If you live in Delaware and need affordable health coverage, Medicaid could be the answer. Delaware is one of the states that expanded Medicaid under the Affordable Care Act, which means more residents qualify than ever before. Whether you are an adult, a parent, pregnant, or caring for children, understanding the eligibility rules can help you access the coverage you need. This guide breaks down everything you need to know about Delaware Medicaid eligibility for 2026, including income limits, how to apply, and what benefits are covered.
Not sure if you qualify? Check your eligibility in minutes with our free screener.
What Is Delaware Medicaid?
Delaware Medicaid is a joint federal and state program that provides free or low-cost health coverage to eligible residents. The program is administered by the Delaware Division of Medicaid and Medical Assistance (DMMA), which operates under the Delaware Department of Health and Social Services (DHSS).
Most Medicaid enrollees in Delaware receive their benefits through a managed care program called the Diamond State Health Plan (DSHP). This system coordinates your care through a single health plan, making it easier to access doctors, specialists, prescriptions, and other services.
Delaware also offers the Delaware Healthy Children Program (DHCP), which provides health coverage for children in families with slightly higher incomes who do not qualify for traditional Medicaid.
For more information about all available programs in the state, visit our Delaware Benefits Overview.
Delaware Medicaid Income Limits for 2026
Income eligibility for Delaware Medicaid is based on the Federal Poverty Level (FPL), which is updated each year. The 2026 FPL guidelines took effect on January 13, 2026. Delaware uses Modified Adjusted Gross Income (MAGI) to determine eligibility for most applicants.
Here are the key income thresholds by category:
Adults (Ages 19 to 64)
Thanks to Medicaid expansion, adults in Delaware can qualify with incomes up to 138% of the FPL.
| Household Size | Annual Income (100% FPL) | Monthly Income Limit (138% FPL) |
|---|---|---|
| 1 | $15,960 | Approximately $1,835 |
| 2 | $21,640 | Approximately $2,490 |
| 3 | $27,320 | Approximately $3,141 |
| 4 | $33,000 | Approximately $3,795 |
| 5 | $38,680 | Approximately $4,448 |
| 6 | $44,360 | Approximately $5,101 |
Note: The 138% FPL figure includes a 5% income disregard, so the effective threshold is 133% FPL plus the disregard. The official Delaware DMMA income tables list the 133% FPL monthly amounts directly. For a household of one, the 133% FPL monthly income limit is $1,769.
Children (Under 19)
Children in Delaware can qualify for Medicaid at higher income levels than adults:
- Children ages 0 to 1: Up to 212% FPL
- Children ages 1 to 5: Up to 142% FPL
- Children ages 6 to 18: Up to 133% FPL
The Delaware Healthy Children Program (DHCP) extends coverage to children in families with incomes up to 212% of the FPL.
| Household Size | Monthly Income at 142% FPL | Monthly Income at 212% FPL |
|---|---|---|
| 2 | $2,560 | $3,824 |
| 3 | $3,233 | $4,827 |
| 4 | $3,905 | $5,830 |
| 5 | $4,577 | $6,833 |
| 6 | $5,250 | $7,838 |
Pregnant Women
Pregnant women in Delaware may qualify for Medicaid with incomes up to approximately 212% of the FPL. Coverage includes prenatal care, delivery, and postpartum services.
Seniors and People with Disabilities
For seniors aged 65 and older and individuals with disabilities, Delaware uses the Supplemental Security Income (SSI) standard rather than MAGI:
| Category | Monthly Income Limit (2026) | Asset Limit |
|---|---|---|
| Individual (SSI level) | $994 | $2,000 |
| Couple (SSI level) | $1,491 | $3,000 |
| Nursing Home / HCBS (250% SSI) | $2,485 | $2,000 (individual) |
For married couples where only one spouse is applying for long-term care Medicaid, the non-applicant spouse may retain up to $162,660 in assets (the Community Spouse Resource Allowance for 2026).
Medicare Savings Programs
Delaware also offers Medicare Savings Programs that help pay Medicare premiums and cost-sharing for low-income seniors:
| Program | Income Limit (Individual) | Income Limit (Couple) |
|---|---|---|
| QMB (Qualified Medicare Beneficiary) | $1,330/month (100% FPL) | $1,804/month |
| SLMB (Specified Low-Income Medicare Beneficiary) | $1,596/month (120% FPL) | $2,164/month |
| QI-1 (Qualifying Individual) | $1,796/month (135% FPL) | $2,435/month |
Other Eligibility Requirements
Beyond income, you must meet the following criteria to qualify for Delaware Medicaid:
- Residency: You must be a resident of Delaware.
- Citizenship or immigration status: You must be a U.S. citizen or have qualifying immigration status. Emergency Medicaid may be available regardless of immigration status.
- Social Security Number: Applicants must provide a Social Security Number or apply for one.
- Age and category: You must fall into a covered category (child, pregnant woman, parent/caretaker, adult under 65, senior, or individual with a disability).
There is no asset or resource test for most MAGI-based Medicaid categories (adults, children, and pregnant women). Asset limits only apply to seniors and individuals with disabilities applying through SSI-related pathways.
