Delaware

Delaware Medicaid and the new work rules

Diamond State Health Plan (DSHP) — Delaware's brand name for Medicaid, covering the ACA Adult Expansion Group (ages 19-64) and other adult eligibility groups is run by Delaware Division of Medicaid and Medical Assistance (DMMA), within the Delaware Department of Health and Social Services (DHSS). Delaware expanded Medicaid on 2014-01-01, which is why the new federal work requirement reaches this state — and why what you do before January 1, 2027 matters.

Work rules start January 1, 2027 Medicaid expanded 237,000 enrolled 70,000 in the expansion group

Start here

From January 1, 2027, most adults have to show 80 hours a month

The requirement applies to adults aged 19 to 64 covered through Medicaid expansion — around 70,000 people in Delaware. It is not only about paid work: study, job training, volunteering and a mix of them all count , and earning at least $580 a month satisfies it on its own.

DMMA says that at each renewal a case manager will first check information the state already has; if more is needed, the member will be asked for documents such as pay stubs, school enrollment records, or proof of volunteer or work-program hours, and must respond on time or risk losing coverage. New applicants must show they met the requirement for at least one month before applying; existing members must meet it for one or more months between renewals.

If your hours swing from month to month, say so. The rule is written per month, which is the wrong shape for farm and fishing work, construction, tourism and seasonal retail — a good month and a dead month average out to a living, but the dead month is the one that fails. Federal law has a provision for exactly this: a seasonal worker can satisfy the requirement using their average monthly income over the previous six months instead of hours worked in the month being checked. It is at 42 CFR 435.552(a)(7), and the law defines who counts as seasonal by pointing at the tax code rather than listing jobs, so do not decide for yourself that it misses you. If your work is seasonal or your hours are irregular, tell the state that when you report, and ask for the six-month average to be used.

2026-06-01 · already happened

CMS issues the interim final rule (CMS-2454-IFC, implementing section 71119 of the Working Families Tax Cut legislation) setting the federal 80-hour/$580-month work and community engagement requirement, effective January 1, 2027

2026-10-01 · already happened

New federal Medicaid eligibility rules for noncitizens take effect

2027-01-01

Work and community engagement requirement and six-month renewals take effect for Delaware's Adult Medicaid Expansion group

You do not have to prove anything if any of these describe you

Exemptions are meant to be applied by the state automatically from records it already holds, but records are imperfect. If one of these fits you and you still get asked to report hours, say so and ask them to check — don't assume the notice is right.

Under age 26 and were in foster care

A member of a federally recognized tribe

A parent, caretaker, or guardian of a child aged 13 or younger, or a family caregiver for a person with a disability

A veteran with a total disability rating of 100%

Have serious health needs, such as blindness or disability, substance use disorder, a mental health condition, a serious medical condition, or another physical or developmental disability that makes it hard to do daily activities

Already meet work rules through SNAP or TANF

In a drug or alcohol treatment program

In jail or were in jail in the last 90 days

Pregnant or receiving Medicaid extended postpartum coverage

Two things people get wrong

Before you assume this applies to you the way you think

If your hours go up and downThe federal CMS interim final rule and the accompanying CMS fact sheet (June 1, 2026) describe a distinct calculation for seasonal workers, allowing compliance based on average income over a prior multi-month period rather than a strict single-month test. Delaware's own Medicaid ENGAGE page and FAQ, as published, describe only the standard $580/month-or-80-hours test and do not yet restate or operationalize the federal seasonal-worker averaging method in consumer-facing terms.

Income limits

What you can earn and still qualify

Monthly income, before tax, for the whole household. These are the state's own published figures, which is what its caseworkers actually apply. If you are close to a line, apply anyway — some income does not count, and only the agency can run the calculation for your situation.

