What is Integrated Supports Day Habilitation in Delaware?

Integrated Supports Day Habilitation is a proposed new provider type under Day Habilitation in Delaware's DDDS Lifespan Waiver. It is meant for people whose physical disability or medical complexity goes beyond what traditional day habilitation offers, and adds licensed nurse oversight, licensed therapist consultation, skilled nursing tasks and adaptive equipment. The need must be shown in a structured assessment and written into the person's plan.

What is benefits counseling in a Medicaid waiver?

Benefits counseling, also called work incentive counseling, helps people on Medicaid and disability benefits understand how earnings affect those benefits and which work incentives they can use. In Delaware's proposed Lifespan Waiver amendment it includes written Benefits Summaries and Analyses and Work Incentive Plans, capped at 20 hours per plan year with exceptions.

Delaware proposes 2 new Lifespan Waiver services; comments due Dec. 15

Delaware proposes adding Integrated Supports Day Habilitation and Benefits Counseling to its DDDS Lifespan Waiver for people with IDD. Public comments are due Dec. 15, and the amendment would take effect July 1, 2027.

policy · delaware · hcbs · waiver-amendment · day-habilitation · benefits-counseling · public-comment · deep-dive

Direct Support News desk · November 1, 2026 · Updated November 3, 2026 · 5 min read

Delaware is proposing to add two services to its main Medicaid waiver for people with intellectual and developmental disabilities. One is a more intensive form of day habilitation for people with complex physical or medical needs. The other is benefits counseling for people who want to work without losing health coverage and other benefits.

The Delaware Health and Social Services Division of Medicaid and Medical Assistance (DMMA) published the public notice in the Nov. 1, 2026 Delaware Register of Regulations. Written comments are due by 4:30 p.m. on Dec. 15, 2026. The draft amendment to the Division of Developmental Disabilities Services (DDDS) Lifespan Waiver lists a proposed effective date of July 1, 2027.

The Lifespan Waiver

The DDDS Lifespan Waiver is Delaware's 1915(c) HCBS waiver for people with IDD, including brain injury, as well as autism spectrum disorder and Prader-Willi syndrome. According to the notice, it has operated continuously since 1987. Changes between five-year renewals have to go through an amendment and a public input process under 42 CFR 441.304. The draft application's cost tables plan for an estimated 3,136 unduplicated participants a year.

New service 1: Integrated Supports Day Habilitation

The amendment adds Integrated Supports Day Habilitation (ISDH) as a new provider type under the existing Day Habilitation service. According to the draft, it is meant for people whose needs go beyond what a traditional day habilitation setting provides because of a physical disability or medical condition. The draft says:

Mobility and health supports. The service is built around helping people build motor skills for sitting, standing, walking and transferring, using equipment such as adaptive chairs, standers and gait trainers.
Licensed therapists. Providers must engage licensed physical, occupational or speech therapists to set up individual therapeutic supports. This is meant to add to, not replace, therapy covered under the Medicaid state plan.
Nurse oversight and skilled nursing. A licensed nurse oversees the clinical supports during the program day, does fall-risk and aspiration assessments, and monitors medication administration by direct care staff. Providers must also make sure skilled nursing tasks that only a licensed nurse can perform are available, such as G/J-tube feedings, catheter and ostomy care, suctioning, and wound care.
Who qualifies. People who need intensive help with lifting, transferring and walking, safe eating and drinking, or incontinence care, and people with skilled nursing needs such as airway management or enteral feeding that cannot be delegated to a direct support professional under the Delaware Nurse Practice Act. The need must show up in a structured assessment and be written into the person's plan.
Transportation. Transportation to and from the program can be billed separately on days it is used. The draft says it cannot duplicate Medicaid non-emergency medical transportation.

The cost tables show no ISDH use in the first three waiver years. Year 4 projects 21 people at $15.40 per 15-minute unit, for about $1.2 million.

New service 2: Benefits Counseling

Benefits Counseling would give work incentive counseling to people who want to work while keeping health care and other benefits. The draft describes helping people understand work incentives and how earnings affect their benefits, and producing written Benefits Summaries and Analyses and Work Incentive Plans.

The service is capped at 20 hours per person per plan year, with exceptions DDDS can approve for exceptional need. Providers must document that the service is not available through vocational rehabilitation or special education funding. Delaware also says it will make sure people cannot get it from any other source, including the Social Security Administration and its WIPA program. The cost tables budget 50 users at $29.92 per 15-minute unit.

Rates

The draft says DDDS computes a single rate for most Lifespan services, including both new ones, using a fee schedule method based on cost assumptions for each service. DDDS last rebased its waiver rates in a rate study completed in November 2025. The Delaware legislature then approved a rate increase effective July 1, 2026, set as a percentage of the study rates.

How to comment

Email: DHSS_DMMA_PublicComment@delaware.gov, with "DDDS Lifespan Waiver Amendment" in the subject line.
Fax: 302-255-4413, attention Melissa Dohring.
Mail: DDDS Lifespan Waiver Amendment, Division of Medicaid and Medical Assistance, Planning, Policy & Quality Unit, 1901 North DuPont Highway, P.O. Box 906, New Castle, DE 19720-0906.

Public hearings, each also on Zoom:

New Castle County: Nov. 16, 10 to 11 a.m., DDDS Fox Run Office, 2540 Wrangle Hill Road, Suite 200, Bear.
Kent County: Nov. 17, 1 to 2 p.m., DDDS Annex, 391 A Rehoboth Blvd., Milford.
Sussex County: Nov. 24, 6 to 7 p.m., Lewes Public Library, 111 Adams Ave., Lewes.

Printed copies are available through Dec. 15 at the DDDS Fox Run Office in Bear, the Thomas Collins Building and Woodbrook Office in Dover, and the Stockley Center campus in Georgetown. People who need accommodations for a hearing, such as sign language interpretation, should contact Larry Pusey at Larry.Pusey@delaware.gov or 302-744-9714 at least 10 days before. The draft also lists a DDDS Quarterly Provider Meeting on Nov. 4 as one place the amendment will be shared.

What this means for providers and DSPs

A new day program model with clinical staffing. Day habilitation agencies thinking about ISDH would need licensed nurses and therapist consultation on top of direct support staff, plus adaptive equipment such as lifts, changing tables and specialized seating. Providers must be credentialed by DDDS for the new provider type.
Clearer lines on nursing tasks. The draft spells out which tasks stay with licensed nurses, and it has the ISDH nurse monitor medication administration done by direct care staff. Staff in day programs serving people with complex medical needs will want to read those service definitions closely.
More people may try work. Benefits counseling targets one of the most common worries about jobs: losing Medicaid or cash benefits. Supported employment and day providers may see more people asking about work once the service is available.
Comment window. Agencies, DSPs, families and self-advocates can weigh in on unit rates, the 20-hour cap and who qualifies for ISDH before Delaware sends the amendment to CMS. DDDS says it will summarize public feedback and any changes it makes in response.