How to get Medicaid or low-cost care in Delaware

Who runs Delaware Medicaid

Medicaid is a health program that pays for care for people with limited income. The Department of Health and Social Services, or DHSS, runs it here. Its Division of Medicaid and Medical Assistance does the daily work.

The Kaiser Family Foundation says Delaware adopted Medicaid expansion on January 1, 2014. Under expansion, adults can qualify by income alone, whether or not they have children at home. The DHSS page on the new rules describes the expansion group as adults ages 19 through 64. Their household income can be up to 133 percent of the federal poverty level. A 5 percent income allowance brings the real limit to about 138 percent. That level is a yearly dollar amount the government uses to measure poverty, and it grows as your household gets bigger.

The state's Medicaid pages list several programs, including the Diamond State Health Plan and a Medical Transportation Program. They also name Adult Dental Services and a Prescription Assistance Program. Call the customer relations unit and ask which ones fit you.

Applying on ASSIST or by phone

ASSIST is Delaware's website for Medicaid and other benefits. The site lets you apply, send in changes and read your notices. If you prefer to talk in person, visit your local DHSS service center.

For questions, call the Delaware Medicaid Customer Relations Unit at 1-866-843-7212. The same number gives help in other languages, and TTY users can dial 711. To report a change by phone, call 302-571-4900 and choose Option 2.

Our guide on how to apply for Medicaid lists the papers to gather, such as proof of income and ID. The state says you must report some changes within 10 days, such as a change in income or in who lives with you.

The Medicaid ENGAGE work rule in 2027

Medicaid ENGAGE is the name Delaware gives to its new work and community engagement requirement. The state starts it on January 1, 2027, for adults in the expansion group. To keep coverage, you must earn at least $580 a month. Another way to qualify is to spend at least 80 hours a month on work, volunteering, a work program or school.

First-time applicants must show they met the rule for at least one month before they applied. Pay stubs, school papers or proof of volunteer hours can serve as proof. Adults in this group will also renew every six months instead of every 12 months, starting January 1, 2027.

The state lists many exemptions, which are reasons you do not have to meet the rule. Pregnant people are exempt, and so are people in postpartum coverage. Parents and caretakers of a child 13 or younger do not have to meet it either. Family caregivers for a person with a disability are also exempt. People with serious health needs can be exempt too, and your doctor fills out a form for the case manager. Veterans with a total disability rating and members of a federally recognized tribe are on the list as well.

The state also names short-term hardships that can excuse you. You may not have to meet the rule if you live in an area with high unemployment. A stay in a hospital or nursing home in the last 12 months can also count. Our guide on the Medicaid work rule explains how these rules work across the country.

DHSS says it will mail a notice before your renewal date. Keep an eye on your mail and your phone, and check your ASSIST account for new messages. If you lose coverage and later find a job, the state says you can apply again at any time. DHSS also says some coverage changes for adults who are not U.S. citizens took effect on October 1, 2026.

Plans for people above the Medicaid limit

People in Delaware buy private plans through the Health Insurance Marketplace at HealthCare.gov. A Marketplace plan is private insurance, and your income decides how much help you get with the monthly cost. Delaware's marketplace web address leads to HealthCare.gov, which says Open Enrollment starts November 1.

If you lose other coverage during the year, you may qualify for a Special Enrollment Period. That is a window to sign up outside the usual dates. Our guide on losing a job and losing insurance covers the first steps.

Clinics near you

Community health centers are clinics funded in part by the federal government. They serve everyone, and their prices are based on income and family size. The Find a Health Center tool, run by the federal health agency HRSA, shows the nearest ones when you type in your zip code. Then call and ask what papers a new patient should bring.

Our guide to sliding-scale clinics can help you compare prices. For dental care, read about Medicaid dental coverage first.

Looking up a doctor's license

The state has an online tool called Search and Verify License. The Division of Professional Regulation runs it, and doctors are licensed under its Medical Practice board. You can look up a doctor there before you book a visit.

Monthly-fee doctors and the ER in Delaware

Some Delaware doctors charge a flat monthly fee for primary care and do not bill insurance for those visits. People call that kind of care direct primary care. You can browse our directory of cash-pay doctors and ask each office what the fee includes.

In an emergency, call 911 or go to the nearest emergency room. Under a federal law, every hospital with an emergency room has to examine you before asking about payment. If you get a bill afterward, our guide on hospital financial assistance shows how to ask for help. Anyone who needs to talk to someone can call the 988 Suicide and Crisis Lifeline by dialing 988.