The Delaware Medicaid program helps low-income individuals and families by providing medical assistance. It pays for various medical services such as hospital care, doctor visits, transportation, and prescription drugs.

Medicaid is administered in the state of Delaware by the Division of Medicaid and Medical Assistance or DMMA; it pays for the medical bills using federal and state tax money.

Needy families and aged, disabled and/or blind people who do not have enough income to pay for medical services receive benefits from Medicaid. The program pays for the following services:

• Doctor visits
• Prescriptions
• Laboratory tests
• Outpatient and inpatient hospital care
• Home health care
• X-rays
• Medical supplies and equipment
• Hospice care
• Dental care (for individuals up to 21 years old)
• Medical transportation services

Once you are eligible for Medicaid, you will receive benefits through Managed Care Organizations or MCO that are under contract with Delaware. However, there are some recipients who do not get medical care this way including:

• Individuals eligible to receive Medicare benefits
• People who live in nursing facilities or intermediate care facilities for the mentally retarded (ICF/MR)
• Unlawful and unqualified non-citizens
• People who are covered by the home and community based waiver programs under Medicaid
• Those who are qualified to receive benefits from the Medicaid Breast and Cervical Cancer program
• Individuals with military health insurance for retired military, active duty, as well as their dependents
• Presumably qualified pregnant women

You may choose from the MCO plans provided by the DMMA that will best suit the needs of your family. You will receive the details through mail about the various plan options. There are three MCO plans under agreement with the state: the Diamond State Partners, the UnitedHealthcare Community Plan, and the Delaware Physicians Care, Inc. If you haven't picked any MCO within the time period given to you, the Health Benefit Manager will decide for you.

The majority of medical services are provided by the Managed Care Organizations, except for the non-emergency medical transportation services and prescriptions which are directly covered by the Medicaid program. For these services, you must show your Medicaid card to transportation providers and pharmacies.

Eligibility Requirements

Here are the basic qualifications you have to meet in order to qualify for the Medicaid program (there are other specific requirements depending on the programs such as age, disability, or pregnancy):

• Must be a U.S. citizen, a legal alien, or a permanent resident
• Must reside in the state of Delaware
• Must meet the set income limits for a certain family size

You have to meet the citizenship and residency requirements to be able to get the full benefits of the Medicaid program in Delaware. Complete coverage for non-citizens depends on the available state funding, but they may be covered for emergency cases and labor & delivery services if they are within the income limits, regardless of whether they reside legally or not.

Income is money you acquire from working in a job, or given by someone, or benefits and checks that you receive (such as unemployment benefits, Social Security check, sick pay, retirement benefits, or child support). It is one of the most important factors in determining your eligibility for Medicaid. You must meet the set income limits to qualify for the program. The federal government sets these limits every year to identify the Federal Poverty Level or FPL for different household sizes. Generally, those who qualify to receive Medicaid benefits include:

• Families with an income at or below 100% of the FPL
• Children from one year old up to six years old in families with an income at or below 133% of the FPL
• Infants below age one (1) and pregnant women in families with an income at or below 200% of the FPL - pregnant women are counted as two (or more) members in a household

Click here to view the tables for the different countable income limits for the year 2012. The tables also include the gross monthly income and the gross annual income for the various family sizes.

Medicaid Application Instructions

To apply for Delaware Medicaid, you can do it online through the ASSIST website. It lets Delaware citizens and community-based organizations gain access to screen and apply for various medical programs in the state. You can use this tool to know if you may possibly qualify to receive Medicaid benefits by providing basic information. After applying online, a web page will appear that will tell you what documents you need to send by mail and the address where you have to send it.

The other way to apply for Medicaid is to get an Application for Health Insurance/Medicaid either by downloading it here (also available in Spanish version) or by requesting it from the Division of Social Services (DSS). You may call DMMA at 1-800-372-2022 or directly to the DSS at (302)255-9500. Staff members will assist you in learning more about the eligibility requirements for Medicaid and other programs. After that, they will mail you the necessary application forms and other information. Complete the form and submit it to the address provided. Click here for a list of all the mailing address and contact numbers of the different offices under DMMA.

Along with your application form, you must provide verification of the following:

• Birthday (for newborn babies only)
• Pregnancy (if applicable)
• Income of family for one month (such as award letters and pay stubs)
• Self employment (tax return of the previous year)
• Citizenship or lawful alien status
• Copy of Medicare card (if applicable)

Verifications of resources or assets (such as stocks, vehicles, bank accounts, and the like) are not required. There is no face-to-face interview necessary.

You must return the form within a period of 30 days from the date you asked for Medicaid. If you don't have all the necessary details, you should not wait to submit your application since it will still be reviewed; you will be informed if more information is needed.