Forms and Publications

Medicaid Application

Delaware Medicaid State Plan

General Program Administration and Table of Contents

Administering Medicaid Programs – these numbered pages contain federal cites and brief statements regarding program administration and organization of the state organization Medicaid

Section 1 – Single State Agency
Section 2 – Coverage and Eligibility
Section 3 – Services: General Provisions
Section 4 – General Program Administration
Section 5 – Personnel Administration
Section 6 – Financial Administration
Section 7 – General Provisions

MAGI Eligibility and Benefits State Plan Amendments

Describes Medicaid program client coverage and conditions of eligibility; Application forms and methods for individuals to apply for and renew Medicaid coverage

MAGI-Based Eligibility Groups
S94 General Eligibility Requirements, Eligibility Process
S10 MAGI-Based Income Methodologies
A1, A2, & A3 Addresses single state agencies delegation of appeals and determinations
S88 Residency
S89 Non-Financial Eligibility Citizenship & Non-Citizen
S21 Hospital Presumptive Eligibility

Attachment 2.1-A Definition of an HMO to 2.2-A Eligibility Groups

Describes Medicaid program client coverage and conditions of eligibility

Mandatory Coverage – Categorically Needy and Other Required Special Groups
Optional Groups Other Than the Medically Needy
Optional Coverage of the Medically Needy
Requirements Relating to Determining Eligibility for Medicare Prescription Drug Low-Income Subsidies
Method for Determining Cost Effectiveness of Caring for Certain Disabled Children at Home

Attachment 2.6-A Income and Resource Eligibility

Describes Medicaid program client coverage and conditions of income and resource eligibility

2.6-A Eligibility Conditions and Requirements, Pages 1-26
2.6-A Supplements 1-18
- Income Eligibility Levels
- Resource Levels
- Reasonable Limits on Amounts for Necessary Medical or Remedial Care Not Covered Under Medicaid
- Methods for Treatment of Income That Differ From Those of The SSI Program
- More Restrictive Methods of Treating Resources Than Those of The SSI Program – Section 1902(f) States Only
- Standards for Optional State Supplementary Payments
- Income Levels for 1902(f) States – Categorically Needy Who are Covered Under Requirements More Restrictive Than SSI
- Resource Standards for 1902(f) States – Categorically Needy
- Transfer of Resources
- The agency does not apply the trust provisions in any case in which the agency determines that such application would work an undue hardship.
- More Liberal Policy Under Section 1902(r) of the Social Security Act
- Eligibility Under Section 1931 of the Act
- Section 1924 provisions
- Income and Resource Requirements for Tuberculosis (TB) Infected Individuals
- Asset Verification System
- Disqualification for Long-Term Care Assistance for Individuals with Substantial Home Equity
- Methodology for Identification of Applicable FMAP Rates

Attachment 3.1-A to Attachment 3.1-I Services

Describes amount, duration, scope, and types of covered services

3.1-A Amount, Duration, and Scope of Medical and Remedial Care and Services Provided to the Categorically Needy
3.1-B Amount, Duration, and Scope of Services Provided Medically Needy Group(s)
3.1-C Standards and Methods of Assuring High Quality Care
3.1-D Methods of Providing Transportation
3.1-E Standards for the Coverage of Organ and Tissue Transplant Services
3.1-I 1915(i) State Plan Home and Community Based Services Administration and Operation

Attachment 3.1-L Delaware Alternative Benefit Plan

Identifies and defines the Adult eligibility group that receives their Medicaid coverage through an Alternative Benefit Plan (ABP)

ABP1 – Alternative Benefit Plan Populations
ABP2a – Voluntary Benefit Package Selection Assurances – Eligibility Group Under Section 1902(a)(10)(A)(i)(VIII) of the Act
ABP3 – Selection of Benchmark Benefit Package or Benchmark-Equivalent Benefit Package
ABP4 – Alternative Benefit Plan Cost-Sharing
ABP5 – Benefits Description
ABP7 – Benefits Assurances
ABP8 – Service Delivery Systems
ABP10 – General Assurances
ABP11 – Payment Methodology

Attachment 4.11-A to Attachment 7.7.C COVID-19 Treatment at section 1905(a)(4)(F)
of the Social Security Act

Describes reimbursement, quality control and Title VI Civil Rights

4.11-A Standards for Institutions
4.14-B Methods for Control of the Utilization of Intermediate Care Facility (ICF) Services
4.16-A Cooperative Arrangements with State Health and State Vocational Rehabilitation Agencies and Title V Grantees
4.17-1 Liens and Adjustments or Recoveries
4.18-A Charges Imposed on Categorically Needy
4.18-C Charges Impose on the Medically Needy
4.18-D Premiums Imposed on Low Income Pregnant Women and Infants
4.18-E Optional Sliding Scale Premiums Imposed on Qualified Disabled and Working Individuals
4.19-A Payment Adjustment for Provider preventable Conditions
4.19-A Methods and Standards for Establishing Payment Rates – Inpatient Hospital Care
4.19-A.1 Methods and Standards for Establishing payment Rates Inpatient Psychiatric Hospital Care
4.19-A.2 Methods and Standards for Establishing Payment Rates for Freestanding Inpatient Rehabilitation Hospital Services
4.19-B Methods and Standards for Establishing Payment Rates Other Types of Care
4.19-C Standards for Payment of Reserved Beds During Absence from Long-Term Care Facilities
4.19-D Methods and Standards for Establishing Payment Rates Prospective Reimbursement System for Long-Term Care Facilities
4.19-E Definition of a “claim”
4.22-A through 4.22-C Requirements for Third Party Liability (TPL)
4.30 Sanctions for Psychiatric Hospitals
4.32-A Income and Eligibility Verification System Procedures Requests to Other State Agencies
4.33-A Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals
4.34-A Requirements for Advance Directives Under State Plans for Medical Assistance
4.35-A through 4.35-H Enforcement of Compliance for Nursing Facilities
4.38 Disclosure of Additional Registry Information
4.39 Definition of Specialized Services
4.39-A Categorical Determinations
4.40-A through 4.40-E Eligibility Conditions and Requirements
4.42-A False Claims Act Attachment
7.2-A Methods of Administration-Civil Rights
7.7-A Vaccine and Vaccine Administration at Section 1905(a)(4)(E) of the Social Security Act
7.7-B COVID-19 Testing at section 1905(a)(4)(F) of the Social Security Act
7.7-C COVID-19 Treatment at section 1905(a)(4)(F) of the Social Security Act