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Financial help for Delaware Medicare enrollees

Medicaid estate recovery applies in Delaware if the deceased received Medicaid-funded long-term care services after turning 55

Josh Schultz // October 4, 2020

Reviewed by our health policy panel.

The state where Medicare beneficiaries reside impacts the care they receive and how that care is paid for. This page explains several options that can help low- and moderate-income beneficiaries pay for health and long-term care services.

Does Delaware help with my Medicare premiums?

Many Medicare beneficiaries who struggle to afford the cost of Medicare coverage are eligible for help through Medicare Savings Programs (MSPs). These programs will pay for Medicare Part B premiums and Medicare cost-sharing. In some case, MSPs pay for Part A premiums as well.

Delaware beneficiaries can access three MSPs:

  • Qualified Medicare Beneficiary (QMB): The QMB program pays for Part A and B cost sharing, Part B premiums; if a beneficiary owes them – it also pays for Part A premiums. The income limit is $1,064 a month if single and $1,723 a month if married.
  • Specified Low-income Medicare Beneficiary (SLMB): The SLMB program pays for Part B premiums for individuals with incomes up to $1,276 a month if single and $1,723 if married.
  • Qualifying Individuals (QI): The QI program pays for Part B premiums. The income limits are $1,416 a month if single and $1,920 a month if married. QI pays for Part B premiums.

MSP asset limit: Delaware does not have an asset limit for QMB, SLMB, or QI.

QI enrollees are not allowed to receive any other Medicaid benefits, but some QMB and SLMB enrollees also receive full Medicaid benefits or have a Medicaid spend-down.

Who’s eligible for Medicaid for the aged, blind and disabled in Delaware?

Original Medicare doesn’t cover important some services like vision and dental benefits. Medicare can also leave its beneficiaries with large cost sharing obligations (e.g. deductibles, co-pays, and coinsurance). Some beneficiaries, namely those who meet incomes criteria for Medicaid, may qualify for cost sharing assistance if they’re enrolled in Medicaid benefits for the aged, blind and disabled (Medicaid ABD).

Delaware’s Medicaid program does not cover dental benefits for adults. But it will cover eyeglasses when they’re medically necessary due to a health condition. (Although Medicaid wouldn’t cover glasses needed because of vision issues alone.) Medicaid programs sometimes also pay for medical supplies that Medicare doesn’t cover.

This resource contains several options in addition to Medicaid for low-income Delaware residents who need help affording dental, vision or medical care.

Due to similar income limits, Medicaid ABD recipients often also receive help with Medicare premiums through an MSP.

Income eligibility: The income limit is $783 a month if single and $1,175 a month if married.

Asset limits: The asset limit is $2,000 if single and $3,000 if married.

Federal assistance with prescription drug costs in Delaware

Medicare beneficiaries who are enrolled in Medicaid, an MSP, or Supplemental Security Income (SSI) also receive Extra Help – a federal program that lowers prescription drug costs under Medicare Part D. Enrollees who don’t receive this benefit automatically can apply for it through the Social Security Administration (SSA). The income limit is $1,615 a month for singles and $2,175 a month for couples, and the asset limit is $14,610 for individuals and $29,160 for spouses.

Pharmaceutical assistance for ESRD beneficiaries in Delaware

Lower-income Delaware beneficiaries who have End Stage Renal Disease (ESRD) can qualify for help with the cost of ESRD related medications through the Delaware Chronic Renal Disease Program. The program can also cover Part D premiums, and transportation to dialysis.

This state-funded State Pharmaceutical Assistance Program (SPAP) is available to enrollees with incomes up to three times the federal poverty level, or monthly income of $3,190 for individuals and $4,310 for couples.

How does Delaware regulate long-term services and supports (LTSS)?

While many beneficiaries will need long-term care at some point, those services are generally not covered by Medicare. Medicaid can fill this gap, but many find it difficult to navigate that program’s complex eligibility rules.

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Delaware uses a “special income limit” equal to 250 percent of the Supplemental Security Income (SSI) payment amount to determine whether an applicant qualifies for Medicaid long-term care benefits.

Because Delaware does not have a Medicaid spend-down, applicants with incomes above this limit are not able to pay the income they have toward long-term care, and have Medicaid pay the rest. Delaware is called an “income cap state” because it imposes this hard limit on Medicaid eligibility. Fortunately, applicants whose incomes are greater than this income cap are allowed to deposit income into a Miller Trust to qualify for Medicaid long-term care benefits.

Delaware’s Medicaid long-term care benefit is called the Diamond State Health Plan – Plus (DSHP-Plus). This program is offered through private insurers that combine LTSS and medical services with prescription drug coverage. In September 2017, Delaware announced that AmeriHealth Caritas and Highmark Health Options BlueCross BlueShield would provide DSHP-Plus services in Delaware going forward. AmeriHealth replaced United Healthcare, whose contract ended in December 2017.

DSHP-Plus covers Medicaid enrollees and dual eligibles who have Medicare and Medicaid.

Medicaid nursing home coverage in Delaware

Some seniors have medical or living situations that make nursing home care a good choice. Medicaid covers these services for an unlimited number of enrollees in each state.

Income limits: The income limit for Medicaid nursing home coverage in Delaware is $1,957.50 a month if single and $2,937.50 a month if married (and both spouses are applying).

However, Medicaid nursing home enrollees are not allowed to keep most of this income. Instead, enrollees must pay all but a small portion of it to their nursing home. They can keep a small personal needs allowance of $44 each month and money to pay for health insurance premiums, such as Medicare Part B and Medigap.

