Diamond State Health Plan – Plus (DSHP-Plus) is a managed long-term care program for Delaware Medicaid. This program is intended to provide a full suite of services to low income, elderly state residents, including nursing home care, assisted living, and a variety of home and community supports that assist frail and / or disabled individuals to remain living at home. Under DSHP-Plus, there are two sub-programs relevant to long term care for the elderly: the Nursing Facility Program and the Long Term Care Community Services (LTCCS) Program. The former provides for care in nursing homes and the latter for care outside of nursing homes. To be clear, LTCCS will pay for medical and personal care services for individuals living at home, in assisted living, and adult foster care, but will not pay for room and board in assisted living or adult foster care.
Even though this is a managed care program, it still allows for consumer direction of certain services, such as attendant care, also known as personal care assistance. Most notably, personal or attendant care provided outside of residential care facilities can be self-directed. Under consumer direction, some family members can work as caregivers and be eligible to receive payments for doing so. This includes spouses and adult children.
In July of 2014, Diamond State Health Plan – Plus fully absorbed the state’s other aged and elderly waivers. These services are now available only through the managed care plan. Specifically, residents who had been receiving benefits through the Delaware Amended Elderly and Disabled Waiver are now covered through the DSHP-Plus. This program is a collaboration between the Division of Services for Aging and Adults with Physical Disabilities (DSAAPD) and the Division of Medicaid and Medical Assistance (DMMA).
This program is a Medicaid managed long-term care program for residents of Delaware. In order to be eligible for this program, all applicants must first qualify for Medicaid. One of the major consideration factors for Delaware Medicaid for seniors is functional ability. A nursing home level of care is required for an applicant to receive nursing home care, while an applicant can receive home and community based services if they are at risk of being placed in a nursing home without the services and supports provided by DSHP-Plus. An applicant’s monthly income and countable assets are also considered.
As of 2022, single applicants cannot have a monthly income greater than 250% of the current Social Security Income (SSI) standard. This means an individual cannot receive more than $2,102.50 a month in income. For married couples when only one spouse is applying for Medicaid, the income of the non-applicant spouse is not counted toward the eligibility of the applicant spouse. Furthermore, there are spousal protections to prevent the non-applicant spouse from becoming impoverished. If the non-applicant spouse has little income, the applicant spouse can supplement the income of his or her spouse. In 2022, the non-applicant’s income can be supplemented to bring his/her income up to $3,435 / month. This is called the monthly maintenance needs allowance. Persons whose incomes exceed these limits may qualify by establishing a specific trust. called a Miller Trust. Speak to a Medicaid Planner to learn more.
In 2022, single applicants’ countable assets, such as bank accounts, bonds, and stocks, cannot exceed $2,000 in value. Homes are not considered to be a countable asset as long as the applicant is residing in the home (or expresses intent to return home) and the his/her equity interest does not exceed $636,000. However, this presents a problem for persons in assisted living, who have no intent to return home, as the home would no longer be considered exempt. Married couples, on the other hand, can have one spouse at home and the other in assisted living, and thereby, the home remains exempt. Additionally, the non-applicant spouse is able to retain a higher amount of the couple’s joint assets. (Medicaid considers all assets of a couple to be jointly owned). In 2022, the non-applicant spouse can have up to $137,400 in assets. (The applicant spouse is still able to retain $2,000 in assets). This non-applicant asset allowance is another rule to prevent spousal impoverishment and is called the community spouse resource allowance. Click here to learn more. Couples with assets valued over these limits may still become eligible through working with a Medicaid planning expert.
The Diamond State Health Plan Plus is intended to cover all of a beneficiary’s needs, including both medical and non-medical care. That said, not every program participant will be eligible for all services. The actual services received will be determined in the individual’s Plan of Care that is created when they become a program member. Services can include, but are not limited to the following.