Delaware Medicaid Guide 2026: Eligibility, LTC & How to Apply

Delaware Medicaid pays for long-term nursing and home care through an income-cap system, with a 2026 income limit of $2,485 per month and a required Miller Trust for applicants over that cap.

Delaware Medicaid is administered by the Delaware Division of Medicaid and Medical Assistance (DMMA), the division within the Delaware Department of Health and Social Services (DHSS) that handles financial eligibility and long-term care for older adults and people with disabilities. This guide maps every key question about Delaware Medicaid to the dedicated article that answers it.1

What Delaware Medicaid Covers

Delaware Medicaid covers the mandatory federal benefit categories plus a set of state-elected optional services:

• Hospital care: inpatient and outpatient services
• Physician, clinic, and specialist visits
• Prescription drugs through the Delaware Medicaid pharmacy benefit
• Behavioral health: mental health and substance use disorder services
• Home health: skilled nursing and home health aide services
• Long-term care: nursing facility care and Home and Community-Based Services (HCBS) waiver services for people who meet the level-of-care standard
• Medicare Savings Programs (MSPs): premium and cost-sharing assistance for dual-eligible Medicare beneficiaries
• Non-emergency medical transportation (NEMT)

For older adults and people with disabilities, long-term care coverage is the most financially significant benefit. Delaware is among the most expensive states in the country for nursing-home care: the median cost of a private nursing-home room reached about $181,588 per year in the CareScout 2025 Cost of Care Survey (released March 2026).2 Once a resident meets Delaware's financial and clinical eligibility standards, Medicaid pays the facility for that care, minus the share of the resident's own monthly income that has to go toward the bill.

Who Qualifies for Delaware Medicaid

Financial Eligibility in 2026

For seniors and people with disabilities applying for long-term care Medicaid, the key financial parameters are:1

• Asset limit: $2,000 for a single applicant; $3,000 for a couple with both spouses applying. Delaware excludes one automobile per household, $1,500 in separately identifiable designated burial funds, and a prepaid burial contract that cannot be revoked. The principal residence is excluded only when a condition is met: the applicant intends to return home, or a spouse or dependent relative is using the home during the absence.1
• Income cap: $2,485/month, equal to 250% of the 2026 SSI Federal Benefit Rate of $994. Delaware has set its long-term care standard at 250% of the SSI standard since October 1, 1994, and DMMA publishes the 2026 figures directly (for a couple, $1,491 at 100% and $3,727.50 at 250%).1
• Miller Trust required: An applicant with gross monthly income above $2,485 must establish a Qualified Income Trust (Miller Trust) and deposit the excess income each month before Medicaid will pay for long-term care.
• Home equity limit: Federal rules set 2026 home-equity limits of $752,000 (the minimum a state may apply) and $1,130,000 (the maximum), and Delaware's manual defers to "the home equity cap as set by federal regulations" without naming a current figure. Its own published table stops at $525,000 from 2012, so ask DMMA which cap it is applying before assuming your home equity rules you out. The cap does not apply at all when a spouse, a child under 21, or a blind or disabled child of any age lawfully occupies the home.1

For full income and asset rules, see Delaware Medicaid Eligibility and Income Limits.

Delaware Medicaid Long-Term Care

Nursing Facility Coverage

Delaware Medicaid pays for nursing facility care for eligible individuals who meet the clinical level-of-care standard. Once financially and clinically eligible, Medicaid covers the cost of care. The resident contributes nearly all monthly income toward the facility cost, keeping only the $75 Personal Needs Allowance ($150 for a married couple), plus deductions for a community spouse income allowance (where applicable) and certain health insurance premiums. The $75 is not universal: DSSM 20995.1.1, the post-eligibility section covering an institutionalized spouse, sets the allowance at $30 per month for SSI recipients and $75 for all others, so an SSI recipient entering a Delaware facility should confirm which amount DMMA is applying.1

HCBS Waivers and Diamond State Health Plan-Plus

Delaware delivers most of its long-term care Medicaid through Diamond State Health Plan-Plus, a managed-care program that covers both nursing facility care and Home and Community-Based Services (HCBS) for people who meet the nursing-facility level of care. HCBS lets eligible seniors receive supportive services (personal care and attendant services, home health, adult day services, and case management among them) while remaining at home or in the community rather than entering a nursing facility. Waiver and institutional coverage use the same $2,000 asset limit and $2,485 income cap.1 See How Delaware Medicaid Pays for Home and Community Care for the waiver programs, covered services, and how to apply.

