Delaware Medicaid Long Term Care Eligibility

Delaware Long Term Care:

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Delaware is an income cap state, meaning that in order to be eligible for Medicaid long term care benefits there is a hard income limit. The income limit for an applicant is set at 250% of the Supplemental Security Income (SSI) standard, which changes annually. Non income cap states allow applicants to spend down money for their care, whereas income cap states require the amount to be no higher than their limit at time of application.

Applicants must meet medical and financial eligibility requirements. A nurse may visit the applicant to decide whether he/she needs skilled or intermediate levels of care as determined by Delaware Medicaid criteria.

When applying, the Delaware Division of Medicaid and Medical Assistance (DMMA) will mail an application packet to the applicant or their family. Financial eligibility is then determined by the information submitted plus an evaluation by a financial eligibility social worker.

  • Liquid resources must be less than $2,000 for an individual. This includes:
    Bank accounts, stocks, bonds, life insurance policies, property insurance policies, retirement accounts, the home if no one is living in it
  • Exempt resources include:

    -a $1,500 burial expense or irrevocable burial trust up to 10,000,

    -the money paid for a burial plot or casket,

    -one car, no equity value mentioned,

    -one home (equity value of $560,000) if planning to return, a spouse is living in it, or a dependent under 21 resides there,

    -a face value of a life insurance policy totaling less than 1,500,

    -a miller trust, where the state is the named beneficiary

Spousal Rules:

If the community spouse’s total assets are less than $25,000.00, an amount may be taken from the applicant spouse’s portion to bring it up to $25,000.00. The maximum amount of resources the community spouse may retain is $120,900.

If the community spouse’s monthly income is less than $2,002.50/month then he or she may keep part of the institutionalized spouse’s income to meet the minimum. Depending on documented shelter expenses, the community spouse may be able to bring their monthly income up to $3,022.50.

The state performs a 60-month look back to determine if funds were spent down or transferred correctly. Exempt transfers include transferring the title of the home to:

  • The spouse
  • A child who is blind, disabled, or under 21
  • Brother or sister who has equity in the home and has been living there for at least one year before the applicant was admitted to a nursing facility
  • An adult child who has been living in the home and providing care, which has delayed the applicant’s admission to the nursing facility for at least two consecutive years

Services available in Delaware:

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1. Nursing Facility Program

2. Long Term Care Community Services (HCBS)
Elderly and Disabled/Assisted Living/Acquired Brain Injury
AIDS/HIV Community-Based Services

3. Developmental Disabilities Services Waiver

4. Program of All-Inclusive Care for the Elderly (PACE)

The majority of the Medicaid population receiving Medicaid services will be enrolled into the Diamond State Health Plan, or Diamond State Health Plan Plus. Individuals that are eligible for the Nursing Facility Program, the Long Term Care Community Services Program (Elderly & Disabled/Acquired Brain Injury/Assisted Living and Aids/HIV services) must enroll in Diamond State Health Plan Plus. This managed care initiative will provide improved access to community-based long-term care services, increased flexibility to more effectively address individual needs, and to better control rising long-term care costs significantly impacting Medicaid.

Individuals that opt for enrollment in the Program of All-Inclusive Care for the Elderly (PACE) are not eligible to enroll in a Managed Care.

Delaware long term care insurance partnership:

This is a program between the state and private insurance companies. Partnership policies protect assets by matching dollar for dollar what policy holders pay into their policies. For example, if you bought a Partnership Policy with a maximum benefit payout of $155,000 then you are able to protect $155,000 of your assets. For married couples each spouse needs to purchase their own policy. Once the $155,000 worth of long term care coverage is used, you may apply for Medicaid with $155,000 worth of assets exempted.

Further Reading:

Apply for programs here: https://assist.dhss.delaware.gov/

Medicaid contact information: http://dhss.delaware.gov/dhss/dmma/contact.html