There’s no single number that answers “what does Delaware Medicaid pay?” It depends on the service, the procedure code, the provider type, the payment methodology, and the arrangement behind the claim.
The Division of Medicaid and Medical Assistance (DMMA) runs Delaware’s Medicaid program — you’ll see it referred to as DMAP, the Delaware Medical Assistance Program. Officially, though, the state calls it the Diamond State Health Plan. Most of it moves through managed care organizations (MCOs) — though not all of it. Some services and populations sit outside managed care entirely.
For a provider trying to get paid correctly, that matters. The 2027 rate you’re owed can hinge on the CPT, HCPCS, or CDT code you bill, the modifier attached to it, the effective date, your specialty, whether prior authorization applies, and whether the claim runs through fee-for-service (FFS) Medicaid or an MCO. Miss one of those variables and you’re guessing.
If you’re also verifying a patient’s eligibility before billing, Delaware’s Medicaid income limits are worth checking first — coverage status changes what gets reimbursed and how.
Delaware Medicaid Rates at a Glance
| Service | Main rate/payment approach | What to check |
|---|---|---|
| Physician & professional | DMAP fee schedule/methodology | CPT/HCPCS, modifier |
| Behavioral health | Service-specific methodology | Procedure/service code |
| Dental | Dental schedule and MCO arrangements | CDT, member plan |
| Home health | Service-specific rates | HCPCS, authorization |
| Personal care | Service-specific/managed care | Units, authorization, EVV |
| HCBS/LTSS | Service-specific methodology | Service, provider, authorization |
| DME & supplies | HCPCS-based payment | HCPCS and modifiers |
| Pharmacy | Drug-specific methodology | NDC, formulary, PA |
| Nursing facilities | Institutional methodology | Facility/service type |
| Transportation | Medicaid payment rules | Procedure and provider type |
What Is the Delaware Medicaid Fee Schedule for 2027?
A fee schedule is the list — or in some cases the methodology — that sets the maximum or established payment for a covered service. Some services get a published fee. Others follow a specific reimbursement formula. Others still are governed entirely by an MCO contract.
The Delaware Medical Assistance Portal is where providers go for the real answers: enrollment details, FFS resources, prior authorization rules, and links to each managed-care plan. Bookmark it.
One thing trips people up constantly: FY2027 doesn’t mean every rate changes on the same calendar day. The fiscal year runs July 1, 2026 through June 30, 2027, sure — but individual services and payment arrangements each carry their own effective dates. Don’t assume a July 1 reset applies across the board.
Delaware Medicaid Fee-for-Service vs MCO Rates
This is probably the single most important distinction in the entire topic.
Delaware delivers most Medicaid benefits through MCOs — currently AmeriHealth Caritas Delaware, Delaware First Health, and Highmark Health Options. That structure means the number on an FFS fee schedule and the number that actually lands in your bank account can be two different things.
FFS Medicaid generally follows the state’s applicable fee schedule or reimbursement methodology — straightforward, at least on paper. MCO Medicaid works differently. Payment comes from a contracted arrangement negotiated between the plan and the participating provider.
Home health and personal care make this especially visible. Delaware’s own rate study found MCO payment amounts varying by provider and by service, largely because of how negotiations played out. So here’s the practical takeaway: an online fee-schedule number is a starting point, not a guarantee. Treating it as gospel is how claims get underpaid or denied.
Delaware Medicaid Provider Rates by Service
Physician and Professional Services
Physician reimbursement runs on CPT and HCPCS codes, modifiers, and service-specific methodologies layered on top.
Before you bill, verify:
- CPT or HCPCS code
- Modifier
- Place of service
- Provider specialty
- Effective date
- FFS or MCO status
- Prior authorization requirements
Medicare data occasionally informs Medicaid methodology. That said, don’t assume Delaware Medicaid mirrors the Medicare rate for a given service — sometimes it does, often it doesn’t.
Behavioral Health
Behavioral health billing covers a wide range of providers: physicians, psychologists, therapists, substance-use specialists, and more.
Rates shift based on the exact service code, the provider’s qualifications, the setting, and the payment arrangement in play. There’s no shortcut here — no flat “behavioral health percentage” you can apply across services. Check the specific DMAP schedule or MCO policy tied to the code you’re billing.
