Delaware - Housing Stabilization — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-15

In Delaware, Medicaid covers Tenancy Support—commonly known as housing stabilization, pre-tenancy, and tenancy-sustaining services—through two primary avenues: the PROMISE (Promoting Optimal Mental Health for Individuals through Supports and Empowerment) 1115 Demonstration program for individuals with behavioral health needs, and the Diamond State Health Plan Plus (DSHP Plus) managed care program for populations needing Long-Term Services and Supports (LTSS). These services fund the concrete, on-the-ground work of helping high-needs individuals find affordable housing, negotiate with landlords, secure move-in funds, and maintain their leases to avoid institutionalization.

The single biggest structural barrier to entry for this service in Delaware is network access. Providers cannot simply complete a Medicaid application and begin billing. To serve the behavioral health population, agencies must first pass the rigorous Division of Substance Abuse and Mental Health (DSAMH) credentialing and program approval process, which is often subject to targeted procurement (RFPs) or open enrollment windows. To serve the DSHP Plus LTSS population, providers must contract directly with Delaware’s Medicaid Managed Care Organizations (MCOs), which have the authority to deny applications based on "network adequacy" if they determine they already have enough tenancy support providers in a given county.

1. Service Definition and Scope

Delaware defines Tenancy Support as targeted interventions that assist Medicaid beneficiaries in acquiring, maintaining, and retaining community-based housing. These services are delivered under the state’s PROMISE behavioral health initiative and the DSHP Plus LTSS waiver, ensuring that vulnerable residents do not lose housing due to psychiatric, physical, or behavioral crises.

The scope is divided into pre-tenancy (housing transition) and tenancy-sustaining (housing retention) services. The service does not pay for room and board or actual rent; it strictly reimburses the administrative and social support labor required to navigate the housing market and mediate tenant-landlord disputes.

• Pre-Tenancy Services: conducting housing assessments, developing a housing stabilization plan, assisting with housing applications, and helping secure one-time transition funds (like security deposits).
• Tenancy-Sustaining Services: educating tenants on lease compliance, developing a retention plan, conducting landlord mediation, and connecting the individual to community resources to prevent eviction.
• Community Transition Services: non-recurring setup expenses (security deposits, essential furnishings, utility deposits) processed by the provider on behalf of the member transitioning from an institution.
• Exclusions: direct payment of rent, daily living assistance (which falls under personal care), and room and board costs.

2. Regulatory and Oversight Agencies

Housing stabilization services in Delaware are governed by a combination of state divisions under the Department of Health and Social Services (DHSS) and private managed care entities. Because the service crosses behavioral health and LTSS, oversight is bifurcated.

The overarching Medicaid authority delegates the clinical and operational management of the PROMISE program to the state's behavioral health division, while managing the broader LTSS population through contracted MCOs.

• Delaware Department of Health and Social Services (DHSS): The umbrella state department managing all health and human services.
• Division of Medicaid and Medical Assistance (DMMA): The state agency responsible for the overall administration of the Medicaid program, DSHP, and DSHP Plus.
• Division of Substance Abuse and Mental Health (DSAMH): The division that manages the PROMISE program, issues provider certifications for behavioral health HCBS, and operates the Eligibility and Enrollment Unit (EEU) that authorizes care.
• Contracted MCOs: Highmark Health Options, AmeriHealth Caritas Delaware, and Delaware First Health, which manage the DSHP Plus LTSS benefits and credential their own provider networks.

3. Gatekeeping Prerequisites: Who Can Even Apply

Delaware restricts access to the Medicaid housing support market through strict pre-approvals and managed care gatekeeping. An applicant will be blocked before a Medicaid enrollment application is even reviewed if they do not hold the required preliminary agency authorizations.

There is no Certificate of Need (CON) required for this non-facility-based service, but the DSAMH credentialing and MCO network adequacy reviews function as the primary market barriers.

• DSAMH Program Approval (PROMISE): To bill for Tenancy Support under PROMISE, the provider must be vetted, credentialed, and approved by DSAMH as a PROMISE HCBS provider; DMMA will reject any Medicaid enrollment application lacking this DSAMH certification.
• MCO Network Adequacy Closures: Highmark, AmeriHealth, and Delaware First Health may close their networks for HCBS providers at any time. If an MCO declares it has adequate Tenancy Support coverage in a county, new applications are flatly denied.
• Procurement/RFP Windows: DSAMH periodically issues Requests for Proposals (RFPs) for specific PROMISE services. If an RFP is required and the window is closed, a provider cannot enter the PROMISE network.
• Delaware Business License: Providers must hold a valid business license from the Delaware Division of Revenue prior to any DSAMH or Medicaid enrollment step.

