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DE Medicaid - Eligibility - General

The Division of Social Services (DSS) uses the general criteria (called Common criteria by DSS) listed below to determine basic eligibility for all Delaware Medicaid programs.

Specific Criteria

To be eligible for Medicaid in Delaware you must also meet current income limits and resource limits (though not all groups have resource limits), and you must be in one of the groups covered by Medicaid. The income and resource limits are established in relation to the number of persons in the family budget group and to the type of covered group to which the family budget group belongs.

The family budget group is the basis for the financial eligibility determination. Eligibility is based on the countable income and resources of the family budget group members and the deemed resources and income deemed of legally responsible relatives who are not included in the assistance unit and who live in the home.

Certain eligibility groups have requirements that include age, household composition/filing unit, and medical eligibility/disability. You can find such specific criteria listed in the topics for the main covered groups.

Common Eligibility Criteria

Social Security Number: All individuals one-year-old or older who apply for Medicaid must furnish their Social Security numbers (SSNs). If they cannot furnish an SSN, they must provide proof that they have applied for one before Medicaid can be approved.

State Residency: Recipients must be residents of the State of Delaware. This includes: all individuals who live in Delaware with the intention to remain permanently or for an indefinite period; or who live in Delaware and have entered with job commitments, or are seeking employment whether or not currently employed. See DSS Policy Manual (Sects. 14110-20) for specific residency rules concerning individuals incapable of indicating intent and individuals in institutions or in foster care.

Citizens: Medicaid must be provided to eligible U.S. citizens and nationals. An individual qualifies as a U.S. citizen if the person was born in the 50 states and District of Columbia, Puerto Rico, Guam, U.S. Virgin Islands, or Northern Mariana Islands. Nationals from American Samoa or Swain's Island are regarded as U.S. citizens for purposes of Medicaid eligibility. Children of a U.S. citizen that are born outside the U.S., may automatically be eligible for a Certificate of Citizenship. In order to receive the certificate, an INS Form N-600 needs to be filed.

Aliens: In State Fiscal Year 1998, (SFY 98), the Delaware legislature appropriated State-Only funds to provide coverage of full Medicaid benefits to legally residing non-citizens who are ineligible for full Medicaid benefits because of Federal restrictions in PRWORA (P.L. 104-193). Coverage for these aliens will be provided on a fee-for-service basis and is subject to the availability of state funding. In the event state funding is exhausted, the benefits will be reduced to coverage of emergency services and labor-and-delivery only.

Assignment of Rights to Benefits: As a condition of eligibility, legally able applicants and recipients must:

·      Assign their rights -- and the rights of any other eligible individuals for whom the individuals have the legal authority under State laws to assign such rights -- to medical support or other third party payments to the agency (for example, a parent must assign the rights of a child);

·      Cooperate in establishing paternity and obtaining medical support unless there is good cause (pregnant and post-partum women do not have to meet this requirement); and

·      Cooperate, unless there is good cause, in identifying and providing information needed to pursue third parties who may be liable to pay for medical services covered by Medicaid.

Accepting Other Benefits: As a condition of eligibility, applicants/recipients are required to take all necessary steps to obtain any income or resource benefits. Examples are annuities, pensions, retirement, disability and veteran's benefits to which they are entitled.

Reporting Changes In Circumstances: Recipients are responsible for notifying DSS of all changes in circumstances that could potentially affect the family budget group's eligibility for Medicaid. Failure to do so may result in overpayments being filed or legal action taken to recover funds expended on the family's behalf during periods of ineligibility.

State-to-State Transfer Of Medicaid Eligibility: Medicaid benefits do not automatically transfer when Medicaid clients move from one state to another. Medicaid clients must cancel Medicaid in one state and call the new state to establish coverage.

See also:

DE Medicaid - Covered Groups

DE Medicaid - Application Procedures

DE DSS - Change Reporting Requirements

DE DSS - Contact Information

Source:

DSS Policy Manual (Sects. 14105-830)

Back to:

DE Medicaid - Overview

DE Division of Social Services - Overview

DE Benefit Information System Overview

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