Delaware Healthy Children Program - Frequently Asked Questions

Q. What is the Delaware Healthy Children Program?

A. The Delaware Healthy Children Program (DHCP) provides low cost health insurance for children who are currently uninsured. It gives your children all the benefits that most private plans provide.

Q. How do I know if my children are eligible?

A. Uninsured children from birth to the age of 19 who live in families with incomes at or below the 200% Federal Poverty Level are eligible for DHCP coverage.

Q. How do I apply?

A. You can obtain an application in English or Spanish by calling DHCP at 1-800-996-9969, or by printing the desired form from the DHCP - How to Apply page. You can also fill out an application on the internet using ASSIST - the State of Delaware's Application for Social Service Programs.

Q. What if my child already has some health coverage?

A. A child who has comprehensive health insurance is not eligible for the Delaware Healthy Children Program. Comprehensive Health Insurance means a plan that provides coverage for hospitalization, doctor visits, x-rays and lab work. A child with more limited coverage may still be eligible for the Delaware Healthy Children Program.

*Exception: Children with coverage in a comprehensive health plan may be eligible for Delaware Medicaid if they meet income requirements.

Q. What if I have insurance for my child, but it is too expensive?

A. A child who already has health insurance, even if it is very expensive, is not eligible for the Delaware Healthy Children Program. If a child is voluntarily dropped from health insurance due to the cost of coverage, they are not eligible for the Delaware Healthy Children Program for six months from the drop date. Only if there is good cause for the loss of health insurance (such as termination of coverage due to employer, expiration of COBRA coverage, death or disability of a parent) will the six month waiting period be waived.

Q. What is a qualified non-citizen?

A. In general, children eligible for the Delaware Healthy Children Program must be U.S. citizens. However, the federal government classifies some non-citizen children as “qualified aliens.” These children are eligible. Also remember some children born outside of the U.S. may be citizens.

Examples of non-citizen children who may be eligible:

Lawful permanent residents who entered the U.S. before August 22, 1996
Parolees of more than one year and conditional entrants
Refugees, asylees, and those whose deportation has been withheld
Cuban and Haitian entrants
Amerasians
Dependents of veterans and active-duty military personnel

Many other groups of non-citizen children may be eligible. Call the Delaware Healthy Children Program at 1-800-996-9969 to ask.

Q. Are children of State employees eligible?

A. Children of permanent State of Delaware employees are not eligible for the Delaware Healthy Children Program. However, children of seasonal, casual or temporary state employees can get DHCP coverage if they meet the income guidelines. Children of permanent State of Delaware employees may be eligible to receive Delaware Medicaid in some cases.

Q. Why aren't children of State employees eligible?

A. The Delaware Healthy Children Program uses federal funds from Title XXI of the Social Security Act – the State Children’s Health Insurance Program (SCHIP). By federal law, these funds cannot be used for dependents of state employees.

Q. What about pre-existing conditions or medical eligibility?

A. The Delaware Healthy Children Program does not exclude children because of pre-existing health conditions.

Delaware does provide Medicaid coverage for disabled children who meet certain eligibility criteria. Children with developmental or neurological disabilities such as autism or mental retardation may be eligible for Medicaid coverage under a special Home and Community Based Services waiver program.

Delaware also provides Medicaid coverage through the Children’s Community Alternative Disability Program (CCADP) for children with severe mental or physical disabilities who would otherwise qualify to be cared for in an institutional setting.

Q. How is the Delaware Healthy Children Program different from other Delaware Medicaid programs?

A. Medicaid eligibility depends on the child's age along with the household income and household size. The Delaware Healthy Children Program checks all applications for Medicaid eligibility. If a child qualifies, by federal law he or she enrolls in Delaware Medicaid, not the DHCP paid premium program. No interview is needed. No visit to a State Service Center is required when a Delaware Medicaid annual redetermination review is due.

Q. How often does the Delaware Healthy Children Program review eligibility? What is the process?

A. All children in the Delaware Healthy Children Program have at least 12 months of continuous coverage if monthly premiums are paid. Prior to the end of their eligibility coverage, families will receive an application in the mail and will be required to submit a copy of one month of income verification along with a completed application.

Q. How much do I have to pay?

A. Premium payments are $10, $15 or $25 per household per month, depending on your income.

There is an added bonus: for every 3 months you pay in advance, you'll get the 4th month free! And, with the exception of non-emergency visits to hospital emergency rooms, there are no co-payments. Prescriptions are covered at 100%.

Q. Who provides the insurance?

A. Delaware provides a choice of different managed care plans so that you can select the plan that is best suited to your child's needs. As of July 1, 2007, Delaware contracts with three Managed Care plans – Delaware Physicians Care, Inc., Unison Health Plan, and Diamond State Partners.

Q. Are parents covered too?

A. Sorry. The plan is currently limited to children under the age of 19. But a single monthly fee does cover every child in the household who is eligible for the plan.

Q. When will my coverage start?

A. After you are approved for the program, you must choose a managed care plan and pay the first month's premium. You will receive a notice telling you when your coverage begins.