A requirement for Delaware Medicaid is that recipient must be Delaware resident.

Any individual who lives in Delaware with the intention to remain permanently or for an indefinite period or where the individual is living and has entered with a job commitment, or seeking employment whether or not currently employed.

An individual is considered incapable of indicating intent if one of the following applies to the individual:

a. Individual has an I.Q. of 49 or less or has a mental age of 7 or less.

b. Individual is judged legally incompetent.

c. Individual is found incapable of indicating intent based on medical documentation obtained from physician, psychologist, or other person licensed by the State in the field of mental retardation.

An individual who is placed in an institution in another State by a Delaware agency including an entity recognized under State law as being under contract with the State for such purposes is considered a Delaware resident. The State arranging or actually making the placement is considered as the individual's State of residence. Any action beyond providing information to the individual and the family constitutes arranging or making a State placement.

The following actions do not constitute State placement:

a. Providing basic information to the individual about another State's Medicaid and information about the availability of services and facilities in another State.

b. Assisting an individual in locating an institution in another State, provided the individual is capable of indicating intent and independently decides to move.

c. A competent individual leaves the facility in which he/she is placed by State, the individual’s State of residence for Medicaid purposes is the State where individual is physically located.

Where a placement is initiated by a State because the State lacks a sufficient number of appropriate facilities to provide services to its residents, the State making the placement is the individual's State of residence.

a. SSI-related individuals - For an individual not residing in an institution, the State of residence is the State where the individual is living.

b. AFDC/TANF-related individuals - For individuals not residing in an institution use the title IVA regulation at 45 CFR 233.40(a) for determining residency. The State of residence is where the individual is living other than on a temporary basis or where the caretaker is a resident.

NOTE: An institution includes medical institution, child care institution or foster care home.

c. Individuals who are emancipated/married - For any individual who is emancipated from his or her parents or who is married and capable of indicating intent, the State of residence is where the individual is living with the intention to remain there permanently or for an indefinite period.

d. Individuals who are institutionalized - For any institutionalized individual who is neither married nor emancipated, use one of the following:

1. the parent's or guardian's State of residence at the time of placement

2. current state of residence of the parents or legal guardian if the individual is institutionalized in that State

3. when the parent's State of residence is used and the parents live in different States, the State of residence of the parent filing the application for assistance is the individual's State of residence.

4. if a legal guardian is appointed and parental rights have been terminated, the State of residence of the guardian is used instead of the parent

5. if the individual has been abandoned by the parents (including deceased parents) and there is no legal guardian, use the State of residence of the individual who files the application if the individual is institutionalized in that State.

a. For any institutionalized individual who became incapable of indicating intent before age 21, the State of residence is: the parent's or legal guardian's State of residence at the time of placement or if a legal guardian is appointed and parental rights are terminated, the State of residence of the guardian is used.

b. For any institutionalized individual who became incapable of indicating intent at or after age 21, (irrespective of any type of guardianship) the State of residence is the State in which the individual is physically present, except where another State makes a placement.

c. For any non-institutionalized individual incapable of indicating intent at or after age 21, the State of residence is where the individual is living.

Factors which must be taken into account when determining residency are variables such as age, institutional status, and ability to express intent. When determining residency, there are prohibitions and exceptions that must always be considered.

A State cannot deny Medicaid eligibility:

a. to an otherwise qualified resident of the State because the individual's residence is not maintained permanently or at a fixed address.

b. because of a durational residence requirement.

c. to an institutionalized individual because the individual did not establish residence in the community prior to admission to an institution.

c. or terminate a resident's Medicaid eligibility due to temporary absence from the State if the person intends to return when the purpose of the absence has been accomplished, unless another State has determined that the person is a resident there for purposes of Medicaid.

e. or wait to approve Medicaid eligibility in situations where the individual has moved to Delaware from another State and the Medicaid case is still open in the former State. The individual is no longer a resident of the former State and is ineligible in that State. The case may not be closed yet due to administrative processes.

When one of the following exists, it supersedes the general residency policy.

a. Exception for individuals receiving a State Supplementary Payment, the State of residence is the State making the payment.

b. Exception for individuals of any age who are receiving Federal payments for foster care under title IV-E of the Social Security Act, and individuals for whom there is an adoption assistance agreement in effect under title IV-E, the State of residence is the State where the individual is living.

c. Exception where a State or agency of the State, including an entity recognized under State law as being under contract with the State, arranges for an individual to be placed in an institution in another State, the State arranging that placement is the individual's State of residence.

d. Exception when residency is disputed - When two or more States cannot resolve which State is the State of residence, the State in which the individual is physically located is the State of residence.