Key takeaway
Delaware pays family caregivers primarily through the Diamond State Health Plan Plus (DSHP Plus) Long-Term Services and Supports program and its self-direction option. Spouses and legal guardians cannot be paid under Medicaid; VA Veteran Directed Care can pay spouses.
- DSHP Plus LTSS: Delaware’s integrated Medicaid managed care program funds in-home care; family caregivers can be hired through self-direction.
- Attendant Services Self-Direction: lets the participant hire their own caregiver — typically an adult child or friend.
- Veterans: Aid & Attendance and Veteran Directed Care can fund family caregiving (VDC can pay spouses).
- State-funded: Delaware Aging and Disability Resource Center (ADRC) coordinates respite, training, and supplemental supports.
Overview
Delaware operates a single integrated Medicaid managed care program — Diamond State Health Plan Plus (DSHP Plus) — that combines acute care and long-term services and supports (LTSS) for older adults and adults with disabilities. The Division of Medicaid and Medical Assistance (DMMA) and the Division of Services for Aging and Adults with Physical Disabilities (DSAAPD) administer the program.
For most Delawareans, the path to being paid as a family caregiver runs through DSHP Plus LTSS with the self-direction (Attendant Services) option. The participant uses a monthly budget to hire their own caregiver — typically an adult child, sibling, or friend. Spouses and legal guardians are not eligible to be paid under Medicaid, but the VA’s Veteran Directed Care program does allow spouses.
Programs that pay family caregivers in Delaware
| Program (Type) | Care recipient eligibility | Paid family caregiver provisions |
|---|---|---|
| Diamond State Health Plan Plus (DSHP Plus) LTSS (Medicaid managed care) | Age 65+ or adults 18+ with a physical disability; meets nursing-facility level of care; Medicaid financial limits apply. | Funds personal care, attendant care, respite, adult day, home-delivered meals, and home modifications. Self-direction allows hiring family caregivers (not spouses or legal guardians). |
| Attendant Services Self-Direction (DSHP Plus self-direction option) | DSHP Plus LTSS enrollees who choose self-direction; participant or representative must be able to direct care. | Provides a monthly attendant services budget. The participant hires and supervises their own caregiver through a fiscal intermediary. |
| Lifespan Waiver / DDDS Services (Medicaid HCBS (DDDS)) | Adults with intellectual or developmental disabilities served by the Division of Developmental Disabilities Services. | Funds residential, day, and personal services. Family members may be paid for certain services with some restrictions. |
| Aid & Attendance Pension (VA benefit) | Wartime veteran or surviving spouse with limited income/assets and documented ADL need. | Increases monthly pension to help cover care costs. Veteran can pay an adult child or relative; spouses cannot be paid directly. |
| Veteran Directed Care (VDC) (VA program) | Veteran enrolled in VA health care who meets nursing-home level of care and lives in an area served by a participating VAMC. | Monthly care budget the veteran manages to hire any caregiver, including a spouse. Wilmington VAMC participates. |
| Long-Term Care Insurance (Private) | Policy must cover in-home personal care and pay benefits to the policyholder. | If allowed by policy, the care recipient can use benefits to pay a family caregiver directly. |
Delaware Medicaid programs
Delaware unified its Medicaid LTSS programs under Diamond State Health Plan Plus (DSHP Plus) — a single managed care program for older adults and adults with physical disabilities. Within DSHP Plus, the Attendant Services Self-Direction option is the primary mechanism for paying family caregivers. Spouses and legal guardians are excluded.
DSHP Plus Long-Term Services and Supports (LTSS)
DSHP Plus LTSS provides in-home care, adult day services, assisted living, and nursing-facility services through three managed care organizations: Highmark Health Options, AmeriHealth Caritas, and Delaware First Health (subject to change).
- Age 65+ or adults 18+ with a qualifying physical disability.
- Must meet nursing-facility level of care.
- Income limit generally at or below 250% of the SSI federal benefit rate; asset limit $2,000 (individual).
- No waitlist for DSHP Plus LTSS — it is an entitlement when eligible.
- Family caregivers can be hired through Attendant Services Self-Direction (not spouses or legal guardians).
Attendant Services Self-Direction
Self-direction within DSHP Plus lets the participant become the employer of record for their caregiver. The MCO and a fiscal intermediary support enrollment, training, payroll, and timesheets.
- Participant or authorized representative directs care, sets schedules, and selects the caregiver.
- Common hires include adult children, siblings, friends, and other relatives.
- Spouses, legal guardians, and parents of minor children cannot be paid.
DDDS Services
For adults with intellectual or developmental disabilities, the Division of Developmental Disabilities Services (DDDS) administers Medicaid HCBS funding for residential, day, and personal services.
- Eligibility requires DDDS determination and Medicaid enrollment.
- Family members may provide certain paid services subject to DDDS policy.
