I/DD Waivers in Delaware

All states: Medicaid disability services map

Delaware I/DD services at a glance

Last verified against state sources: 2026-10-23.

Who runs I/DD services in Delaware?

The Division of Developmental Disabilities Services (DDDS), part of the Delaware Department of Health and Social Services (DHSS), runs I/DD services day to day. It operates the Lifespan Waiver under an agreement with the Division of Medicaid and Medical Assistance (DMMA), Delaware's Medicaid agency. DMMA's fiscal agent pays the claims. People start by applying to DDDS Applicant Services.

• Division of Medicaid and Medical Assistance (DMMA): the state Medicaid agency. It delegates operation of the Lifespan Waiver to DDDS through a memorandum of understanding (MOU) and processes waiver claims through its fiscal agent.
• Division of Developmental Disabilities Services (DDDS): decides who is eligible for DDDS services, enrolls people in the waiver, sets provider rates under delegation from DMMA, credentials providers and reviews them each year. DDDS also operates Pathways to Employment.
• Front door: DDDS Applicant Services, by phone at 302-744-9700 or 866-552-5758 (Option 2).
• Case management: Delaware pays for case management as targeted case management under its Medicaid state plan (a 1915(g) service). DDDS Support Coordinators serve people in residential settings. Community Navigators, employed by a contracted organization (The Columbus Organization, according to the DDDS applicant page), serve people who live in the family home. DDDS also lists Family Resource Coordinators.

What Medicaid waivers and programs serve people with I/DD in Delaware?

Delaware has one 1915(c) waiver for people with I/DD, the DDDS Lifespan Waiver. A 1915(c) waiver is a federal Medicaid option that lets a state pay for home and community services instead of institutional care. The Lifespan Waiver covers residential, day, employment and in-home services for people age 12 and older. A separate program, Pathways to Employment, funds job supports for youth and young adults.

• DDDS Lifespan Waiver (1915(c), control number DE.0009): renewed effective July 1, 2024 for five years (renewal DE.0009.R09.00), with 3,136 participants approved each year. It serves people age 12 and older, with no maximum age, who are eligible for DDDS services, meet the level of care for an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) and qualify for Medicaid. Main services are Residential Habilitation (neighborhood group homes, staffed apartments and Shared Living host homes), Medical Residential Habilitation, Supported Living, Day Habilitation, Community Participation, Prevocational Services, Supported Employment, Respite, Personal Care, Behavioral Consultation, Nurse Consultation, Assistive Technology, home and vehicle accessibility changes, Specialized Medical Equipment and Community Transition. In July 2026 the state announced CMS approval of three more services, described in the last section below.
• Pathways to Employment (1915(i) state plan program, effective January 1, 2025): a 1915(i) program adds home and community services to the regular Medicaid plan. Pathways is operated by DDDS for low-income youth and young adults on Medicaid who want to work and have an intellectual disability, autism spectrum disorder, a visual impairment or a physical disability. It is not limited to I/DD. Services include Employment Navigation (by state staff), Career Exploration and Assessment, individual and small group Supported Employment, Benefits Counseling and Financial Coaching, Non-Medical Transportation, Personal Care, Orientation and Mobility and Assistive Technology.

Delaware also has ICF/IID care as the institutional option that the waiver is an alternative to. We did not confirm current details for it, so this page does not describe it.

Does Delaware pay for I/DD services through managed care?

No. Lifespan Waiver services are paid fee-for-service, which means providers bill the state's Medicaid claims system directly and DMMA's fiscal agent pays them. Waiver members can also be enrolled in the Diamond State Health Plan, Delaware's 1115 managed care program, for their doctor, hospital and other acute care. That health plan does not pay for Lifespan Waiver services.

• Who authorizes and coordinates: DDDS enrolls people in the waiver, and DDDS Support Coordinators or Community Navigators coordinate their services.
• Who pays claims: DMMA's fiscal agent, through the state's Medicaid claims system.
• Pathways to Employment: DDDS operates it outside the health plans. We did not find a separate confirmation of how Pathways claims are paid, so providers should ask DDDS.

Is there a waiting list for I/DD services in Delaware?