How to Apply for Delaware Medicaid
Applying for Medicaid in Delaware is straightforward. Follow these steps:
Step 1: Gather Your Information
Before you begin, collect the following documents for each household member:
- Social Security Numbers
- Proof of income (pay stubs, tax returns, or employer statements)
- Proof of Delaware residency (utility bill, lease, or ID)
- Date of birth and citizenship or immigration documentation
- Information about any current health insurance
Step 2: Choose Your Application Method
You can apply through any of these channels:
- Online: Visit Delaware ASSIST to submit your application electronically. This is the fastest method.
- By phone: Call the Delaware Medicaid helpline at 1-800-372-2022.
- In person: Visit your local Division of Social Services (DSS) office.
- By mail: Download an application from the DHSS website and mail it to your local DSS office.
- Through Healthcare.gov: Since Delaware uses the federal marketplace, you can also apply through Healthcare.gov, which will route Medicaid-eligible applicants to the state program.
Step 3: Complete and Submit Your Application
Fill out all required sections of the application. Be sure to include information for everyone in your household, even if not everyone is applying for coverage. Household size and total income affect eligibility.
Step 4: Respond to Any Requests
After submitting, the state may ask for additional documentation to verify your information. Respond promptly to avoid delays in processing.
Step 5: Receive Your Determination
Delaware typically processes Medicaid applications within 45 days (90 days for disability-based applications). You will receive a notice by mail with your eligibility determination. If approved, you will be enrolled in the Diamond State Health Plan and can begin using your benefits.
What Does Delaware Medicaid Cover?
Delaware Medicaid provides comprehensive health coverage, including:
- Doctor visits and preventive care
- Hospital stays (inpatient and outpatient)
- Prescription medications
- Mental health and substance use treatment
- Laboratory tests and X-rays
- Home health services
- Dental services for children (limited adult dental may also be available)
- Vision care for children
- Maternity and newborn care
- Transportation to medical appointments
- Durable medical equipment
- Long-term care services (nursing home and home-based care for eligible individuals)
Most services are provided at no cost to the enrollee. Some adults may have small copayments for certain services, but these are minimal.
Medicaid for Workers with Disabilities
Delaware offers a Medicaid for Workers with Disabilities (MWD) program that allows individuals with disabilities to work and still maintain Medicaid coverage. The income limit for MWD is 275% of the FPL, which is $3,658 per month for an individual in 2026. This program has an asset limit and may require a small premium, but it provides a critical pathway for people with disabilities who want to work without losing their health coverage.
Renewing Your Delaware Medicaid Coverage
Medicaid coverage must be renewed annually. Delaware will send you a renewal notice before your coverage period ends. You can renew:
- Online through your Delaware ASSIST account
- By phone at 1-800-372-2022
- By mail using the renewal form sent to you
Keep your contact information up to date in your ASSIST account so you do not miss renewal notices. If you fail to renew on time, your coverage may be terminated, and you would need to reapply.
What If You Are Denied?
If your application is denied, you have the right to appeal. Your denial notice will include instructions for requesting a fair hearing. You typically have 30 days from the date of the notice to file an appeal. During the appeals process, you may be able to maintain your current benefits if you file quickly enough.
Consider reaching out to Delaware Legal Help or community organizations for free assistance with appeals.
Frequently Asked Questions
How do I know if I qualify for Delaware Medicaid?
The quickest way to check is to use our free eligibility screener. You can also review the income limits above or call 1-800-372-2022 to speak with a representative.
Can I apply for Delaware Medicaid at any time?
Yes. Unlike marketplace health insurance, Medicaid does not have an open enrollment period. You can apply at any time of the year.
Does Delaware Medicaid cover dental care?
Delaware Medicaid provides comprehensive dental coverage for children. Adult dental benefits are more limited but may include emergency dental services and some preventive care. Check with your managed care plan for specific covered services.
What is the Diamond State Health Plan?
The Diamond State Health Plan (DSHP) is Delaware's Medicaid managed care program. When you are approved for Medicaid, you are enrolled in DSHP and choose a managed care organization (MCO) to coordinate your care.
Can I have Medicaid and other insurance at the same time?
Yes. If you have other health insurance, Medicaid can serve as secondary coverage to help pay for costs that your primary insurance does not cover.
What happens to Delaware Medicaid with federal budget changes?
Recent federal legislation may affect Medicaid funding over the coming years. While changes are being phased in gradually, Delaware residents currently enrolled in Medicaid should continue to maintain their coverage and renew on time. Stay informed by checking the DHSS website or contacting your local DSS office.
How long does it take to get approved?
Most applications are processed within 45 days. Disability-related applications may take up to 90 days.
Take the Next Step
If you think you or your family might qualify for Delaware Medicaid, do not wait. Health coverage can protect you from unexpected medical costs and give you access to the care you need. Use our free screener to check your eligibility now, or visit Delaware ASSIST to start your application today.
For a complete look at all benefit programs available in your state, visit our Delaware Benefits Overview.
