DSHP-Plus Delaware: Eligibility, Services, and How to Enroll

If you're researching long-term care Medicaid in Delaware, every path leads to the same program: the Diamond State Health Plan Plus, or DSHP-Plus. Unlike most states that split Medicaid between fee-for-service and separate waiver programs, Delaware folds everything — nursing home care, assisted living support, and home-based services — into this single managed care system.

What DSHP-Plus Actually Is

DSHP-Plus operates under a federal Section 1115 demonstration waiver. In practice, that means Delaware takes its federal Medicaid funding and channels it through three commercial managed care organizations (MCOs) rather than paying providers directly. Every long-term care Medicaid recipient in Delaware is enrolled in one of these MCOs: Highmark Health Options, AmeriHealth Caritas Delaware, or Delaware First Health.

The critical advantage over traditional waiver programs is that DSHP-Plus has no enrollment cap and no waiting list. If your parent meets the eligibility criteria, they're entitled to services. That's a meaningful difference — many states maintain HCBS waiver waiting lists of two to five years.

LTCCS: The Home and Community Services Track

Within DSHP-Plus, the track that covers non-institutional care is called Long-Term Care Community Services (LTCCS). This is what allows your parent to receive Medicaid-funded care at home or in an assisted living facility instead of a nursing home.

LTCCS covers:

• Personal care assistants — help with bathing, dressing, toileting, transfers, and meal preparation
• Home-delivered meals — for recipients who cannot safely prepare food independently
• Home modifications — wheelchair ramps, grab bars, walk-in showers, and other safety modifications (up to $6,000 per project, $10,000 per year)
• Emergency response systems — medical alert devices
• Adult day care — structured daytime programs providing supervision, social activity, and medical monitoring
• Respite care — temporary relief for the primary family caregiver
• Self-directed care — the option to hire and manage your own caregiver, including a family member, as a paid aide

The MCO care coordinator determines how many hours of each service your parent receives. This is based on the authorized plan of care developed after an in-home clinical assessment.

Eligibility: Two Tests, Both Mandatory

Financial test: Countable assets must be at or below $2,000 for an individual applicant. Gross monthly income cannot exceed $2,485 (250% of the SSI Federal Benefit Rate). If your parent's income exceeds the cap, a Qualified Income Trust (Miller Trust) can bring them back into eligibility. When a spouse is involved, the Community Spouse Resource Allowance protects up to $162,660 in joint assets.

Clinical test: Your parent must require a nursing home level of care. A physician completes the Pre-Admission Evaluation (PAE Tool-001), documenting that the applicant needs hands-on assistance with at least two Activities of Daily Living or has severe cognitive impairment. DMMA's Central Intake Unit reviews the evaluation.

Meeting only one test isn't enough. Both financial and clinical criteria must be satisfied.

How Enrollment Works

1. Apply through the ASSIST portal or at a county DSS office
2. Submit the physician-completed PAE Tool-001 to DMMA's Central Intake Unit
3. Once approved, select one of the three MCOs
4. The MCO assigns a care coordinator who conducts an in-home assessment and builds the plan of care
5. Services begin once the plan of care is authorized

In-home personal care and skilled home health providers must use Delaware's Electronic Visit Verification (EVV) system for each visit. This is a state mandate that applies regardless of MCO.

Why the Structure Matters for Your Family

The integrated managed care model keeps nursing facility, home care, and assisted living support within one system. It also means one point of contact — the MCO care coordinator — handles authorizations, provider changes, and care plan updates.

The Delaware Medicaid Long-Term Care & Asset Protection Guide walks through the full DSHP-Plus enrollment process and includes worksheets for comparing the three MCOs and tracking your parent's authorized service hours.

See more Delaware guides →