4. Licensure and Certification Requirements

Delaware does not issue a specific "Housing Stabilization Agency" license. Instead, the state relies on a service-specific certification model tied to the PROMISE HCBS manual and DSHP Plus provider standards. Providers are qualified against the service definition rather than a facility building code.

To become certified, the agency must demonstrate compliance with the Delaware Adult Behavioral Health DHSS Service Certification and Reimbursement Manual and federal community integration rules.

• HCBS Settings Final Rule Compliance: Providers must prove that their services integrate members into the broader community, ensuring tenants have leases in their own names and lockable doors.
• DSAMH Service Certification: A formal review of the agency's policies, procedures, and staff qualifications by DSAMH to ensure alignment with the PROMISE program standards.
• Corporate Structure: Must be registered with the Delaware Division of Corporations and maintain good standing.
• Liability Insurance: Proof of general liability, professional liability, and workers' compensation insurance at minimum thresholds dictated by DHSS and the MCOs.

5. Medicaid Provider Enrollment

Once the gatekeeping prerequisites and DSAMH certifications are secured, the agency must formally enroll as a billing entity through the Delaware Medical Assistance Program (DMAP). This process registers the provider in the state’s Medicaid Management Information System (MMIS).

The DMAP enrollment is managed by the state's fiscal agent, Gainwell Technologies. Only after DMAP issues a Medicaid Provider ID can the provider finalize credentialing with the DSHP MCOs.

• DMAP Provider Portal: The online system operated by Gainwell Technologies where applications, revalidations, and document uploads are managed.
• Provider Type/Specialty: Agencies typically enroll under the HCBS/Behavioral Health provider types mapping to PROMISE services, selecting the specialty code for Tenancy Support.
• Required Documentation: Uploads must include the DSAMH certification letter, Delaware Division of Revenue business license, W-9, and IRS CP-575 (Proof of EIN).
• Application Fee: Federal Medicaid application fees (approximately $731 in 2026) apply to institutional providers, though HCBS agencies may be exempt depending on their exact taxonomy and Medicare enrollment status; DMAP will prompt for payment if required.

6. Staffing, Training and Background Checks

Because Tenancy Support relies on navigating complex housing markets and mediating behavioral crises, Delaware mandates specific qualifications for frontline staff. The service is typically delivered by case managers, housing specialists, or certified peer support specialists.

Agencies must maintain strict personnel files proving that all staff met educational and background requirements prior to their first client contact.

• Education and Experience: Tenancy support staff generally must hold a Bachelor’s degree in a human services field, OR a high school diploma/GED with at least two years of relevant experience in housing, social services, or property management.
• Peer Support Specialists: Certified Peer Recovery Specialists (CPRS) in Delaware may deliver tenancy supports if they hold current certification through the Delaware Certification Board.
• Background Checks: Mandatory fingerprint-based criminal background checks through the Delaware State Bureau of Identification (SBI).
• Registry Clearances: Mandatory checks against the Delaware Adult Abuse Registry and Child Protection Registry before hire.
• Required Training: Staff must be trained in Housing First principles, trauma-informed care, ASAM criteria awareness, and the specific PROMISE assessment tools utilized by DSAMH.

7. Documentation, Policies and Records

Providers must maintain a robust, audit-ready paper trail demonstrating exactly what housing barriers the member faced and what active steps the provider took to resolve them. Delaware Medicaid and the MCOs aggressively audit HCBS files for person-centered compliance.

The core of the documentation is the Housing Stabilization Plan, which must seamlessly integrate into the member's overarching Person-Centered Recovery Plan (PCRP).

• Housing Stabilization Plan: Must be developed upon admission, outlining specific housing barriers, goals, and step-by-step interventions. It must be updated at least every 180 days or when the member's housing status meaningfully changes.
• Progress Notes: Must be written for every billing event, detailing the date, start and stop times, specific intervention provided, member's response, and progress toward the housing plan goals.
• DSAMH EEU Coordination: Documentation must show active communication and coordination with the DSAMH Eligibility and Enrollment Unit care manager.
• Lease Records: The provider must keep copies of the member's lease or rental agreement, demonstrating that the living arrangement complies with HCBS Settings guidelines (e.g., tenant holds a legally enforceable lease).

