Delaware Self-Directed Care: How to Get Medicaid to Pay a Family Caregiver

What Self-Directed Care Means in Delaware

Most Delaware Medicaid long-term care runs through managed care organizations under DSHP-Plus, which assign a care coordinator and an agency to send aides to your parent's home. Self-directed care flips that arrangement. Instead of an agency choosing who shows up, your parent (or you, as their authorized representative) hires, trains, schedules, and supervises their own caregivers — including family members.

This option operates under the Long-Term Care Community Services (LTCCS) program within DSHP-Plus. Your parent still needs to meet the same eligibility requirements: income at or below $2,485 per month (or routed through a Miller Trust), countable assets at or below $2,000, and clinical approval at the nursing-home level of care through the PAE Tool-001 assessment.

The difference is control. Under the self-directed model, a fiscal intermediary handles payroll, tax withholding, and workers' compensation insurance. Your parent sets the schedule and picks the person.

Can You Actually Hire a Family Member?

Yes. Delaware's self-directed option allows the beneficiary to hire and pay family caregivers, including an adult child. The MCO and program rules determine which relatives can serve and what requirements apply, so confirm those details with the care coordinator.

Pay and payroll arrangements are handled through the MCO and fiscal intermediary rather than negotiated privately. Ask them for the current rate schedule and payroll requirements.

To set this up, contact your parent's MCO care coordinator (Highmark Health Options, AmeriHealth Caritas Delaware, or Delaware First Health) and request enrollment in the self-directed option. The coordinator will walk through the authorized hours from the current plan of care and connect you with the designated fiscal intermediary.

What Self-Directed Care Covers

The authorized services mirror what an agency would provide under the standard LTCCS program:

• Personal care assistance — bathing, dressing, grooming, toileting, transfers, and mobility support
• Homemaker services — meal preparation, light housekeeping, laundry, and grocery shopping
• Home-delivered meals — if the caregiver is unavailable during certain hours
• Respite care — temporary relief when the primary caregiver needs a break
• Home modifications — wheelchair ramps, grab bars, walk-in showers, and widened doorways (up to $6,000 per project and $10,000 per year through the MCO's environmental accessibility benefit)
• Personal emergency response systems — medical alert devices

The number of authorized hours depends on the clinical assessment. The care coordinator manages the plan, and you can ask the MCO to review it if your parent's condition changes.

Home Modifications Through Medicaid

The home modification benefit is underused because many families do not realize it exists. If your parent is approved for LTCCS home care under DSHP-Plus, their MCO can authorize structural changes to make the home safe and accessible.

Common approved modifications include bathroom grab bars, stair lifts, ramp construction, and threshold removal. Confirm the MCO's authorization and contractor process before work begins; do not pay out of pocket assuming reimbursement.

The cap is $6,000 per individual project and $10,000 total per calendar year. Do not assume work above those caps will be covered; confirm authorization before committing funds.

Electronic Visit Verification Requirements

Every in-home caregiver working under the self-directed option — including family members — must clock in and out using Delaware's mandatory Electronic Visit Verification (EVV) system, operated through the Sandata platform. This is a federal requirement under the 21st Century Cures Act, not a state preference.

The caregiver logs their arrival and departure time using either GPS verification on a mobile app or a landline telephone check-in from the beneficiary's home phone. Each visit record captures the caregiver's identity, the date, the start and end time, the type of service provided, and the location.

Missing or incomplete EVV records can delay caregiver payment and, in serious cases, trigger a fraud investigation. If you are hiring a family member, make sure they understand that the time-tracking requirement is not optional.

How to Get Started

1. Confirm your parent is enrolled in DSHP-Plus with LTCCS community services (not nursing facility placement)
2. Call their MCO care coordinator and request the self-directed care option
3. Complete the fiscal intermediary enrollment paperwork
4. Identify your family caregiver and confirm that person meets the program's requirements
5. Complete the fiscal intermediary's worker enrollment and payroll requirements
6. The caregiver starts working the authorized hours and logs every visit through EVV

The transition from agency-directed to self-directed depends on the MCO and fiscal intermediary; ask what remains before the caregiver can begin.

If you are trying to set up Medicaid coverage for a parent who is not yet enrolled, the Delaware Medicaid Long-Term Care & Asset Protection Guide walks through the full eligibility process — income cap workarounds, asset spend-down, the DSHP-Plus application, and MCO selection — so you can get to this point without paying an elder law attorney for the basics.

See more Delaware guides →