Long Term Care Medicaid Programs
The Division of Medicaid & Medical Assistance provides the following Long Term Care services:
- Medicaid Nursing Facility Care
- Medicaid Home and Community-Based Services
- Medicaid 30-Day Acute Care Hospital services
- Children's Community Alternative Disability Program
- Medicaid Out-of-state Rehabilitation Hospital Services
- Qualified Medicare Beneficiary (QMB) programs
- Supplemental Security Income (SSI) related programs
The Nursing Facility Program
An individual applying for the Nursing Facility program must be a Delaware resident and must be willing to enter a nursing facility and accept Medicaid coverage. To apply for this program, contact either the Medical Eligibility Unit for New Castle County or the Medical Eligibility Unit for Kent and Sussex Counties.
The medical criteria for this program are as follows: the applicant must be in need of a skilled or intermediate level of care as defined by Delaware Medicaid criteria. In other words, the individual must require the level of care provided by a nursing facility. If his gross monthly income exceeds the income limit for this program (set at 250% of the Supplemental Security Income - SSI - standard), he will need to establish a Miller Trust in order to qualify. His assets cannot exceed $2,000 unless he has a spouse.
The Nursing Facility Program pays for the cost of care provided in nursing facilities in Delaware that have contracts with Delaware Medicaid. These nursing facilities provide room, board and nursing services to persons who are elderly, infirm or disabled.
Official lists of all Licensed Long Term Care Facilities in Delaware are maintained by the Division of Long Term Care Residents Protection, which is responsible for licensing and certifying all Delaware Long Term Care facilities.
- Medicaid may only pay for covered services after all other coverage has been exhausted. Examples of other coverage are Medicare, employment-related health insurance, Union Health & Welfare Funds, workers' compensation, and no-fault automobile insurance. This is based on the Code of Federal Regulations (42 CFR 433 Subpart D) and Delaware State Law (Medical Care Subrogation Law - Chapter 5, Title 31, Section 522). When a recipient receives payment from an insurance carrier, court settlement, etc. for any medical services paid by Medicaid, the recipient is obligated to reimburse the program for those related services. All such cases must be referred to the Third Party Liability Unit at the Delaware Division of Medicaid & Medical Assistance .
- A Medicaid nursing facility resident may keep $44.00 of his monthly income for his personal needs.
This "Personal Needs Amount" is set by the Delaware Legislature. The rest of his income must
be paid to the facility unless an amount has been protected for:
- The needs of a community spouse under the Spousal Impoverishment Provision,
- Medically necessary medical equipment and medical services not covered by Medicaid (e.g. eye glasses, dentures, hearing aids...), and/or private health insurance premiums.
- If a patient in a Medicaid-enrolled nursing facility runs out of private funds and converts to Medicaid payment, the nursing facility cannot discharge the patient if there is an available Medicaid-certified bed.
- Federal law prohibits nursing facilities from charging Medicaid residents or their families for items and/or services that are covered by Medicaid. Nursing facilities must provide a list of what items and services are included in the basic Medicaid rate and what items or services would require an extra charge.
- Nursing facilities that accept Medicaid cannot ask Medicaid residents for contributions as a condition of admission or charge fees to supplement the Medicaid rate.
Medicaid nursing facility rates are based on the facilities' annual costs reports.