Delaware LTCCS Program: Medicaid Long-Term Care Community Services Explained

What the LTCCS Program Is

Long-Term Care Community Services (LTCCS) is the home and community-based care track within Delaware's DSHP-Plus managed care system. Instead of placing a parent in a nursing home, LTCCS delivers the same types of services in the parent's own home or in a community setting like adult day care or assisted living.

The distinction matters because LTCCS is not a separate waiver program with its own waiting list and enrollment cap. It runs inside DSHP-Plus as an entitlement. Any Delaware resident who meets the financial and clinical eligibility criteria for Medicaid long-term care can access LTCCS services without waiting for a slot to open up. This is unusual — many states operate their home care programs as capped waiver programs with waitlists that can stretch for years.

Eligibility

LTCCS eligibility requirements are identical to nursing facility Medicaid:

Financial: Gross monthly income at or below $2,485 (or routed through a Miller Trust if over the cap), and countable assets at or below $2,000.

Clinical: The applicant must meet the nursing-home level of care, confirmed through the PAE Tool-001 assessment submitted to DMMA's Central Intake Unit. This means the applicant needs hands-on assistance with at least two activities of daily living, has severe cognitive impairment, or requires daily skilled nursing interventions.

The clinical bar is the same whether the person is entering a nursing home or staying at home with LTCCS services. Someone who only needs occasional help with housework or meal preparation — but not skilled or intermediate nursing-level care — will not qualify for LTCCS.

What LTCCS Covers

Once approved, the MCO care coordinator (from Highmark Health Options, AmeriHealth Caritas Delaware, or Delaware First Health) develops a plan of care specifying the authorized services:

• Personal care aides — Hands-on assistance with bathing, dressing, grooming, toileting, transfers, and mobility
• Homemaker services — Meal preparation, light housekeeping, laundry, and grocery shopping
• Home-delivered meals — For beneficiaries who cannot prepare food safely
• Adult day care — Daytime supervision, socialization, meals, and health monitoring at a licensed center
• Home modifications — Structural changes for safety and accessibility (grab bars, ramps, widened doorways, walk-in showers), capped at $6,000 per project and $10,000 per calendar year
• Personal emergency response systems (PERS) — Medical alert devices that connect to emergency dispatch
• Respite care — Temporary relief for family caregivers
• Self-directed care option — The beneficiary hires and manages their own caregivers, including family members, with payroll handled through a fiscal intermediary

The number of authorized hours varies based on clinical need. The care coordinator manages the plan, and families can ask the MCO to review it if the parent's condition changes.

How LTCCS Keeps People Out of Nursing Homes

The financial logic is straightforward. Private-pay nursing home care in Delaware averages approximately $14,494 per month. A typical LTCCS home care package with 30 to 40 hours per week of personal care aide services, home-delivered meals, and a PERS device covers scheduled services rather than a 24-hour nursing home room and board, so its cost is not directly comparable. LTCCS exists partly because it allows eligible people to receive covered services in a community setting and partly because most people prefer staying at home.

For families, the advantage is that the parent retains their housing, their community, and their daily routines. Medicaid pays for the care services — the family pays for the standard household costs (mortgage or rent, utilities, groceries) that they would pay anyway.

The disadvantage is that LTCCS does not cover 24-hour supervision. If a parent has advanced dementia with nighttime wandering or requires round-the-clock clinical monitoring, the authorized aide hours may not be sufficient, and the family must supplement with unpaid family caregiving or consider nursing home placement.

The Medicaid Regional Divisor Connection

One number families encounter during the Medicaid application process is the regional divisor: $13,378.33 per month for 2026 in Delaware. This figure represents the average monthly cost of nursing home care as calculated by DMMA, and it is used to determine the penalty period when an applicant has made asset transfers within the five-year lookback window.

The divisor is relevant to LTCCS applicants because the lookback and transfer penalty rules apply equally to home care and nursing home Medicaid. If a parent made a $40,000 uncompensated transfer to a child three years ago and that transfer is subject to a penalty, the calculation is $40,000 ÷ $13,378.33 = 2.99 months during which Medicaid will not pay for services — not home care, not nursing home.

The divisor updates annually in January based on statewide nursing home cost data. It directly affects how long a family must private-pay during a penalty period, making it a critical planning number for anyone who has made transfers and is now facing a care crisis.

Getting Started with LTCCS

1. Confirm your parent meets the financial criteria (or can qualify through a Miller Trust and asset spend-down)
2. Have the PAE Tool-001 clinical assessment completed and submitted to DMMA
3. File the Medicaid application through Delaware ASSIST or at a county DSS office
4. Upon approval, select an MCO (Highmark, AmeriHealth Caritas, or Delaware First Health)
5. Work with the MCO care coordinator to develop the plan of care and authorize services

The Delaware Medicaid Long-Term Care & Asset Protection Guide covers the full application sequence — financial qualification, clinical assessment, MCO selection, and care plan authorization — for both LTCCS home care and nursing facility placement.

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