Adults 19 to 64133% of the poverty line

1 person: $1,769
2 people: $2,398
3 people: $3,028
4 people: $3,658
5 people: $4,287
6 people: $4,917
7 people: $5,546
8 people: $6,176
9 people: $6,805
10 people: $7,435

Parents and caretakers87% of the poverty line

1 person: $1,157
2 people: $1,569
3 people: $1,981
4 people: $2,393
5 people: $2,804
6 people: $3,216
7 people: $3,628
8 people: $4,039
9 people: $4,452
10 people: $4,863

Pregnant212% of the poverty line

1 person: $2,820
2 people: $3,824
3 people: $4,827
4 people: $5,830
5 people: $6,833
6 people: $7,838
7 people: $8,840
8 people: $9,843
9 people: $10,848
10 people: $11,851

Source: DMMA Administrative Notice, "2026 Federal Poverty and Medicaid Assistance Levels" and the DHSS Medicaid Income Limits page, both effective January 1, 2026. A note on precision: (1) DMMA's combined 2026 income-limits table lists the 212% FPL monthly figure for a family of 2 as $3,822, but the same page's dedicated "2026 Countable Income Limits 212% FPL" table — the one used specifically for DHCP and pregnant women/infants — lists $3,824 for a family of 2. We publish the state figure.

January 1, 2027

Two other changes land on the same day

Renewals get more frequent, and back-dated coverage gets shorter.

Renewals every six months Starting in 2027, Medicaid for the Adult Expansion group must be renewed every six months instead of once a year.

Back-dated coverage is changing on January 1 Delaware's Adult Medicaid Expansion group will have one month of retroactive coverage; everyone else in Delaware Medicaid will have two months. Both are down from three months. If you have unpaid medical bills, applying sooner covers more of them.

P.L. 119-21 §71112, amending 42 U.S.C. §1396a(a)(34). Applies to applications submitted on or after January 1, 2027.

Do this now

Update your address and phone number first. Everything about the new rules arrives by mail, and a stale address is the most common reason people lose coverage they are still entitled to. Then check whether an exemption applies to you.

Apply, renew or update details Delaware ASSIST Free, and open all year Talk to a person 1-866-843-7212 Medicaid Customer Relations Unit Medicaid Customer Relations (local Delaware line) 302-571-4900

About the phone numbers: 866-843-7212 is confirmed current on both the DMMA Contact page and the 2026 Medicaid ENGAGE page, which also lists phone support in Español, Kreyòl ayisyen, Arabic, and Chinese.

Deaf, hard of hearing or speech-impaired: 711.

EnglishSpanishArabicHaitian CreoleMandarin Chinese

Delaware Health and Social Services provides free interpretation and translation for Medicaid applicants and members, including telephone, in-person, and American Sign Language interpreters. Medicaid applications are available in English, Spanish, Arabic, Haitian Creole, and Mandarin on the DMMA website and at DMMA and DSS offices, and written notices generated through the online ASSIST system are automatically produced in English or Spanish. The Medicaid Customer Relations Unit also answers calls in Español, Kreyòl ayisyen (Haitian Creole), Arabic, Chinese, and other languages at 1-866-843-7212 (TTY: 711).

If a letter arrives

Most people who lose coverage lose it over paperwork, not eligibility

Nationally, most people who lose Medicaid lose it over paperwork rather than because they stopped qualifying. From January 1, 2027 that matters more, not less.

Delaware Division of Medicaid and Medical Assistance (DMMA), within the Delaware Department of Health and Social Services (DHSS) · Notice of action

NOTICE OF ELIGIBILITY DETERMINATION

Case number: ███████
Date of this notice: 1January 12, 2027

Our records do not show that you met the community engagement requirement for the reporting period.

2If you believe this is incorrect, or if an exemption applies to you, contact us on or before February 11, 2027.

3Coverage for other members of your household is not affected by this notice.

The clock starts on this date. Not the day it reached you. Assume you have less time than it feels like.

"Our records do not show" is not the same as "you did not".The state is matching against databases that are often out of date. If you worked those hours, or an exemption fits you, say so — call 1-866-843-7212.

Your children's coverage is separate. The work requirement does not apply to them. A notice about you does not end their coverage.

You can ask for a fair hearing. It's free, you don't need a lawyer, and asking can keep your coverage running while it's reviewed.

Know your state

What the federal data says about coverage here

Public federal data describes how each state runs its program. Almost all of it is written for policy analysts. Here is what those numbers mean if you are the person enrolled.

How care is delivered

Managed care

Coverage here runs through private health plans rather than the state paying providers directly. You pick a plan, and your plan decides your network.

