The Division of Medicaid & Medical Assistance (DMMA) provides the following Long Term Care services:
- Medicaid Nursing Facility Care
- Medicaid Home and Community-Based Services
- Medicaid 30-Day Acute Care Hospital Services
- Medicaid Out-of-State Rehabilitation Hospital Services
- Children’s Community Alternative Disability Program
- Supplemental Security Income (SSI) related programs
The Nursing Facility Program
The Nursing Facility Program pays for the cost of care provided in nursing facilities in Delaware that have contracts with Delaware Medicaid. These nursing facilities provide room, board and nursing services to those who are elderly, infirm or disabled.
An individual applying for the Nursing Facility program must be a Delaware resident and must be willing to enter a nursing facility and accept Medicaid coverage. To apply for this program, contact Division of Medicaid and Medical Assistance Medicaid Central Intake Unit at 1-866-940-8963.
To meet medical criteria for this program, the applicant must be in need of a skilled or intermediate level of care as defined by Delaware Medicaid criteria. In other words, the individual must require the level of care provided by a nursing facility. If the applicant’s gross monthly income exceeds the income limit for this program (set at 250% of the Supplemental Security Income – SSI – standard), they will need to establish a Miller Trust in order to qualify. Their assets cannot exceed $2,000 unless they have a spouse.
The Delaware Division of Health Care Quality (DHCQ) licenses and certifies Medicaid-enrolled nursing facilities. DHCQ issues survey reports to the facilities after each annual survey and each complaint or incident survey.
Important things to know about Medicaid and Nursing Facilities
Payment Issues
Medicaid may only pay for covered services after all other coverage has been exhausted. Examples of other coverage are Medicare, employment-related health insurance, Union Health & Welfare Funds, workers’ compensation, and no-fault automobile insurance. This is based on the Code of Federal Regulations (42 CFR 433 Subpart D) and Delaware State Law (Medical Care Subrogation Law – Chapter 5, Title 31, Section 522). When a recipient receives payment from an insurance carrier, court settlement, etc. for any medical services paid by Medicaid, the recipient is obligated to reimburse the program for those related services. All such cases must be referred to the Third Party Liability Unit at the Delaware Division of Medicaid & Medical Assistance.
Personal Needs
A Medicaid nursing facility resident may keep $75.00 of his monthly income for his personal needs. The rest of his income must be paid to the facility unless an amount has been protected for:
- The needs of a community spouse under the Spousal Impoverishment Provision,
- Medically necessary medical equipment and medical services not covered by Medicaid (e.g. eye eyeglasses, dentures, hearing aids…), and/or private health insurance premiums.
Discharge due to private funds shortage
If a patient in a Medicaid-enrolled nursing facility runs out of private funds and converts to Medicaid payment, the nursing facility cannot discharge the patient if there is an available Medicaid-certified bed.
Non-Medicaid-certified beds
Some beds in a nursing facility may not be Medicaid-certified. Medicaid cannot pay for care in a non-Medicaid-certified bed.
Charges for items/services covered by Medicaid
Federal law prohibits nursing facilities from charging Medicaid recipients or their families for items and/or services that are covered by Medicaid.
Contributions for Admission
Nursing facilities that accept Medicaid cannot ask Medicaid recipients for contributions as a condition of admission, nor can they charge fees to supplement the Medicaid rate.
Provision of a list of covered items/services
Nursing facilities must provide a list of items and services that are included in the basic Medicaid rate. They must also provide a list of items and services that are not included and would be paid out-of-pocket by the resident. Residents may also request a list of what Medicaid pays for and what nursing facilities are required to pay from DMMA.
