If a parent in Delaware needs long-term nursing-home care, the bill is among the highest in the country: a private room runs about $181,588 a year. That is far more than most families can pay out of pocket for long. For many families facing a long stay, what makes it affordable is Delaware Medicaid, which pays for nursing-facility care once a person meets the level-of-care and financial rules.,

This guide covers how Delaware oversees its nursing homes, what a stay costs, who pays for it (Medicare's limited skilled benefit versus Medicaid for long-term care), and how to check a facility's record before you choose one.

In This Guide

How Delaware Oversees Nursing Homes

A nursing home, often called a skilled nursing facility, provides 24-hour licensed nursing care, help with daily activities like bathing and dressing, and rehabilitation services such as physical, occupational, and speech therapy. That round-the-clock nursing is the line separating it from assisted living, which is built for people who need help with daily tasks but not constant skilled care. Before you weigh cost or payment, it helps to know who watches over these facilities in Delaware, because that oversight is what gives you a record to check.

Two layers of regulation apply, and they work together. At the state level, nursing facilities are licensed and inspected by the Delaware Department of Health and Social Services through its Division of Health Care Quality. The same division investigates complaints, enforces both state and federal law, and licenses and certifies the nursing facilities enrolled in Delaware Medicaid. Separately, Medicare publishes an overall rating of one to five stars for certified nursing homes on Care Compare, combining health inspections, staffing, and quality measures.

There's also a free advocate you should know about before you need one. The Delaware State Long-Term Care Ombudsman, housed in the DHSS Office of the Secretary, advocates for people living in skilled nursing and assisted living facilities and for people receiving home- and community-based services, and helps residents file complaints and appeals at no cost. The program states that it does not inspect facilities for licensing or investigate complaints for the State, so it's a different kind of help than the state survey process. An ombudsman is assigned to and regularly visits every licensed nursing and assisted living facility, so they can tell you things a brochure never will.

What a Nursing Home Costs in Delaware

Nursing-home care is the priciest long-term care in Delaware, and the numbers are large enough that paying privately for years is out of reach for most families. According to the CareScout Cost of Care Survey, the 2025 median for a private nursing-home room in Delaware was about $181,588 a year, a figure that places the state among the most expensive in the country. These are medians from an industry survey, not government rates and not maximums. The figure at any one facility can land higher or lower depending on location, room type, and how much care a resident needs.

What stands out about Delaware is that long-term care runs above the national line in every residential setting. The same 2025 survey put the national median at about $114,975 a year for a semi-private nursing-home room, about $129,575 for a private room, and about $74,400 for assisted living, and Delaware sits above each of those national figures: about $173,922 for a semi-private room and roughly $90,600 to $91,200 for assisted living, depending on which CareScout table you read. So a Delaware family weighing residential settings is choosing among options that all cost more than the national typical, with nursing-home care at the top of that range.

Care setting Delaware (year) National (year)
Nursing home, private room about $181,588 about $129,575
Nursing home, semi-private room about $173,922 about $114,975
Assisted living about $90,600 to $91,200 about $74,400

That gap between nursing-home care and lighter settings is the reason families look hard at whether assisted living or in-home care can meet the need before moving to a nursing home, and it's why so many families look to Medicaid rather than planning to pay privately for years.

Who Pays: Medicare vs. Medicaid

People often assume Medicare covers a nursing home. It does, but only in a narrow way, and mixing up the two programs can leave a family unprepared for the bill. Here's how they divide the work.

Medicare covers short rehab, not a long stay. Medicare Part A covers skilled nursing facility care only on a short-term basis after a hospital stay. To qualify, a person generally needs a qualifying inpatient hospital stay of at least three consecutive days, then enters a Medicare-certified facility, generally within 30 days of leaving the hospital, for skilled care related to that stay. Time spent under observation or in the emergency room doesn't count toward those three days, and the rule can be waived in some cases, such as when your doctor participates in an approved Accountable Care Organization or a Medicare Advantage plan waives it. Under Original Medicare, coverage then runs up to 100 days per benefit period: days 1 through 20 at $0 a day after the Part A deductible ($1,736 in 2026, usually already paid for the hospital stay in the same benefit period), and days 21 through 100 with a daily coinsurance of $217 in 2026, after which Medicare pays nothing. If you have a Medicare Advantage plan, it may charge copayments during the first 20 days, so check with the plan. Medicare does not pay for long-term custodial care, the ongoing help with daily living that someone needs when skilled rehab is finished. That is the care most families worry about affording, and it's where Medicaid takes over.

