Page 1

TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE 1 DEPARTMENT OF HEALTH AND SOCIAL SERVICES Division of Social Services Division of Social Services 25000 Children’s Community Alternative Disability Program (CCADP) This program was formerly known as the Disabled Children’s Program and is based on 42 CFR §435.225. 25050 PURPOSE The Children’s Community Alternative Disability Program (CCADP) is a Delaware Medicaid option that is designed to serve children with significant disabilities. Such children would otherwise qualify to be cared for in an institutional setting. The State desires that this program serve as many children as possible at home or in non-institutional settings as long as it can be done safely, efficiently and economically. The best care for children who would be eligible for this program is with the support and direction of involved parents or guardians. This care will generally result from the active collaboration of DSS, and multidisciplinary providers, and parents or guardians. In general, any child whose disability profile meets a designated level of care may be eligible for Medicaid without regard to parental income, resources, or other health insurance. Given the State’s commitment to promoting children’s access to basic health care, any benefit of the doubt concerning program qualification should be resolved in favor of eligibility. To the extent eligibility is jeopardized by safety concerns, DSS will act affirmatively to eliminate or reduce unsafe conditions to an acceptable level through Departmental and community resources. DSS recognizes its responsibility to make a referral to a protective agency if conditions so warrant. 25100 ELIGIBILITY Medicaid eligibility is available to children who meet ALL of the following 7 criteria established by Federal regulation (42 CFR §435.225): 1 . The child must be 18 years of age or younger (under age 19). 2 . The child’s countable resources do not exceed the SSI limit for a single individual described in DSSM §20300. 3 . The child’s countable income does not exceed 250% of the SSI benefit level. 4 . The child’s profile is consistent with the level of care of a hospital, Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), Intermediate Care Facility for Mental Retardation (ICF/MR), or Intermediate Care Facility Institution for Mental Disease (ICF/IMD). 5 . The child must meet Supplemental Security Income (SSI) medical disability standards codified at 42 U.S.C. § 1382c(a) (presumptively met if child with chronic condition qualifies for SNF, ICF, ICF/MR, or ICF/IMD level of care). 6 . It is appropriate to provide a comparable level of care in an alternative setting (e.g. natural family home). 7 . The estimated Medicaid cost of care in the alternative setting is no higher than the estimated cost of the comparable facility-based level of care. 25100.1 Continuous Eligibility (42 CFR 435.926) Effective January 1, 2024, all children under the age of 19 who are enrolled in Medicaid under any eligibility program, including the Childrens Community Alternative Disability Program (CCADP) shall have 12 months of continuous eligibility, regardless of change in circumstances, with limited exceptions. Refer to DSSM 14810 Continuous Eligibility for additional information. 27 DE Reg. 680 (03/01/24) 25110 Managed Care Enrollment Requirements Individuals who are found eligible must enroll with a managed care organization. The Health Benefits Manager (enrollment broker) will be responsible for the enrollment process. 15 DE Reg. 1716 (06/01/12) 25150 APPROVAL DURATION AND ANNUAL REDETERMINATION Approval of an initial application is generally effective for a period not to exceed 1 year. Redetermination of eligibility is expected to occur on an annual basis. Redetermination shall include a reassessment of whether the child meets all seven eligibility criteria (DSSM 25100). If a child manifests a chronic profile, the Division may utilize abbreviated reassessment process and rely on previous medical or functional evaluations

Office of the Registrar of Regulations, Legislative Council, State of Delaware