Delaware and the ACA’s Medicaid expansion

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 more than 21,000 people from 2013 to March 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. From 2017 through 2019, Delaware is responsible for 5 percent of the cost; that will grow to 10 percent in 2020, remaining at that level going forward.

But that’s assuming that the ACA remains in place. In May 2017, House Republicans passed the American Health Care Act, which would make changes to Medicaid across the country. The legislation has a very uncertain future in the Senate, but if the House version were to be enacted, Medicaid expansion would remain unchanged through 2019. After that, the enhanced federal funding (currently set at 90 percent of the cost starting in 2020) would no longer be available for new enrollees. Existing enrollees would still be covered, but states would find it challenging to maintain the ACA-level eligibility rules without the enhanced federal funding.

Importantly, the AHCA would also reduce overall federal Medicaid funding by switching from the current open-ended federal match to a system of block grants or per-capita allotments. Overall, the CBO estimates that federal Medicaid funding would be reduced by $834 billion over the next decade under the AHCA (as opposed to continuing under the ACA).

But Delaware is one of 14 states selected to participate in the National Governors Association’s Bipartisan Health Reform Learning Network. The focus of the project is reducing health care costs in order to help states prepare for the possibility of less federal funding under potential ACA repeal scenarios.

As of March 2017, total enrollment in Delaware’s Medicaid/CHIP programs had grown by 10 percent since 2013, with net enrollment up more than 21,000 people.  Nationally, Medicaid/CHIP enrollment grew by 30 percent from 2013 to March 2017 (including the 19 states that haven’t expanded Medicaid), 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 March 2017, 244,571 Delawareans were covered by Medicaid/CHIP.