Delaware Medicaid for a Grandchild in Relative Care

Getting health coverage for a grandchild you're raising is one of the first things that has to happen — the child needs a doctor, a dentist, and prescriptions, and you shouldn't be paying out of pocket for a child who almost certainly qualifies for Medicaid or CHIP. The good news is Delaware makes this relatively straightforward for relative caregivers.

Two Programs, One Goal

Delaware covers children's health through two related programs:

• Medicaid (Diamond State Health Plan): Delaware's income limits for children are 212% of the Federal Poverty Level for infants under age one, 142% for ages one through five, and 133% for ages six through 18. Pregnant women qualify up to 212% FPL. The standard 5% MAGI disregard may also apply.
• Delaware Healthy Children Program (DHCP/CHIP): covers children in households up to 212% FPL who don't qualify for Medicaid. No premiums.

Both provide comprehensive coverage: preventive care, hospital visits, dental, vision, prescription drugs, and behavioral health services.

How Household Income Is Counted

Medicaid and CHIP eligibility for children uses Modified Adjusted Gross Income (MAGI) household rules. Who claims the child for taxes and whether the child is treated as a non-filer can affect which adults' income is counted. The child's own income is not always the only income considered.

These income-based children's coverage routes do not use an asset test. Your retirement savings, home, car, and bank balance do not affect eligibility through these routes.

Many children in relative care may qualify for Medicaid based on their income and household rules, but an application is still needed to confirm eligibility. If an uninsured child does not qualify for Medicaid, DHCP can cover eligible children up to 212% FPL.

How to Apply

Use the ASSIST portal (assist.dhss.delaware.gov) or visit a State Service Center. You can apply for Medicaid alongside TANF and SNAP on the same application.

Standard processing takes up to 45 calendar days. Medicaid also allows up to 90 days of retroactive coverage — if the child was eligible in the months before you applied, coverage can be backdated.

Renewals and Continuity

Delaware uses automated renewals by cross-referencing state databases. If the automated renewal works, you don't need to do anything. If it fails, DMMA mails a renewal packet. Complete and return it promptly. If Medicaid coverage lapses because of a missed renewal, Delaware allows reconsideration within 90 days without filing a brand-new application, though coverage may not be retroactive to the termination date.

Managed Care Plans

Once enrolled, the child is assigned to a managed care organization (MCO) under the Diamond State Health Plan. You can choose among the available MCOs. Each covers the same comprehensive benefits, but provider networks differ — check which plan includes the child's current pediatrician if they already have one.

The Delaware Financial Help for Kinship Caregivers guide covers the full Medicaid application process and includes income threshold tables to help you confirm the child's eligibility before you apply.

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