Delaware Nursing Home Medicaid

Level-of-care review is not just an application form

Delaware’s long-term-care manual says that common requirements include medical and financial eligibility. For Long Term Care Community Services, the DMMA Pre-Admission Screening Unit decides medical eligibility and the DMMA Long Term Care Financial Unit decides financial eligibility; the community applicant must need nursing-facility level of care as defined by DMMA (Delaware LTC eligibility manual).

For DSHP-Plus enrollment, Delaware’s Medicaid quality strategy describes the State Pre-Admission Evaluation, or PAE, as the assessment used to determine level of care and support-needs assessment. It says members have a level-of-care determination showing a need for service placement before enrollment in DSHP-Plus long-term services and supports and receipt of Medicaid-reimbursed services (Delaware Medicaid Quality Strategy).

Patient pay and the personal-needs allowance

Effective January 1, 2025, DMMA increased the personal-needs allowance for long-term-care-facility members subject to a patient-pay liability to $75 per month for an individual and $150 for a couple. The notice describes the previous allowance as $50 for an individual and $100 for a couple, so older Delaware materials displaying another number should not be used for a current patient-pay calculation (DMMA personal-needs-allowance notice).

The balance of income can be relevant to patient pay after permitted protections and deductions. DMMA’s public nursing-facility page identifies possible protection for a community spouse, necessary medical equipment or services not covered by Medicaid, and private health-insurance premiums, but the written individual calculation controls (DMMA patient-pay overview).

For program-wide context, see Delaware Medicaid Long-Term Care and Medicaid (Baseline). Keep the PAE or other screening, admission date, award notice, and patient-pay notice with the financial file.