Most of the long-term-care system in the United States is paid for by Medicaid, not by Medicare or by private insurance.1 Delaware is no exception. The question most families ask is some version of: how do we qualify, what does the process look like, and what mistakes do families make that cost them months or tens of thousands of dollars?

How DSHP+ works

Since 2012, Delaware has delivered Medicaid long-term services and supports through a managed care model called Diamond State Health Plan Plus (DSHP+). Once a member is determined eligible for long-term care Medicaid, they enroll in one of two managed care organizations — Highmark Health Options or AmeriHealth Caritas Delaware.2 The plan then becomes responsible for both the member’s medical care and their long-term care services, including nursing home placement, assisted living (where covered), and home- and community-based services.

This is different from fee-for-service Medicaid where the state pays providers directly. In Delaware, the plan receives a capitated payment per member per month and is responsible for coordinating the full continuum of care. For families, this usually means a single case manager assigned by the plan, a single point of contact for service authorization, and coordination across medical and long-term care needs.

The three eligibility tests, in order

1. Medical eligibility (level of care)

Before the financial math starts, your parent needs to meet Delaware’s nursing facility level-of-care threshold. Delaware uses a standardized assessment tool that scores the applicant on activities of daily living — bathing, dressing, transferring, toileting, eating — and instrumental activities of daily living (managing medications, meal preparation, transportation). The assessment is typically completed in person at home or in the facility, depending on the setting being applied for.3

Schedule this assessment early. Wait times can vary depending on intake capacity at DMMA and the contracted assessment agency.

2. Income

Delaware uses the standard 300% of SSI federal benefit rate as its income cap for long-term care Medicaid — approximately $2,901/monthin 2026. If your parent’s gross monthly income from all sources (Social Security, pension, IRA distributions, annuity payments) exceeds this cap, they’re not automatically disqualified. Delaware allows the use of a Qualified Income Trust (QIT), sometimes called a Miller Trust, to handle excess income.

3. Assets

The applicant’s countable assetsmust be at or below $2,000 at the moment of application. “Countable” is doing the real work in that sentence.

Not counted (in most cases):

Counted:

The 5-year look-back, in Delaware

Delaware applies the same 60-month look-back as every other state. Any transfer of assets for less than fair market value in the 60 months prior to the application generates a penalty period— a window during which your parent is otherwise eligible but Medicaid will not pay for long-term care.

The penalty math is straightforward: the value of the transfer divided by Delaware’s penalty divisor. Delaware’s penalty divisor is set annually by DMMA and approximates the statewide average private-pay nursing home rate; figure approximately $11,000/month in 2026. A $100,000 gift roughly translates to a 9-month penalty. The clock does not start on that penalty until your parent is otherwise eligible — meaning they’ve spent down to $2,000 and are receiving care.

The community-spouse situation

If one spouse needs long-term care and the other doesn’t, the rules become more favorable. Delaware follows the federal framework for community-spouse protections:

Estate recovery in Delaware

Federal Medicaid law requires every state to attempt recovery from the estate of a deceased Medicaid LTC recipient for services paid after age 55. Delaware pursues estate recovery through DMMA against probate assets — meaning assets passing through the decedent’s probate estate. Assets held in revocable trust, transferred during life with a retained life estate, or passing outside probate (joint tenancy, beneficiary designations) are generally not subject to recovery, though specific structures should be reviewed with Delaware counsel. There is no recovery against the spouse’s estate while the spouse is living, and recovery is deferred if there is a surviving spouse, disabled child, or minor child.4

When to start planning

Five years before need, if you can. The look-back math means every legitimate planning move — spend-down on exempt assets, certain trust structures, spousal transfers — works best at the 5-year mark and progressively worse as the application date approaches. That said, plenty of families plan in the final 6–18 months and still meaningfully improve the outcome; the toolkit narrows but it’s never empty.

What to do this month

For the broader Medicaid context nationally, see our Medicaid pillar overview. For Delaware-specific legal planning — the trust statutes that make Delaware unusual — see Legal & Financial in Delaware.