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Delaware - Transitional Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

Delaware Health and Social Services (DHSS) funds transition set-up costs through the Diamond State Health Plan Plus (DSHP Plus) 1115 Demonstration Waiver and the Division of Developmental Disabilities Services (DDDS) Lifespan Waiver. Providers seeking to offer Transitional Assistance Services, often referred to under the state's Nursing Home Transition Program or as Community Transition Services, must first be approved as a DDDS waiver provider or secure a contract with one of Delaware's Medicaid Managed Care Organizations (MCOs).

Approval requires navigating the DDDS Provider Application process or MCO credentialing, followed by enrollment in the Delaware Medical Assistance Portal (DMAP). Because this service involves one-time administrative and purchasing coordination rather than direct clinical care, Delaware does not issue a distinct facility license for it, relying instead on waiver certification and MCO network adequacy standards to regulate providers.

1. Service Definition and Scope

In Delaware, Transitional Assistance Services (or Community Transition Services) cover non-recurring set-up expenses for individuals transitioning from an institutional setting, such as a nursing facility or an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID), to a community living arrangement. This service is authorized under the DSHP Plus 1115 Demonstration and the DDDS Lifespan Waiver.

The scope is strictly limited to essential household items and services necessary to establish a basic community residence. It does not cover ongoing rent, food, or recreational items, and is capped at a specific lifetime or per-transition dollar amount defined in the participant's person-centered service plan.

2. Regulatory and Oversight Agencies

Multiple divisions within the Delaware Department of Health and Social Services (DHSS) oversee the administration, certification, and funding of transition services. The Division of Medicaid and Medical Assistance (DMMA) holds the ultimate authority over the Medicaid state plan and waivers.

For individuals with intellectual and developmental disabilities, the Division of Developmental Disabilities Services (DDDS) directly manages provider certification. For older adults and individuals with physical disabilities, the DSHP Plus MCOs manage the provider networks.

3. Gatekeeping Prerequisites: Who Can Even Apply

Delaware does not impose a Certificate of Need (CON) or a closed moratorium on HCBS waiver providers. The DDDS accepts provider applications on an open and continuous basis as mandated by federal Medicaid regulations.

However, to serve the majority of the aging and physical disability population under DSHP Plus, a provider must successfully contract with at least one of the state's three designated MCOs. MCOs may restrict network entry based on their own internal network adequacy assessments, meaning a provider could be fully qualified but denied an MCO contract if the plan determines it already has enough transition coordinators.

4. Licensure and Certification Requirements

Delaware's Division of Health Care Quality (DHCQ) does not issue a specific "Transitional Assistance" license. Instead, providers must achieve certification through the DDDS Provider Application process or MCO credentialing.

Applicants must review the DDDS Provider Application Manual and submit a comprehensive application packet that demonstrates their administrative capacity to manage state funds, procure goods, and maintain receipts.

5. Medicaid Provider Enrollment

After receiving DDDS authorization or an MCO contract, the agency must enroll as a Delaware Medicaid provider through the Delaware Medical Assistance Portal (DMAP), operated by Gainwell Technologies.

Providers must complete the enrollment application, sign the Delaware Medical Assistance Program Provider Agreement, and pay the federal Medicaid application fee if they have not already paid it to Medicare or another state's Medicaid program.

6. Staffing, Training and Background Checks

Staff coordinating transition services must meet basic educational and experiential requirements, typically an Associate's degree in a human services field or equivalent experience in health or human services support.

All personnel must pass comprehensive background checks through the Delaware DHSS Background Check Center (BCC) and complete mandatory DDDS or MCO training modules regarding person-centered planning and incident reporting.

7. Documentation, Policies and Records

Because Transitional Assistance involves purchasing goods and services on behalf of a participant, rigorous financial documentation is the primary compliance requirement. Providers must maintain original receipts, invoices, and proof of delivery for every item purchased.

All expenditures must be explicitly authorized in advance within the participant's approved person-centered service plan. Providers must have written policies for procurement, fraud prevention, and client record retention.

8. Billing, Rates and Claims

Transitional Assistance is typically billed as a reimbursement for actual costs incurred, up to the maximum cap established by the waiver (e.g., a lifetime cap per participant). Providers submit claims through the DMAP system for fee-for-service DDDS participants or to the respective MCO's clearinghouse for DSHP Plus members.

Providers must use the specific HCPCS procedure code designated in their authorization (often T2038 for Community Transition Services) and must not bill for services or items until they have been successfully delivered to the participant's new home.

9. Approval Sequence and Timeline

The approval process begins with Phase 1A (Information Gathering) as outlined in the DDDS Provider Application Manual. The provider submits a Letter of Intent and the full application packet to DDDS.

Once DDDS reviews and approves the application, the provider receives an approval letter, which is then used to apply for Medicaid enrollment via DMAP. The entire process from application submission to active Medicaid billing status typically takes 3 to 6 months.

10. Common Denials and Survey Findings

Applications are most frequently delayed or denied due to incomplete policy submissions or failure to demonstrate sufficient financial reserves to purchase transition items prior to state reimbursement.

During audits, the most common survey findings involve missing receipts, purchasing items not explicitly authorized in the person-centered service plan, or failing to document that the participant actually received the goods.

11. Key Contacts and Resources

Prospective providers should rely on the official Delaware Health and Social Services websites for the most current manuals, forms, and waiver appendices.

The DDDS Provider Application Manual is the primary source of truth for agency certification requirements under the Lifespan Waiver.

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