medicaid eligibility, and individuals can work, own assets, and still qualify for Medicaid. Most recipients are enrolled with a managed care plan under the Diamond State Health Plan (DSHP), which was approved in 1995 and implemented in 1996. The DSHP 1115 Demonstration mandates the enrolment of eligible Medicaid recipients into managed care organizations (MCOs) to create cost efficiencies and expand coverage.
The Delaware Medicaid program covers doctor visits, hospital care, laboratory services, prescription drugs, transportation, routine immunizations for children, mental health services, and substance abuse treatment. The Delaware Healthy Children Program (CHIP) is a partnership between federal and state governments that provides low-cost health coverage to children in families who do not qualify for Medicaid due to higher incomes.
The DMMA provides a Health Benefits Manager to help individuals enroll in an MCO and understand their benefits and prescriptions. The Delaware Aging and Disability Resource Center assists eligible individuals in finding dental care and other services, including locating dentists who accept Medicaid and CHIP.
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Frequently asked questions
You can apply for medical insurance in Delaware by applying for Medicaid online at HealthCare.gov or through Delaware ASSIST. You can also fill out a paper application and return it by mail. Call 1-800-372-2022 or 302-255-9500 to have an application mailed out to you.
Medicaid is a federal and state government-funded program that provides low-cost health coverage to those who are eligible.
Eligibility for Medicaid in Delaware is based on income and other factors. To find out if you are eligible, you can contact the Medicaid Health Benefits Manager at (800) 996-9969 or the Delaware Medicaid Assistance Bureau at (800) 336-9500.
