Delaware - Homemaker Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

Delaware regulates Homemaker Services under the Personal Assistance Services Agency (PASA) licensure category, overseen by the Division of Health Care Quality (DHCQ) and funded primarily through the Diamond State Health Plan Plus (DSHP-Plus) 1115 waiver and the Division of Developmental Disabilities Services (DDDS) HCBS waivers. Providers seeking to offer general household support such as meal preparation, laundry, and light housekeeping must first submit a formal written Statement of Intent to DHCQ just to receive the licensure application packet.

Once licensed as a PASA, agencies must enroll in the Delaware Medical Assistance Program (DMAP) and secure network contracts with the state's Medicaid Managed Care Organizations (MCOs) to serve the DSHP-Plus population. For the DDDS waiver population, providers apply directly through the DDDS open and continuous enrollment process, executing a provider agreement to deliver provider-managed HCBS.

1. Service Definition and Scope

In Delaware, Homemaker Services are typically delivered and regulated under the umbrella of Personal Assistance Services. The state defines a Personal Assistance Services Agency (PASA) as any business entity that refers direct care workers to provide personal assistance services to individuals primarily in their home or private residence.

Under the state's HCBS waivers, these services provide essential general household support when the participant cannot perform them independently. The scope is strictly non-medical and focuses on maintaining a safe and sanitary living environment.

• Service Category: Personal Assistance Services / Homemaker
• Covered Tasks: Meal preparation, laundry, shopping, and light housekeeping
• Setting Limitations: Services must be delivered in the participant's own home or private residence
• Exclusions: Cannot include skilled nursing tasks or medication administration beyond prepackaged medication reminders
• Regulatory Definition Citation: 16 Del. Admin. Code 3345 Section 1.0

2. Regulatory and Oversight Agencies

Multiple divisions within the Delaware Department of Health and Social Services (DHSS) oversee homemaker and personal assistance providers. The Division of Health Care Quality (DHCQ) handles facility and agency licensure, while the Division of Medicaid and Medical Assistance (DMMA) manages the overarching Medicaid state plan and 1115 waiver.

For providers serving individuals with intellectual and developmental disabilities, the Division of Developmental Disabilities Services (DDDS) acts as the operating agency for the specific HCBS waiver, managing provider enrollment and compliance for that population.

• Licensing Agency: Division of Health Care Quality (DHCQ) (https://dhss.delaware.gov/dhcq)
• Medicaid Authority: Division of Medicaid and Medical Assistance (DMMA) (https://dhss.delaware.gov/dmma)
• Waiver Operating Agency: Division of Developmental Disabilities Services (DDDS) (https://dhss.delaware.gov/ddds)
• Medicaid Enrollment Portal: Delaware Medical Assistance Program (DMAP) Provider Healthcare Portal (https://medicaid.dhss.delaware.gov)

3. Gatekeeping Prerequisites: Who Can Even Apply

Delaware imposes a specific procedural gate before a licensure application can even be accessed. Under 16 Del. Admin. Code 3345 Section 2.2.1, all entities must submit a written Statement of Intent to DHCQ describing the proposed services; only after review of this statement will DHCQ issue an application form.

For Medicaid participation, access depends on the target population. DDDS accepts HCBS provider applications on an open and continuous basis. However, serving the aging and physical disability population under DSHP-Plus requires securing a network contract with one of Delaware's contracted MCOs, which may close their networks based on geographic adequacy.

• Licensure Prerequisite: Written Statement of Intent submitted to DHCQ
• Application Issuance: DHCQ explicitly states that issuing an application form does not guarantee acceptance or licensure
• DDDS Waiver Access: Open and continuous enrollment via the DDDS Provider Application Manual process
• DSHP-Plus Access: Requires contracting with Highmark Health Options, AmeriHealth Caritas, or Delaware First Health
• Operating History: No specific minimum operating history is required by statute for a new PASA license

4. Licensure and Certification Requirements

Agencies providing homemaker services must obtain a Personal Assistance Services Agency (PASA) license from DHCQ. The licensure process requires submission of a comprehensive policies and procedures manual, organizational charts, and ownership disclosures.

A separate license is required for each office location maintained by the agency in Delaware. Agencies must not hold themselves out to the public as a PASA until the license is officially issued by the Department.

• License Type: Personal Assistance Services Agency (PASA)
• Regulation Citation: 16 Del. Admin. Code 3345
• Required Documentation: Policies and procedures manual, identity of all officers/directors, and list of all owned facilities
• Location Requirement: Separate license required for each physical office location
• Change of Ownership: Any modification of ownership and control requires re-applying as a new agency

5. Medicaid Provider Enrollment

After obtaining a PASA license, the agency must enroll as a Delaware Medicaid provider through the DMAP Provider Healthcare Portal, operated by Gainwell Technologies. This establishes the provider's base Medicaid ID.

During enrollment, providers must submit their DHCQ license, a State Business License, and proof of 501(c)(3) status if applicable. For DDDS waiver services, providers must also complete the specific DDDS Phase 1A Information Gathering and application process.

