August 28, 2026
3:59 am

Delaware Medicaid Home and Community-Based Waivers for Long-Term Care (2026)

Almost every family that decides they are “over the limit” for Delaware long-term care Medicaid reaches that conclusion by counting things that do not count. The house usually does not count. The car does not count. A properly structured burial arrangement does not count. The at-home spouse’s protected share does not count. A great many applications are never filed because of arithmetic that included assets the state excludes.

So this page starts with the exceptions rather than the rules. Delaware’s long-term care benefit runs through Diamond State Health Plan-Plus, the managed long-term services and supports program that Delaware folded its home and community-based waiver services into under a Section 1115 demonstration. It is overseen by the Division of Medicaid and Medical Assistance within the Department of Health and Social Services, with the Division of Services for Aging and Adults with Physical Disabilities involved on the aging services side.

Figures are stated as of 2026. Delaware’s long-term care income standard in particular is set differently from the common three-times-SSI cap, so confirm every number with DMMA rather than assuming the national default applies here.

In This Article

Exception 1: The house you live in usually does not count
Exception 2: The at-home spouse is protected, and the protection is large
Exception 3: Burial arrangements and small policies are excluded
Exception 4: Delaware’s income standard is not the usual three-times-SSI cap
Exception 5: There is generally no waiting list — Delaware built that out
The exceptions that do not exist: the look-back and the policy decision
Frequently Asked Questions

Delaware Medicaid Home and Community-Based Waivers for Long-Term Care (2026)

Exception 1: The house you live in usually does not count

The principal residence is generally excluded as a countable asset while the applicant lives in it, and it stays excluded while a spouse, a minor child or a child with a disability lives there. It also remains excluded when the applicant is receiving care and intends to return home. In a state where the median home carries a substantial value, this exclusion is the difference between “we have too much” and “we should apply.”

Two limits attach. There is a federal home equity ceiling above which the excess equity is treated as available, indexed annually — confirm the 2026 figure with DMMA. And exclusion during life is not the same as protection after death: Delaware pursues estate recovery against recipients aged 55 and older, and the house is the asset most commonly reached. Our Delaware estate recovery page covers who gets a claim and the hardship route.

What families should do with this exception: stop treating the home as a disqualifier during the application, and start treating its titling at death as a separate planning question for a Delaware elder law attorney.

Exception 2: The at-home spouse is protected, and the protection is large

When one spouse needs long-term care and the other stays in the community, federal spousal impoverishment rules — which Delaware applies — let the community spouse keep a protected share of the couple’s countable resources between an indexed minimum and maximum, plus a monthly income allowance if their own income falls below a floor. The 2026 figures are indexed annually and DMMA publishes the current numbers.

Families rarely account for this correctly. A couple with $150,000 in savings often assumes both are disqualified. In fact the community spouse retains a substantial protected amount, and the resource assessment is done as of the date the ill spouse first entered a continuous period of institutionalization or waiver-level care, which means the timing of the snapshot matters enormously.

Ask DMMA for a resource assessment in writing before you spend anything down. A spend-down performed before the assessment is a spend-down performed blind, and money spent unnecessarily is not recoverable.

Exception 3: Burial arrangements and small policies are excluded

An irrevocable burial arrangement or a properly structured irrevocable funeral trust is excluded within Delaware’s limits, as is a designated burial fund up to the state’s threshold. This is the most commonly missed conversion in the entire process: it turns a countable dollar into an excluded dollar without giving anything away and without triggering a transfer penalty.

Life insurance has its own exception with a trap inside it. When the combined face value of all life insurance on the applicant is at or below Delaware’s small-policy threshold, the policies are excluded entirely regardless of cash value. Cross that threshold by a dollar and the full cash surrender value of every policy becomes countable. The rule aggregates face amounts, so two modest policies can jointly break the exclusion that either alone would fit inside. Term insurance with no cash value is generally not counted at all. The aggregation rule is explained in detail here.

Practical step: list every policy on the applicant, with face amount and current cash surrender value in writing from each carrier, before you assume anything about which side of the threshold you are on.

Asset	Counts Toward the Limit?	Condition
Home you live in	Generally no	Subject to the federal home equity ceiling; reachable in estate recovery later
One vehicle	No	Standard exclusion
Household goods, personal effects	No	Standard exclusion
Irrevocable burial arrangement	No	Must be irrevocable and within Delaware’s limits
Life insurance, all policies at or under the small-policy threshold	No	Face amounts aggregate; one dollar over makes all cash value countable
Community spouse’s protected resource share	No	Indexed annually; snapshot date matters
Bank, brokerage, second property	Yes	No exception applies

Exception 3: Burial arrangements and small policies are excluded

Exception 4: Delaware’s income standard is not the usual three-times-SSI cap

Most states cap long-term care Medicaid income at roughly three times the federal SSI benefit rate — a figure in the low-$2,900s per month as of 2026 — and require a Miller trust for anything above it. Delaware sets its long-term-care income standard differently, using a percentage-of-federal-poverty-level standard for the DSHP-Plus long-term care group rather than the plain three-times-SSI figure. That produces a different, and for many single applicants a more generous, cutoff.

This is exactly the kind of number that goes stale, so treat the direction as reliable and the digits as something to verify. Ask DMMA directly: “What is the current monthly income standard for DSHP-Plus long-term care eligibility, and is a qualified income trust required in my case?” Get the answer in writing. Families who assume the national cap applies sometimes conclude wrongly that they are ineligible.

