Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
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Delaware program

Free health insurance for your child (Delaware Medicaid)

Delaware’s Medicaid plan for children under 19. It can sit behind insurance you already have.

What it is

Delaware’s Medicaid plan for children under 19. It can sit behind insurance you already have.

Delaware Medicaid covers children under 19 whose income meets the state’s rules. The state decides who belongs in your child’s household and which income counts. A yearly income divided by 12 is only an estimate of this month’s income.

Eligibility rules
  • Your child must be under 19 and live in Delaware.
  • The line depends on your child's age. For four people it is $5,830 a month under age 1, $3,905 at ages 1 to 5 and $3,658 at ages 6 to 18 (2026).
  • Federal rules allow a five-percentage-point income disregard beyond the base figures. The state calculates whether it applies.
  • Wages before tax count; child support you receive and SSI do not; self-employment counts profit. Who is counted follows tax-filing rules, so it is not always everyone at your address. There is no savings test. (two bullets)
How it works with work insurance
  • Your work insurance is billed first. Delaware Medicaid can sit behind it.
  • There is no premium for the child’s Medicaid coverage.
What to check together
  • The hospital financial counselor can check both plans against the cancer team, pharmacy and planned care.
  • For covered care that Medicaid has approved, the hospital or clinic must accept your child’s Medicaid. It generally cannot charge your work plan’s deductible, coinsurance or copay, even when Medicaid pays nothing extra. A billing error does not mean you refused to cooperate. The financial counselor can check both plans, the coverage dates and the bill.
What you get
  • No premium or child copays for covered hospital care, chemotherapy, prescriptions and clinic visits.
  • Dental and vision care.
  • Rides to covered appointments, with home nursing available after a separate care review.
What the help includes
  • Covered care includes lab tests and medically necessary services within Medicaid’s child benefit. Nursing and personal care need separate approval.
  • Keeping work insurance can preserve access to its doctors, but its premium and two-plan billing remain considerations.
  • Worked example (illustrative figures): the work plan allows $10,000 and pays $7,000, leaving your $3,000 deductible. Medicaid allows $6,000, less than what was already paid, so it adds $0, and the clinic still cannot bill you the $3,000.
  • These billing protections concern covered, properly authorized care during eligible dates from an enrolled or accepting provider. Noncovered services and informed private-pay arrangements have different rules. Administrative errors do not establish family noncooperation.
If you decide to apply
  1. Ask the hospital social worker whether a child Medicaid review could help, including insurance and earlier bills.
  2. Have your child’s identity document, Social Security number, address, current pay, insurance cards and earlier bills ready.
  3. Ask the counselor to check which Medicaid plans your child’s hospital and cancer team accept.

Delaware Medicaid and ASSIST · 1-866-843-7212 · Official page ↗

What happens next
  • Children keep coverage for 12 months after approval unless they move out of Delaware or turn 19. A child still in hospital at 19 can keep it until discharge; ask the social worker.
  • Through 2026, eligible bills can reach back three months before the application month. Federal law changes this to two months for child applications from January 1, 2027.
  • A decision is due within 45 days, or 90 when disability must be decided. (the look-back and hospital-coverage sentences repeat after.items[1] and [3])
  • A qualified participating hospital can assess temporary hospital coverage. Without a full application by the end of the following month, it ends then. With a timely full application, it lasts until the eligibility decision. The hospital confirms whether it offers this process.
Good to know

Your work insurance stays in place. It is billed first, and for covered care the clinic generally cannot bill you the rest, whether Medicaid pays anything or not. Give both cards to every clinic and pharmacy.

Other details
  • Before changing work coverage, the financial counselor can compare the cancer team, pharmacy and planned treatment under both plans.
  • The employer can explain how much removing one child would save and when the child could rejoin.

Federal background: Medicaid · Medicaid with insurance you already have.

Official sources
Ask your social worker

“Could Medicaid reduce our child’s treatment bills? What are the benefits and drawbacks of adding it to any insurance we have, and would you help us apply if it makes sense?”

Why I’m asking: I want to understand which treatment bills Medicaid could cover and what managing two plans would involve.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File on ASSIST with this month’s income, name any insurance, and name the months that already have bills.

Your social worker

The oncology social worker or financial counsellor helps you file and chases the decision.

The care team

Nothing for ordinary child Medicaid. Medical records are needed only for the disability route.

