16 Del. Admin. Code § 13000-13310

Current through Register Vol. 28, No. 7, January 1, 2025

Section 13000-13310 - Delaware Medicaid Program Growth

The Medicaid Program was implemented in Delaware in July, 1967. The following pages chart the growth of the program and identify the groups and services that are covered in Delaware.

Delaware Medical Assistance Program (DMAP) History

DATE	ELIGIBILITY GROUP	MANDATE	OPTION	COVERED SERVICE	MANDATE	OPTION
7/67	AFDC recipients	X		Inpatient Hospital	X
	Old Age Assistance (OAA)	X		Outpatient Hospital	X
	Aid to the Blind (AB)	X		X-Ray and Laboratory	X
	Aid to the Disabled (AD)	X		Skilled Nursing for age 21 +	X
	18-21 yr. old AFDC-related	X		Physician Services	X
	Foster Children		X	Drugs		X
	AFDC < $5 (no grant pymt)	X		Home Health Services	X
				Clinic Services		X
				Family Planning	X
				Podiatry (non-routine)		X
4/70				Inpatient Psychiatric ? age 65		X
1/72	Adult Foster Care		X	Transportation		X
7/72	Loss of SSI due to 7/72 COLA	X		EPSDT	X
				Optometry for < age 21	X
7/73				Intermediate Care Facilities		X
	SSI (replacing OAA, AB, AD)	X
1/74	Mandatory State Supplement	X
	Optional State Supplement		X
7/77	Loss of SSI due to SSA COLA	X
9/77	Prospective eligibility (4 Mos.)	X		Long Term Care Bed-Hold Days		X
5/78	Retroactive eligibility (3 Mos.)	X
5/79	GAs under age 21		X
7/79				Skilled nursing for < age 21		X
10/79	AFDC-UP	X		Rural Health Clinic Services	X
6/80	Foster Kids awaiting placement		X
7/80	Patients in medical institutions with incomes less than 180% of SSI standard		X
				Aphakic lenses		X
10/80				Apnea Monitors		X
1/81	1619(b) disabled working - loss of SSI	X		Dental / Oral Surgery	X
1/82	Pregnant women in 9th month of pregnancy		X
				Nurse Midwifery	X
7/82				ICF/MR (Stockley Center)		X
9/82	IV-E Adoption Assistance	X
1/83	Cases denied AFDC due to step-parent or alien sponsor income deeming	X
4/83				Private Duty Nursing		X
7/83				Home and Community-Based Services Waiver for the Mentally Retarded		X
1/84	AFDC-related pregnant women in the 4th month of pregnancy		X
8/84	Families losing AFDC due to child support (4 additional months of Medicaid.)	X
10/84	Families losing AFDC due to loss of 30 &/or 1/3 income deductions	X
	Pregnant women from verification of pregnancy	X
	Cases denied AFDC due to grandparent or sibling income deeming	X
	Children < age 5 with family income < AFDC standard	X
	Infants of Medicaid mothers from date of birth	X
	Pickle People (loss of SSI due to any type of SSA increase)	X
7/85				ICF/IMD (Delaware State Hospital)		X
10/85	AFDC < $10 cases (no cash grant)	X
	Disabled Widows/Widowers	X		Super Skilled Nursing Pymt Method		X
	Pregnant women to 60+ days postpartum	X
1/86	Disabled Children under 42 CFR § 435.225		X
7/86				Home and Community-Based Services Waiver for the Elderly and Disabled		X
1/87	State-funded Adoption Assistance children		X	Experimental Organ Transplants		X
7/87	Adult Disabled Children	X		Hospice services		X
	Dropped GA's age 18 - 21 by federal mandate	X		Added limited services for aliens	X
12/87				Federal redefinition of nursing facilities (NFs) merge ICF services and SNF services (ICF no longer optional)	X
1/88	Pregnant women and infants under 100% of Federal Poverty Limit (FPL)		X	Extended Pregnancy Services - "Smart Start" Program		X
7/88	Kids < age 2 < 100% of FPL		X
10/88	Private Adoption Agency Kids		X
1/89	Kids < age 3 < 100% of FPL		X	Community Mental Health Support Services (Rehabilitation option)		X
10/89	Long-Term Care eligibility increased from 180% to 200% of SSI standard		X	Prescribed Pediatric Extended Care (PPEC)		X
1/90	Qualified Medicare Beneficiaries (QMBs) *	X
4/90	Pregnant women and infants < 133% of FPL	X		Federally Qualified Health Centers (FQHCs)	X
	Children < age 6 < 133% of FPL	X		Expanded EPSDT requirements including school-based services	X
				Certified Nurse Practitioners	X
7/90	Pregnant teens (disregard 1/2 of parental income)		X	Durable Medical Equipment and Supplies (DME)	X
	Qualified Disabled Working Individuals (QDWIs)	X		Enteral & Parenteral supplements & supplies in limited circumstances		X
1/91	Long-Term Care eligibility increased from 200% to 210% of SSI standard		X	Home and Community-Based Services Waiver for AIDS and HIV+ patients		X
4/91	Pregnant women and infants < 160% of the FPL		X
	Children < age 8 < 100% of FPL	X
10/91	Children < age 9 < 100% of FPL (born after 9/30/83)	X
1/92				Mental Health Clinics		X
4/92				Personal Care services for mental health Community Support Clients		X
10/92	Children < age 19 < 100% of FPL (born on or after 10/1/74)		X	Day Health and Rehabilitation services for the Mentally Retarded and Developmentally Delayed		X
	Pregnant women and infants < 185% of FPL		X
1/93	Specified Low Income Medicare Beneficiaries (SLIMBs) *	X
7/1/93	DMAP assumed responsibility for the operation of the State funded Chronic Renal Care program which provides limited coverage to non-Medicaid eligibles or for non-Medicaid services	N/A	N/A	Services provided under the Chronic Renal program include transportation to and from dialysis and some pharmaceuticals and over-the-counter drugs	N/A	N/A
10/93	Long-Term Care eligibility increased from 210% to 230% of SSI standard		X
10/94	Long-Term Care eligibility increased from 230% to 250% of SSI standard		X
1/1/95	SLIMB eligibility increased to 120% of FPL	X
3/1/95	Individuals suspended or terminated from SSI due to drug and/or alcohol program limitations (group deleted 1/1/97)	X
10/1/95	GAHF clients become regular Medicaid		X (Demo- waiver)	Post-partum coverage extended from 60 days to 90 days		X (Demo- waiver)
10/1/95	As part of the State's Welfare Reform waiver, Delaware's A Better ChanceWelfare Reform Program (TANF), transitional Medicaid was extended up to 24 months after loss of cash benefits.		X (Demo- waiver)
1/1/96				Implementation of managed care for all clients except long-term care recipients (nursing home and home and community-based waiver clients), dual Medicare/Medicaid eligibles, and individuals with accessible managed care health insurance from another source		X (Demo- waiver)
				As part of the Diamond State Health Plan managed care waiver, family planning services will continue for women for 24 months beyond the month that they are terminated from a Medicaid eligibility group for non-fraudulent reasons		X (Demo- waiver)
3/1/96	Adults with incomes less than or equal to the Federal Poverty Level who have no other health insurance coverage once a managed care plan is chosen - no resource test		X (Demo- waiver)
1/1/97	The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) replace the AFDC program with the TANF (Temporary Assistance for Needy Families) program and uncoupled the automatic link to Medicaid eligibility for individuals who receive financial assistance. Delaware opted to maintain the same eligibility groups for Medicaid.	X
1/1/97	PRWORA limited eligibility for non-citizens	X		PRWORA limited services for non-citizens	X
7/1/97	The Balance Budget Act of 1997 protects Medicaid eligibility for children who lost SSI because of PRWORA changes which redefined disability for SSI.	X		Medicaid will pay Medicare Part B premiums for QI=1s and the small portion of Part B premium for QI-2s that was transferred from Part A.	X
4/1/98	The Balanced Budget Act of 1997 added a new group of Medicare qualifying individuals who have income between 120% and 135% of FPL (QI-1) and another group who have income between 135% and 175% of the FPL (QI-2).	X		Medicaid will pay Medicare Part B premiums for the QI-1s and the small portion of the Part B premium for QI-2s that was transferred from Part A	X
10/1/98				Home and Community-Based Services, waiver for Assisted-Living		X
1/1/99	Delaware Healthy Children Program (See Chart on page 22)		X	See Chart on page 22.		X
1/1/99	Made changes to the Diamond State Health Plan (DSHP) to include clients with other accessible managed care.		X	Included all private duty nursing hours PPEC services, and PDDN services in basic DSHP MCO benefit.		X
6/1/99	Section 1931 - Eliminate resource test exclude interest/dividend income, recipient income test for applicants, disregard 2nd and 3rd month of earned income.		X

