Waiver Consulting Group — Start any program. In any state.

Delaware - Case Management Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In Delaware, Case Management Services (often referred to as Targeted Case Management or Care Coordination) are essential Home and Community-Based Services (HCBS) that provide comprehensive assessment, person-centered service planning, referral, and ongoing monitoring. These services are delivered primarily through the Division of Developmental Disabilities Services (DDDS) Lifespan Waiver (1915c), the Pathways to Employment program (1915i), and the Diamond State Health Plan Plus (DSHP-Plus) 1115 demonstration waiver.

The single biggest structural barrier to entry for prospective case management providers in Delaware is the lack of open enrollment. Standalone case management agencies cannot simply apply for a license and enroll in Medicaid. For DDDS waivers, applicants must successfully respond to a closed Request for Proposal (RFP) and pass an Authorized Provider Committee Interview before Medicaid enrollment is permitted. For the DSHP-Plus waiver, case management is heavily internalized or strictly subcontracted by Delaware's three designated Managed Care Organizations (MCOs), meaning providers must secure a network contract with an MCO to operate.

1. Service Definition and Scope

Delaware defines HCBS Case Management as the collaborative process of assessing, planning, implementing, coordinating, monitoring, and evaluating the options and services required to meet an individual's health and human service needs. The service ensures that waiver participants receive a comprehensive, person-centered service plan (PCSP) that integrates both paid Medicaid services and unpaid natural supports.

Case managers act as the central hub for the participant's care, conducting level-of-care screenings and ensuring continuous financial and functional eligibility. Federal conflict-free case management rules strictly apply, meaning the agency providing case management cannot also provide direct care services (like personal care or residential habilitation) to the same individual.

2. Regulatory and Oversight Agencies

The Division of Medicaid and Medical Assistance (DMMA) is the single state Medicaid agency responsible for overall program administration and the DSHP-Plus 1115 waiver. However, the Division of Developmental Disabilities Services (DDDS) directly operates and oversees providers for the Lifespan Waiver and Pathways to Employment.

While the Division of Health Care Quality (DHCQ) licenses many healthcare facilities and home health agencies in Delaware, it does not issue a distinct license for standalone case management agencies. Oversight and certification are instead handled administratively by DDDS and the Medicaid MCOs.

3. Gatekeeping Prerequisites: Who Can Even Apply

Delaware utilizes strict gatekeeping mechanisms that prevent open-door enrollment for case management providers. An agency cannot submit a Medicaid enrollment application to DMAP without first clearing specific procurement or contracting hurdles.

For IDD populations, providers must go through a formal state procurement process. For aging and physical disability populations under DSHP-Plus, providers are entirely dependent on the network adequacy needs of the state's three Managed Care Organizations.

4. Licensure and Certification Requirements

Because the Delaware Division of Health Care Quality (DHCQ) does not issue a specific "Case Management Agency" license, legal authority to operate is granted through waiver-specific certification. For DDDS waivers, this means adhering to the state's published Provider Standards.

Agencies must prove they have the administrative, financial, and structural capacity to manage Medicaid funds and coordinate care. DDDS reserves the right to issue Provisional Authorizations based on state need before granting full authorization.

5. Medicaid Provider Enrollment

Once authorized by DDDS or sponsored by an MCO, agencies must enroll as Delaware Medicaid providers through the Delaware Medical Assistance Program (DMAP) portal. The portal is managed by Gainwell Technologies.

Enrollment requires precise matching of the agency's National Provider Identifier (NPI) and taxonomy codes to the services authorized in the DDDS approval letter. Group practices must enroll with a Type 2 NPI and link individual rendering case managers.

6. Staffing, Training and Background Checks

Delaware mandates strict qualifications for the individuals performing case management. Staff must meet educational thresholds and pass comprehensive background checks before interacting with waiver participants.

Training requirements are heavily focused on person-centered practices. DDDS requires specific orientation to the Charting the Lifecourse framework to ensure case managers align with the state's philosophy of care.

7. Documentation, Policies and Records

Case management is a documentation-heavy service. Providers must maintain detailed records of assessments, service plans, and monitoring visits to justify Medicaid billing and ensure participant safety.

Delaware utilizes specific electronic systems for waiver management. For DDDS waivers, providers are required to use the state's designated electronic health record system to document all case management activities.

8. Billing, Rates and Claims

Reimbursement for case management depends on the waiver authority. For the DDDS Lifespan Waiver, claims are submitted directly to the DMAP MMIS (Gainwell) as fee-for-service. For DSHP-Plus, claims must be routed to the participant's assigned MCO.

Unlike personal care or home health services, case management is generally exempt from Electronic Visit Verification (EVV) mandates, though strict audit trails of time spent coordinating care are still required.

9. Approval Sequence and Timeline

Becoming a case management provider in Delaware is a lengthy, multi-phased process due to the procurement and committee review requirements. Prospective agencies should plan for a 6 to 12-month timeline from initial RFP response to final MCO credentialing.

Providers cannot skip steps; attempting to enroll in DMAP without the DDDS Authorization Letter or attempting MCO credentialing without an active DMAP ID will result in immediate rejection.

10. Common Denials and Survey Findings

The DDDS Provider Authorization Committee is notoriously strict regarding application formatting and completeness. Applications that do not follow the exact submission instructions are returned without review.

During post-enrollment surveys, the most common citations involve failures in person-centered planning documentation and violations of conflict-free case management rules.

11. Key Contacts and Resources

Prospective providers must interact with multiple state divisions and private contractors to complete the enrollment process. The DDDS Provider Authorization Committee is the primary point of contact for IDD waivers.

For DSHP-Plus, providers must establish relationships with the provider relations departments of the three Medicaid MCOs.

See all Delaware services · Delaware Medicaid consulting · book a consultation.