Delaware Medicaid for seniors and long-term care

Last verified: June 2026

What Delaware Medicaid covers for seniors and people needing long-term care

Delaware DMMA provides the following long-term care services, per the DMMA Long Term Care Medicaid Programs page at dhss.delaware.gov/dmma/ltcmedicaid.html:

• Medicaid nursing facility care (skilled nursing home)
• Medicaid home and community-based services (HCBS)
• Medicaid 30-day acute care hospital services
• Children's Community Alternative Disability Program
• Medicaid out-of-state rehabilitation hospital services
• Qualified Medicare Beneficiary (QMB) programs — help with Medicare premiums
• SSI-related programs for people with disabilities
• Personal care services
• Adult Day Health Program
• Hospice care

Source: DMMA Long Term Care Medicaid Programs page (dhss.delaware.gov/dmma/ltcmedicaid.html).

Delaware nursing facility financial eligibility (2026)

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.

Source: DMMA Long Term Care Medicaid Programs (dhss.delaware.gov/dmma/ltcmedicaid.html); DMMA SSI Income Standards (2026 DMMA income table). Personal needs allowance ($75/mo) is the portion of monthly income the nursing facility resident keeps — the remainder goes toward the cost of care. Spousal protection amounts are federal floor/cap figures; verify with DMMA for Delaware's current exact figures.

Delaware's HCBS programs: home-based alternatives to nursing facilities

Delaware operates home and community-based services (HCBS) programs under federal Medicaid waiver authority, including the Developmental Disabilities Home and Community Based Waiver Program (DDDS Lifespan Waiver). These programs fund services that help people remain in their homes and communities rather than entering a nursing facility.

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) 843-7212 or the Central Intake Unit for long-term care to learn about current HCBS options and any waitlist status.

Delaware Medicaid estate recovery

Delaware operates an estate recovery program. Per federal law (42 U.S.C. § 1396p) 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 enforces the federal 60-month (5-year) lookback period for asset transfers.

Medicaid as the primary payer for long-term care

Medicare does not cover custodial nursing home care beyond 100 days following a qualifying hospital stay. Private long-term care insurance covers only those who purchased it. For the majority of Americans who need extended nursing home care, Medicaid ends up as the payer — after they have spent down their own assets to the program's limit.

Nationally, Medicaid pays for roughly two-thirds of all nursing home residents, per CMS data. Delaware's share of that population is administered through Delaware Medicaid. The rules that determine eligibility — income, assets, lookback periods, and exempt property — differ from the MAGI-based rules used for standard Medicaid.

Long-term care Medicaid also includes home and community-based services (HCBS), which allow people to receive care at home or in assisted living rather than a nursing facility. These programs operate through Section 1915(c) waivers and have waiting lists in most states.

Nursing facility coverage

Delaware Medicaid covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.

Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance (which varies by state but is often $30–$50 per month). Medicaid covers the gap.

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. Not all states allow this; verify whether Delaware uses this approach with Delaware Medicaid.

Home and community-based services (HCBS)

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Section 1915(c) of the Social Security Act authorizes these waivers. Each state designs its own waiver programs, so what's available through Delaware Medicaid differs from what's available in neighboring states.

Common HCBS services include personal care assistance, home health aide visits, adult day health care, respite care for family caregivers, and modifications to make a home accessible. Some states cap the number of waiver slots, creating waiting lists that can run for months or years.

Contact Delaware Medicaid to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.

Asset limits for long-term care Medicaid

Unlike MAGI-based Medicaid, long-term care Medicaid has an asset test. Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. The specific threshold varies by state and is updated periodically; it is not a figure this page can reliably publish.

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. Personal belongings and a prepaid funeral arrangement are also generally exempt.

Medicaid has a 60-month (5-year) lookback period for asset transfers. Transfers of assets for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care. Consult Delaware Medicaid or a Medicaid planning attorney before transferring assets.

Spousal protections

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse (the one still at home) is entitled to keep a minimum amount of assets — called the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income.

The CSRA allows the community spouse to keep between a federal minimum and maximum, with the exact amount varying by state and updated annually. Delaware's current CSRA is set by Delaware Medicaid and published on their website.

The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them — the minimum monthly maintenance needs allowance (MMMNA).

What long-term care Medicaid typically covers

• Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
• Physical, occupational, and speech therapy provided in a nursing home
• Personal care assistance with daily activities (bathing, dressing, eating) through HCBS waivers
• Home health aide visits for those receiving care at home
• Adult day health care programs
• Respite care to give family caregivers temporary relief
• Durable medical equipment prescribed by a physician
• Transportation to and from medical appointments