Delaware Medicaid HCBS waivers pay for long-term care at home through one program, Diamond State Health Plan Plus (DSHP-Plus), for residents who are elderly or physically disabled.Centers for Medicare & Medicaid Services. (n.d.). Delaware Diamond State Health Plan - Section 1115 Demonstration (Medicaid.gov demonstration and waiver list). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81256 Medicaid is the joint federal-state program that funds this care, and home- and community-based services (HCBS) are the pieces of it delivered in your own home or community instead of in an institution. DSHP-Plus is the managed-care plan Delaware uses to deliver those services to older and disabled adults, and it exists to help someone who would otherwise need a nursing-facility level of care stay in the community.Centers for Medicare & Medicaid Services. (n.d.). Delaware Diamond State Health Plan - Section 1115 Demonstration (Medicaid.gov demonstration and waiver list). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81256
In This Guide
- What Delaware Medicaid HCBS waivers actually are
- Diamond State Health Plan Plus, Delaware's HCBS program
- Who qualifies for Delaware Medicaid HCBS waivers
- What DSHP-Plus covers
- How enrollment works
- How to apply for DSHP-Plus
What Delaware Medicaid HCBS Waivers Actually Are
Home- and community-based services (HCBS) are the long-term care supports Medicaid pays for outside of an institution, in your own home, a family member's home, or a community setting. Federal Medicaid law lets states offer HCBS through several authorities. The most familiar is the Section 1915(c) HCBS waiver, a standalone waiver that a state runs on its own.
Delaware took a different route. It delivers its home- and community-based long-term care for older and physically disabled adults through a Section 1115 demonstration, the same federal authority behind its broader Diamond State Health Plan.Centers for Medicare & Medicaid Services. (n.d.). Delaware Diamond State Health Plan - Section 1115 Demonstration (Medicaid.gov demonstration and waiver list). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81256 That demonstration has been approved since it took effect in 1996 and is currently approved through 2028.Centers for Medicare & Medicaid Services. (n.d.). Delaware Diamond State Health Plan - Section 1115 Demonstration (Medicaid.gov demonstration and waiver list). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81256 The practical difference for a Delaware family is that the state's HCBS benefits are delivered inside a mandatory managed-care plan rather than through a standalone waiver.
Diamond State Health Plan Plus, Delaware's HCBS Program
DSHP-Plus is Delaware's managed-care long-term care program, and it is the home for the state's home- and community-based services. It is administered by the Division of Medicaid and Medical Assistance (DMMA), Delaware's Medicaid agency, in partnership with the state's division for aging and adults with physical disabilities (DSAAPD).Centers for Medicare & Medicaid Services. (n.d.). Delaware Diamond State Health Plan - Section 1115 Demonstration (Medicaid.gov demonstration and waiver list). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81256
Nursing-facility care is one benefit DSHP-Plus can cover, but the program is built to deliver home- and community-based services that prevent or delay a nursing-home admission.Centers for Medicare & Medicaid Services. (n.d.). Delaware Diamond State Health Plan - Section 1115 Demonstration (Medicaid.gov demonstration and waiver list). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81256 In plain terms, the idea is that someone who needs a nursing-facility level of care can receive that care at home or in the community, with a plan of services put together for them, rather than moving into a facility by default.
Who Qualifies for Delaware Medicaid HCBS Waivers
Qualifying for DSHP-Plus home- and community-based services comes down to two tests: a functional (medical) test and a financial test. You have to meet both.
The functional test: nursing-facility level of care
To receive long-term care services through DSHP-Plus, an applicant has to need a nursing-facility level of care. DMMA states the medical criterion as needing a skilled or intermediate level of care as defined by Delaware Medicaid criteria, meaning the person requires the level of care a nursing facility provides.Centers for Medicare & Medicaid Services. (n.d.). Delaware Diamond State Health Plan - Section 1115 Demonstration (Medicaid.gov demonstration and waiver list). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81256 The specific functional and clinical determination is DMMA's to make, so confirm the current standard and the assessment process with them before you count on it.
The financial test: income and assets
Delaware uses its institutional, or long-term care, financial rules for DSHP-Plus, the same standard that applies to its nursing-facility and HCBS-waiver populations. The state sets that income standard at 250% of the SSI benefit rate, which DMMA publishes for 2026 as $2,485 a month for a single applicant.Centers for Medicare & Medicaid Services. (n.d.). Delaware Diamond State Health Plan - Section 1115 Demonstration (Medicaid.gov demonstration and waiver list). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81256 The countable-resource, or asset, limit is generally $2,000 for a single applicant.Centers for Medicare & Medicaid Services. (n.d.). Delaware Diamond State Health Plan - Section 1115 Demonstration (Medicaid.gov demonstration and waiver list). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81256
Being over the income limit does not automatically disqualify you. An applicant whose gross monthly income is above the 250% standard can still qualify by setting up a Miller Trust, also called a Qualified Income Trust, which holds the excess income so it does not count against the limit.Centers for Medicare & Medicaid Services. (n.d.). Delaware Diamond State Health Plan - Section 1115 Demonstration (Medicaid.gov demonstration and waiver list). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81256
| Requirement | Delaware DSHP-Plus rule |
|---|---|
| Income standard | 250% of the SSI benefit rate (in 2026, $2,485 a month, single applicant) |
| Asset limit | $2,000 in countable resources (single applicant) |
| If income is over the cap | Still possible to qualify using a Miller Trust (Qualified Income Trust) |
| Functional test | Nursing-facility level of care, determined by DMMA |
The figures above apply to a single applicant.Centers for Medicare & Medicaid Services. (n.d.). Delaware Diamond State Health Plan - Section 1115 Demonstration (Medicaid.gov demonstration and waiver list). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81256 A married couple's situation, where one spouse needs care and the other stays in the community, follows separate spousal rules; confirm those with DMMA when you apply.
