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Delaware - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Delaware Division of Developmental Disabilities Services (DDDS) does not enroll providers under a distinct "Adult Companion Services" category, instead funding non-medical supervision and socialization through Community Participation and Personal Care services within the 1915(c) Lifespan Waiver. Providers seeking to offer these socialization and supervision supports must apply under the broader Home and Community-Based Services (HCBS) umbrella for individuals with intellectual and developmental disabilities.

Approval mandates passing a multi-phase review by the DDDS Authorized Provider Committee and securing a contract award through the Division of Management Services (DMS) open Request for Proposals (RFP) process via the state's Bonfire hub. Applicants cannot accept referrals or bill the Delaware Medical Assistance Program until they complete the RFP procurement, enroll through the Gainwell Technologies portal, and finalize billing rates with the DDDS Office of Business Supports and Services.

1. Service Definition and Scope

Because Delaware does not utilize a standalone Adult Companion Services definition, providers deliver non-medical supervision, socialization, and community integration under the Lifespan Waiver's Community Participation or Personal Care service lines. These services ensure the health and safety of adults residing in the community while fostering independence.

Providers must adhere to the DDDS Provider Standards and the specific service definitions outlined in the Lifespan Waiver appendix. The scope includes assisting with activities of daily living, providing protective oversight, and facilitating community engagement.

2. Regulatory and Oversight Agencies

The Department of Health and Social Services (DHSS) oversees all Medicaid and waiver programs in Delaware. Within DHSS, multiple divisions coordinate to authorize, enroll, and monitor HCBS providers.

DDDS manages the programmatic approval and quality assurance, while the Division of Medicaid and Medical Assistance (DMMA) handles the federal Medicaid authority. The Division of Management Services (DMS) controls the mandatory procurement process.

3. Gatekeeping Prerequisites: Who Can Even Apply

Delaware utilizes a procurement-based gatekeeping model for Lifespan Waiver services. Providers cannot simply submit a Medicaid enrollment application; they must first submit a proposal in response to the open and continuous Request for Proposals (RFP) titled "Home and Community Based Services for Individuals with Intellectual and Developmental Disabilities."

Additionally, existing providers attempting to add new service lines must pass a Provider Compliance Checklist with a score of at least 86% to demonstrate substantial compliance before their application is even reviewed by the Authorized Provider Committee.

4. Licensure and Certification Requirements

While non-medical socialization services do not require a traditional medical facility license, agencies must comply with comprehensive DDDS Provider Standards. If the services are delivered in specific residential formats, Health Care Quality (HCQ) regulations apply.

Providers must maintain an active business license in Delaware and demonstrate adherence to the Essential Elements to a Medicaid Compliance Plan as part of their certification.

5. Medicaid Provider Enrollment

After receiving Initial Authorization from DDDS, agencies must enroll as Delaware Medicaid providers through the state's MMIS portal, operated by Gainwell Technologies. Enrollment cannot precede DDDS authorization.

Providers must supply their National Provider Identifier (NPI) and upload the Qualified Provider Authorization Letter issued by the Division during the portal registration process.

6. Staffing, Training and Background Checks

Direct support professionals providing community participation and personal care must meet DDDS training and background check mandates. Agencies are responsible for utilizing the state's Electronic Training System to track compliance.

Staff must complete mandatory orientation, abuse and neglect reporting training, and, if serving specific populations, dementia-specific or behavioral support training.

7. Documentation, Policies and Records

Delaware requires HCBS providers to maintain robust electronic records. Agencies must implement an Electronic Health Record (EHR) and interface with the state's Electronic Client Data Management System.

Providers must also maintain a formal Medicaid Compliance Plan and promptly report any corporate restructuring or mergers to DDDS to reassess qualification status.

8. Billing, Rates and Claims

Billing for Lifespan Waiver services is conducted through the Gainwell MMIS portal. Before billing can commence, providers must establish a contract and finalize billing rates with the DDDS Office of Business Supports and Services (OBSS).

Providers must register as a new Supplier with the State of Delaware via the eSupplier portal to receive payments.

9. Approval Sequence and Timeline

The Delaware approval process is divided into four distinct phases: Information Gathering, Application/Interview, Medicaid Enrollment/RFP Response, and Final Approval/Contracting.

The DMS Procurement Office and DDDS review RFP proposals once per quarter, which dictates the overall timeline. Providers must complete all steps, including OBSS contracting, before receiving the Authorization to Accept Referrals letter.

10. Common Denials and Survey Findings

Applications are frequently rejected at the initial review stage if they are incomplete or not formatted exactly as specified in the Requirements Summary Checklist. DDDS does not accept incomplete applications and will return them immediately.

Existing providers often face delays or denials if they fail to meet the 86% substantial compliance threshold on the Provider Compliance Checklist when attempting to add new services.

11. Key Contacts and Resources

Prospective providers should direct application materials and specific procedural questions to the DDDS Provider Authorization Committee. The Bonfire hub is the sole mechanism for submitting the required RFP.

For technical issues related to the MMIS portal or Medicaid billing, providers must contact the Gainwell call center.

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