Medicaid covers long-term nursing-facility care. Delaware Medicaid pays for nursing-home care for people who meet the financial rules, mainly through its Diamond State Health Plan-Plus managed long-term-care program. Qualifying turns on two findings on separate tracks: a level-of-care determination on the medical side, usually made by DMMA's Pre-Admission Screening team, and the income and asset rules on the money side.

Delaware's income rule is where it differs from most states, so it's worth slowing down here. Delaware is a 1634 state, which means it has asked Social Security to make its Medicaid eligibility decisions for people receiving SSI, so an SSI award ordinarily carries Medicaid with it. Where it stands out is the long-term-care income limit: instead of the 300% of the federal benefit rate cap that federal law allows a state to use, Delaware sets its special income standard at 250% of the SSI standard, which is about $2,485 a month for a single applicant in 2026. An applicant whose gross monthly income runs above that limit isn't automatically disqualified; they can still qualify by establishing a qualified income trust, often called a Miller trust. Countable assets cannot exceed $2,000 for an applicant with no spouse, and once enrolled, a nursing-facility resident keeps a $75 monthly personal needs allowance and pays the rest of their income to the facility, apart from any amount protected for a community spouse, uncovered medical needs such as eyeglasses or hearing aids, and private health-insurance premiums.

A married couple is not held to the single-person numbers. When one spouse enters a nursing home and the other stays in the community, Delaware protects a community spouse resource allowance so the at-home spouse is not left without savings. It is not a flat amount: the allowance is the greater of the state's minimum or half the couple's combined countable resources, within 2026 bounds of $32,532 at the low end and $162,660 at the high end. Two more rules shape long-term-care eligibility. Delaware applies a five-year, or 60-month, look-back to assets transferred for less than fair market value. And Delaware's lien and estate-recovery policies apply to people age 55 and older who apply for long-term-care services, though the state does not seek recovery from an estate while there is a surviving spouse or a child under 21, among other limits. Delaware Medicaid also covers home- and community-based services for people who would otherwise need nursing-facility care, so a nursing home isn't the only path Medicaid will fund. For a family that has spent decades saving, the look-back and estate-recovery rules can feel harsh, and they're worth understanding before any assets change hands. Because these rules are detailed and the math depends on your own income and expenses, it's worth getting professional advice before assuming any outcome.

How to apply. You can apply for Delaware Medicaid online through Delaware ASSIST, or by calling the Division of Medicaid and Medical Assistance's Medicaid Central Intake Unit at 1-866-940-8963. The application has two steps: first a level-of-care determination that confirms the person medically needs nursing-facility care, and then the financial eligibility review. Because Medicare's short-term coverage runs out after at most 100 days, it helps to start the process as soon as a long-term stay looks likely rather than waiting for Medicare to stop.

How to Vet a Facility

Quality varies from one nursing home to the next, and you have several free tools to check a place before you commit. Use more than one, because each shows you something the others don't.

Start with the federal scorecard. On Medicare Care Compare, Medicare rates certified nursing homes from one to five stars, combining an Overall rating with separate ratings for health inspections, staffing, and quality measures. Read the component ratings, not just the headline star count, because a strong Overall can hide a weak staffing or inspection score. The staffing score deserves a close look on its own, since it carries its own star rating separate from the Overall.

Then go to the source of those ratings. When you tour a facility, ask to see its most recent state survey results from the Delaware Division of Health Care Quality, and watch for a pattern of repeat deficiencies rather than reacting to a single old citation. Finally, call the Delaware State Long-Term Care Ombudsman before you sign anything. An advocate who visits facilities in your area regularly can give you an honest, on-the-ground read on a specific place that no rating captures.

Frequently Asked Questions

How much does a nursing home cost in Delaware?

The CareScout 2025 Cost of Care Survey put Delaware's median for a private nursing-home room at about $181,588 a year, among the highest in the nation. That runs well above the national median of about $129,575 for a private room. These are statewide medians from an industry survey, not maximums, and the cost at any one facility depends on location, room type, and level of care.

Does Medicare pay for a nursing home in Delaware?

