Current Updates as of 8/3/2021
Managed Long-Term Services and Supports
The State of Delaware Division of Medicaid & Medical Assistance (DMMA) announced the beginning of the procurement process for managed care organizations (MCOs). DMMA is hosting four virtual town hall meetings to obtain input and feedback on the managed care delivery system. DMMA will select health plans to deliver long-term services and supports to eligible Delawareans beginning January 1, 2023. Current contracts, awarded to AmeriHealth Caritas Delaware and Highmark Health Options are set to expire at the end of 2022. DMMA is expected to release the contract request for proposals (RFP) on December 1, 2021.
(Source: DMMA MCO Procurement Announcement, 7-12-2021)
Managed LTSS Program & State Demonstration to Integrate Care for Dual Eligible Individuals
In 1996, through its Diamond State Health Plan (DSHP) §1115 Medicaid managed care demonstration waiver, the state began mandatorily enrolling most Medicaid recipients into managed care organizations (MCOs) to create efficiencies in the Medicaid program and expand Medicaid coverage.
In June 2012, through an amendment to its DSHP §1115 Medicaid managed care demonstration waiver, the state began providing LTSS to eligible individuals, including dual eligibles, through a mandated managed care delivery system entitled Diamond State Health Plan Plus (DSHP-Plus). (Source: BNA Register, 6/12/2012; DSHP Fact Sheet)
Waiver Amendment Request Letter to CMS
Current Approval Document
On May 1, 2017, the Delaware Department of Health and Social Services (DHSS) Division of Medicaid & Medical Assistance (DMMA) released a request for qualifications (RFQ) for delivery system transformation regarding the states’ Diamond State Health Plan (DSHP) and Diamond State Health Plan Plus (DSHP Plus) Medicaid managed care programs. DSHP has been in operation since 1996 and provides physical and behavioral health services through MCOs. DSHP Plus was implemented in 2012 and expanded to populations including dual eligibles and individuals receiving services in a nursing facility and HCBS. Roughly 92 percent of the state’s Medicaid population—170,000—are enrolled in DSHP or DSHP Plus.
The intent of the RFQ is to garner innovative feedback regarding the enhancement of quality and delivery of services to individuals enrolled in the DSHP and DHSP Plus programs. DMMA notes that it is exempt from certain procurement requirements in fiscal year (FY) 2017, and therefore DMMA has the option to contract directly with respondents to the RFQ without going through an RFP process. Respondents were encouraged to submit a notice of intent to respond by May 15, 2017. Responses to the RFQ are due no later than June 15, 2017, 11:00 a.m. Eastern Time. DMMA intends the contracts to be operational, if the state chooses, on January 1, 2018. (Source: RFQ 5/1/2017)
On September 29, 2017, the Delaware Department of Health and Social Services (DHSS) announced it has selected AmeriHealth Caritas and Highmark Health Options Blue Cross Blue Shield to operate the state’s Medicaid managed care program (Diamond State Health Plan/Diamond State Health Plan Plus) which includes long-term services and supports (LTSS). Highmark Health Options Blue Cross Blue Shield is an incumbent health plan, while AmeriHealth Caritas is new to the Delaware market, and will replace United HealthCare. Roughly 200,000 of Delaware’s 230,000 Medicaid population are served under managed care. (Source: DHSS Press Release 9/29/2017)
Balancing Incentive Program
Delaware is planning to participate in the Balancing Incentive Program in FY 2014. However, the state has not yet submitted a BIP Application to CMS. (Source: Kaiser BIP website, 6/2014)
Section 1915(i) HCBS State Plan Option
As of June 2014, Delaware has submitted to CMS a proposed §1915(i) HCBS State Plan Amendment known as Pathways to Employment. The proposed program will target youth aged 14 to 25 in certain disability groups and offer an array of employment-related services including: Employment Navigator; career exploration and assessment; supported employment (individual and small group); benefits counseling; financial coaching; non-medical transportation; personal care (including a self-directed component); and orientation, mobility, and assistive technology. The program will seek to ensure more seamless transitions from school to work, and across the array of employment options and supports. (Source: Kaiser HCBS State Plan Option website, 5/2014; Pathways to Employment website)
Proposed State Plan Amendment
As of June 2014, the state has not officially submitted a Proposed Health Home State Plan Amendment to CMS, but the state plans to participate in the Health Home State Plan Option in FY 2014. (Source: CMS Health Home Proposal Status website, 6/2014; Kaiser Health Home website, 6/2014)