Medicaid in Delaware: What Coverage Looks Like and Who It’s For

Medicaid can feel overwhelming — especially because it looks different depending on where you live. This post walks through how Medicaid works in Delaware, who it’s for, and the different pathways people use to qualify.

As always, this is education, not legal advice — but the goal is to help you understand the landscape so you’re not navigating it blind.

The Big Picture

Delaware is a Medicaid expansion state, which means adults without children can qualify based on income alone — something that isn’t true everywhere.

Delaware Medicaid is administered through Delaware Health and Social Services (DHSS) and includes several different eligibility categories depending on your situation.

Medicaid for Low-Income Adults (Expansion Medicaid)

For adults ages 19–64 who are not pregnant and not on Medicare, Delaware offers Medicaid under the Affordable Care Act expansion.

Income limit:
Up to 138% of the Federal Poverty Level (FPL)
(For a single adult, this is roughly a little over $20,000 per year — adjusted annually.)

Assets:
There is no asset limit for this category.

This pathway covers many people who:

• Work part-time or seasonally

• Are self-employed with fluctuating income

• Are between jobs

• Have chronic illness but are not yet on disability

Medicaid for Children & Families

Delaware Medicaid also covers:

• Children

• Parents and caretakers

• Pregnant people

Income limits are higher for children and pregnancy-related coverage than for adult expansion Medicaid, recognizing the additional needs around care, growth, and prenatal health.

Pregnancy & Family Planning Coverage

Delaware provides Medicaid coverage for:

• Prenatal care

• Labor and delivery

• Postpartum care

There is also family planning–only Medicaid, which can cover services like contraception and reproductive health care for people who may not qualify for full Medicaid.

Income limits here are typically higher than standard adult Medicaid.

Medicaid for People Who Are Aged, Blind, or Disabled

Delaware offers Medicaid pathways for people who are:

• Age 65+

• Blind

• Living with a disability

These programs are often called ABD Medicaid and are different from expansion Medicaid.

Key differences:

• Income limits are lower

• Asset limits apply

• Medical eligibility (disability status) may be required

This is where Medicaid can become more complex — especially for people who receive SSDI, SSI, or Medicare.

Spend-Down Medicaid (Medically Needy)

Delaware does allow a Medically Needy / spend-down pathway.

This means:

• You can qualify even if your income is over the limit

• You must incur medical expenses that “spend down” your income to the eligibility level

• Coverage may be time-limited and require regular requalification

Spend-down Medicaid is often used by people with:

• High medical costs

• Inconsistent income

• Disabilities who don’t qualify under standard categories

Medicaid Buy-In for Workers with Disabilities (MBIWD)

Unlike some states, Delaware does not currently offer a Medicaid Buy-In for Working Disabled (MBIWD) program.

That means there is no dedicated pathway that allows people with disabilities to earn higher income and pay a premium to keep Medicaid coverage.

This is an important distinction — especially for people trying to balance work, health, and benefits.

Why This Matters

Delaware Medicaid offers meaningful coverage — but how you qualify matters just as much as whether you qualify.

Two people with the same diagnosis can end up in very different programs depending on:

• Income source

• Work status

• Age

• Medicare eligibility

• Assets

• Family composition

Understanding the category you fall into can help prevent:

• Unexpected loss of coverage

• Gaps during transitions (job changes, disability applications, recovery periods)

• Costly mistakes when income fluctuates

A Gentle Reminder

If Medicaid feels confusing, that’s not because you’re missing something — it’s because the system is layered, technical, and often poorly explained.

You’re not meant to figure this out alone.

At Lantern & Rune, I help people make sense of Medicaid, disability benefits, and public systems — not from a compliance lens, but from a human one.

Clarity first. Panic never.