Who decides
The Division of Medicaid and Medical Assistance checks income; the health plan you pick then runs the coverage.
Ask your social worker
“Can you help us file on ASSIST this week, list the bills from the three months before, and check that the hospital and the oncology group take the health plan we pick?”

How to apply

First step: Apply at assist.dhss.delaware.gov this week, or call 1-866-843-7212.

  1. Apply on ASSIST this week and report this month’s income.
  2. List the months that already have bills so the look-back covers the admission.
  3. Pick a health plan that the hospital and the oncology group take.

Official application / program page ↗

Where it starts: Apply on ASSIST, the state benefits site, or call the Medicaid line. Ask the hospital financial counsellor to help you file the same week.

What to gather

  • Your child’s birth certificate or identity document and Social Security number
  • Delaware address
  • This month’s pay for every parent in the tax household
  • Insurance cards, if any
  • Hospital bills from the three months before you apply

How long: The ordinary decision standard is 45 days, or 90 for a disability-based decision, with limited delay exceptions. Children generally receive 12 months of continuous eligibility. Eligible earlier bills can reach back three months before the application month through 2026; child applications from January 1, 2027 have a two-month federal look-back.

What a yes looks like

A notice with coverage dates and a choice of health plan. Check that the hospital and the oncology group are in that plan before you choose.

What a no looks like, and the next move

Read whether the state said no on income, on a document or on a category. If it is income, ask in the same application for the Children’s Community Alternative Disability Program by name.

Watch out

  • Do not cancel a work plan to apply. Delaware lets a low-income family with minor children hold both; the work plan simply bills first.
  • Delaware publishes the base lines only. The federal 5 percent allowance is not printed in its table, so a family just over a line should still apply and let the state count.
  • DSSM 15300 confirms the base income columns: under age 1, 212% of poverty; ages 1–5, 142%; ages 6–18, 133%. The applicable five-percentage-point disregard and household review remain part of eligibility.

If they say no, quote this: Delaware’s own Medicaid FAQ: "If your income is low, and you have minor children, you and your children can have private health insurance and still be eligible for Medicaid."

Dates that change this

2023-12-01: DSSM 15300 confirms the base income columns: under age 1, 212% of poverty; ages 1–5, 142%; ages 6–18, 133%. The applicable five-percentage-point disregard and household review remain part of eligibility. (not yet confirmed against the final rule)

2026-01-01: Federal rules add a 5 percent allowance on top of the line. Delaware does not publish that column, so the figures here are the base lines and the state’s own count can come out slightly higher.

2027-01-01: Current child applications can cover up to three earlier eligible months. Federal law changes that to two for child applications from January 1, 2027. Medicaid confirms transition cases. (not yet confirmed against the final rule)

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Full Delaware Medicaid with no premium and no child copays. The 2026 monthly lines for a home of four are $5,830, $3,905 and $3,658 depending on your child’s age.

  • $5,830/month — Family of 4, 212 percent column (the youngest age band)
  • $3,905/month — Family of 4, 142 percent column
  • $3,658/month — Family of 4, 133 percent column (the oldest age band)
  • $3,028/month — Family of 3, 133 percent column
  • $3 — Months of coverage before the application month, until the end of 2026
  • $12 — Continuous coverage for a child once approved

Covers: Hospital and clinic care · Chemotherapy and prescriptions · Anything medically necessary for a child under 21, under the health plan’s child benefit · Private duty nursing, personal care and home health when approved · Rides to medical and dental appointments · Dental and vision

What it costs the family: No premium. No copays for a child.

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Income
DSSM 15300 confirms the base income columns: under age 1, 212% of poverty; ages 1–5, 142%; ages 6–18, 133%. The applicable five-percentage-point disregard and household review remain part of eligibility.
Insurance status condition
none: Delaware says a low-income family with minor children can hold private insurance and Medicaid together; the private plan bills first
Residency
Delaware
Continuous eligibility
12 months for a child under 19
Retroactive months
3 now; 2 for applications made on or after 2027-01-01 under Public Law 119-21
Processing standard
45 days ordinarily; 90 days for a disability-based decision, subject to permitted delay exceptions.

Decisions this site cannot make: Division of Medicaid and Medical Assistance income determination through the ASSIST application

Expect friction on: Choosing one of the three Diamond State Health Plan health plans that the oncology team takes

The trap: Families cancel private insurance to apply. Do not. Delaware says a family with a low income and minor children can hold private insurance and Medicaid at once, and the private plan simply bills first.

Where I read this

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