Delaware Medicaid Income Limits 2025

Delaware Medicaid, also known as the Diamond State Health Plan (DSHP), provides free or low-cost health coverage to eligible low-income residents.

In 2025, eligibility is determined by updated Federal Poverty Level (FPL) guidelines — with adults covered up to 138% FPL and higher limits available for children, pregnant women, and individuals needing long-term care.

You can use the Delaware Medicaid income calculator to quickly check whether your household meets the current income limits.

Key Takeaways

• Adults ages 19–64 without children qualify up to 138% FPL.
• Children and pregnant women qualify at higher thresholds, in some cases up to 217% FPL.
• Seniors and long-term care applicants must meet both income and asset limits.
• Delaware Medicaid enrollment has shifted as post-pandemic renewals resumed.

Understanding Delaware’s Medicaid System & Trends

Delaware administers Medicaid through the Division of Medicaid & Medical Assistance (DMMA) at DHSS. Most members get care via DSHP managed care; people who need long-term services and supports (LTSS) receive them under DSHP-Plus. The state provides details about the managed care and LTSS system on its DSHP-Plus program page.

To manage healthcare costs, DHSS and the Delaware Health Care Commission launched the Benchmark Trend Report Dashboard to monitor spending and outcomes. As reported by Delaware Public Media, this dashboard helps the state adjust Medicaid policy when cost growth rises too quickly.

Enrollment trends also reflect national changes. A KFF report found that Medicaid enrollment dropped by 7.5% in FY 2024 and could decline another 4.4% in FY 2025, as continuous coverage protections end. Delaware, with nearly 300,000 Medicaid/CHIP members in 2023–2024, mirrors this trend.

Delaware Medicaid Income Limits 2025 by Household Size

Below are key FPL-based benchmarks Delaware uses across its Medicaid and medical-assistance programs. The state publishes these in its 2025 Federal Poverty and Medical Assistance Levels notice (Administrative Notice A-03-2025, effective January 1, 2025).

Medicare Savings Programs & QDWI

Program Use:

• 100% FPL: QMB (Qualified Medicare Beneficiary)
• 120% FPL: SLMB (Specified Low Income Medicare Beneficiary)
• 135% FPL: QI-1 (Qualifying Individual 1) – income must be over 120% but not exceed 135%
• 200% FPL: QDWI (Qualified Disabled Working Individual)

Children & Pregnancy-Related Medicaid

Program Use:

• 133% FPL: Children ages 6-18
• 142% FPL: Children ages 1-5
• 212% FPL: Pregnant women, infants under age 1, and Delaware Healthy Children Program (DHCP)

Adult Medicaid Expansion

Program Use:

• 138% FPL: Adults under age 65 (with or without children) under ACA Medicaid expansion

Source: View the full tables on the Delaware DMMA income limits page.dhss.delaware

Who Qualifies for Delaware Medicaid?

Eligibility combines income, household size, and category:

• Adults (19–64): Eligible up to 138% FPL under Medicaid expansion.
• Children: Infants up to 217% FPL, ages 1–5 up to 147% FPL, and ages 6–18 up to 138% FPL.
• Pregnant women: Covered up to 217% FPL, with guaranteed 12 months of postpartum coverage.
• Aged, blind, or disabled individuals needing long-term care: Must meet both income and asset tests. Delaware is an income-cap state, with a 2025 nursing home income limit of $2,417.50/month, and applicants may use a Miller Trust to qualify, as explained by Senior Planning.
• DSHP-Plus members: Those needing home- and community-based services (HCBS) or nursing care must also meet medical necessity requirements.

How to Apply for Delaware Medicaid

To apply in 2025:

1. Start with the Delaware DMMA income limits page and check your category.
2. Apply online through Delaware ASSIST or at a local DHSS office.
3. Prepare required documents: income proof, Social Security numbers, proof of residency, and medical records if applying for long-term care.
4. Submit your application online, in person, or by mail.
5. Watch for renewal requests. Delaware resumed redeterminations after the pandemic, so failing to respond may cause coverage loss.

For children, the Delaware Healthy Children Program (DHCP) is an option for families slightly above Medicaid limits. Premiums were eliminated effective July 1, 2024, according to the official 2025 FPL notice.

What If You Don’t Qualify? Alternatives & Supplemental Help

• Delaware Healthy Children Program (DHCP): Provides coverage for children in families above Medicaid limits; now premium-free.
• ACA Marketplace plans: Subsidized plans are available on HealthCare.gov, often lowering premiums significantly.
• Community health centers: Offer sliding-scale services regardless of insurance.
• Miller Trusts: For applicants exceeding long-term care income limits, a trust may allow eligibility. Details are available in Senior Planning’s Delaware Medicaid overview.

FAQs: Delaware Medicaid 2025

Conclusion

Delaware’s 2025 Medicaid rules keep adults covered up to 138% FPL, with higher thresholds for children and pregnant women. Seniors and those needing long-term care face stricter rules, but options like Miller Trusts exist for those just above the cap.

Enrollment has decreased slightly after pandemic-era protections ended, but Medicaid still supports nearly 300,000 Delawareans. With premiums removed for children’s coverage and continued monitoring through the state’s benchmark system, Delaware is balancing access with sustainability.