How Delaware pays for disability services

Waiver inventory

Delaware terminated its Elderly and Disabled and AIDS/HIV waivers in 2012 when it folded them into the 1115. The Lifespan Waiver is the state's single IDD waiver; there is no separate supports waiver or children's waiver.

State-only funded programs

• Purchase of Community Services, $27,061,200 General Fund plus $4,843,500 Appropriated Special Fund in FY 2026 (total $31,904,700). Buys community services for people who are DDDS-eligible but not Lifespan Waiver enrollees or not Medicaid-eligible. DDDS. FY 2027 recommendation adds $829,300 for 70 people entering residential services, $82,700 for 348 people entering community-based services, and $184,200 for a Direct Support Professional rate increase. budget.delaware.gov
• Tobacco Fund: Autism Supports, $460,000 Appropriated Special Fund in FY 2026, reduced to $230,000 in the FY 2027 recommendation on Health Fund Advisory Committee recommendation. DDDS Administration. Same source.
• Tobacco Fund: Family Support, $36,300 Appropriated Special Fund in FY 2026, eliminated in the FY 2027 recommendation. DDDS Community Services. Same source.
• DDDS state-funded respite. Available to people age 4 and older who are preliminarily or fully DDDS-eligible and lack respite funding through a Medicaid waiver. Minimum 1 hour, maximum 10 hours per day, requested at least two weeks in advance, paid by the family and reimbursed by the state roughly six weeks after service. Subject to fund availability. Appropriation not separately broken out; it sits inside Purchase of Community Services. dhss.delaware.gov
• Stockley Center, $18,519,100 General Fund plus $295,000 non-appropriated special fund in FY 2026 (total $18,814,100), 198.6 positions. State-operated ICF/IID in Georgetown. Partially Medicaid-reimbursable as an ICF/IID; the General Fund line is the state's gross cost. Same budget source.

County / regional / local funding

None identified. Delaware's three counties (New Castle, Kent, Sussex) do not levy for or fund developmental disability services; DDDS operates statewide from a single appropriation with regional offices in New Castle and Kent/Sussex. Checked: the FY 2027 Governor's Recommended Operating Budget Health and Social Services volume, the DDDS website, and the Lifespan Waiver application (Appendix B-3-e explicitly selects statewide allocation of waiver capacity rather than allocation to local or regional non-state entities).

Funding scale

• Total DDDS appropriation, all funds: $150,291,100 FY 2025 actual; $171,176,900 FY 2026 budget; $194,000,800 FY 2027 Governor's recommendation. General Fund portion: $127,349,600 / $152,908,300 / $175,995,000. budget.delaware.gov
• DDDS State Match line (the state share of Lifespan Waiver claims): $77,007,100 FY 2025 actual; $87,266,000 FY 2026; $109,303,900 FY 2027 recommended, including a $10,398,700 enhancement for a Direct Support Professional rate increase and $10,583,900 for volume growth. Same source.
• Grossed up at the FY 2026 FMAP, the $87,266,000 state match implies roughly $215 million in total Lifespan Waiver computable spending for FY 2026. This is a derived figure, not a published one.
• Waiver cost-neutrality projection: total waiver services of $311,139,654 for 3,136 participants in waiver year 1, a Factor D of $99,215.45 per participant, rising to $110,763.28 by year 5. Adding Factor D' (other Medicaid services), total per-participant cost is $114,256.53 in year 1. Institutional comparison (Factor G plus G') is $511,375.55. dhss.delaware.gov
• Residential Habilitation alone accounts for $257,310,770 of the $311.1 million waiver year 1 estimate, or 82.7 percent. Day Habilitation is $28,492,585. Same source.
• People served: 3,136 unduplicated waiver capacity, of whom the cost model assumes 1,125 in group homes or community living arrangements, 102 in shared living, 725 in facility-based day habilitation per diem, 400 in individual supported employment.
• FMAP: 59.41 percent for FY 2026. kff.org
• Waiting list: no published count located. DDDS does not operate a date-ordered waiting list. Instead it reserves capacity each year (60 slots for emergency risk, 100 for school graduates rising to 115 by year 5, 5 for people returning from institutions) and, beyond reserved capacity, admits by a standardized risk assessment tool sorting applicants into Emergency, High Risk and Intermediate Risk categories. The only "waitlist" performance measure in the FY 2027 budget document (417 in FY 2025, 426 budgeted FY 2026, 436 FY 2027) belongs to the Division of Services for Aging and Adults with Physical Disabilities personal care and respite program, not DDDS.

Residential funding detail

Neighborhood Group Home / Community Living Arrangement. This is Delaware's 24-hour group home model. It is billed as a per diem, but the per diem is computed rather than fixed: DDDS multiplies a computed hourly rate by the number of approved hours per day of direct support the person is assessed to need. The base hourly rate is $39.43, raised to $41.92 effective January 1, 2025 when the Delaware minimum wage went to $15 per hour and all DDDS rates built on a lower wage were leveled up. Two premium tiers exist: $47.92 per hour where the direct support worker is a Registered Behavior Technician, and $61.67 per hour where the worker is fluent in American Sign Language. Support hours are set using the Inventory for Client and Agency Planning (ICAP).

Shared Living Arrangement, independent contractor model. The host is an independent contractor. Computed hourly rate $14.11, leveled up to $15.00 effective January 1, 2025; $22.07 for an ASL-fluent host.