10/1/99	Add coverage of adoption subsidy children coming from other states.		X
12/1/99	Implement six (6) month guaranteed eligibility for managed care enrollees under The Balanced Budget Act of 1997.		X
1/14/2000	The Delaware Prescription Assistance Program is a State funded program for individuals 65 or over or under 65 and receiving Social Security Disability with income less than 200% FPL and prescription drug expenses that exceed 40%of income.		N/A	Medically necessary prescriptions provided by manufacturers who agree to participate in the State Rebate Program. Limited to $2500.00 per fiscal year.		N/A
5/1/2000	Eliminate resource test and disregard interest/dividend for QMBs, SLMB, QI's and QDWI.		X
7/2000				DSHP MCO will cover only 28 hours of private duty nursing services per week.		X
11/1/2000	Pregnant women and infants increased to 200% FPL.		X
3/1/2001	Add optional State supplement for individuals who lose SSI due to receipt of Social Security Disability and who do not have Medicare.		X
1/1/2002	Add uninsured women under age 65 who need treatment for breast or cervical cancer.		X
6/1/2002	Eliminate six (6) month guaranteed eligibility for managed care enrollees.		X
1/1/2003	Group of Medicare qualifying individuals with income between 135% and 175% FPL sunsets.	X

16 Del. Admin. Code § 13000-13310