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Delaware - I/DD Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Delaware Division of Developmental Disabilities Services (DDDS) authorizes providers for the DDDS Lifespan Waiver and the Pathways to Employment program through a structured four-phase approval sequence. Prospective agencies must first respond to an active Request for Proposals (RFP) issued by the Division of Management Services (DMS) for "Home and Community Based Services for Individuals with Intellectual and Developmental Disabilities" before any Medicaid enrollment can occur.

Once the RFP response is accepted, applicants submit a comprehensive application package to the DDDS Authorized Provider Committee and complete a mandatory interview. Successful candidates receive authorization to enroll in the Delaware Medical Assistance Program (DMAP) via the Gainwell portal, followed by final contracting to deliver services ranging from residential habilitation in licensed Neighborhood Homes to group supported employment.

1. Service Definition and Scope

Delaware funds I/DD services primarily through the 1915(c) DDDS Lifespan Waiver and the 1915(i) Pathways to Employment program. These waivers cover a comprehensive array of supports designed to integrate individuals into the community in compliance with the CMS HCBS Settings Rule.

Authorized services range from facility-based and in-home supports to specialized employment training. Providers must specify which exact services they are applying to deliver during the initial Information Gathering phase.

2. Regulatory and Oversight Agencies

Multiple divisions within the Delaware Department of Health and Social Services (DHSS) oversee I/DD waiver services. DDDS handles programmatic authorization and policy, while the Division of Medicaid and Medical Assistance (DMMA) manages the overarching Medicaid authority.

Facility licensure is managed separately by the Office of Health Facilities Licensing and Certification (OHFLC), which enforces regulations for residential and home health agencies.

3. Gatekeeping Prerequisites: Who Can Even Apply

Delaware utilizes a strict procurement and committee-review model for I/DD waiver services. Agencies cannot simply submit a Medicaid enrollment application; they must first pass through the state's RFP and authorization gates.

The Division explicitly states it will not accept incomplete applications, and all applicants must complete a mandatory 12-session Information Gathering review before submitting their materials.

4. Licensure and Certification Requirements

While DDDS authorizes the programmatic delivery of waiver services, the physical sites and specific agency types must be licensed by OHFLC. The required license depends entirely on the service being provided.

Providers must secure these licenses prior to final contracting and service delivery, ensuring compliance with Delaware Administrative Code Title 16.

5. Medicaid Provider Enrollment

After receiving authorization from DDDS, providers move to Phase 3: enrolling as a Delaware Medicaid provider. This is conducted entirely online through the DMAP portal operated by Gainwell.

Providers must have their National Provider Identifier (NPI) and DDDS authorization letter ready before initiating the Gainwell application.

6. Staffing, Training and Background Checks

DDDS enforces strict training and qualification standards for all Direct Support Professionals (DSPs) and agency staff. Providers must utilize the state's Electronic Training System to track compliance.

All staff must be trained on the participant's specific service plan and unique disability needs prior to delivering any billable service.

7. Documentation, Policies and Records

Authorized providers must maintain comprehensive electronic records and adhere to DDDS-specific policy mandates. The state requires the use of a designated Electronic Client Data Management System.

During the application phase, agencies must submit a Requirements Summary Checklist in Word format, mapping their policies to state standards.

8. Billing, Rates and Claims

Claims for the DDDS Lifespan Waiver are processed through the DMAP MMIS. Providers must follow the billing guidelines outlined in the DDDS HCBS Waiver Provider Policy Manual.

Rates are established by DHSS and require specific modifiers to distinguish between individual and group service delivery models.

9. Approval Sequence and Timeline

The DDDS provider approval process is divided into four distinct phases. The timeline depends heavily on the agency's readiness and the scheduling of the Authorized Provider Committee interview.

DDDS reserves the right to issue a Provisional Authorization to existing providers applying to add new services, though full authorization steps must still be completed.

10. Common Denials and Survey Findings

The most frequent cause for immediate application rejection is failure to follow the strict submission formatting rules. DDDS explicitly states they will return incomplete applications without review.

During post-enrollment surveys, OHFLC and DDDS frequently cite providers for failing to fully implement the CMS HCBS Settings Rule in residential environments.

11. Key Contacts and Resources

Prospective providers should direct all application materials and procedural questions to the DDDS Provider Authorization Committee. The state maintains a dedicated resource mailbox for this purpose.

For Medicaid enrollment technical assistance, providers must contact Gainwell Technologies through the DMAP portal.

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