8. Billing, Rates and Claims

Reimbursement for Tenancy Support depends on whether the member is receiving the service through the PROMISE FFS structure or via a DSHP Plus MCO. Claims must be submitted with precision to avoid immediate denial.

Services are generally billed using standardized Healthcare Common Procedure Coding System (HCPCS) codes. Rates are established by the DMMA PROMISE HCBS Fee Schedule or through negotiated MCO contracts.

• Prior Authorization: Services cannot be billed without an active prior authorization on file from the DSAMH EEU (for PROMISE) or the MCO's utilization management department (for DSHP Plus).
• Billing System (PROMISE): Claims are submitted directly through the DMAP Provider Portal via Gainwell Technologies using the 837P format.
• Billing System (MCOs): Claims for DSHP Plus members are submitted to the specific MCO's designated clearinghouse (e.g., Availity, Change Healthcare).
• HCPCS Codes: Typically billed using H2015 (Comprehensive Community Support Services) or specific T-codes (e.g., T2038 for Community Transition) with modifiers denoting pre-tenancy or tenancy-sustaining phases, as defined in the current PROMISE manual.
• Unit Measurement: Most face-to-face or direct advocacy tenancy supports are billed in 15-minute increments.

9. Approval Sequence and Timeline

Becoming an active, billing housing stabilization provider in Delaware is a multi-step process that spans state agencies, fiscal agents, and private insurance companies. Providers should expect the process to take 4 to 8 months.

Any attempt to skip a step (such as applying to the DMAP portal before securing DSAMH approval) will result in an immediate application rejection and reset the timeline.

• Step 1: Secure a Delaware Business License from the Division of Revenue (1-2 weeks).
• Step 2: Apply for DSAMH PROMISE provider certification or respond to a DSAMH Open Enrollment/RFP (60-90 days).
• Step 3: Complete the DMAP Medicaid Provider Enrollment application via the Gainwell portal using the DSAMH approval letter (30-60 days).
• Step 4: Apply for credentialing and network contracting with Highmark, AmeriHealth Caritas, and Delaware First Health (90-120 days, subject to network adequacy).

10. Common Denials and Survey Findings

Delaware's DHSS and MCO auditors routinely review Tenancy Support providers for compliance. Failures typically stem from administrative oversights during the application process or poor clinical documentation during service delivery.

Providers who fail audits may face clawbacks (recoupment of paid funds), suspension of prior authorizations, or removal from the PROMISE or MCO network.

• Enrollment Denial (Network Adequacy): MCOs frequently deny provider credentialing applications simply because they already have enough HCBS providers in a specific zip code or county.
• Claim Denial (No Prior Auth): Billing for services delivered before the DSAMH EEU formally issued the prior authorization date span.
• Survey Finding (Missing Timeframes): Progress notes lacking exact start and stop times for the 15-minute billing increments.
• Survey Finding (Plan Expiration): Failing to update the member’s Housing Stabilization Plan at the mandatory 180-day mark.
• Survey Finding (Registry Violations): Allowing a staff member to conduct pre-tenancy client interviews before the state Adult Abuse Registry clearance was officially returned and filed.

11. Key Contacts and Resources

Successful providers maintain close relationships with state program managers and MCO network representatives. Delaware's small size allows for more direct access to state administrators than larger jurisdictions.

Bookmark the specific portals and manuals to ensure compliance with the most current fee schedules and certification standards.

• DSAMH Provider Relations Unit: Handles questions regarding the PROMISE program, certification standards, and EEU coordination (302-255-9463).
• DMAP Provider Enrollment (Gainwell Technologies): The portal for submitting the formal Medicaid enrollment application and checking FFS claim statuses.
• Delaware Division of Revenue: For securing the mandatory state business license prior to application.
• MCO Provider Network Management: The respective provider relations departments for AmeriHealth Caritas Delaware, Highmark Health Options, and Delaware First Health for LTSS contracting.
• Delaware Adult Behavioral Health DHSS Service Certification Manual: The authoritative rulebook for PROMISE service standards, staffing, and documentation rules.

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