Delaware Medicaid

Last verified: June 2026

What is Delaware Medicaid — the Diamond State Health Plan?

Delaware Medicaid is administered by the Division of Medicaid and Medical Assistance (DMMA), part of the Delaware Department of Health and Social Services (DHSS). The primary delivery vehicle is the Diamond State Health Plan (DSHP) — Delaware's managed care program, operating under a Section 1115 Demonstration Waiver initially approved by CMS in 1995 and implemented January 1, 1996. Delaware was an early adopter of mandatory Medicaid managed care, and the DSHP waiver has been renewed and expanded multiple times since its initial approval.

Delaware expanded Medicaid under the ACA. As of 2025, approximately 280,000 Delawareans are enrolled in Medicaid and CHIP — a substantial share of the state's approximately 1 million residents. Most members are enrolled in one of two managed care organizations: Highmark Health Options or Molina Healthcare of Delaware.

Delaware also operates Diamond State Health Plan Plus — a specialized MCO program for members with complex needs, including dual Medicare-Medicaid eligibles and people with significant disabilities. DMMA administers this through a Delaware Dual Eligible Special Needs Plan (D-SNP) structure.

Who qualifies for Delaware Medicaid?

Per DMMA, Delaware does not use an asset test for standard Medicaid eligibility — savings accounts, vehicles, and a home do not disqualify an applicant. Income is the primary determinant for most categories. Per the DMMA eligibility page, you can work and still qualify for Medicaid.

• Adults ages 19–65 (ACA expansion): at or below 138% FPL — approximately $1,732/month for a single person (2026 DMMA table)
• Children under age 19: up to 212% FPL through Medicaid or the Delaware Healthy Children Program (CHIP)
• Pregnant women: up to 212% FPL
• Seniors and people with disabilities: separate income and asset rules apply
• Parents and caretaker relatives: income varies by household composition
• Medicare Savings Programs: QMB, SLMB, and QI-1 help low-income Medicare beneficiaries

Source: DMMA Eligibility page (dhss.delaware.gov/dmma/fpl.html), updated February 2026. Monthly income figures are from the official 2026 DMMA countable income table. Apply at assist.dhss.delaware.gov or call (866) 843-7212.

How the Diamond State Health Plan works

Most Delaware Medicaid members are enrolled in the Diamond State Health Plan and assigned to either Highmark Health Options or Molina Healthcare. The Health Benefits Manager — reachable at (800) 996-9969 — helps members choose between the two MCOs and understand benefits. If a member does not choose a plan, one is assigned.

Per DMMA, certain member categories are not enrolled in an MCO and remain in fee-for-service Medicaid: Medicare enrollees, nursing facility residents, individuals on HCBS waivers, non-qualified immigrants, active military and their dependents, and members with Breast and Cervical Cancer program coverage.

Apply online at assist.dhss.delaware.gov, by phone at (866) 843-7212, or in person at a DHSS office. Provider relations questions: (800) 999-3371.

Delaware Medicaid topics

What does Delaware Medicaid cover?

Medicaid covers a broad range of health services. Federal law mandates certain benefits — inpatient and outpatient hospital care, physician services, lab work, X-rays, and nursing facility services, among others. States add optional services on top of those. Dental, vision, and long-term home care coverage vary by state.

The national benefits overview lists required and commonly optional services. Check the Delaware Medicaid website for the current state-specific benefit package.

How to apply

Most people can apply online through Delaware's Medicaid portal, by phone, or in person at a local eligibility office. The how to apply page walks through each method, what documents you'll need, and what to expect during the review period.

Under 42 CFR 435.912, states must process most standard Medicaid applications within 45 days (90 days for disability-based applications). Delaware must follow that federal timeline.