Medicaid for nursing home and home care in Delaware

Who qualifies

You must:

• live in Delaware and be a U.S. citizen or lawful permanent resident,
• need a skilled or intermediate level of care, as decided by a Pre-Admission Screening (PAS) nurse from the Division of Medicaid and Medical Assistance (DMMA), and
• be willing to enter a nursing home or accept home and community-based services.

The same income and asset limits apply to nursing home care and to home and community-based services.

If your income is over the limit: Miller Trust

If your gross income is above $2,485, you must set up a Miller Trust (also called a qualified income trust) to qualify. DMMA suggests talking to a lawyer about Miller Trusts.

What counts and what does not

Income

DMMA uses your gross income, such as Social Security before the Part B premium, pensions and interest. Small amounts are not counted: $20 a month of any income, and if you work, another $65 of earnings plus half of the rest.

Assets that do not count

• Your home, if you plan to return to it, or if your spouse or a dependent relative lives there. You must say yourself that you plan to return.
• One car used for transportation.
• Burial funds up to $1,500, plus burial plots and prepaid funeral plans that cannot be cancelled.
• Life insurance with a total face value of $1,500 or less.

Bank accounts, stocks, bonds, revocable annuities, extra cars and other property count.

Home equity

If your home equity (value minus what you owe) is over $752,000, Medicaid will not pay for long-term care. This does not apply if your spouse, a child under 21, or a blind or disabled child lives there. You can ask for a hardship waiver.

Gifts and transfers

DMMA looks back 60 months at what you gave away or sold for less than it was worth. A transfer can lead to a penalty period when Medicaid will not pay for your care. Annuities bought on or after February 8, 2006 must name the State of Delaware as a beneficiary.

What you pay toward your care

If you live in a nursing home, you keep $75 a month for personal needs. The rest of your income goes to the nursing home, except for:

• health insurance premiums,
• medically needed items Medicaid does not cover, such as eyeglasses, dentures and hearing aids,
• an allowance for a spouse living at home, and
• an allowance for a dependent family member.

Protection for a spouse at home

Under federal spousal impoverishment rules, your spouse at home can keep some of your joint assets and receive part of your income each month. DMMA has not posted current Delaware amounts, so ask Central Intake to work out your figures.

What Medicaid pays for

Nursing facility care

Care in a Medicaid-certified nursing home bed. A nursing home cannot discharge you just because you switch from paying yourself to Medicaid, if a Medicaid-certified bed is available. It also cannot charge you for covered services or ask for a payment to admit you.

Home and community-based services (DSHP Plus)

These services help you stay at home or in assisted living:

• case management,
• personal care (help with bathing, dressing, light housekeeping and laundry),
• adult day services,
• respite care for caregivers, including short stays in a nursing home,
• emergency response systems,
• assisted living.

These services do not pay for rent or other living costs. Most people in nursing homes or home care Medicaid are enrolled in a DSHP Plus managed care plan. You choose from the plans offered.

PACE

PACE covers all Medicare and Medicaid services for people 55 or older who need nursing home level care but can live safely at home in a PACE service area. People in PACE do not also join a DSHP Plus plan. Call DHSS at 302-255-9040 to ask if PACE serves where you live.

How to apply

1. Call DMMA Central Intake at 1-866-940-8963. You can also start an application online through ASSIST at assist.dhss.delaware.gov.
2. Complete the packet Central Intake sends you. Fill it out before your interview, but do not sign it yet.
3. Go to your interview with a financial eligibility social worker. Bring the application, proof of identity, your income and asset papers (such as bank statements and trust papers), and your spouse's income and asset papers.
4. Medical review. A PAS nurse decides if you need nursing home level care.
5. Send missing papers. If DMMA needs more, it sends a letter (Form 415). You get 15 days, and you can ask for 15 more. If papers are still missing, your application can be denied.
6. Decision. DMMA sends a notice with your Medicaid start date.

After you apply

• Renewals: DMMA reviews your case regularly. Answer renewal letters on time.
• Report changes in income, assets or where you live.
• If you are denied, your notice explains your right to a fair hearing and the deadline. Ask Central Intake or the ADRC for help.

Estate recovery

Delaware may seek repayment of long-term care costs from your estate, but only after you and a surviving spouse have died. It will not take a home where a minor, blind or disabled child lives. Your family can ask for a hardship waiver.

Things people miss

• Income too high is not the end. A Miller Trust can make you eligible.
• The home is usually safe while you plan to return or your spouse lives there.
• Prepaid funeral plans that cannot be cancelled do not count as assets.
• Older papers show a lower personal needs allowance. Since January 2025 it has been $75 a month.

Free help

• Aging and Disability Resource Center (ADRC): 1-800-223-9074. TDD: (302) 424-7141.
• Delaware Medicare Assistance Bureau for Medicare questions: 1-800-336-9500.
• Adult Protective Services: 1-888-277-4302.

Read more about paying for a nursing home, Medicare, and all benefits in Delaware.

Phone numbers: Free help lines for Delaware agencies

Check what you may qualify for