Medicaid Waivers
Through the Medicaid waiver program, the federal Centers for Medicare & Medicaid Services (CMS) approves exceptions to normal Medicaid rules allowing states to create and cover innovative home and community-based programs to serve individuals who previously did not qualify under standard eligibility requirements.
Diamond State Health Plan 1115 Demonstration Waiver
On May 17, 2024, the Centers for Medicare & Medicaid Services (CMS) approved Delaware’s request for a five-year extension of the Diamond State Health Plan section 1115 demonstration waiver (Project Number 111-W-00036/4), in accordance with section 1115(a) of the Social Security Act. This extension allows Delaware to introduce new initiatives to improve health coverage, access and consistent provision of high-quality services and advance health equity for Medicaid beneficiaries.
The extension helps Delaware improve and expand healthcare access, create a managed care delivery system emphasizing primary care, and control healthcare costs for the Medicaid population by:
- Expanding health coverage through long-term services and supports through Diamond State Health Plan – Plus
- Enhancing behavioral health services and supports through the voluntary Promoting Optimal Mental Health for Individuals through Supports and Empowerment (PROMISE) program
- Adding clinically approved substance use disorder treatment services for short-term residents in residential and inpatient treatment settings that qualify as an institution for mental diseases
- Adding adult dental services
- Allowing coverage for former foster care youth under age 26 who currently reside in Delaware but who were enrolled in Medicaid in a different state or tribe when they “aged out” of the foster care system
- Supporting two models of evidence-based home visiting for pregnant women and children
- Adding permanent coverage for a second home-delivered meal for beneficiaries receiving home and community-based services in Diamond State Health Plan – Plus
- Allowing a pediatric respite benefit
- Supporting a self-directed option for parents on behalf of children receiving state plan personal care services; and
- Covering Delaware’s Nursing Home Transition Program.
The waiver also approves piloting of Delaware’s Postpartum Nutrition Supports Initiative under Medicaid for postpartum beneficiaries, allowing coverage of two home-delivered meals per day or one medically appropriate shelf-stable food box that does not constitute a full nutritional regimen, up to 80 diapers per week, and up to one pack of baby wipes for the first 12 weeks in the postpartum period. This benefit reaches low-income postpartum members with disproportionately high rates of food insecurity and inequitable adverse maternal and birth outcomes.
Approval of this waiver is effective through December 31, 2028.
- Delaware’s DSHP 1115 Waiver Approval Letter 2024
- Diamond State Health Plan 1115 Waiver Approved Interim Evaluation Report April 2024
- Diamond State Health Plan 1115 Waiver Approved Evaluation Design April 2024
- FFY 2023 MCPAR Annual Report for Delaware Diamond State Health Plan
- FFY 2022 MCPAR Annual Report for Delaware Diamond State Health Plan
- 2024 MCO Master Service Agreement (pending CMS approval)
- Diamond State Health Plan 1115 Waiver 2022 Annual Report[MOU2]
- 1115 Dental Amendment Waiver Request
- The Delaware Quality Strategy 2023
- Summary of Changes from the 2018 Quality Management Strategy to 2023 Quality Strategy
- Evaluation of the 2018 Quality Strategy
- Budget Neutrality Document
- DSHP-Plus Waiver Amendment
- Diamond State Health Plan Plus Concept Paper
Delaware Division of Developmental Disabilities Home and Community Based 1915 (c) HCBS Lifespan Waiver
Delaware has operated a Home and Community Based Services (HCBS) Waiver for individuals with intellectual and developmental disabilities continuously since 1987. The program allows the state to furnish an array of home and community-based services that assist Medicaid beneficiaries to live in the community and avoid institutionalization. The DDDS waiver is targeted to individuals with intellectual and developmental disabilities (IDD) (including brain injury), autism spectrum disorder, and Prader-Willi Syndrome. It provides services and supports as an alternative to institutional placement and is designed to enable the individual to live safely in the community and to respect and support their desire to work or engage in other productive activities.
Extensions to the waiver in 2022 included the following changes:
- A tiered rate structure for Behavioral and Nurse Consultation services, where providers of these services are compensated based upon their education and experience.
- Transportation as a component part of Day Habilitation, Community Participation, and Pre-Vocational services, will be reimbursed as a separate rate on days when it is provided.
- Increasing the current combined Respite and Personal Care service budget from $2,700 to $3,500 annually.
- The addition of a rate for Day Habilitation, Community Participation, Pre-Vocational, Supported Employment, Residential Habilitation, and Medical Residential Habilitation services where providers are compensated for employing Direct Support Professionals (DSPs) that are American Sign Language (ASL) fluent or certified when supporting Deaf service recipients that use ASL to communicate.
- The addition of a rate for Day Habilitation, Community Participation, Pre-Vocational, Supported Employment, Residential Habilitation, and Medical Residential Habilitation services where providers are compensated for employing Direct Support Professionals (DSPs) that are Registered Behavior Technicians (RBTs) when supporting service recipients with an increased behavioral support need.
- New provider type added to Assistive Technology.
- Removal of DDDS as a direct provider of HCB services.
- Technical changes related to state procedure/policy changes.
- DDDS HCBS 1915(c) Lifespan Waiver Amendment – Application 2022[MOU3]
- DDDS HCBS 1915(c) Lifespan Waiver Amendment – Public Notice May 2022
Delaware Division of Developmental Disabilities Home and Community Based 1915 (I) SPA Pathways
Through this waiver, Delaware implements the optional 1915(i) State plan Home and Community-Based Services benefit for elderly and disabled individuals to include the following services:
- Employment Navigation
- Financial Coaching Plus
- Benefits Counseling
- Non-Medical Transportation
- Orientation, Mobility and Assistive Technology
- Career Exploration and Assessment
- Small Group Supported Employment
- Individual Supported Employment
- Personal Care (including option for self-direction)
The Centers for Medicare & Medicaid Services (CMS) has extended the Pathways waiver program through December 31, 2029.
Delaware Division of Developmental Disabilities Waiver Fee-for-Service Selecting Contract Program 1915(b)(4)