Dental Reimbursement
Adult and pediatric dental reimbursement are not the same conversation.
Delaware shifted children’s dental services into managed care on January 1, 2025. If you’re billing for a pediatric patient, the applicable MCO — not DMAP directly — is your source for coverage and payment details.
For any dental claim, you’re working with a CDT code. Confirm the member’s plan, the covered service, the applicable fee schedule, and any authorization requirements before you submit.
Home Health and Personal Care
Don’t expect a single hourly rate to answer everything here — it won’t.
These services span nursing, home health aide visits, and other in-home care. Delaware has run rate studies looking at provider costs, staffing levels, productivity, and how MCOs actually pay in practice. What they found: real variation. Billing-code usage differed across MCOs, and payment amounts swung by provider and by service.
That means a benchmark from an older rate study isn’t automatically your FY2027 payment. Treat historical study numbers as context, not confirmation.
Providers navigating rates across multiple states sometimes find it useful to compare Delaware’s structure against Medicaid reimbursement rates by state — particularly if you operate across state lines or want a sense of where Delaware’s approach lands relative to its neighbors.
HCBS and LTSS
Home and Community-Based Services (HCBS) and Long-Term Services and Supports (LTSS) don’t follow one universal formula. Each program brings its own layer of specifics:
- Individual service definitions
- Units of service
- Provider qualifications
- Authorization
- Care plans
- MCO arrangements
- Specific rate methodologies
Nail down the exact service and its effective period before you bill. Guessing here costs money.
DME and Medical Supplies
Durable Medical Equipment and supplies typically ride on HCPCS codes. Add to that medical necessity documentation and, in many cases, prior authorization.
Skip the assumption that Medicaid pays the same as Medicare for DME. Check the applicable DMAP resource or MCO policy instead — every time, not just once.
Pharmacy
Pharmacy claims follow their own logic entirely, separate from physician or facility billing.
Delaware keeps distinct pharmacy resources for FFS and MCO arrangements, and the state is explicit that FFS prior authorization criteria differ from MCO criteria. Depending on the drug and the claim type, you’re dealing with NDCs, formulary status, prior authorization, MAC pricing, and other drug-specific payment rules.
Nursing Facilities and Institutional Services
Nursing facility payment doesn’t map onto a professional fee schedule — it’s a different system altogether.
Some Delaware Medicaid recipients enrolled in nursing-facility programs don’t get their medical care through an MCO at all. Institutional payment methodologies here are facility-specific and program-specific. A CPT-based mental model won’t get you far.
Transportation
Non-emergency medical transportation is one of the clearer carve-outs from Delaware’s managed-care structure. Along with prescription services, it’s covered directly by Medicaid — not routed through an MCO.
How to Look Up a Delaware Medicaid CPT, HCPCS or CDT Rate
Here’s a process that actually works, step by step:
- Identify the service category. Physician, dental, behavioral health, home health, DME, pharmacy — pin it down first.
- Find the billing code. CPT, HCPCS, or CDT, depending on the service.
- Check the effective date. Confirm the schedule matches FY2027 or the actual date of service.
- Determine FFS or MCO. Never assume an FFS number applies to an MCO claim.
- Check modifiers. They can shift the payable amount more than people expect.
- Confirm authorization requirements. A published rate is not a payment promise.
- Verify current DMAP or MCO policy before submitting. This last step catches most mistakes.
This process matters even more for PCS and HHCS providers. Delaware requires electronic visit verification (EVV) for applicable in-home services, and the provider portal is blunt about it: claims get denied when authorization, visit, and claims data don’t line up.
What Changed for Delaware Medicaid Reimbursement Rates in 2027?
FY2027 needs to be researched on its own terms — separate from FY2026. Rates, policies, and methodologies shift between periods, sometimes significantly.
Keep these categories distinct in your head:
- FY2027 approved rates
- FY2026 historical rates
- Rate-study benchmarks
- Proposed changes
- Budget allocations
- MCO-negotiated payment amounts
A budget allocation is not the same thing as a specific reimbursement increase — conflating the two leads to bad assumptions. And a rate-study benchmark, however detailed, isn’t necessarily what you’ll actually be paid on a given FY2027 claim.