We could not confirm whether Delaware keeps a waiting list for the Lifespan Waiver. The waiver itself does not describe one. Instead, it reserves slots for certain groups and ranks other people by risk, and the state does not publish a count of people waiting.

• Reserved slots each year (2024 renewal): 60 for people in crisis or at risk of homelessness, 100 rising to 115 for school graduates, and 5 for people leaving institutions.
• Risk categories: other people are ranked with a state standardized risk assessment tool into Emergency, High Risk and Intermediate Risk.
• Residential services: limited to people whose need is documented and prioritized with the state risk tool.

For questions about a person's place in line, families can call DDDS Applicant Services at 302-744-9700 or 866-552-5758 (Option 2).

How do people apply for I/DD services in Delaware, and how are budgets set?

People apply to DDDS Applicant Services online through the DDDS portal or on a paper application sent by email, fax or in person. DDDS confirms receipt within 7 days and decides eligibility within 30 days of a complete application. Medicaid is a separate application through ASSIST, and a DDDS application is not a waiver application. Once a person is eligible, their case manager works with them on waiver enrollment.

• DDDS eligibility: set by 16 Del. Admin. Code 2100. A person must have an intellectual or developmental disability, which includes brain injury, autism spectrum disorder or Prader-Willi Syndrome, that began in the developmental period and causes documented limits in daily functioning. DDDS uses standardized assessments to decide.
• Lifespan Waiver eligibility: age 12 or older, ICF/IID level of care, Medicaid financial eligibility, and either a place in a reserved slot group or priority under the state risk tool.
• Assessment and support levels: DDDS uses the Inventory for Client and Agency Planning (ICAP) to measure daily support needs for people in residential or day services. The ICAP hours of support set the per diem rate for those services. A separate state risk tool decides priority for waiver entry and residential services.
• Self-direction: Lifespan members can self-direct respite and personal care through an Agency With Choice model, where an agency is the co-employer and the participant helps choose and manage workers. Pathways to Employment also offers a self-direction option for personal care.

What day and residential services can I/DD providers offer in Delaware?

Lifespan Waiver providers can offer four day and employment services and several kinds of residential support. Day and employment providers are credentialed by DDDS rather than licensed. Neighborhood group homes are licensed by the DHSS Division of Health Care Quality. DDDS reviews waiver providers each year through its Office of Service Integrity and Enhancement.

Day and employment services (Lifespan Waiver)

• Day Habilitation (facility-based and non-facility-based): scheduled skill-building activities at a fixed site, in the community or both. Non-facility participants may spend no more than 1 hour a day at a hub. Billed in 15-minute units plus a facility per diem, with transportation billed per trip on days it is provided. Providers need a Delaware business license or 501(c)(3) status, DDDS credentialing as a Day Habilitation provider and compliance with the DDDS Provider Standards for HCBS. The research did not find a published staff ratio.
• Community Participation: individual activities outside the home that build community connections and natural supports. It cannot be delivered in a provider owned or managed setting beyond brief hub time. Staffing is 1:1 or 1:2 only, billed in 15-minute units, and providers are credentialed under the Day Habilitation standards.
• Prevocational Services: facility and non-facility services that build work skills, billed in 15-minute units plus a facility per diem, with transportation per trip. The 2024 renewal removed references to sub-minimum wage because Delaware no longer has such sites. The research did not find a published staff ratio.
• Supported Employment (individual and small group): help to get and keep jobs in regular workplaces, billed in 15-minute units. Waiver small groups are crews of 2 to 8 workers, and individual supported employment may be delivered virtually. Pathways to Employment also pays for supported employment, with small groups of 1 staff to 2 to 4 participants.

Residential services (Lifespan Waiver)

• Residential Habilitation in neighborhood group homes and staffed apartments: skill-building, supervision and support in a provider-managed home, for people whose need is documented and prioritized with the state risk tool. Paid as a per diem based on ICAP hours, with a transportation add-on. Room and board are not included. Neighborhood group homes are licensed by the Division of Health Care Quality under its regulations for Neighborhood Homes for Persons with Developmental Disabilities.
• Shared Living (host homes): support for adults in a private host home certified by DDDS, through an independent caregiver or a Shared Living agency (an agency provider type added in 2024). One person per home is preferred, with exceptions up to 3. Paid through per diems tiered by acuity since July 1, 2024.
• Medical Residential Habilitation: residential support that includes skilled nursing, up to 24 hours a day, for people with significant health needs. Paid hourly. Nursing staff must be licensed (RN, LPN or APRN) and meet DDDS training rules.
• Supported Living: individual support, up to 40 hours a week, in a home the person owns or leases rather than one the provider manages. Providers are credentialed by DDDS, and this service is subject to EVV.

