Diamond State Health Plan Plus: Delaware's Medicaid Long-Term Care Program

Most states run their Medicaid home care through a patchwork of separate waivers, each with its own waitlist and application process. Delaware does it differently. The Diamond State Health Plan Plus (DSHP-Plus) bundles home care, assisted living, and nursing facility coverage into a single mandatory managed care program — and once you qualify, there is no waiting list.

Understanding how DSHP-Plus works is essential for any family trying to secure state-funded care for an aging parent in Delaware.

What DSHP-Plus Covers

DSHP-Plus is Delaware's integrated long-term services and supports (LTSS) program. All services are coordinated through one of three state-contracted Managed Care Organizations (MCOs): AmeriHealth Caritas, Delaware First Health (Wellcare), or Highmark Health Options.

Through your parent's assigned MCO, DSHP-Plus covers:

• Personal care assistants for bathing, dressing, toileting, meal preparation, and light housekeeping
• Home-delivered meals including a second daily meal for qualifying beneficiaries
• Home modifications for safety and accessibility (up to $6,000 per project, $10,000 per benefit year, $20,000 lifetime)
• Non-emergency medical transportation (via Modivcare) to and from medical appointments
• Personal emergency response systems (medical alert devices)
• Adult day services at licensed facilities
• Respite care for family caregivers
• Skilled home health including nursing, physical therapy, and occupational therapy when ordered by a physician
• Assisted living and nursing facility placement when home-based care is no longer sufficient

The key structural difference from most states: DSHP-Plus is classified as an entitlement. Any applicant who meets both the financial thresholds and the clinical level-of-care criteria is legally guaranteed services. There is no waitlist.

How to Qualify

Eligibility requires passing both a financial screen and a clinical assessment.

Financial eligibility:

• Countable assets must be at or below $2,000 for a single applicant
• Gross monthly income must not exceed $2,982 (the 2026 cap at 300% of SSI)
• If income exceeds the cap, a Qualified Income Trust (Miller Trust) must be established before applying
• Delaware audits 60 months of financial history for gifts and below-market transfers

Clinical eligibility:

• A Registered Nurse conducts a face-to-face assessment using the Uniform Assessment Instrument (UAI)
• The assessment must establish that your parent requires a Nursing Facility Level of Care (NFLOC)
• This means they need physical assistance or constant cognitive oversight to perform activities of daily living

The clinical assessment is initiated through the Delaware ADRC (1-800-223-9074) or the DSAAPD Medical Eligibility Unit, and must be completed within 14 to 30 days of intake.

How the MCO System Works

Once approved, you select one of the three MCOs. This choice matters because:

• Your parent's MCO assigns a care coordinator who drafts the service plan and authorizes specific care hours
• If your parent qualifies for both Medicare and Medicaid (dual-eligible), their Medicare D-SNP plan must be "exclusively aligned" with their Medicaid MCO carrier as of January 2026
• Different MCOs may authorize different care hour levels for similar needs — the care coordinator's assessment drives this

After MCO enrollment, a care coordinator conducts a home visit, assesses your parent's daily needs, and creates a formal service agreement specifying exactly which services are authorized and for how many hours per week.

The timeline from Medicaid approval to care authorization and service start is typically 15 to 30 days.

Consumer-Directed Care Option

DSHP-Plus includes a consumer-directed personal care option that allows your parent to hire, schedule, and manage their own caregivers — including paying family members such as adult children or spouses for providing care using state funds.

This option requires registration with Delaware's Financial Management Services and compliance with the Electronic Visit Verification (EVV) system, which tracks caregiver check-ins in real time.

Getting Started

The Delaware Home Care Guide maps the complete DSHP-Plus process from ADRC intake through MCO selection, with financial pre-screening worksheets, a lookback audit checklist, and a Miller Trust setup guide — everything needed to prepare a complete application before contacting DMMA.

See more Delaware guides →