Key takeaways
ACA’s Medicaid eligibility expansion in Delaware
Through the Affordable Care Act, Delaware opted to expand Medicaid eligibility to adults under the age of 65 with incomes up to 138% of the federal poverty level (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, although states now pay 10% of the cost.
Total enrollment in Delaware’s Medicaid/CHIP program grew by over 78,000 people from late 2013 to mid-2022 — a net enrollment growth of 35%.
Not coincidentally, the uninsured rate in Delaware dropped from 9.1% in 2013 to 5.7% in 2017. But it grew to 6.6% in 2019, in line with the nationwide increase in the uninsured rate under the Trump administration.
Delaware has accepted federal Medicaid expansion
- 301,402 – Number of Delawareans covered by Medicaid/CHIP as of July 2022 (source)
- 78,078 – Increase in the number of Delawareans covered by Medicaid/CHIP fall 2013 to September 2021 (source and source)
- 32% – Reduction in the uninsured rate from 2010 to 2019
- 35% – Increase in total Medicaid/CHIP enrollment in Delaware since Medicaid expansion took effect
Who is eligible for Medicaid in Delaware?
The following eligibility levels apply to Delaware’s Medicaid program.
- Children birth to 1 year with family income up to 212% of the federal poverty level (FPL)
- Children 1 to 5 years with family income up to 142% of FPL
- Children 6 to 18 with family income up to 133% of FPL
- Pregnant women with family income up to 212% of FPL
- Parents with family income up to 138% of FPL
- Childless, non-elderly adults with family income up to 138% 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 who aren’t eligible for Medicaid but whose household income doesn’t exceed 212% of FPL, are covered through the Healthy Children program, which is Delaware’s Children’s Health Insurance Program.
How does Medicaid provide financial assistance to Medicare beneficiaries in Delaware?
Many Medicare beneficiaries receive Medicaid financial assistance that can help them with Medicare premiums, lower prescription drug costs, and pay for expenses not covered by Medicare – including long-term care.
Our guide to financial assistance for Medicare enrollees in Delaware includes overviews of these programs, including Medicaid nursing home benefits, Extra Help, and eligibility guidelines for assistance.
How do I enroll for Medicaid in Delaware?
- 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 Medicaid Central Intake Unit at 1-866-940-8963 or the Nursing Facility Program Medical Eligibility Unit for your county.
Delaware Medicaid enrollment numbers
As of July 2022, total enrollment in Delaware’s Medicaid/CHIP programs had grown by 35% since 2013, reaching 301,402 people. Percentage-wise, this is smaller than the enrollment growth in other states, particularly those that have 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
Nationwide, total Medicaid/CHIP enrollment is up 55% from where it stood in late 2013, with significant enrollment growth since 2020 as a result of the COVID pandemic (under the Families First Coronavirus Response Act, states receive additional federal Medicaid funding but cannot disenroll Medicaid members for the duration of the COVID public health emergency period, which is expected to last at least through mid-January 2023).
Delaware Medicaid history
Delaware originally implemented Medicaid in October 1966.
Starting in 1996, the state began converting much of its program to managed care, contracting with managed care organizations (MCOs) to provide Medicaid benefits. The state currently contracts with two MCOs (AmeriHealth Caritas Delaware and Highmark Health Options) to provide Medicaid benefits to eligible enrollees. Those contracts expire at the end of 2022, and the state solicited feedback in 2021 on ways to improve the program before the new contracts begin at the start of 2023.
Initially, DSHP primarily covered low-income children and adults. As of 2020, Delaware covered about 85% 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.
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.