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

Last reviewed: 2026-08-16

In Delaware, Homemaker Services provide essential general household support—such as meal preparation, laundry, shopping, and light housekeeping—for Medicaid participants who cannot manage these tasks independently due to physical or cognitive limitations. These services are primarily delivered through the Diamond State Health Plan Plus (DSHP Plus) 1115 managed care waiver and the Lifespan Waiver administered by the Division of Developmental Disabilities Services (DDDS). Because Delaware does not issue a standalone "Homemaker" license, providers must obtain a Personal Assistance Services Agency (PASA) license or a Home Health Agency license from the state before enrolling in Medicaid.

The single biggest structural barrier to entry for this service in Delaware is the mandatory Managed Care Organization (MCO) network contracting requirement. Because Delaware operates its long-term care and home and community-based services almost entirely through managed care, obtaining a state license and enrolling in the Delaware Medical Assistance Program (DMAP) only grants fee-for-service billing rights. To actually receive client referrals and authorizations, a provider must successfully negotiate and secure active contracts with Delaware's designated MCOs (such as Highmark Health Options, AmeriHealth Caritas Delaware, or Delaware First Health) or obtain approval from the DDDS Provider Authorization Committee.

1. Service Definition and Scope

Homemaker services in Delaware encompass general household support activities provided when a Medicaid participant is unable to manage these tasks independently. Under the state's waiver programs, these services are often authorized alongside personal care but maintain distinct task limits focused on environmental support rather than hands-on bodily care.

Providers must adhere to the specific service definitions outlined in the participant's care plan, ensuring that homemaker tasks directly benefit the participant rather than other household members.

• Covered Tasks: Meal preparation, laundry, grocery shopping, and light housekeeping (e.g., dusting, vacuuming, trash removal).
• Excluded Tasks: Hands-on personal care (bathing, toileting), skilled nursing, and heavy chore services (moving furniture, exterior maintenance).
• Primary Authority: Diamond State Health Plan Plus (DSHP Plus) 1115 Demonstration Waiver, which covers long-term care and dual-eligible populations.
• Alternative Authority: Lifespan Waiver, administered by the Division of Developmental Disabilities Services (DDDS) for individuals with intellectual or developmental disabilities.
• Service Location: The participant's private residence; services cannot be billed concurrently with residential habilitation or assisted living facility rates.

2. Regulatory and Oversight Agencies

Oversight of Homemaker services in Delaware is split between the state's licensing body and its Medicaid authorities. Providers must satisfy the regulatory frameworks of both entities, alongside the credentialing requirements of the contracted MCOs.

Failure to maintain good standing with the licensing division will result in immediate suspension of Medicaid enrollment and MCO contracts.

• Licensing Agency: Delaware Division of Health Care Quality (DHCQ) (https://dhss.delaware.gov/dhcq) licenses and inspects home care agencies.
• Medicaid Authority: Division of Medicaid and Medical Assistance (DMMA) (https://dhss.delaware.gov/dmma/) administers the overarching Medicaid program.
• Waiver Administrator: Division of Developmental Disabilities Services (DDDS) (https://dhss.delaware.gov/ddds/) oversees services for the IDD population.
• Enrollment Portal: Delaware Medical Assistance Portal (DMAP) (https://medicaid.dhss.delaware.gov/provider) processes fee-for-service provider enrollments.

3. Gatekeeping Prerequisites: Who Can Even Apply

Delaware does not require a Certificate of Need (CON) for non-medical home care agencies. However, there are strict structural prerequisites before a provider can actively bill for Homemaker services under Medicaid.

Applicants must clear these specific hurdles before their business can become operational and receive Medicaid reimbursement.

