Delaware’s Medicaid expansion eligibility rules cover adults aged 19 through 64 who live in Delaware, aren’t on Medicare, and have household income at or below 138 percent of the federal poverty level. For a single person in 2026, that income ceiling works out to roughly $22,025 a year. The program runs through the Diamond State Health Plan and covers medical, behavioral health, dental, and vision care at little or no cost.
Who Qualifies
The expansion created what Delaware calls the “ACA Adult Group.” To fit into it, you must be a Delaware resident between 19 and 64 and a U.S. citizen, national, or qualified immigrant.1Legal Information Institute. Delaware Code 16 Del. Admin. Code 15000-15400 – Adult Group You can’t already qualify as aged, blind, or disabled, and you can’t be pregnant. Pregnant women have a separate, more generous coverage track.
One exclusion catches people off guard: you cannot be entitled to or enrolled in Medicare Part A or Part B.1Legal Information Institute. Delaware Code 16 Del. Admin. Code 15000-15400 – Adult Group If you’re under 65 but already on Medicare because of a disability or end-stage renal disease, the expansion group isn’t open to you.
The expansion is often described as covering “childless adults,” but parents and caretaker relatives qualify too as long as their income is low enough. Before 2014, low-income parents in Delaware had limited Medicaid access and childless adults had virtually none.
2026 Income Limits by Household Size
Eligibility turns on household income at or below 138 percent of the federal poverty level. The guidelines update every January. Based on the 2026 figures, the approximate annual income ceilings are:2HHS ASPE. 2026 Poverty Guidelines – 48 Contiguous States
- 1 person: about $22,025
- 2 people: about $29,863
- 3 people: about $37,702
- 4 people: about $45,540
Each additional household member raises the ceiling by roughly $7,840.
How Income Is Counted
Delaware uses Modified Adjusted Gross Income (MAGI), the standardized method required under the Affordable Care Act for most non-elderly, non-disabled applicants.3Legal Information Institute. 16 Del. Admin. Code 16000-16200 – Application of MAGI Income and Household Size MAGI starts with the adjusted gross income from your federal tax return, then adds back tax-exempt interest, non-taxable Social Security benefits, and tax-exempt foreign income.
MAGI brings one real benefit: no asset test. Unlike traditional Medicaid, which examines bank accounts, vehicles, and property, the expansion group looks only at income. You can have savings or own a home and still qualify, provided your income is under the threshold.
How Household Size Is Counted
Household size controls your income limit, so getting it right matters. MAGI rules follow federal tax filing relationships, not simply who lives at the address.4Centers for Medicare & Medicaid Services. MAGI-Based Household Income Eligibility Training Manual The key question is whether you plan to file a tax return and who you’ll claim as dependents.
If you file, your household generally includes you, your spouse (if filing jointly), and anyone you claim as a tax dependent. If someone else claims you as a dependent, you’re counted in their household instead. You don’t need to have filed in prior years; the system uses your plan to file for the year you’re seeking coverage. Different family members under one roof can land in different MAGI households depending on their tax relationships, so a parent and an adult child living together can sometimes qualify under separate household sizes.
How to Apply
You can apply three ways:
- Online through Delaware ASSIST at assist.dhss.delaware.gov, or through HealthCare.gov, which will route your application to the state if you look Medicaid-eligible.5Delaware Health and Social Services. Delaware ASSIST Home6HealthCare.gov. How to Apply for Health Insurance
- By phone at (800) 372-2022, or (302) 255-9500 locally.7Centers for Medicare & Medicaid Services. Delaware Health and Social Services
- In person or by mail through a Division of Social Services office.
You’ll need to document Delaware residency, citizenship or immigration status, and income. Pay stubs, a recent tax return, or benefit award letters usually cover the income side. If you’re self-employed, bank statements or a profit-and-loss statement may work.
What Happens After You Apply
Federal rules give the state up to 45 days to decide non-disability Medicaid applications.8eCFR. 42 CFR 435.912 – Timely Determination and Redetermination of Eligibility Clean online applications with complete documentation often move faster.
If approved, you’ll enroll in one of three managed care organizations: Highmark Health Options, AmeriHealth Caritas, or Delaware First Health. Managed care is mandatory for expansion adults; there’s no fee-for-service option.9Centers for Medicare & Medicaid Services. Delaware Diamond State Health Plan Each plan has its own provider network, so check which one includes your doctor or pharmacy before picking.
Keeping Coverage: The New Six-Month Renewal Rule
Medicaid eligibility isn’t permanent. The state has to confirm periodically that you still meet the income and residency rules. That used to happen once a year. Under Section 71107 of the Working Families Tax Cut legislation signed on July 4, 2025, states must redetermine eligibility for Medicaid expansion adults every six months, starting with renewals scheduled on or after January 1, 2027.10Centers for Medicare & Medicaid Services. Implementation of Eligibility Redeterminations – Section 71107
If you’re enrolled through the expansion, that means responding to renewal paperwork twice a year. Not responding, even if nothing in your situation has changed, can cost you coverage. The six-month cycle applies only to the expansion adult group. Children, pregnant women, and people in traditional Medicaid categories stay on annual renewals.10Centers for Medicare & Medicaid Services. Implementation of Eligibility Redeterminations – Section 71107
Keep your address current with the Division of Social Services. Renewal notices mailed to an old address are the most common reason people lose Medicaid they’re still eligible for.
If You’re Denied or Terminated
If your application is denied or your existing coverage is cut, you can request a fair hearing through the Division of Social Services. The deadline is 90 days from the written notice.11Delaware Regulations. 5000 Fair Hearing Practice and Procedures
There’s a shorter window inside that one that matters more if you’re already enrolled. Request the hearing within 10 days of the date the adverse action notice is mailed and the state cannot reduce or terminate your benefits until the hearing decision comes down.11Delaware Regulations. 5000 Fair Hearing Practice and Procedures Miss the 10 days and you can still appeal inside the 90, but your coverage may lapse while the appeal is pending. The notice arrives, it sits for two weeks, and the protection window closes before anyone acts. Open the mail from DSS the day it comes.