Medicaid is a health insurance program for low-income individuals of all ages. While health coverage is available for various groups of Delaware residents, the focus here is on long-term care Medicaid eligibility for elders, aged 65 and over. In addition to care services in nursing homes, assisted living facilities, and adult foster care homes, DE Medicaid pays for non-medical services and supports to help frail seniors remain living in their homes. There are three categories of Medicaid long-term care programs for which DE seniors may be eligible.
1) Institutional / Nursing Home Medicaid – An entitlement; anyone who meets the eligibility requirements will receive assistance. Benefits are provided only in nursing home facilities.
2) Home and Community Based Services (HCBS) / Long Term Care Community Services (LTCCS) – Although Delaware previously offered Home and Community Based Services (HCBS) Medicaid Waivers for its elderly population, the state no longer does. With these Waivers, the number of participant slots was limited and waiting lists could exist. Currently, long-term care services are provided at home, adult day care, rest residential care homes (adult foster care), and in assisted living via a managed care system. This allows program participants to receive all needed services via one administering agency. Unlike with HCBS Waivers, the LTCCS managed care program does not have enrollment caps, which means there are no waiting lists to receive benefits.
3) Regular Medicaid / Aged Blind and Disabled – An entitlement; anyone who meets the eligibility requirements is guaranteed assistance. Limited long-term care services, such as personal care assistance or adult day care, may be available.
In Delaware, the majority of Medicaid enrollees receive benefits via a managed care program called the Diamond State Health Plan (DSHP). Specific to long-term care, it is called Diamond State Health Plan Plus (DSHP Plus). It is broken into two programs: The Nursing Facility Program and Long-Term Care Community Services (LTCCS) Program. The state’s previous HCBS Medicaid Waivers, including the Elderly & Disabled Waiver, were absorbed by the state’s LTCCS Program.
While Medicaid is jointly funded by the state and federal government, it is administered by the state under federally set parameters. The Delaware Division of Medicaid & Medical Assistance (DMMA), which is within Delaware Health and Social Services (DHSS), is the administering agency.
The American Council on Aging now offers a free, quick and easy Medicaid Eligibility Test for seniors.
The three categories of Medicaid long-term care programs have differing financial and functional (level of care need) eligibility requirements. Further complicating financial eligibility is that the requirements change annually, vary with marital status, and Delaware offers multiple pathways towards Medicaid eligibility.
Simplified Eligibility Criteria: Single Nursing Home Applicant
Delaware seniors must have limited income and assets, and a medical need to qualify for Medicaid long-term care. In 2024, a single Nursing Home Medicaid applicant must meet the following criteria: 1) Income under $2,358 / month 2) Assets under $2,000 3) Require a Nursing Home Level of Care.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long-term care from a Delaware Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all of the criteria does not mean one is ineligible or cannot become eligible for Delaware Medicaid. More.
| 2024 Delaware Medicaid Long-Term Care Eligibility for Seniors | |||||||||
| Type of Medicaid | Single | Married (both spouses applying) | Married (one spouse applying) | ||||||
| Income Limit | Asset Limit | Level of Care Required | Income Limit | Asset Limit | Level of Care Required | Income Limit | Asset Limit | Level of Care Required | |
| Institutional / Nursing Home Medicaid | $2,358 / month* | $2,000 | Nursing Home | $2,358 / month per spouse*† | $3,000 | Nursing Home | $2,358 / month for the applicant* | $2,000 for applicant & $154,140 for non-applicant | Nursing Home |
| Home and Community Based Services / Long Term Care Community Services | $2,358 / month‡ | $2,000 | Nursing Home | $2,358 / month per spouse†‡ | $3,000 | Nursing Home | $2,358 / month for the applicant‡ | $2,000 for applicant & $154,140 for non-applicant | Nursing Home |
| Regular Medicaid / Aged Blind and Disabled | $943 / month | $2,000 | Help with ADLs | $1,415 / month | $3,000 | Help with ADLs | $1,415 / month | $3,000 | Help with ADLs |
*All of a beneficiary’s monthly income, with the exception of a Personal Needs Allowance of $50 / month, Medicare premiums, and potentially a Needs Allowance for a non-applicant spouse, must be paid to the nursing home. This is called a Patient Liability.