The countable-asset limit for a single applicant remains $2,000 as of 2026, in line with the national norm. Confirm it with DMMA.

Exception 5: There is generally no waiting list — Delaware built that out

Here is the structural exception. Most states deliver elderly home care through capped 1915(c) waivers with a fixed slot count and, frequently, a multi-year interest list. Delaware moved its long-term care population into Diamond State Health Plan-Plus under an 1115 demonstration, delivered through contracted managed care organizations. An applicant who meets the financial test and the nursing-facility level of care is enrolled and assigned a care manager rather than queued.

What that unlocks: DSHP-Plus covers services in the home and in the community — personal care and attendant services, adult day services, respite for a family caregiver, home modifications such as ramps and grab bars, a personal emergency response system, home-delivered meals, non-emergency medical transportation, and assisted living services in participating settings. Nursing facility care is covered in the same program, so the choice of setting is a care-plan conversation rather than a separate application.

The level-of-care determination is made through DMMA’s pre-admission screening function, and the care plan is written by the MCO’s care manager. Two different people; ask for both names.

On paid family caregiving: Delaware offers self-directed attendant care within DSHP-Plus. An adult child, sibling, grandchild, niece or friend can generally be hired and paid through a fiscal agent. A spouse generally cannot, and neither can a legal guardian in most circumstances — Delaware follows the national default here rather than departing from it. Confirm with the MCO care manager before anyone leaves a job.

The exceptions that do not exist: the look-back and the policy decision

Where Delaware simply follows the federal baseline: the 60-month look-back on asset transfers, with a penalty period computed against a state average private-pay rate; the community spouse resource and income allowances; the home equity limit; and estate recovery against recipients 55 and older. There is no Delaware exception that forgives a gift made to a grandchild three years ago. That is the exception families most want and it is the one that does not exist.

Where Delaware genuinely departs: the 1115-based managed long-term services structure with no separate elderly waiver queue, and the long-term-care income standard set off the poverty level rather than three-times-SSI.

Which brings the life insurance decision back to the front. If the policies on the applicant break the small-policy threshold, the cash value counts and something has to change. Work the ladder in order. Reduced paid-up converts a whole life policy to a smaller fully-paid death benefit with no further premiums, cutting cash value while keeping coverage. An irrevocable funeral trust moves a countable dollar into the excluded column — often the cleanest fix for a policy near the threshold. Surrender takes the cash value and may create taxable income above premiums paid. A life settlement sells the policy to a licensed buyer in the secondary market, which for an older insured in declining health can pay materially more than surrender value; the proceeds are countable and must be spent on care, and any gifted portion sits inside the 60-month look-back.

And there is a real exception to the whole exercise: sometimes you keep the policy. A burial-sized policy already inside the exclusion, a policy the community spouse still depends on, or a policy on a relatively healthy insured that the market would price poorly should stay in force. Pine Lake Legacy does not purchase policies; we offer a free policy review so a family has the actual number before choosing, and we say keep it when that is true. This is education, not legal, tax or eligibility advice — take the decision to a Delaware elder law attorney, your CPA, DMMA, or Delaware’s State Health Insurance Assistance Program.

Frequently Asked Questions

Is there a waiting list for Delaware home care Medicaid?

Generally no. Delaware folded its home and community-based services for older adults into Diamond State Health Plan-Plus under a Section 1115 demonstration delivered by managed care organizations, rather than running a slot-limited elderly waiver. An applicant who meets the financial test and the nursing-facility level of care is enrolled and assigned a care manager. Confirm current status with DMMA.

Will Delaware make my mother sell her house to get home care?

Generally no during her lifetime. The principal residence is excluded while she lives there or intends to return, subject to a federal home equity ceiling. That exclusion is separate from estate recovery, which Delaware pursues against recipients aged 55 and older after death. How the property is titled is a question for a Delaware elder law attorney, not something to solve during the application.

What is Delaware’s income limit for long-term care Medicaid?

Delaware sets its long-term-care income standard off a percentage of the federal poverty level rather than the three-times-SSI cap most states use, which produces a different cutoff. Because that figure changes, ask DMMA directly for the current monthly income standard for DSHP-Plus long-term care and whether a qualified income trust is required in your case. Get the answer in writing.

Can my son be paid to care for me under DSHP-Plus?

Usually yes. Delaware offers self-directed attendant care within Diamond State Health Plan-Plus, and an adult child, sibling, grandchild, niece or friend can generally be hired and paid through a fiscal agent after a background check. A spouse generally cannot be paid, and neither can a legal guardian in most circumstances. Confirm with the managed care organization’s care manager.

Two small policies – are they excluded?

Only if their combined face value is at or under Delaware’s small-policy threshold. The rule aggregates face amounts across all life insurance on the applicant, so two modest policies can jointly break an exclusion that either alone would fit inside. Once broken, the full cash surrender value of every policy counts. Get written face amounts and surrender values from each carrier.

Does Delaware forgive gifts made a few years ago?

No. Delaware applies the standard 60-month look-back on transfers made for less than fair market value, with a penalty period calculated against a state average private-pay rate. Gifts to grandchildren, forgiven loans and property transferred to a child all count. There is no state exception for this. Any past transfer should be reviewed by a Delaware elder law attorney before you apply.

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