Does Medicaid Cover Assisted Living in Delaware?

Delaware is one of the few states where Medicaid can pay for assisted living services without a separate waiver application or a waiting list. That surprises most families, who assume the only Medicaid option is a nursing home bed. Here's how it actually works.

Assisted Living Runs Through DSHP-Plus, Not a Standalone Waiver

Delaware doesn't offer separate Home and Community-Based Services waivers the way most states do. Instead, all long-term care Medicaid — whether it's a nursing home, home care, or assisted living — runs through a single mandatory managed care program called the Diamond State Health Plan Plus (DSHP-Plus).

Because DSHP-Plus operates as a managed care entitlement rather than a capped waiver, there's no enrollment limit and no waiting list for eligible applicants. If your parent meets the clinical and financial criteria, they're in.

What Medicaid Covers (and What It Doesn't)

This is where most families get confused. Medicaid through DSHP-Plus pays for the care services inside an assisted living facility — personal care assistance, nursing oversight, medication management, and related health services. It does not pay for room and board.

The practical impact: your family is responsible for the facility's monthly room and board charge, which varies by facility. The market-research baseline for the overall assisted-living cost in Delaware is $7,600 per month. Medicaid picks up the clinical care on top of that. This split means assisted living under Medicaid still costs significantly less than private-pay nursing home care (averaging $14,494/month in Delaware), but it's not free.

Eligibility Requirements

Your parent needs to clear two gates:

Financial eligibility follows the same rules as nursing home Medicaid. Countable assets must be at or below $2,000 for the applicant, and gross monthly income can't exceed $2,485. If income exceeds that cap, a Miller Trust (Qualified Income Trust) can bring your parent back into eligibility. Spousal protections apply — the community spouse can retain up to $162,660 in assets through the Community Spouse Resource Allowance.

Clinical eligibility is the part many families overlook. Your parent must require a nursing home level of care, even though they're seeking assisted living. A physician completes the Pre-Admission Evaluation (PAE Tool-001), which DMMA's Central Intake Unit reviews. The applicant typically needs hands-on help with at least two Activities of Daily Living, or has severe cognitive impairment from dementia or Alzheimer's.

Meeting the financial threshold alone isn't enough — and meeting the clinical threshold alone isn't enough. Both must be satisfied.

How to Get Approved

The process follows the same path as any DSHP-Plus long-term care application:

1. Submit the Medicaid application through the online ASSIST portal or at a county Division of Social Services office
2. Have your parent's physician complete and submit the PAE Tool-001 to the Central Intake Unit
3. Once both financial and medical eligibility are confirmed, choose one of Delaware's three managed care organizations (Highmark Health Options, AmeriHealth Caritas, or Delaware First Health)
4. The MCO care coordinator works with you to identify Medicaid-certified assisted living facilities within the plan's network

Finding Medicaid-Certified Beds

Not every assisted living facility in Delaware accepts Medicaid residents. The number of Medicaid-certified assisted living beds is limited, and availability fluctuates. Your MCO care coordinator can provide a current list of in-network facilities with openings. Start this search early — waiting until the application is approved often means scrambling for a bed.

For families weighing nursing home versus assisted living costs, the Delaware Medicaid Long-Term Care & Asset Protection Guide breaks down the full financial comparison and walks through the asset protection strategies that work regardless of which care setting you choose.

See more Delaware guides →