State-funded supports and the Delaware ADRC
Beyond Medicaid, the Delaware Aging and Disability Resource Center (ADRC) and DSAAPD coordinate caregiver supports that do not pay a salary but offset family caregiving costs and burden.
Federally funded program providing information, training, counseling, respite, and supplemental services to unpaid family caregivers of older adults.
Short-term respite services arranged through DSAAPD and community partners to give family caregivers a break.
A single point of entry to find services for older adults and people with disabilities. Call 1-800-223-9074 for help navigating options.
Who qualifies
- Family caregivers of adults age 60+ or of any age with Alzheimer’s/related dementia.
- Grandparents 55+ raising grandchildren.
- Most services are not income-tested but may prioritize low-income or rural households.
Veterans’ programs
Delaware has about 70,000 veterans. The main VA pathways for paying family caregivers are Aid & Attendance, Veteran Directed Care, and PCAFC.
Aid & Attendance Pension
A&A boosts a wartime veteran’s or surviving spouse’s VA pension to cover care needs. The veteran can use these funds to pay a family caregiver.
- Qualifying wartime service, limited income/assets, documented ADL need.
- Adult children and other relatives may be paid; spouses cannot be paid directly.
Veteran Directed Care (VDC)
VDC provides a monthly care budget the veteran manages to hire caregivers — including a spouse. The Wilmington VA Medical Center participates.
- Veteran must meet nursing-home level of care.
- Spouses may be paid under VDC.
- Financial management service handles payroll.
Program of Comprehensive Assistance for Family Caregivers (PCAFC)
PCAFC provides a monthly stipend, training, and other supports to the primary family caregiver of an eligible veteran.
- Stipend tier depends on the veteran’s assessed needs.
- Apply through the VA Caregiver Support Program.
Long-term care insurance
If the care recipient owns a long-term care insurance policy, benefits may be used to pay a family caregiver, subject to policy terms.
What to check in the policy
- Coverage includes in-home personal care, not just facility care.
- Benefits pay the policyholder directly (cash/indemnity model), enabling payment to a chosen family caregiver.
If the policy reimburses only licensed agencies, the family caregiver may need to work through a Delaware-licensed home care agency that bills the policy.
How to apply in Delaware (step-by-step)
- Identify your most likely path: DSHP Plus LTSS with Attendant Services Self-Direction, DDDS, VA benefits, or LTC insurance.
- Gather documents: photo ID, Social Security card, proof of Delaware residency, income/asset documentation, medical records, current medications list, and (for veterans) DD-214.
- Start with the right agency:
- DSHP Plus LTSS: contact the Delaware ADRC at 1-800-223-9074 or apply at Delaware ASSIST (assist.dhss.delaware.gov).
- Attendant Services Self-Direction: once enrolled in DSHP Plus, ask your MCO case manager about self-direction options.
- DDDS: contact the Division of Developmental Disabilities Services for an eligibility determination.
- VA paths: contact the VA Caregiver Support Line at 1-855-260-3274 or Wilmington VAMC social work.
- LTC insurance: call the insurer to confirm caregiver payment rules and documentation.
- Complete the DSHP Plus level-of-care assessment and Medicaid financial eligibility review.
- Choose self-direction and your MCO, designate your family caregiver, and enroll with the fiscal intermediary for payroll.
- Begin services. Submit timesheets, keep care logs, and prepare for annual reassessment.
Delaware paid caregiver FAQs
Can a spouse be paid as a caregiver in Delaware?
Not under Delaware Medicaid — DSHP Plus LTSS and the Attendant Services Self-Direction option exclude spouses and legal guardians as paid caregivers. Spouses can be paid through the VA’s Veteran Directed Care program if the veteran qualifies and lives in an area served by Wilmington VAMC.
How much do caregivers get paid in Delaware?
Caregiver pay under DSHP Plus Attendant Services Self-Direction is set within the participant’s monthly budget and typically ranges from about $14 to $18 per hour depending on care complexity and MCO. VA Veteran Directed Care budgets vary by assessed needs.
Can I be paid to care for my parent in Delaware?
Yes. Adult children are commonly hired through DSHP Plus LTSS Attendant Services Self-Direction, the DDDS program (for developmental disabilities), and VA programs such as Aid & Attendance and Veteran Directed Care.
What is Diamond State Health Plan Plus?
DSHP Plus is Delaware’s integrated Medicaid managed care program for older adults and adults with physical disabilities. It combines acute medical care and long-term services and supports under one plan, delivered through contracted managed care organizations. It replaced the older Elderly & Disabled Waiver in Delaware.
Is there a waitlist for DSHP Plus LTSS?
No. DSHP Plus LTSS is an entitlement — when an applicant meets both the functional level-of-care requirement and the Medicaid financial requirements, services begin without a waitlist.