• MCO Contracting Requirement: Providers must secure network contracts with DSHP Plus MCOs; DMAP enrollment alone does not guarantee client referrals or network access.
• DDDS Provider Authorization: For the Lifespan Waiver, providers must be approved by the DDDS Provider Authorization Committee (PAC) before providing services.
• Licensure Prerequisite: A valid Personal Assistance Services Agency (PASA) or Home Health Agency license from DHCQ is required before a Medicaid enrollment application will be accepted.
• Physical Location: Providers must maintain a physical office location that complies with DHCQ administrative requirements.
• Moratorium Status: There is currently no state-imposed moratorium on new PASA licenses or Medicaid provider enrollments for this specialty.

4. Licensure and Certification Requirements

Delaware does not have a standalone "Homemaker" license. Instead, agencies must obtain a Personal Assistance Services Agency (PASA) license or a Home Health Agency (Aide Only or Skilled) license from DHCQ.

The PASA license is the most common and cost-effective route for agencies providing strictly non-medical homemaker and personal care services.

• Governing Regulation: 16 DE Admin. Code 3345 governs Personal Assistance Services Agencies (PASA).
• Alternative Licensure: 16 DE Admin. Code 4406 (Home Health Agencies - Aide Only) or 4410 (Skilled Home Health Agencies) can also provide these services.
• Initial License Duration: DHCQ issues an initial provisional license for 90 calendar days to agencies that complete the application process.
• On-Site Survey: All agencies must undergo an on-site survey by DHCQ during the first 90 calendar days of operation to secure a permanent license.
• Application Components: Requires submission of a business plan, management credentials, and a training plan for the first year of operation.
• Director Qualifications: The agency must designate a qualified director responsible for day-to-day management and regulatory compliance.

5. Medicaid Provider Enrollment

Once licensed by DHCQ, providers must enroll in the Delaware Medical Assistance Program (DMAP) via the online provider portal. This establishes the fee-for-service baseline required before MCO credentialing.

Providers must complete all steps in the online portal and retain their Application Tracking Number (ATN) to monitor the status of their submission.

• Enrollment System: Applications must be submitted through the Delaware Medical Assistance Portal (DMAP) Provider Enrollment system.
• Provider Type: Must enroll under the specific HCBS/Atypical provider type corresponding to PASA/Homemaker services.
• Required Identifiers: Must provide an Employer Identification Number (EIN) with a matching W-9; a National Provider Identifier (NPI) is required only if applicable to the provider type.
• Application Fee: Subject to the ACA institutional provider application fee unless waived by Medicare or another state's Medicaid program.
• Application Tracking: Providers receive an Application Tracking Number (ATN) to check the status of their submitted enrollment application.
• Revalidation: The federal regulation at 42 CFR 455.414 requires that state Medicaid agencies revalidate the enrollment of all providers at least every 5 years.

6. Staffing, Training and Background Checks

Delaware enforces strict background check and training mandates for all direct care workers, including homemakers, under state law. Agencies must maintain compliance files for every employee.

Failure to complete these checks prior to an employee's first day of client contact is a primary cause for licensure citations and Medicaid disenrollment.

• Criminal Background Checks: Required for all direct care workers in accordance with 11 Del. C. Sections 8563 and 8564.
• Abuse Registry Screening: Mandatory screening against the Delaware Child Abuse and Adult Abuse Registries; no adverse findings are permitted.
• Service Letters: Agencies must obtain service letters from previous employers in accordance with 19 Del. C. Section 708.
• Drug Testing: Pre-employment drug testing is required for home care agency staff under Delaware law.
• Required Training: Employees must complete Department-required training on the participant's service plan, communication, mobility, and disability-specific needs.
• Work Authorization: All individuals employed by providers must be legally able to work in the state of Delaware.

7. Documentation, Policies and Records

PASAs must maintain comprehensive administrative and client records. DHCQ surveyors will review these during the initial 90-day survey and subsequent unannounced inspections.

Documentation must clearly link the services provided to the authorized care plan and demonstrate continuous compliance with state labor and health regulations.