†Generally each spouse is considered as an individual, but in just a few cases, the income limit of a couple is used. For 2024, this is $3,537 / month.
‡Based on one’s living setting, a program beneficiary may not be able to keep monthly income up to this level.
Countable vs. Non-Countable Income
Nearly any income from any source that a Medicaid applicant receives is counted towards Medicaid’s income limit. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, Supplemental Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. Furthermore, in DE, the VA Aid & Attendance and Housebound Allowances, which are above and beyond the Basic VA Pension, do not count as income.
Treatment of Income for a Couple
When only one spouse of a married couple applies for Nursing Home Medicaid or Home and Community Based Services Medicaid, only the income of the applicant is counted. This means the income of the non-applicant spouse is disregarded and does not impact their spouse’s income eligibility. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse. The MMMNA is a Spousal Impoverishment Rule and is the minimum amount of monthly income a non-applicant spouse is said to require to avoid spousal impoverishment.
The MMMNA in DE is $2,555 (eff. 7/1/24 – 6/30/25). If a non-applicant spouse’s monthly income is under $2,555, income can be transferred to them from their applicant spouse, bringing their income up to this level. In Delaware, a non-applicant spouse can further increase their Spousal Income Allowance if their housing and utility costs exceed a “shelter standard” of $766.50 / month (eff. 7/1/24 – 6/30/25). However, in 2024, a Spousal Income Allowance cannot push a non-applicant’s total monthly income over $3,853.50. This is the Maximum Monthly Maintenance Needs Allowance. More on how this allowance is calculated.
Income is counted differently when only one spouse applies for Regular Medicaid / Aged Blind and Disabled; the income of both the applicant spouse and the non-applicant spouse is calculated towards the applicant’s income eligibility. Furthermore, there is no Monthly Maintenance Needs Allowance for a non-applicant spouse. More about how Medicaid counts income.
Countable vs. Non-Countable Asset
The value of countable assets, also called resources, are added together and counted towards Medicaid’s asset limit. This includes cash, stocks, bonds, investments, annuities, bank accounts (credit union, savings, and checking), and real estate in which one does not reside. In DE, the IRA / 401K of the applicant is counted. There are also many assets that are non-countable; they are exempt. Exemptions include personal belongings, such as clothing, household furnishings, an automobile, up to $1,500 for burial, an irrevocable funeral trust up to $15,000, life insurance with a combined face value of $1,500, and generally one’s primary home. In DE, the IRA / 401K of a non-applicant spouse is exempt.
Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned. This is true regardless of the long-term care Medicaid program for which one is applying and regardless of if one or both spouses are applicants. Spousal Impoverishment Provisions, however, permit the non-applicant spouse of a Nursing Home Medicaid or Medicaid Home and Community Based Services applicant a Community Spouse Resource Allowance (CSRA).
In 2024, the CSRA allows the community spouse (the non-applicant spouse) to retain 50% of the couple’s assets, up to a maximum of $154,140. If the non-applicant’s share of the assets falls under $30,828, they can keep 100% of the assets, up to $30,828. There is no CSRA for a non-applicant spouse of a Regular Medicaid applicant.
Medicaid’s Look-Back Rule
It is vital that one does not give away assets or sell them for less than fair market value within 60-months of applying for Nursing Home Medicaid or Medicaid Home and Community Based Services in Delaware. This is because there is a Medicaid Look-Back Period that immediately precedes one’s Medicaid application date. During the “look back”, the Medicaid agency scrutinizes all past asset transfers, and if assets have been gifted or sold under fair market value, it is assumed it was to meet Medicaid’s asset limit. Persons who violate the Look-Back Period are penalized with a period of Medicaid ineligibility. There is no Look-Back Period for Regular Medicaid.
The U.S. Federal Gift Tax Rule does not extend to Medicaid eligibility. In 2024, this rule allows individuals to gift up to $18,000 per recipient without filing a Gift Tax Return. Gifting under this rule violates Medicaid’s Look-Back Period.