Check your doctor is in the plan before you choose it.

Where you live in this state changes what coverage is worth. Sussex County, in southern Delaware, is fully rural under HRSA's Federal Office of Rural Health Policy definition, and — like Kent County — it is designated an entire Medically Underserved Area and Health Professional Shortage Area for primary care, dental care, and mental health. Delaware's own Rural Health Transformation Plan reports that only about 130 active primary care physicians serve Sussex County's roughly 271,000 residents, a ratio exceeding 2,000-to-1 that is well above HRSA's shortage threshold (Kent County is about 1,700-to-1; urban New Castle County is about 960-to-1). An estimated 40% of Sussex County residents have no primary care provider at all, and the average wait for a new-patient appointment in the county more than doubled, from about 11.5 days in 2013 to 27 days in 2021. Delaware has no in-state medical school, limiting the pipeline of new physicians; the state's $1 billion, 5-year federal Rural Health Transformation Plan (2025-2030) includes a proposal to establish Delaware's first medical school with a primary-care/rural-health track. Delaware DHSS Rural Health Transformation Plan Project Narrative (2026): https://dhss.delaware.gov/wp-content/uploads/sites/12/2026/06/RHTP_Project_Narrative_1.16.2026.pdf

Common questions

Questions people ask about this

Do the new Medicaid work rules apply to me in Delaware?

They apply to adults aged 19 to 64 who are covered through Medicaid expansion — about 70,000 people in Delaware. Children, people over 65, and most people covered on grounds of disability or pregnancy are not in that group. There is also a long list of exemptions.

How many hours a month do I have to work?

80 hours a month. Work is not the only way to meet it — study, job training, volunteering and a combination of these count too, and earning at least $580 a month also satisfies it.

Who is exempt from the work requirement in Delaware?

Exemptions include: Under age 26 and were in foster care; A member of a federally recognized tribe; A parent, caretaker, or guardian of a child aged 13 or younger, or a family caregiver for a person with a disability; A veteran with a total disability rating of 100%; Have serious health needs, such as blindness or disability, substance use disorder, a mental health condition, a serious medical condition, or another physical or developmental disability that makes it hard to do daily activities; Already meet work rules through SNAP or TANF; In a drug or alcohol treatment program; In jail or were in jail in the last 90 days.

When do the Delaware work rules start?

January 1, 2027. Starting in 2027, Medicaid for the Adult Expansion group must be renewed every six months instead of once a year. Keeping your address and phone number current with the state is the single most important thing to do before then, because everything arrives by mail.

What is the income limit for Delaware Medicaid?

For adults 19 to 64, about $1,769 a month for one person and $7,435 for a household of 10.

How do I apply for Diamond State Health Plan (DSHP) — Delaware's brand name for Medicaid, covering the ACA Adult Expansion Group (ages 19-64) and other adult eligibility groups?

Online at Delaware ASSIST, or by phone on 1-866-843-7212. It is free and there is no open-enrollment window — you can apply at any time of year.

How often do I have to renew Delaware Medicaid?

Adults covered through Medicaid expansion move from a yearly renewal to one every six months starting with renewals due on or after January 1, 2027. Children, people over 65 and most people covered on grounds of disability stay on yearly renewals. Keep your address and phone number current so the renewal notice reaches you, and answer it before the date on the letter — most people who lose coverage lose it over paperwork.

Other states

Guides for neighboring states

The rules change completely at the state line. If you moved recently, or you're helping family somewhere else, start with their state rather than this one.

MarylandThe new work rules New JerseyThe new work rules PennsylvaniaThe new work rules

See all 50 states and Washington, D.C. on the map →

If you're covered through Delaware's Adult Medicaid Expansion group, starting January 1, 2027 you'll need to show at least 80 hours a month of work, school, job training, or volunteering — or at least $580 a month in earnings — to keep your coverage, and your case will be reviewed every six months instead of once a year.

If your work hours vary by season, start keeping pay stubs or other proof of your hours and earnings now, and make sure Delaware ASSIST has your current address and phone number so you don't miss a renewal notice.

Updating your address takes two minutes and protects everything else. Do that first, then check the exemption list above.

Go to Delaware ASSIST →