How are I/DD provider rates set and how do agencies enroll in Delaware?

DDDS sets statewide rates under delegation from DMMA, with a single rate for each service that applies to all providers. Rates come from a rate study that starts with a benchmark direct support professional (DSP) wage and adds employment, program and administrative costs. The legislature funds rates at a percentage of that benchmark. Agencies apply to DDDS on an open, continuous basis.

• How rates are built: most Lifespan services use a fee schedule. Residential and day per diems depend on hours of support set through the ICAP. Shared Living uses per diems tiered by acuity. Enhanced rates have applied since October 1, 2022 for staff fluent in American Sign Language (ASL) and for Registered Behavior Technicians (RBTs). DDDS asks for funding that keeps all DSP rates at the same percentage of benchmark.
• Latest rate change: the 2024 renewal says DSP rates were last fully rebased effective July 1, 2020, and that the next full rebase was delayed to 2025 at the earliest. Tiered Shared Living rates took effect July 1, 2024. We did not find a completed 2025 or 2026 rebase.
• Becoming a provider: agencies review the Provider Application Manual and information sessions, send a complete application to DDDS_ProviderAuthCommittee@delaware.gov, interview with the Provider Authorization Committee and enroll as a Delaware Medicaid provider. Details are on the DDDS providers page.
• EVV for I/DD services: DMMA's EVV code crosswalk lists DDDS respite (T1005), waiver personal care (T1019) and supported living (T2013) as services that need electronic visit verification (EVV). Visits go to the statewide HHAeXchange aggregator (formerly Sandata), and DDDS names Therap as its alternate EVV vendor. Residential habilitation and day services are not on the EVV code list. See DMMA's EVV page for details.

What is changing next for I/DD services in Delaware?

As of October 23, 2026, we did not find a confirmed change with a set date ahead for Delaware's I/DD services. The most recent change is a Lifespan Waiver amendment that CMS approved in July 2026, adding three services. Its effective date was not stated in the state's announcement.

• New Lifespan Waiver services: the state announced on July 28, 2026 that CMS gave final approval to add Enhanced Behavioral Residential Services (intensive residential support for people with significant behavioral health needs), Crisis Stabilization Services (short-term crisis support in a home-like setting) and Remote Supports. Two of the three were piloted with federal American Rescue Plan Act (ARPA) funds. They are available to enrolled participants based on assessed need.
• Possible EVV contract change: a state request for proposals (HSS-27-005) would move the statewide EVV contract to an aggregation-only model where providers choose their own EVV system. The solicitation estimated a start in early 2027, but we did not find an award, so this is not final.
• Rates: a full DSP rate rebase was planned after 2024, but we did not find that it has happened.

Delaware I/DD sources

• DHSS: DDDS Lifespan Waiver application, renewal DE.0009.R09.00 (effective July 1, 2024)
• DDDS: Waiver Programs (Lifespan Waiver)
• DDDS: Applicant Services
• DDDS: Contact
• DDDS: Providers
• DDDS: Pathways to Employment
• Delaware News: Delaware adds new services to help people with intellectual and developmental disabilities live more independently (July 28, 2026)
• DMMA: EVV Payer, Program and Taxonomy Crosswalk
• DMMA: Electronic Visit Verification
• Delaware bid HSS-26-019 (Agency With Choice), addendum 1

Related reading

• Disability Services and Independent Living Guide
• Essential Acronyms in Disability Services: A Quick Reference Guide
• Developmental Disabilities vs. Mental Health: Key Differences
• Disability Services DayHab has a dilemma - how to solve it
• I/DD services in every state (map)
• Delaware EVV requirements

Page history

• October 23, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for I/DD provider agencies, including EVV, service documentation, goal tracking and billing. If you would like to talk through your program, contact Ankota or read more about Ankota's I/DD software.