Delaware and the ACA’s Medicaid expansion

• Delaware expanded Medicaid in 2014, and enrollment has grown by 11 percent
• Delaware’s uninsured rate had dropped to just 5.4 percent by 2017

Medicaid expansion in Delaware

For many years, Delaware officials have worked to expand health insurance coverage to state residents, especially those with low incomes. The state implemented Medicaid soon after federal legislation was enacted in 1965.

Over the years, Delaware has successfully contracted with managed care organizations (MCOs) to lower Medicaid costs and used the savings to make Medicaid available to more people. In January 2014, Delaware adopted Medicaid expansion through the Affordable Care Act (ACA), and total enrollment in Delaware’s Medicaid/CHIP program grew by almost 25,000 people from 2013 to August 2018 — a net enrollment growth of 11 percent.

Not coincidentally, the uninsured rate in Delaware has dropped from 9.1 percent in 2013 to 5.4 percent in 2017.

Delaware’s Medicaid eligibility guidelines

Delaware has set the following eligibility levels for its Medicaid program.

• Children birth to 1 year with family income up to 212 percent of the federal poverty level (FPL)
• Children 1 to 5 years with family income up to 142 percent of FPL
• Children 6 to 18 with family income up to 133 percent of FPL
• Pregnant women with family income up to 212 percent of FPL
• Parents with family income up to 138 percent of FPL
• Childless, non-elderly adults with family income up to 138 percent of FPL (Medicaid expansion population)
• Elderly and disabled individuals with special requirements and who meet certain income limits. Use Delaware ASSIST (Application for Social Services and Internet Screening Tool) to see if you qualify.

Children ages 1-18 up to 212 percent of FPL are covered through the Healthy Children program, which is Delaware’s Children’s Health Insurance Program.

How to sign up for Medicaid

• You can apply for Medicaid online at HealthCare.gov or through Delaware ASSIST.
• You can fill out a paper application and return it by mail. Call 1-800-372-2022 or 302-255-9500 to have an application mailed to you.
• Call 1-800-372-2022 or 302-255-9500 to be directed to the nearest DSS office.
• To apply for long-term care, call the Long Term Care Medicaid Unit for your county.

Medicaid expansion

Through the Affordable Care Act, Delaware opted to expand Medicaid eligibility to adults without dependents with incomes up to 138 percent of FPL. Coverage effective dates for those qualifying for Medicaid expansion started Jan. 1, 2014.  The federal government paid the full cost of expanding coverage to the newly-eligible population through 2016. Starting in 2017, Delaware was responsible for 5 percent of the cost, and that gradually grows each year until it reaches 10 percent in 2020, remaining at that level going forward.

As of August 2018, total enrollment in Delaware’s Medicaid/CHIP programs had grown by 11 percent since 2013, with net enrollment up nearly 25,000 people. Nationally, Medicaid/CHIP enrollment grew by 27 percent from 2013 to August 2018 (including the 19 states that hadn’t expanded Medicaid at that point), but Delaware’s median household income is higher than the national average, so fewer people are eligible for coverage intended for low-income households.

History of Medicaid in Delaware

Delaware originally implemented Medicaid in October 1966.

Starting in 1996, the state began converting much of its program to managed care. The managed care program is called the Diamond State Health Plan (DSHP).

Initially, DSHP primarily covered low-income children and adults. As of 2011, Delaware covered about 80 percent of its Medicaid beneficiaries through managed care.

In April 2012, Delaware received approval to move some of its long-term care and dual eligible (those who qualify for both Medicaid and Medicare) populations to managed care. This program is called DSHP Plus.

As of August 2018, 248,310 Delawareans were covered by Medicaid/CHIP.

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Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.