Shared Living Arrangement, agency model host homes. Fixed per diems by six acuity levels and by host qualification. Non-skilled host home: $117.14 (Level 1), $141.64, $175.94, $229.56, $279.57, $329.59 (Level 6). ASL-fluent host home: $146.09 to $426.54. Registered Nurse host home: $259.51 to $806.37. Agency as a provider type for shared living was added in the July 2024 renewal.

Medical Residential Habilitation. Nurse-delivered residential support, priced per member per day and discounted for shared coverage. RN: $97.69 for one member, $48.84 for two, $32.57 for three. LPN: $70.83, $35.42, $23.61. Shared Living independent contractor model: $41.83, $20.92, $13.94.

Supported Living. $60.49 per hour, up to 40 hours per week of support for people living more independently. Does not include room and board.

In-home and family settings. Personal Care is capped in combination with Respite at $5,000 per year (raised from $3,500 in the July 2024 renewal). Home and Vehicle Modifications are capped at $10,000 combined (raised from $6,000).

Room and board. Payments for residential habilitation, shared living arrangement services, medical residential habilitation and supported living are explicitly not made for room and board. There is no state room and board subsidy line in the DDDS budget. Room and board falls to the individual's SSI, SSDI and earned income.

ICF/IID. Stockley Center is the state ICF/IID. The respite line of the fee schedule prices an ICF/IID respite per diem at $1,402.87 using the approved FFY 2023 public ICF/IID Medicaid rate, which is the best published proxy for the state ICF/IID per diem in the retrieved sources.

Rate structure link: dhss.delaware.gov

Comparable service rates

Official rate schedule links

• DDDS Provider Rates index page: dhss.delaware.gov
• SFY 2025 DDDS HCBS 1915(c) Lifespan Waiver provider rates, effective July 1, 2024 (most recent HCBS schedule posted as of August 29, 2026): dhss.delaware.gov
• SFY 2026 Targeted Case Management fee schedule, effective July 1, 2025: dhss.delaware.gov
• SFY 2025 Pathways to Employment 1915(i) fee schedule, effective July 1, 2024: dhss.delaware.gov
• FY 2024 DDDS HCBS provider rates, effective July 1, 2023: dhss.delaware.gov
• SFY 2025 TCM rates: dhss.delaware.gov
• DDDS Lifespan HCBS Waiver provider-specific policy manual: dhss.delaware.gov

Notable features and flags

• January 1, 2025: the Delaware minimum wage rose to $15 per hour and DDDS leveled up every rate built on a lower wage assumption. Residential habilitation went from $39.43 to $41.92 per hour and facility-based day habilitation from $10.28 to $10.93 per 15 minutes. Delaware states this affected only residential habilitation and facility-based day habilitation and prevocational service.
• No SFY 2026 HCBS fee schedule has been published as of August 29, 2026. The DDDS rates page still shows FY 2025 (July 1, 2024) as the current HCBS schedule while showing a current SFY 2026 targeted case management schedule. Providers are operating on rates set two fiscal years back for HCBS, which is a real flag for capacity.
• August 14, 2025: Delaware submitted a Lifespan Waiver amendment proposed effective July 1, 2026 adding Enhanced Behavioral Residential Services, Remote Support Services, and Crisis Respite as a component of respite, and cutting the maximum Group Supported Employment group size from eight workers with disabilities to five, framed as pushing group employment toward competitive integrated employment.
• July 1, 2024 renewal (DE.0009.R09.00) raised the combined Respite and Personal Care annual allotment from $3,500 to $5,000, raised combined Home and Vehicle Modifications from $6,000 to $10,000, added agency as a provider type for Residential Habilitation in a Shared Living setting, added Organized Health Care Delivery System as a provider type for underused services, and allowed Individual Supported Employment, Behavioral Consultation and Nurse Consultation to be delivered virtually.
• The FY 2027 Governor's recommendation includes a $10,582,900 enhancement across DDDS State Match and Purchase of Community Services for a Direct Support Professional rate increase, plus volume funding for 70 additional people in residential services and 348 in community-based services. If enacted this drives DDDS total funds from $171.2 million to $194.0 million, a 13.3 percent increase.
• Delaware is unusual in publishing explicit ASL-fluent and Registered Behavior Technician premium tiers across residential, day and employment services, and in reserving 100 or more waiver slots annually specifically for people exiting K-12 special education, coordinated with the Department of Education.
• Health Fund (tobacco settlement) support for Autism Supports is being halved in FY 2027 ($460,000 to $230,000) and Family Support is being zeroed out ($36,300 to $0).

Confidence

Solid: waiver identifier, unduplicated participant caps, reserved capacity structure, Factor D and the full Appendix J service-by-service cost build, every rate on the SFY 2025 HCBS and SFY 2026 TCM schedules, the FY 2025 through FY 2027 DDDS appropriation lines and their internal composition, and the 59.41 percent FMAP. Estimated: the roughly $215 million total computable Lifespan Waiver spend for FY 2026, which I derived by grossing up the published $87,266,000 state match at the FMAP rather than reading a published total. Could not find: an SFY 2026 or SFY 2027 HCBS fee schedule (none is posted); Pathways to Employment 1915(i) enrollment (the DMMA-hosted 1915(i) PDF has parentheses in its filename that broke retrieval, and the DDDS provider-side copy does not carry enrollment); any published DDDS waiting list count; and the University of Kansas State of the States Delaware profile.

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