• Enrollment System: DMAP Provider Healthcare Portal
• Fiscal Agent: Gainwell Technologies
• Required Credentials: State Business License and DHCQ PASA License
• Background Screening: Owners and managing employees must undergo federal database exclusion checks
• Revalidation: Providers must revalidate their Medicaid enrollment at least every five years

6. Staffing, Training and Background Checks

Delaware mandates strict background check requirements for all direct care workers under 19 Del. Code Section 708 and 11 Del. Code Sections 8563 and 8564. Agencies must obtain service letters from previous employers and screen applicants against state abuse registries.

Direct care workers must complete Department-required training, including instruction on the participant's specific service plan, communication needs, and mobility requirements before providing services independently.

• Registry Checks: Mandatory screening against the Delaware Child Abuse and Adult Abuse Registries
• Criminal Background: Fingerprint-based criminal background investigations required by state law
• Service Letters: Must obtain service letters from previous employers per 19 Del. C. Section 708
• Training Standard: Must complete training on the participant's unique disability-specific needs
• Legal Status: All employees must be legally able to work in the state of Delaware

7. Documentation, Policies and Records

PASA regulations require agencies to maintain a separate, comprehensive record for each consumer. This record must be kept current and available for DHCQ inspection during surveys.

Agencies must also maintain a formal Plan of Correction process for any regulatory non-compliance findings, adhering to the format and timeframes specified by the licensing agency.

• Intake Data: Must document consumer demographics, primary physician, and emergency contacts
• Service Plan: Individual service plan (initial and reviews) must be in the file
• Activity Logs: Direct care worker activity logs documenting services provided on a daily basis
• Visit Records: Documentation of initial and follow-up home visits
• Record Retention: Records must be retained in accordance with state and federal Medicaid requirements

8. Billing, Rates and Claims

Reimbursement for homemaker and personal assistance services depends on the authorizing waiver. Under DSHP-Plus, rates are negotiated directly between the provider and the contracted MCOs, and claims are submitted to the respective MCO's clearinghouse.

For the DDDS waiver, services are reimbursed according to a published fee schedule established by the state. Claims for DDDS services are typically processed through the state's MMIS or designated fiscal intermediary.

• DSHP-Plus Billing: Claims submitted to Highmark, AmeriHealth Caritas, or Delaware First Health
• DDDS Billing: Reimbursed via state-established fee schedule
• Procedure Codes: Typically billed under standard HCBS codes (e.g., S5130 for homemaker) as defined by the MCO/waiver
• EVV Requirement: Electronic Visit Verification is required for personal care and related in-home services
• Prior Authorization: All waiver services require prior authorization based on the approved care plan

9. Approval Sequence and Timeline

The approval sequence begins with the Statement of Intent to DHCQ, followed by the submission of the PASA licensure application. DHCQ will review the policies and procedures and conduct an initial survey before issuing the license.

Once licensed, the provider applies to DMAP for a Medicaid ID, which can take 30 to 60 days. Finally, the provider must complete credentialing and contracting with the MCOs (for DSHP-Plus) or execute the DDDS provider agreement, adding another 60 to 90 days to the timeline.

• Step 1: Submit Statement of Intent to DHCQ
• Step 2: Submit PASA application and policy manual
• Step 3: Pass DHCQ initial licensure survey
• Step 4: Enroll in DMAP via Provider Healthcare Portal
• Step 5: Complete MCO contracting or DDDS provider agreement

10. Common Denials and Survey Findings

DHCQ frequently cites new and existing PASA providers for incomplete personnel files, particularly regarding the strict statutory requirements for background checks and service letters. Failure to secure a service letter from a prior employer without documenting exhaustive attempts is a common deficiency.

Another frequent survey finding is the failure to maintain daily activity logs that accurately reflect the tasks outlined in the consumer's individual service plan, leading to potential Medicaid clawbacks.

• Personnel Files: Missing Adult/Child Abuse Registry checks prior to patient contact
• Service Letters: Incomplete documentation of attempts to obtain required service letters
• Care Plans: Daily activity logs not matching the authorized tasks in the service plan
• Policies: Failure to implement or follow the agency's own written policies and procedures
• Unapproved Locations: Operating out of an address not explicitly listed on the PASA license

11. Key Contacts and Resources

Providers should rely on the official Delaware Department of Health and Social Services (DHSS) portals for the most current regulations, manuals, and application materials. The DHCQ website is the primary resource for PASA licensure.

For Medicaid enrollment and waiver-specific guidelines, providers must utilize the DMAP portal and the DDDS provider resources page.

• DHCQ Licensing: https://dhss.delaware.gov/dhcq
• DDDS Provider Page: https://dhss.delaware.gov/ddds/homepage/providers/
• DMAP Provider Portal: https://medicaid.dhss.delaware.gov
• Delaware Administrative Code (PASA): https://regulations.delaware.gov/AdminCode/title16/3345
• DMMA HCBS Information: https://dhss.delaware.gov/dmma

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