Highmark vs AmeriHealth vs Delaware First Health: Choosing a Delaware Medicaid MCO

Once Delaware approves your parent for long-term care Medicaid through DSHP-Plus, the state requires enrollment in one of three managed care organizations. The choice matters more than most families realize — each MCO controls which doctors, nursing homes, and home care agencies your parent can access, and switching mid-year is restricted.

The Three DSHP-Plus MCOs

Delaware contracts with Highmark Health Options, AmeriHealth Caritas Delaware, and Delaware First Health to deliver all Medicaid long-term care services. Every approved beneficiary must enroll in one. There is no fee-for-service alternative.

Highmark Health Options operates the largest provider network in Delaware. Families in New Castle County typically find the broadest choice of nursing facilities and home health agencies here. Highmark assigns a licensed care coordinator who conducts an in-home assessment and builds the written plan of care authorizing specific services — personal care aide hours, home-delivered meals, medical equipment, and adult day programs.

AmeriHealth Caritas Delaware focuses on care coordination for complex cases. If your parent has multiple chronic conditions alongside the need for long-term care, AmeriHealth often assigns specialized coordinators with clinical backgrounds in managing overlapping diagnoses. Their network covers all three counties.

Delaware First Health tends to have strong rural coverage in Kent and Sussex counties. For families in southern Delaware, this plan may offer more nearby home health agencies and participating assisted living facilities than the other two options.

How to Compare Plans Before Choosing

The single most important step is checking whether your parent's current doctors and preferred facilities are in-network. Each MCO publishes an online provider directory. Search for your parent's primary care physician, specialists, preferred nursing homes, and any home care agencies already providing services.

Beyond the directory, ask each plan these questions:

• How many authorized personal care aide hours per week does the plan typically approve for your parent's level of need?
• Does the plan participate with the nursing facility where your parent is currently receiving care (or the one you're considering)?
• How does the plan handle the self-directed care option if you want to hire a family member as a paid caregiver?
• What is the plan's process for authorizing home modifications or durable medical equipment?

Enrollment Timing and Lock-In Rules

After initial enrollment, Delaware generally keeps beneficiaries in their chosen MCO for the 12-month cycle. New members can switch plans during the first 90 days after initial enrollment, and all members can switch during the annual Open Enrollment period in October, with the change taking effect January 1. Outside those windows, switching requires demonstrating good cause, such as the plan failing to provide authorized services.

If your parent doesn't actively choose a plan, the Health Benefits Manager will assign one. Make the selection proactively during the enrollment window following approval.

What All Three Plans Must Cover

Regardless of which MCO you choose, DSHP-Plus requires all three to cover the same core services: nursing facility care, personal care assistants, home-delivered meals, adult day care, minor home modifications (up to $6,000 per project), emergency response systems, and respite care. The difference is in network breadth, coordinator responsiveness, and how aggressively each plan authorizes hours.

In-home personal care and skilled home health services require Electronic Visit Verification through Delaware's EVV system — providers must record each visit electronically, regardless of which MCO manages the case.

When to Escalate a Plan Problem

If your parent's MCO denies a service or reduces authorized hours, you have the right to file a grievance directly with the plan. If the internal grievance doesn't resolve it, you can request a State Fair Hearing through the Division of Social Services. Document everything — the written plan of care, denial letters, and any communication with the care coordinator.

The Delaware Medicaid Long-Term Care & Asset Protection Guide includes an MCO selection worksheet that walks you through comparing all three plans against your parent's existing providers, plus templates for appealing service denials.

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