Assets limits: The asset limit is $2,000 if single and $3,000 if married (and both spouses are receiving nursing home care). Some assets are protected meaning they are not counted against the limit. Examples of excluded assets include a single car, home furnishings, family heirlooms, and prepaid burial arrangements.

If only one spouse has Medicaid, federal rules allow the other spouse to keep up to $128,640.

Here is more information about applying for Medicaid nursing home coverage in Delaware.

Home and Community Based Services (HCBS) waivers in Delaware

Medicaid also covers community-based long-term care services, which are provided to enrollees in their homes or another “community” location. Medicaid programs offering this type of care are called Home and Community Based Services (HCBS) waivers, because enrollees continue living in the community (rather than entering a nursing home). HCBS waivers have waiting lists in many states.

Income limits: The income limit is $1,957.50 a month if single and $2,937.50 a month if married (and both spouses are need care). If only one spouse needs nursing home care, the income limit for single applicants is used and usually only the applicant’s income is counted.

Asset limits: The asset limit is $2,000 if single and $3,000 if if both spouses are applying. If only one spouse has Medicaid, the other spouse can keep up to $128,640.

Qualifying for Medicaid LTSS benefits while over-income in Delaware

Delaware does not have a Medicaid spend-down, which means applicants whose income is above the limit for Medicaid ABD usually don’t have a way to qualify for those benefits.

However, an individual in this situation who needs Medicaid LTSS benefits can still qualify for that coverage by depositing income into a Qualified Income Trust, which is also called a “Miller Trust.”

Some states require Medicaid LTSS applicants to have monthly incomes below the average cost of nursing home care in order to apply for Medicaid using a Miller Trust, but Delaware doesn’t require applicants who use Miller Trusts to have a certain income.

Delaware residents can use a Miller Trust to become eligible for Medicaid LTSS coverage, but not for regular Medicaid ABD benefits.

Spousal impoverishment protections in Delaware

Rules to protect against spousal impoverishment allow the “community spouse” the one who is not receiving Medicaid LTSS benefits allow spouses to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s monthly income.

These rules apply only to spouses who don’t receive any Medicaid benefits, and are particularly helpful when one spouse is in a nursing home and would would otherwise pay nearly all their income toward their care.

In Delaware in 2020, community spouses are allowed to keep:

Permitted home value in Delaware

States are required by federal law to restrict eligibility for Medicaid nursing home and HCBS to applicants with a home equity interest below a certain amount. In 2020, states set their home equity limits based on a federal minimum home equity interest of $595,000 and a maximum of $893,000.

Delaware uses the most restrictive home equity limit allowed under federal law, so applicants for Medicaid LTSS must have more than $595,000 in home equity.

Penalties for transferring assets in Delaware

To address the very high cost of long-term care, Medicare beneficiaries may look to give assets away or transfer them in hopes of an in-need family member qualifying for Medicaid LTSS benefits. To discourage this, federal law requires states to have a penalty period for those seeking Medicaid nursing home coverage who give away or transfer assets for less than their value. States can also have a penalty period for HCBS.

Delaware has penalty periods for both nursing home care and HCBS. This penalty period is based on a 5-year long lookback period where asset transfers and gifts are prohibited. Individuals who transfer or give away assets may become ineligible for LTSS programs.

To calculate the penalty, an eligibility worker divides the value of what was given away or transferred below its market value during the lookback period by the monthly cost of nursing home care (which is $10,213 in Delaware in 2020).

This website has the regulations that govern Delaware’s lookback period.

Estate recovery in Delaware

State Medicaid agencies must attempt to recover their payments for long-term care related costs received beginning at age 55. States also have the option of recovering the cost of all other Medicaid benefits. This is called estate recovery.

Delaware only pursues estate recovery when Medicaid covers nursing home care or HCBS for an enrollee beginning at the age of 55. However, if the state does pursue an estate recovery, it will attempt to recover the cost of all Medicaid-covered services.

The state will not attempt an estate recovery if a nursing home or HCBS recipient is survived by their spouse or a child who is under 21, blind or disabled.

Congress exempted Medicare premiums and cost sharing from Medicaid estate recovery if they were paid after December 31, 2009, but Medicaid may attempt to recover MSP benefits paid through that date. In Delaware, this could only occur if an enrollee also received LTSS.

Here are the regulations governing estate recovery in Delaware.

Where can Medicare beneficiaries get help in Delaware?

Delaware Medicare Assistance Bureau (DMAB)

Free Medicare counseling is available by contacting the Delaware Medicare Assistance Bureau (DMAB) at 1-800-336-9500. This is Delaware’s State Health Insurance Assistance Program (SHIP). This website has more information about the SHIP in Delaware.

SHIPs offer assistance like helping beneficiaries with initial Medicare enrollment, changing plans, and evaluating Medigap options. They may also be able to offer referrals to local agencies for services like home care and long-term care.

Elder Law Attorneys

Elder law attorneys can help you plan for long-term care needs. Find an elder attorney in your area with the search feature on the National Academy of Elder Law Attorneys (NAELA) website.

Delaware Aging and Disability Resource Centers

Medicare beneficiaries in Delaware can also receive assistance from one of the state’s Aging and Disability Resource Centers (ADRCs). ADRCs help seniors and people with disabilities understand LTSS benefits and access services to help with aging or living with a disability.

You can reach one of the Delaware ADRCs by calling 1-800-223-9074. This website lists the regional ADRC offices in Delaware.

How do I apply for Medicaid in Delaware?

Medicaid is administered by the Division of Health and Social Services (DHSS) in Delaware. You can apply for Medicaid or an MSP using this website. This website has more information about applying for Medicaid in Delaware.

Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive. He has also held consulting roles, including at Sachs Policy Group, where he worked with clients on Medicare and Medicaid issues.

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