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Medicaid


Delaware Diamond State Health Plan (DSHP) 1115 Demonstration Waiver Amendment

Delaware's 1115 DSHP Waiver demonstration was initially approved in 1995, and implemented on January 1, 1996. The demonstration mandatorily enrolls eligible Medicaid recipients into managed care organizations (MCOs) to create efficiencies in the Medicaid program and enable the expansion of coverage to certain individuals who would otherwise not be eligible for Medicaid. On November 21, 2016, the Center for Medicaid Services (CMS) published a final rule clarifying that states can use 1115 demonstration authority to provide coverage for former foster care youth who were in foster care under the responsibility of other states and have income higher than 133 percent of the FPL. States that provide coverage under the new adult group have the option of covering former foster care youth with MAGI-based income above 133 percent of the FPL, under the eligibility group described in section 1902(a)(10)(ii)(XX) of the Act and implementing regulations at 42 CFR 435.218.

Delaware currently provides coverage to former foster care youth under the age of 26, not otherwise mandatorily eligible, who were on Medicaid and in foster care in Delaware when they turned age 18 or "aged out" of foster care. Delaware also currently provides coverage to individuals with income up to 133 percent of FPL under the new adult group identified in the ACA. The purpose of this amendment is to provide coverage on a state-wide basis to former foster care youth who currently reside in Delaware and were in foster care and enrolled in Medicaid at age 18 or when they "aged out" of the system in a different state.

The purpose of this posting is to provide public notice and receive public input for consideration regarding Delaware's proposed 1115 Waiver Amendment. The comment period begins on August 1, 2017 and ends on September 11, 2017.

On May 25, 2017, CMS approved an amendment to Delaware's Home and Community Based Services (HCBS) 1915(c) waiver that serves individuals with intellectual and developmental disabilities (IDD). The waiver was rebranded as the Division of Developmental Disability Services (DDDS) Lifespan Waiver and amended to allow Delaware to expand the waiver's target criteria to enroll individuals who live with their family. The amendment also added HCB services designed to meet the needs of families who support a loved one with intellectual and developmental disabilities in the family home. Under the current design of the 1115 DSHP Waiver, individuals enrolled in the 1915(c) Lifespan Waiver are excluded from the 1115 Waiver. When an individual enrolls in the 1915(c) Lifespan Waiver, they are dis-enrolled from the 1115 waiver and are, therefore, also dis-enrolled from their Managed Care Organization.

Delaware planned to submit an amendment to enable Lifespan Waiver enrollees with diagnosis of IDD that live in their homes or family home to remain enrolled in the 1115 DSHP Waiver in order to receive their State Plan benefits from a managed care organization. After the public notice above was sent to publication, DMMA received news that an amendment to the 1115 Waiver is not required. CMS has provided instruction that this change is only a technical change and can be handled in a different manner. The draft amendment is posted below for those that are interested in the details of how this will work.

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Medicaid furnishes medical assistance to eligible low-income families and to eligible aged, blind and/or disabled people whose income is insufficient to meet the cost of necessary medical services. Medicaid pays for: doctor visits, hospital care, labs, prescription drugs, transportation, routine shots for children, mental health and substance abuse services.

Eligibility

  • You can have a car, bank account, and a home and still qualify for Medicaid. DMMA does not look at any of your resources when determining your eligibility for Medicaid.
  • You can work and still qualify for Medicaid.
  • Some persons can have other insurance and still receive Medical Assistance.
  • Low-income uninsured adults between the ages of 19 and 65 may qualify for Medicaid.
  • Certain children living with stepparents, grandparents, or siblings with income may receive Medicaid.
  • Needy families with children may be eligible for Medicaid if they are part of Temporary Assistance for Needy Families.
  • When a family getting a welfare check starts working and leaves welfare they still may receive Medicaid.
  • Low-income pregnant women and children under age 19 may qualify for Medicaid.
  • Most women of child bearing age may be eligible for birth control and family planning services for up to 24 months after their regular Medicaid stops.

Most people receiving Medicaid are enrolled with one of the managed care plans under the Diamond State Health Plan.

To apply for Delaware Healthy Children's Program click here

Diamond State Health Plan - Delaware's Medicaid Managed Care Program

The majority of people receiving Medicaid must choose a family doctor who, along with a managed care organization (MCO), will provide or arrange for all your preventive care and medical needs.  The following individuals are not enrolled with a MCO:

  • Individuals entitled to or eligible to enroll in Medicare
  • Individuals residing in a nursing facility or intermediate care facility for Individuals with Intellectual Disabilities (ICF/IID).
  • Individuals covered under the Medicaid home and community based waiver programs.
  • Non lawful and non qualified non citizens (aliens).
  • Individuals who have military health insurance for active duty, retired military, and their dependents.
  • Individuals eligible for the Medicaid Breast and Cervical Cancer program.
  • Presumptively eligible pregnant women.


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