DSHP Plus Delaware: Get Paid To Care For A Family Member

It depends, and this is the most important rule to get right. Delaware's Self-Directed Attendant Care policy says a person who is legally responsible for the member cannot serve as the paid attendant - and a spouse is generally considered a legally responsible relative, as is the parent of a minor child. So a spouse usually cannot be the primary paid caregiver the way an adult child or sibling can. At the same time, the policy caps any legally responsible family member who does provide care at 40 hours of care per week, which is why you will sometimes see it described as spouses being paid "in certain circumstances." The practical takeaway: do not assume a spouse can simply sign up as your paid attendant. Ask your DSHP Plus case manager and financial management services agency exactly what is allowed in your situation before you plan around it. Adult children and most other relatives face no such restriction.

In 2026, self-directed attendant care caregivers in Delaware typically earn somewhere in the range of about $13 to $21 per hour. The exact rate is set by your DSHP Plus managed care organization and processed by the financial management services (FMS) agency, and it can vary based on the plan and the level of care involved. Caregivers are treated as W-2 employees, so federal, state, and local employment taxes are withheld from each paycheck, and the FMS agency arranges workers' compensation coverage. Because Medicaid rates are updated periodically and can differ by plan, treat this as a general range rather than a guaranteed number - confirm the current rate with your case manager or FMS agency when you enroll. Also remember that caregivers living in the same home as the member are not paid overtime for hours over 40, which affects total earnings for live-in family caregivers.

There is no single official timeline, but families should generally plan for a process that takes several weeks to a few months. The main steps are applying for Delaware Medicaid long-term care through the DMMA Central Intake Unit, completing the nursing-facility level-of-care assessment, enrolling in a DSHP Plus managed care plan, and then setting up Self-Directed Attendant Care with a financial management services agency. If the member is not yet on Delaware Medicaid, the financial eligibility review can add significant time on its own. You can speed things up by gathering documents in advance: proof of Delaware residency, identification, Social Security card, proof of income and assets, and medical records that support the need for home care. Starting the FMS onboarding paperwork - background checks and the employment agreement - as early as possible also helps, since your caregiver cannot be paid until those clear.

One of the biggest advantages of self-directed attendant care is that no formal certification, license, or medical training is required. Your caregiver does not need to be a Certified Nursing Assistant (CNA) or Home Health Aide (HHA). Delaware's policy sets basic qualifications instead: the attendant must be at least 18 years old, have the skills necessary to perform the required services, hold a valid Social Security number, and be willing to submit to a criminal background check. Before the caregiver starts, the financial management services agency also runs checks against Delaware's Adult Abuse Registry, the state and national sex offender registries, and the federal excluded-provider list. The member (or their representative) trains the caregiver on the specific tasks they need help with, and the FMS agency can provide training and support on employer responsibilities. This makes SDAC especially welcoming to family members who have already been providing care informally.

DSHP Plus is Delaware Medicaid's managed care program for long-term services and supports, overseen by the Division of Medicaid & Medical Assistance (DMMA). Day-to-day coverage runs through one of three managed care organizations you choose from: AmeriHealth Caritas Delaware, Highmark Health Options, and Delaware First Health. Your MCO assigns a case manager who builds your care plan. For the self-directed option, a separate financial management services (FMS) agency acts as your IRS-approved fiscal/employer agent - Delaware works with agencies such as Easter Seals, JEVS, and GT Independence. The FMS agency is the entity that verifies your caregiver's eligibility, runs background checks, collects and approves timesheets, processes payroll, withholds and files taxes, arranges workers' compensation, and disburses caregiver pay. It does not choose your caregiver or supervise the care - those decisions stay with you as the employer.

Yes on both counts. You can split your authorized attendant care hours across more than one attendant - for example, two adult children each covering part of the week. And a caregiver can work for more than one Medicaid member. Delaware's policy is explicit that a caregiver's hours are not counted across different members, different managed care organizations, or different financial management services agencies. That means someone caring for their mother under one member's authorization and picking up hours with a neighbor under a separate authorization would not automatically hit overtime just because the combined total tops 40. Each employment relationship is handled separately through the FMS agency. If you plan to work for multiple members, confirm the arrangement with your FMS agency so timesheets and taxes are set up correctly for each one.

No. This is a specific and important exception in Delaware. Caregivers who provide self-directed attendant care and live in the same home as the member do not receive overtime pay, even for hours worked beyond 40 in a week. These caregivers complete a form provided by the financial management services agency confirming that they reside with the member. Caregivers who do not live with the member are generally paid overtime at 1.5 times their regular rate for hours over 40 in a workweek. Overtime is not paid retroactively and does not require a separate prior authorization. For many family caregivers - especially an adult child who has moved in with an aging parent - this rule matters a lot when estimating total pay, because a live-in schedule of more than 40 hours will be paid at the straight-time rate rather than time-and-a-half.

No. Choosing the self-directed attendant care option does not reduce or replace the member's other Medicaid coverage. DSHP Plus is a single managed care plan that bundles medical care, behavioral health, and long-term services and supports together, so the member keeps their doctor visits, hospital coverage, prescriptions, and other covered services while also receiving self-directed personal care. Self-direction simply changes how the attendant care piece is delivered - you hire and direct your own caregiver instead of using an agency assigned by the plan. There is also a limited respite benefit (generally up to about 14 days per year) that can pay a substitute caregiver when the main one needs time off, without cutting into the member's other benefits. If you ever want to switch back to agency-provided care, you can work with your case manager to change the care plan.