• Service Plans: A written service plan detailing the specific homemaker tasks required, frequency, and duration, updated annually or upon a change in condition.
• Visit Verification: Electronic Visit Verification (EVV) is required for in-home personal care and related services to capture date, time, location, and worker identity.
• Personnel Files: Must contain proof of background checks, drug screens, service letters, and completed training modules.
• Emergency Preparedness: Agencies must maintain and train staff on a written emergency preparedness and continuity of operations plan.
• Record Retention: Client and billing records must typically be retained for a minimum of 5 years post-discharge or service date.

8. Billing, Rates and Claims

Because most Homemaker services fall under DSHP Plus, billing is primarily directed to the participant's MCO rather than the state's fee-for-service MMIS. Rates are negotiated with the MCOs.

Providers must ensure that all claims are supported by accurate Electronic Visit Verification (EVV) data to avoid automatic denials.

• Billing System: Claims are submitted to the respective MCO clearinghouses (e.g., Delaware First Health, Highmark) rather than directly to DMAP for managed care enrollees.
• HCPCS Codes: Typically billed using S5130 (Homemaker service, NOS, per 15 minutes) or similar state-approved waiver codes.
• Prior Authorization: All homemaker services require prior authorization from the MCO care coordinator or DDDS case manager before service delivery.
• EVV Integration: Claims must be supported by matching EVV data; claims lacking EVV verification will be denied.
• Rate Structure: Reimbursed in 15-minute increments; MCO contracted rates may vary but must align with state actuarial soundness requirements.

9. Approval Sequence and Timeline

The end-to-end process from business formation to billing the first claim is lengthy, primarily due to the sequential nature of licensing, Medicaid enrollment, and MCO credentialing.

Providers should anticipate a minimum of 6 to 9 months before they are fully authorized to accept and bill for Medicaid clients.

• Step 1: Business formation and submission of the PASA license application to DHCQ (30-60 days for initial review).
• Step 2: Issuance of the 90-day provisional PASA license by DHCQ.
• Step 3: Submission of the DMAP provider enrollment application using the provisional license (30-45 days for processing).
• Step 4: DHCQ on-site survey during the first 90 days of operation to secure the permanent license.
• Step 5: MCO Credentialing and Contracting (90-120 days, often the longest phase of the process).

10. Common Denials and Survey Findings

Applications and surveys frequently face delays or denials due to administrative omissions or failure to strictly adhere to Delaware's background check statutes.

DHCQ surveyors are particularly strict regarding personnel files and the timing of abuse registry checks.

• Background Check Violations: Failure to obtain the required Adult/Child Abuse Registry clearances before the employee's first day of client contact.
• Missing Service Letters: Incomplete compliance with 19 Del. C. Section 708 regarding obtaining service letters from prior employers.
• Inadequate Training Documentation: Missing signatures or dates on required employee training modules, particularly regarding participant-specific needs.
• EVV Non-Compliance: High claim denial rates due to mismatches between EVV clock-in/out data and submitted claim units.
• Application Omissions: DMAP applications rejected for missing W-9s, mismatched DBA names, or failure to pay the application fee.

11. Key Contacts and Resources

Providers should bookmark the primary regulatory portals and MCO provider relations pages to stay updated on policy changes, billing manuals, and training requirements.

Maintaining open lines of communication with MCO network representatives is critical for securing and maintaining active contracts.

• DHCQ Licensing: Delaware Division of Health Care Quality (https://dhss.delaware.gov/dhcq)
• Medicaid Enrollment Portal: Delaware Medical Assistance Portal (DMAP) (https://medicaid.dhss.delaware.gov/provider)
• DDDS Provider Authorization: Division of Developmental Disabilities Services (https://dhss.delaware.gov/ddds/)
• Delaware First Health (MCO): Provider Network Contracting (https://www.delawarefirsthealth.com/providers/become-a-provider.html)
• Background Check Center: Delaware Department of Health and Social Services Background Check Center (BCC) portal for mandatory employee screenings.

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