The 60-Month Look-Back

Delaware applies a 60-month (five-year) look-back to asset transfers made for less than fair market value before a long-term care application, following the federal rule under 42 U.S.C. § 1396p(c). Uncompensated transfers within that window generate a penalty period of Medicaid ineligibility for long-term care services, calculated by dividing the transferred value by the state's average monthly private-pay nursing-facility cost. That penalty period does not run from the date of the transfer: for transfers made on or after February 8, 2006, it begins on the later of the transfer date or the date the applicant is eligible for Medicaid and would otherwise be receiving institutional-level care on an approved application, but for the penalty. A family that assumes an old gift's penalty has already expired is usually mistaken, because those months have not begun running. An undue-hardship waiver is available under 42 U.S.C. § 1396p(c)(2)(D) where applying the penalty would endanger the applicant's health or life, or deprive them of food, clothing, shelter, or other necessities of life.3

Estate Recovery

Delaware's estate-recovery and lien policy applies to people age 55 and over who applied for DHSS long-term care services, meaning nursing facility care, HCBS waiver services, and community-based long-term care services and supports.1

Federal law bars recovery until after the death of a surviving spouse, and bars it while there is a surviving child who is under 21 or who is blind or permanently and totally disabled. Read those as timing bars rather than permanent exemptions: recovery can proceed once a protected survivor has died or a protected child turns 21. Federal law also requires every state's estate definition to include probate assets and permits a state to extend recovery to non-probate assets such as jointly held property, a life estate, or a living trust.3 Delaware's published policy does not say which of those it elects, so ask DMMA before assuming a jointly held or trust-held asset is out of reach.

Two carve-outs do come straight from Delaware's own manual: Medicaid payments for Medicare cost-sharing with a date of service on or after January 1, 2010 are exempt from recovery, and recovery may be waived for the period of an undue hardship.1

See Delaware Medicaid Estate Recovery for the full rules, protections, and hardship waiver process, and Delaware Medicaid Appeals and Fair Hearings if you need to challenge a decision.

Delaware Medicare Savings Programs

DMMA administers the Medicare Savings Programs (MSPs) for low-income Medicare beneficiaries, and publishes three income tiers set as percentages of the federal poverty level. You must be entitled to Medicare Part A to qualify for any of them.4

Two things about those numbers are worth knowing before you rule yourself out. First, Medicare.gov publishes slightly higher federal 2026 limits for the same programs, $1,350, $1,616 and $1,816 for an individual, and notes that some states do not count certain types or amounts of income. If your income falls in the roughly $20 gap between the two sets of figures, apply and let DMMA make the determination. Second, on assets: the federal 2026 MSP resource limits are $9,950 for one person and $14,910 for a married couple, but DMMA's own Qualified Medicare Beneficiary page states "Your assets are not considered" in its QMB section, and its SLMB and QI-1 sections give an income limit and state no resource limit at all. Confirm with DMMA rather than assuming savings disqualify you.4

Enrolling in QMB, SLMB, or QI automatically qualifies you for Extra Help, the Part D Low-Income Subsidy. QI-1 is the one tier you must apply for again every year, because being selected in one year does not entitle you to continued assistance the next. A fourth federal MSP, the Qualified Disabled and Working Individual (QDWI) program, pays the Part A premium for certain working people with disabilities who lost premium-free Part A, and it does not carry Extra Help.5 Federal law bars every Medicare provider and supplier from billing a QMB enrollee for Medicare Part A or Part B cost sharing, including deductibles, coinsurance, and copayments, even where Delaware Medicaid pays nothing toward that cost sharing. That shield covers Part A and Part B cost sharing; it is not a bar on Part D drug copays.6 Delaware residents apply through DMMA.4

See Delaware Medicare Savings Programs for full income limits and how to apply.

