Diamond State Health Plan Plus (Delaware Medicaid Managed Care)

What is Medicaid Managed Care?
Many states are changing their long-term care Medicaid programs by replacing their HCBS Waivers with Medicaid Managed Care Organizations (MCO).  For the elderly, this means they work with a single administering organization for all of their health and personal care needs.  It also means the elimination of enrollment caps and a reduction in waiting times for those wishing to receive care and services outside of nursing homes.

Program Description

Diamond State Health Plan Plus (DSHP+) is a new 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+, 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 to individuals living at home or in assisted living, but will not pay for room and board in assisted living.

Even though this is a managed care program, it still allows for consumer direction of certain services. 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.

In July of 2014, Diamond State Health Plan Plus fully absorbed the state’s other aged and elderly waivers, so that 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).

Learn more about how family members can become paid caregivers under Medicaid.

Eligibility Guidelines

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. The major consideration factors for Delaware Medicaid for seniors are functional ability (nursing home level care is required) and monthly income and countable assets.

As of 2017, single applicants may not have a monthly income greater than 250% of the current Social Security Income (SSI) standard. This means an individual cannot receive more than $1,837.50 a month in income. For married couples, their incomes will be considered separately if only one spouse is seeking Medicaid assistance. The non-applicant spouse is permitted up to $3,022.50. Persons whose incomes exceed these limits may qualify by establishing a specific trust. Speak to a Medicaid Planner to learn more.

In 2017, 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 and the value of their home equity does not exceed $560,000. However, this presents a problem for persons in assisted living, since they are not residing in their home. Married couples, on the other hand, can have one spouse at home and the other in assisted living thereby the home remains exempt. Furthermore, married couples are subject to a considerably higher asset limit. In 2017, the non-applicant spouse can have up to $120,900 in assets including jointly held assets. Couples with assets value over these limits may still become eligible through working with a Medicaid planning expert.

Persons exceeding these limits may still qualify though it will be necessary to work with a Medicaid planning professional in advance of applying for assistance.  Learn more about Medicaid planning.

Benefits and Services

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 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.

  • Adult day care
  • Case Management
  • Assisted living care / Nursing home care
  • Chore services
  • Durable medical equipment
  • Emergency Response System
  • Emergency transportation
  • Home health services
  • Home modifications (to help persons remain at home)
  • Home safety / accessibility modifications
  • Home-delivered meals
  • Hospice care
  • Inpatient hospital services,
  • Outpatient hospital services,
  • Personal care (can be consumer directed)
  • Physical and occupational therapy
  • Private duty nursing
  • Respite care
  • Speech, hearing and language therapies

 

How to Apply / Learn More

One can learn more by downloading a pamphlet for this program.  To begin the application process, contact the Division of Medicaid and Medical Assistance.  Contact information is available here.

In some areas of the state, elderly residents may have the option of joining a PACE health plan. PACE stands for the Program for All-Inclusive Care for the Elderly and it is an innovative and inclusive plan for the elderly 55 and older where most services are provided at Adult Day Care health center. Learn more about PACE.