Only for short-term rehab, not long-term custodial care. Medicare Part A covers skilled nursing facility care after a qualifying inpatient hospital stay of generally at least three consecutive days, for up to 100 days per benefit period. Under Original Medicare, that's $0 a day for days 1 through 20 after the Part A deductible, and a daily coinsurance ($217 in 2026) for days 21 through 100; a Medicare Advantage plan may charge copayments during the first 20 days. It does not pay for long-term custodial nursing-home care, which families fund through Medicaid, private long-term care insurance, or their own money.

Does Medicaid pay for nursing home care in Delaware?

Yes. Delaware Medicaid pays for nursing-facility care for people who meet the financial rules, mainly through Diamond State Health Plan-Plus, and the applicant must also need a nursing-facility level of care under Delaware Medicaid criteria., A resident pays most of their monthly income to the facility while keeping a $75 monthly personal needs allowance, and countable assets cannot exceed $2,000 for an applicant with no spouse.

What are the Medicaid income and asset limits for a Delaware nursing home?

Delaware sets its long-term-care special income standard at 250% of the SSI standard, about $2,485 a month for a single applicant in 2026, rather than the 300% of the federal benefit rate that federal law allows. An applicant over that limit can still qualify by setting up a qualified income trust, or Miller trust. Countable assets cannot exceed $2,000 for an applicant with no spouse. When one spouse stays in the community, the state protects a community spouse resource allowance, the greater of the state minimum or half the couple's countable resources, between $32,532 and $162,660 in 2026. Delaware also applies a 60-month look-back to assets given away for less than fair market value, and it applies estate recovery to people age 55 and older who apply for long-term-care services, though it does not seek recovery while there is a surviving spouse or a child under 21.

How do I apply for Medicaid for a Delaware nursing home?

Apply online through Delaware ASSIST at assist.dhss.delaware.gov, or call the Division of Medicaid and Medical Assistance's Medicaid Central Intake Unit at 1-866-940-8963. The process has two steps: first a level-of-care determination, usually made by DMMA's Pre-Admission Screening team, confirming the medical need for nursing-facility care, and then the financial eligibility review. Because Medicare's coverage runs out after at most 100 days, start the process as soon as a long-term stay looks likely.

How do I check a Delaware nursing home's quality before choosing it?

Use the free tools together. Look up the facility's one-to-five-star ratings on Medicare Care Compare, reading the separate health-inspection, staffing, and quality-measure scores rather than just the Overall star. Ask the facility to show you its most recent state survey results from the Delaware Division of Health Care Quality, and contact the Delaware State Long-Term Care Ombudsman, who can offer a candid read on a specific place.

Learn More

Care TypesNursing Homes by State: Costs, Medicaid Coverage, and How to ChooseWhat a nursing home costs, how Medicaid pays for it, and how facilities are rated all share a federal floor but vary by state. See yours, with a 50-state guide. Care TypesAssisted Living in DelawareAssisted living in Delaware sits above the national median of about $6,200 a month. How the state licenses care, what it costs, and what Medicaid covers. Care TypesMemory Care in DelawareDelaware has no separate memory care license. Its assisted-living rules address dementia care, and a disclosure duty tells you what a facility provides. Care TypesMemory Care vs. Nursing Home in DelawareMemory care vs. nursing home in Delaware: the choice turns on skilled-nursing need and who pays. Memory care is mostly self-paid; Medicaid covers nursing homes. Care TypesHome Care vs. Home Health in DelawareHome care vs. home health in Delaware: home health is skilled care Medicare covers; home care is non-medical help it won't. That line decides who pays. Care TypesCost of Senior Care in DelawareCost of senior care in Delaware (2026): assisted living about $90,600 to $91,200 a year, a private nursing-home room about $181,588 a year, plus how to pay. Care TypesAssisted Living vs. Nursing Home in DelawareAssisted living vs. a nursing home in Delaware: the care-level line, the cost gap, and who pays. Medicaid covers nursing homes, only some assisted-living costs.
MedicaidMedicaid Estate Recovery, ExplainedMedicaid estate recovery can claim a home after death, but not while a spouse or a child under 21, blind or disabled survives. See your state's rules. MedicaidMedicaid Personal Needs Allowance, ExplainedHow the Medicaid Personal Needs Allowance works in 2026: the $30 federal floor, what the states set, and how patient liability is calculated. MedicaidMedicaid Planning StrategiesSee which assets you keep, how the 5-year look-back works, and the legal moves that qualify you for Medicaid long-term care without losing the house.

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The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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