Spousal Impoverishment Protections

When one spouse applies for Delaware Medicaid long-term care coverage, federal spousal impoverishment protections under 42 U.S.C. § 1396r-5 keep the community spouse from losing all of their shared resources.7

Key 2026 figures:

• Community Spouse Resource Allowance (CSRA): Delaware protects the greater of its state spousal share or half the couple's combined countable resources as of the start of the first continuous period of institutionalization, and in no case more than the 2026 federal maximum of $162,660.7 The floor is genuinely unsettled in Delaware, so this guide does not assert one: DSSM 20910.10 still prints a $25,000 state spousal share set by Senate Bill 99 in 1993, while the same section says the minimum and maximum resource allowances rise each January under federal law, and the 2026 federal minimum resource standard published by CMS is $32,532. Ask DMMA which floor it applies before relying on either number.1
• Monthly income for the community spouse: Delaware brings the community spouse's own monthly income up to a Minimum Monthly Maintenance Needs Allowance (MMMNA), computed as the applicable percentage of the federal poverty level for two plus an additional amount for excess shelter costs.1 The 2026 MMMNA is $2,705.00 a month, effective July 1, 2026. A separate federal standard, the Maximum Monthly Maintenance Needs Allowance of $4,066.50 effective January 1, 2026, caps how high that allowance can be raised. These are two distinct standards on two different annual clocks, not the two ends of one published range.7
• Home: exempt from the eligibility calculation while the community spouse lives there.

See Delaware Medicaid Spousal Impoverishment Rules for the snapshot process and income diversion mechanics.

How to Apply for Delaware Medicaid

Applying for Delaware long-term care Medicaid follows a defined sequence. Gather your paperwork first, then submit through one of the agency pathways.

See How to Apply for Delaware Medicaid for a full walkthrough and document checklist.

If Delaware Medicaid Says No

Delaware allows the full federal appeal window, so the useful number is not 90 but the date the 90 runs from. You have 90 days to request a fair hearing, counted from the date your notice of action is mailed rather than the day you opened it.8 The 90 in 42 CFR 431.221(d) is a ceiling on what a state may allow, not a guarantee every state matches, and Delaware happens to allow all of it. Read the mailing date off the notice and count from there.

Two clocks inside that one matter more. To keep your current benefits while the appeal is decided, request the hearing before the effective date of the action, which always falls earlier than the 90-day deadline; DSS then continues those benefits within 5 working days of receiving the request.8 And if the denial came from your Medicaid health plan (AmeriHealth Caritas, Delaware First Health, or Highmark Health Options) rather than from DMMA, you file that plan's internal appeal within 60 calendar days of the date printed on its notice. That 60 days is the health-plan deadline, not the eligibility-denial deadline, and once the plan upholds its decision you have 120 calendar days from its resolution notice to request the state fair hearing.8

For the full deadline table and how to file, see Delaware Medicaid Appeals and Fair Hearings.

Keeping Delaware Medicaid Once You Have It

Missing a renewal is one of the most common ways people lose coverage they still qualify for, and federal rules put most of the work on the agency rather than on you. Before it asks you for anything, Delaware Medicaid must first try to renew your coverage automatically from information it already holds, and may only request documents if it cannot.9 If it does need paperwork, it must send a renewal form and give you at least 30 days from the date on that form to return it.9 That duty, and the 90-day reconsideration window below, cover eligibility based on modified adjusted gross income (MAGI). If you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Delaware may offer the same windows but is not required to, so ask DMMA what applies to you.9

If coverage does close because a form went unreturned, that is not the end of it. Federal rules require the agency to reconsider your eligibility without a new application if you return the renewal form within 90 days of the termination (required for MAGI-based coverage; a state option otherwise).9 So a MAGI-based renewal missed by a few weeks is usually recoverable, provided you act.

Return a renewal form the week it arrives. See Delaware Medicaid Recertification and Renewal for the full cycle and how to recover coverage that has already closed.

Where to Get Help

Delaware Medicaid FAQ

Learn More

Find personalized help with Delaware Medicaid programs at brevy.com.

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.