How Providers Can Verify the Correct Delaware Medicaid Rate
Verify before you bill. Not after.
The DMAP Provider Portal is the central resource — enrollment information, FFS and MCO links, and current operational notices covering enrollment, prior authorization, EVV, and other billing requirements.
For MCO claims specifically, go a step further. Check the plan’s provider contract, its fee schedule, its clinical and payment policies, and its authorization requirements. The state portal won’t have MCO-specific contract terms — that’s between you and the plan.
Official Delaware Medicaid Rate Resources
Two starting points cover most of what you’ll need:
- Delaware Medical Assistance Portal for Providers — provider enrollment, FFS information, MCO links, EVV rules, operational updates.
- Delaware Medicaid FAQ — explains the managed-care structure, the MCOs involved, and covered services.
For eligibility questions that sit alongside reimbursement — who qualifies, what income thresholds apply — the Delaware Medicaid income limits page fills that gap.
FAQs About Delaware Medicaid Reimbursement Rates
What are Delaware Medicaid reimbursement rates in 2027?
There isn’t one rate. It depends on the service, the billing code, the provider type, the payment methodology, the effective date, and whether the claim runs through FFS or an MCO.
Where can I find the Delaware Medicaid fee schedule?
Start with the Delaware Medical Assistance Portal for Providers. It’s the main hub for DMAP resources, FFS information, and links to each managed-care plan.
Does Delaware Medicaid have one reimbursement rate?
No. Different services follow different payment methodologies, and managed-care contracts often produce numbers that don’t match the FFS schedule.
How do I look up a Delaware Medicaid CPT code?
Identify the code, confirm the provider and service category, check the current effective schedule, verify modifiers, and determine FFS or MCO status.
What is DMAP?
The Delaware Medical Assistance Program — administered by the state’s Division of Medicaid and Medical Assistance.
Are Delaware Medicaid MCO rates the same as FFS rates?
Not necessarily. Delaware’s own rate-study work documented real variation between MCO payments and the FFS schedule.
Does Delaware Medicaid use Medicare rates?
Sometimes Medicare data informs the methodology. There’s no universal rule that Delaware Medicaid pays the Medicare rate across the board.
What are Delaware Medicaid dental reimbursement rates?
It depends on the CDT code, the service, member eligibility, the applicable fee schedule, and whether FFS or an MCO handles the claim. Children’s dental runs through managed care.
What are Delaware Medicaid home health reimbursement rates?
Rates vary by service and payment arrangement. Check the current DMAP or MCO rate directly — don’t lean on an older rate-study number.
What are Delaware Medicaid HCBS rates?
They vary by specific service, unit, provider requirements, authorization, and the applicable payment methodology.
Do Delaware Medicaid rates change during the year?
Yes. Different programs carry different effective dates, so verify against the actual date of service.
How should providers verify a rate before billing?
Check the applicable DMAP or MCO resource, confirm the code and effective date, review modifiers and authorization requirements, and make sure EVV or documentation requirements are met.
Conclusion
There’s no shortcut around the legwork here. Delaware Medicaid reimbursement is a patchwork of service-specific schedules and methodologies — not a number you can memorize and apply everywhere.
Get the code right. Confirm the date. Know whether you’re dealing with FFS or an MCO. Check authorization before you submit, not after the denial shows up. That’s the whole game, and the DMAP Provider Portal is where you go to play it correctly.
Official Resources
- Check Provider Rates — Delaware Medical Assistance Portal
- Verify Program Details — Delaware Medicaid FAQ (DHSS)
- Find Federal Guidelines — Medicaid.gov
- See State Payment Policy — CMS Medicaid State Plans
Disclaimer: Rates and billing rules shift — sometimes without much notice. Nothing here replaces the current Delaware DMAP fee schedule, official Medicaid guidance, your provider agreement, or the payment policy your MCO has on file. Before you submit a claim, confirm the rate and billing requirements against the actual date of service. That step isn’t optional.
About Naseer
Naseer has 10+ years of experience creating informative content and researching medicare topics. He focuses on simplifying Medicaid and benefits details to support readers find clear, reliable, and easy-to-understand guidance.