What DSHP-Plus Covers
DSHP-Plus is built around keeping people in the community, so its covered home- and community-based services focus on the day-to-day support that makes that possible. Covered services include:
- Case management
- Personal care services
- Respite care
- Adult day services
- Home-delivered meals
- Personal emergency response systems (PERS)
- Consumer-directed attendant care
- Assisted living care
- Home modificationsCenters for Medicare & Medicaid Services. (n.d.). Delaware Diamond State Health Plan - Section 1115 Demonstration (Medicaid.gov demonstration and waiver list). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81256
A couple of these are worth calling out. Consumer-directed attendant care lets an enrollee direct their own attendant services rather than relying only on an agency-assigned worker, which many families use to arrange care with someone they know and trust. Case management runs underneath the whole plan: a care manager helps identify which of these services an enrollee needs and coordinates them.
How Enrollment Works
Because DSHP-Plus is a mandatory managed-care program under Delaware's Section 1115 demonstration rather than a standalone Section 1915(c) waiver, eligible Delawareans are enrolled and served through the managed-care plan once DMMA determines they qualify.Centers for Medicare & Medicaid Services. (n.d.). Delaware Diamond State Health Plan - Section 1115 Demonstration (Medicaid.gov demonstration and waiver list). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81256 In practice that means enrollment runs through DMMA's eligibility process, the functional and financial tests described above, and once someone is approved a care manager helps build a service plan from the covered benefits.
Enrollment steps and any capacity considerations can change over time, so confirm the current process directly with DMMA or the state's Aging and Disability Resource Center when you start.
How to Apply for DSHP-Plus
You apply for DSHP-Plus long-term care through DMMA, which publishes a Medicaid Central Intake Unit line, 1-866-940-8963, as the contact point for its long-term-care nursing-facility program. Delaware's Aging and Disability Resource Center (ADRC) helps families get answers about eligibility, benefits, and how to apply.Centers for Medicare & Medicaid Services. (n.d.). Delaware Diamond State Health Plan - Section 1115 Demonstration (Medicaid.gov demonstration and waiver list). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81256 DMMA handles the Medicaid eligibility determination itself.
A few things are set by federal rule and worth counting on. Delaware, like every state, must let you apply through more than one channel: online, by phone, by mail, or in person.U.S. Government Publishing Office. (n.d.). 42 CFR 435.907 — Application (eCFR, current). ecfr.gov. Retrieved Jul 13, 2026, from https://www.ecfr.gov/current/title-42/section-435.907 And once you have applied, the state works under a federal cap on how long it may take to decide, no more than 45 days for most applicants, and no more than 90 days when you apply on the basis of disability.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912 Those are outer limits on the agency rather than a promised decision date, and the longer one turns on the basis you applied under, not on whether a disability determination happens to be involved, so an older applicant applying on the basis of age is on the 45-day standard. If that window runs long, the federal standard is your basis for following up.
Expect a functional assessment alongside the financial review, since a nursing-facility level-of-care determination is part of qualifying. Ask DMMA what documents to gather so the process moves as smoothly as it can.Centers for Medicare & Medicaid Services. (n.d.). Delaware Diamond State Health Plan - Section 1115 Demonstration (Medicaid.gov demonstration and waiver list). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81256
Frequently Asked Questions
Does Delaware Medicaid pay for care at home, or only in a nursing home?
Yes, Delaware Medicaid pays for care at home. It delivers home- and community-based services (HCBS) through Diamond State Health Plan Plus (DSHP-Plus), and those services, such as personal care, adult day services, and home-delivered meals, are designed to let someone who needs a nursing-facility level of care stay in their own home or community.Centers for Medicare & Medicaid Services. (n.d.). Delaware Diamond State Health Plan - Section 1115 Demonstration (Medicaid.gov demonstration and waiver list). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81256
Is there a waiting list for DSHP-Plus?
DSHP-Plus is a mandatory managed-care program authorized under Delaware's Section 1115 demonstration rather than a standalone Section 1915(c) waiver, so enrollment runs through the Division of Medicaid and Medical Assistance (DMMA) eligibility process.Centers for Medicare & Medicaid Services. (n.d.). Delaware Diamond State Health Plan - Section 1115 Demonstration (Medicaid.gov demonstration and waiver list). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81256 Because capacity and enrollment steps can change, confirm the current process directly with DMMA or Delaware's Aging and Disability Resource Center (ADRC).
Can I choose my own caregiver through DSHP-Plus?
DSHP-Plus covers consumer-directed attendant care, which lets an enrollee direct their own attendant services rather than relying only on an agency-assigned worker.Centers for Medicare & Medicaid Services. (n.d.). Delaware Diamond State Health Plan - Section 1115 Demonstration (Medicaid.gov demonstration and waiver list). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81256 Personal care and respite care are also among the covered home- and community-based services.
What happens if my income is above the limit?
Being over the income limit does not automatically disqualify you. Delaware's long-term-care income standard is 250% of the Supplemental Security Income (SSI) benefit rate, in 2026 $2,485 a month for a single applicant, and someone above it can still qualify by setting up a Miller Trust, also called a Qualified Income Trust, to hold the excess income.Centers for Medicare & Medicaid Services. (n.d.). Delaware Diamond State Health Plan - Section 1115 Demonstration (Medicaid.gov demonstration and waiver list). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81256
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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.