Delaware Medicaid Benefits & Eligibility

In December of 2018, Delaware Medicaid reported 248,964 enrollees. Those enrolled are able to save thousands of dollars and get the healthcare services they otherwise would not have been able to afford. This guide can help you determine if you can join those 248,964 members and learn how to apply.

Click below to learn more about Delaware Medicaid:

• What’s Covered?
• How Delaware Medicaid Works
• Delaware Medicaid Eligibility
• Medicaid, Medicare, and Chronic Renal Disease
• Complete the Delaware Medicaid Application
• Qualify for Both Medicare and Medicaid in Delaware

What’s Covered?

The top covered services under the Medicaid program include prescription drugs, doctor and hospital care, lab tests and x-rays, some home health care, hospice, some medical equipment/supplies, dental for kids, and medical transportation.

Delaware Medicaid Formulary (Covered Drugs)

If you have both Medicaid and Medicare, your prescription drug coverage will have to come from your Medicare benefits, and you should consider purchasing either a Part D plan or a Medicare Advantage plan with prescription drug benefits. If you do NOT have Medicare, your prescriptions will be covered through Medicaid. This list outlines which drugs are covered and which drugs require prior authorization.

If you are either over the age of 65 or receiving Social Security Disability benefits AND either if your income is below 200% of the Federal Poverty Level or your prescriptions cost more than 40% of your annual income, you may qualify for extra help through the Delaware Prescription Assistance Program (DPAP). If you have Medicare, you can ONLY enroll in the DPAP if you show proof that you have a Medicare prescription drug plan and have joined the Medicare Extra Help program.

Dental Benefits

While Delaware adults with Medicaid may have access to some emergency dental services, only those under the age of 20 can get full coverage. That full coverage includes preventative benefits like exams, cleanings, X-rays, sealants, and 6-month fluoride treatments as well as fillings, crowns, root canals, extractions, dentures, and limited (medically necessary) orthodontic care.

Medical Transportation

All adult Delaware Medicaid members have coverage for both emergency and non-emergency medical transportation. CHIP members (Delaware kids) only have coverage for emergency transportation. Emergency air and ground ambulance transportation is only covered when medically necessary, and all you have to do is call 911. Non-emergency services are covered through a company called LogistiCare and are for those who do not have a reliable or affordable means of getting to medical appointments. To schedule your non-emergency transportation, call 1-866-412-3778 at least three days in advance.

How Delaware Medicaid Works

Most people with Medicaid in Delaware will get their benefits through a “Managed Care Organization,” sometimes shortened to MCO. The only beneficiaries who will not receive services through an MCO are those who are also enrolled in Medicare and those who reside in long-term care facilities. Those who need an MCO will receive a packet of information about how to select an MCO, what MCOs are available, etc. If you don’t choose one, one will be chosen for you – however, the MCO you select will determine which doctors you can visit, so it’s important to look at your options closely.

Delaware Medicaid Eligibility

To receive Medicaid benefits in the state of Delaware, you must be a U.S. citizen (or legal non-citizen) who is permanently residing in Delaware. You also must meet the income eligibility requirements as stated below. Your household size is taken into account. Contrary to popular belief, you CAN own a car and a home, you CAN have money in savings accounts, AND you can still work and/or have other health insurance and still qualify for Medicaid.

If your eligibility status changes (for example, if you start a new job with a higher salary), you are required to notify Medicaid within ten days. If you don’t, the program will discover your change during their annual review, and you may be charged for the misinformation. Those residing in long term care facilities can qualify for Medicaid with a income at 250% of the Supplemental Security Income (SSI) standard.

Medicaid, Medicare, and Chronic Renal Disease

People who do not meed the Medicaid income requirements but are diagnosed with End-Stage Renal Disease (ESRD) may have a hard time finding good health insurance. The state of Delaware offers a Chronic Renal Disease Program (CRDP) for Delaware residents with an ESRD diagnosis and income below 300% of the Federal Poverty Level.

Those interested in the CRDP who already have Medicare coverage must enroll in a form of Medicare prescription drug coverage first and must apply for the Extra Help program if they are eligible. The CRDP includes coverage for some medications, medical appointments, and even transportation to medical appointments and dialysis. To apply for CRDP, call 1-302-424-7180 and ask for an application for the CRDP program.

Complete the Delaware Medicaid Application

You can apply for Medicaid in Delaware either in person, by mail, or by phone. To speak to someone on the phone, simply call Medicaid Customer Relations at 1-800-372-2022. To download the application and mail it in, click here. To apply online, visit ASSIST. Through this website, you can not only apply but also verify your eligibility for all several different programs. Once you’ve completed your online application, you can go back to ASSIST to check your application status, complete an unfinished application, or renew your benefits.

Qualify for Both Medicare and Medicaid in Delaware

If you meet the Medicaid eligibility requirements as listed above but also qualify for Medicare, you can benefit from both programs. We have licensed agents in 38 states who are contracted with the top Medicare plans. They can lay out all your options for you and help you select the best plan for your needs. To get started, request a call by completing this form.