For home exemption, the Medicaid applicant or their spouse must live in their home. If there is no spouse in the home, there is a home equity interest limit of $713,000 (in 2024). Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of home equity owned by the applicant. Furthermore, if there is not a spouse in the home, and the Medicaid applicant does not live there, the applicant must have Intent to Return. For Regular Medicaid, there is no home equity interest limit. Other exemptions exist.
While one’s home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program. Following a long-term care Medicaid beneficiary’s death, Delaware’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.
An applicant must have a medical need for long-term care Medicaid. For Nursing Home Medicaid and Home and Community Based Services Medicaid, a Nursing Facility Level of Care (NFLOC) is required. Furthermore, additional criteria may be required for specific program benefits. As an example, for Medicaid to cover the cost of home modifications, an inability to safely and independently live at home without modifications may be required. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living (ADLs) is required, but a NFLOC is not necessarily required.
For Delaware elderly residents (aged 65 and over) who do not meet the financial eligibility requirements above, there are other ways to qualify for long-term care Medicaid.
1) Qualified Income Trusts (QIT’s) – Also called Miller Trusts. QITs allow Nursing Home Medicaid and Home and Community Based Services Medicaid applicants who are over the income limit, yet still cannot afford their long-term care costs, to become income-eligible. In simple terms, one’s excess income (over the Medicaid limit) is directly deposited into an irrevocable trust, meaning once the trust has been established, it cannot be changed or canceled. A trustee is named, giving that individual legal control of the money in the trust, and no longer counting towards Medicaid’s income limit. Trust funds can only be used for very specific purposes, such as paying long-term care services / medical expenses accrued by the Medicaid enrollee. Furthermore, upon death of the Medicaid participant, any remaining funds must be paid to the state of Delaware.
2) Asset Spend Down – Persons who have assets over the Medicaid eligibility limit can still become asset-eligible by “spending down” excess assets. This can be done by spending countable assets on non-countable ones, such as home modifications (wheelchair ramps, roll-in showers, and stair lifts), vehicle modifications (wheelchair lifts, adaptive control devices, and floor modifications to allow one to drive from a wheelchair), prepaying funeral and burial expenses, and paying off debt. Remember, Medicaid has a 60-month Look-Back Period, which if one violates, results in a Penalty Period of Medicaid ineligibility. It is recommended one keep documentation of how assets were spent as proof this rule was not violated.
Our Spend Down Calculator can assist persons in determining if they might have a spend down, and if so, provide an estimate of the amount.
3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and / or “over-asset”, but they still cannot afford their cost of care. For these persons, Medicaid planning exists. By working with a Medicaid Planning Professional, families can employ a variety of strategies to help them become Medicaid-eligible, as well as to protect their home from Medicaid’s Estate Recovery Program. Connect with a Medicaid Planner.
1) Diamond State Health Plan Plus (DSHP-Plus) – This managed care program is broken into two sub-programs: The Nursing Facility Program and the Long Term Community Services (LTCCS) Program. DSHP-Plus provides supportive services to program participants living at home, in assisted living, adult foster care, and nursing homes. Benefits via LTCCS may include adult day care, meal delivery, minor home modifications, respite care, personal emergency response systems, and more. Self-direction of personal care assistance is an option for those living outside of a residential facility. This option allows one to hire friends and relatives, including a spouse or adult child, to be the caregiver.
2) Program of All-Inclusive Care for the Elderly (PACE) – The benefits of Medicaid, including long-term care services, and Medicare are combined into one program. Additional benefits, such as dental and eye care, may be available.
Seniors can apply for Delaware Medicaid online at Delaware ASSIST. Alternatively, individuals can contact Delaware Health and Social Services (DHSS). The Delaware Aging & Disability Resource Center might also be helpful with providing program information and application assistance. The application process may vary based on the program for which one is applying.
Prior to submitting an application for Delaware Medicaid, senior applicants should be positive that all eligibility requirements are met (as discussed above) for the program for which they are applying. Having income and / or assets greater than the limits(s), or being uncertain if eligibility criteria are met, can result in a denial of Medicaid benefits. Persons in these situations should seriously consider Medicaid Planning for the best chance of acceptance into a Medicaid program. Familiarizing oneself with general information about the application process can be helpful.