DELAWARE
C-Delaware's system, honestly. A letter grade is a summary, not a verdict on your family — a low grade doesn't mean nothing is available, it means the path is narrower. What's behind it is below.
Do this first
Apply to DDDS online — applications can be completed, managed and tracked there — and then understand that you are not finished. DDDS says on its own intake page that an application to DDDS is not an application for waiver services: the HCBS Lifespan Waiver is a second application you pursue with your case manager. Families routinely complete the first and wait, believing they have done both. Ask your case manager, in writing, to start the waiver application and to explain the priority criteria for entrance, because meeting DDDS eligibility is not the same as meeting those. Note also that Pathways to Employment is a separate programme with its own application, and that TEFRA/Katie Beckett is the route if family income is too high for regular Medicaid.
Last verified 2026-07-03
HOW WE GRADE DELAWARE
Full methodology (v2.1) →Delaware's strongest area is hcbs spending per capita; what pulls the grade down most is waiver program count & breadth.
Waitlist Burden
30% of grade—Not available
Nobody waiting scores 100. 225 per 100,000 scores 0.
- Not scored: We could not find any Delaware document confirming there is no waiting list. The state does run a two-step process — you must first be found eligible by the disabilities division before you can apply for waiver services — and children aged 3 to 9 receive only a limited set of services.
Source:KFF State Health Facts, People Waiting for HCBS by Target … (FY2025 (KFF Medicaid HCBS Waiver Program Survey, FY 2025))US Census Bureau Vintage 2025 state population estimates (2025-07)
HCBS Spending Per Capita
25% of grade90/100$630 spent per resident
$200 per resident scores 0. $675 scores 100.
Source:CMS / Mathematica — Medicaid LTSS Annual Expenditures and … (CY2023)
Self-Direction Index
20% of grade33/10033 out of 100 on the self-direction index
Scored directly on its own 0–100 scale.
Source:CMS approved 1915(c) waiver application (2026-08-05)CMS approved 1915(c) waiver application (2026-08-05)
Waiver Program Count & Breadth
15% of grade10/10010 out of 100 on program breadth
Scored directly on its own 0–100 scale.
- No authoritative national roster of 1915(i) adopters exists; scored as absent where unconfirmed.
Source:Medicaid.gov State Waivers List, Authority=1915(c), Status… (Section 1915(c) counts: Medicaid.gov State Waivers List retrieved 2026-08-05. Target populations & 1915(k): KFF Medicaid HCBS Survey 2025 (FY2025). 1915(i): CMS SPA database retrieved 2026-08-05.)KFF Medicaid Home Care (HCBS) in 2025, Appendix Table 2 (Section 1915(c) counts: Medicaid.gov State Waivers List retrieved 2026-08-05. Target populations & 1915(k): KFF Medicaid HCBS Survey 2025 (FY2025). 1915(i): CMS SPA database retrieved 2026-08-05.)KFF Medicaid Home Care (HCBS) in 2025, Appendix Table 1 (Section 1915(c) counts: Medicaid.gov State Waivers List retrieved 2026-08-05. Target populations & 1915(k): KFF Medicaid HCBS Survey 2025 (FY2025). 1915(i): CMS SPA database retrieved 2026-08-05.)
Each factor is scored against a fixed bar, not against the other states, so Delaware's grade moves when Delaware moves. Think we have it wrong? Every number above links to its source — email hello@spectrumpathways.ai and we will correct it in public.
WHAT THINGS ARE CALLED IN DELAWARE
Use these exact words when you search, call, or fill out forms — they're what Delaware's own offices use.
- Medicaid here is
- Delaware Medicaid (Diamond State Health Plan)
- The DD agency is
- Developmental Disabilities Services (DHSS)
- You contact
- DDDS Office of Applicant Services
- The plan is
- Person-Centered Plan (PCP)
- Self-direction is
- Self-Directed Servicescontrolling your own budget and hiring your own people
- A denial arrives as a
- written notice of denialthe letter that gives you the right to appeal
WHO TO CONTACT, IN ORDER
Five different offices, and they don't talk to each other. Disability services, health coverage, and income each run through a separate agency — applying to one does not start the others. Ask each office for the name of the person you spoke to and write down the date; if something is later denied, that record is what an appeal is built on.
- 1
Developmental disability services
This is the office that decides whether your child is eligible for disability services. Ask for "intake" or "eligibility determination" by name. In Delaware, you contact DDDS Office of Applicant Services.
Delaware Division of Developmental Disabilities Services (DDDS)
- 2
Health coverage — Delaware Medicaid (Diamond State Health Plan)
Almost every waiver and personal-care route requires this first, and it is decided by a different office from the one above. Apply in parallel rather than waiting.
- 3
Help at home, and who can be paid for it
Unless you say otherwise, services come the traditional way: the agency picks and pays the providers. Self-direction — where you get a budget and hire your own people — is opt-in almost everywhere and is not offered automatically. Here it is called Self-Directed Services. Ask for it by that name.
- 4
Income — SSI
Federal, so it's the same everywhere: 1-800-772-1213 (TTY 1-800-325-0778). There is no minimum age — you can apply for a newborn. Until 18, the parents' income is deemed to the child, so an early denial is usually about that rather than the child's disability. In many states an SSI award also opens Medicaid automatically — ask when you call.
- 5
If you get told no
Every state has a Protection & Advocacy agency by federal law — free legal help on disability services and appeals. Most families never hear of it, and it is the number to have before a deadline, not after. Yours is Disabilities Law Program (Community Legal Aid Society, Inc.).
Disabilities Law Program (Community Legal Aid Society, Inc.) · 302-575-0660
RUNNING IT YOURSELF
In many states you can control the budget and hire your own people — including, sometimes, family. Most families are never told this is an option. Here's what we've verified for Delaware; where we haven't verified an answer we say so — it does not mean the answer is no, and it is worth asking.
Can you control the budget?
Not verified yet — ask, don't assume the answer is no.
Can a family member be paid to provide care?
Not verified yet — ask, don't assume the answer is no.
Who is legally the employer of the people you hire?
The agency is — Agency with Choice, entered through a DDDS community navigator
How freely can money move between services?
Not verified yet — ask, don't assume the answer is no.
Can the budget buy things, not just staff time?
Not verified yet — ask, don't assume the answer is no.
Is your case manager independent of your providers?
Not verified yet — ask, don't assume the answer is no.
Deadlines reflect this state’s rules as researched; they can change — always confirm the current deadline with your state agency or Protection & Advocacy office before relying on it.
HOW TO GET SERVICES & APPEAL IN DELAWARE
- DD track (optional): DDDS internal Appeals Committee review (not a prerequisite)
- Request a DSS Medicaid Fair Hearing at any point up to 90 days following receipt of the written DDDS decision (or general Notice of Action)
- Fair hearing before a DMMA/DSS Hearing Officer
- MCO members: complete the plan's internal appeal, then request a State Fair Hearing within 120 days of the MCO appeal-resolution notice
KEY AGENCIES & RESOURCES
NOTABLE WAIVERS
DDDS Lifespan Waiver
SourceChildren and adults with developmental disabilities living in the community.
Waitlist: Delaware combined its DD waivers into Lifespan; verify enrollment timing with DDDS.
Diamond State Health Plan Plus (managed LTSS)
SourceSeniors and adults with physical disabilities needing long-term services.
Waitlist: Entitlement-style managed care; apply through DMMA.
Full milestone guide
View the Delaware Roadmap →
Six age-based stages — state-correct programs, benefits, and milestones from birth through adulthood.
