Frequently Asked Questions

What is Delaware First Health?

Delaware First Health is a Medicaid Managed Care health plan offering services to children, adults, pregnant women, families with children, elderly, children and adults with disabilities.

What is a Managed Care Organization (MCO)?

An MCO is an insurance company that contracts with providers and medical facilities to provide health care services to its members.

What services are covered under Delaware First Health?

Delaware First Health services include physical health, behavioral health, pharmacy, long-term services and supports, and home and community benefits.

How do I know if my doctors are contracted with a Delaware Medicaid MCO?

Ask your doctors if they are contracted with Delaware First Health. You can check the Find a Provider webpage on our website to view our online provider directory or consult our Provider Directory. If you have questions about our doctors, contact Delaware First Health Member Services at 1-877-236-1341 (TTY: 711).

If I have Ambetter Health of Delaware or WellCare by Delaware First Health, do I also have Delaware First Health?

No.  Enrollment in Ambetter Health of Delaware or WellCare by Delaware First Health does not mean enrollment in Delaware First Health. 

• Ambetter Health of Delaware is our Marketplace health insurance product.
• Wellcare is our Medicare product.
• Delaware First Health is our Medicaid product. 
• Wellcare by Delaware First Health is our Dual Special Needs Plan (D-SNP) for people who have both Medicare and Medicaid.

Delaware requires exclusive alignment for D-SNP members. This means:

• If you are enrolled in Wellcare by Delaware First Health (our full-benefit D-SNP ), you are also enrolled in Delaware First Health, our Medicaid plan.
• If you are enrolled in Ambetter Health of Delaware, you are not automatically enrolled in Delaware First Health. These are separate programs.

When is open enrollment for Medicaid?

The open enrollment period is in October each year, members do not have to do anything during Medicaid open enrollment to retain your eligibility and benefits. View this page for more information. 

How do I renew my coverage?

If you receive a Delaware Medicaid renewal form, complete it, and return it by following the instructions on the form. If you have questions about benefits or the renewal process, call Delaware Medicaid Customer Relations at 1-866-843-7212.

How do I add my child to my plan?

To apply for benefits for you child, please contact the Medicaid Customer Relations Call Center at 1-302-571-4900 or 1-866-843-7212.

Can I change my Primary Care Provider (PCP)?

Yes. You can change your PCP at any time.

I need to see a specialist, what do I need to do?

Delaware First Health does not require a referral from your PCP to see a specialist for covered services. The Provider specialist may still need a referral or additional information from your PCP. This helps them give you the right treatment. They will tell you if they need a referral. If you would like additional information, you may contact Delaware First Health Member Services at 1-877-236-1341 (TTY: 711).

Does DFH offer telehealth services?

Delaware First Health has partnered with Teladoc Health to offer 24/7 access to health care at no cost to you. Talk to a doctor anytime and anywhere by phone, video, or app. You will have access to in-network providers for non-emergency health issues. Just set up your account online or by phone, directions on our website. You can also receive telehealth  services from your normal providers if they offer that service.

How do I get a member rewards card?

After completing a qualifying healthy activity, a card will be mailed with the applicable reward amount within 12 weeks.  If you have questions please contact customer service at 1-877-236-1341.

What activities can I schedule transportation for?

You can utilize our Whole Health transportation value added benefit for up to four roundtrip rides per month to address non-medical needs such as food insecurity (grocery stores, WIC appointments, food pantries, farmer's markets), housing needs, prenatal support programs, job interviews, childcare, to/from VAB's and DFH events.  Some mileage limitations apply.

You also receive the Standard Medicaid transportation benefits which include transportation to and from doctor's appointments and other non-emergency covered medical services.

What is a Home and Community Benefit?

The “Home and Community Benefit” is the name given to a set of services that help to keep people in their homes and communities. Some of these services include adult day health, respite care, and personal care services.

What services are not covered?

• Services that are not medically necessary
• Abortion unless the pregnancy is the result of rape or incest, or if the woman suffers a life-endangering physical condition caused by, or arising from, the pregnancy itself per Section 508 of PL 110-161 (the Hyde Amendment). The Contractor shall have information on file to demonstrate that any abortions performed were in accordance with Federal law
• Sterilization of a mentally incompetent or institutionalized individual
• Except in an emergency, inpatient hospital tests that are not ordered by the attending physician or other licensed practitioner, acting within the scope of practice, who is responsible for the diagnosis or treatment of a particular patient’s condition
• Infertility treatments
• Cosmetic services, unless the Contractor determines the service is medically necessary
• Christian Science nurses and sanitariums
• Pharmacy-related services such as
  • Any drug or device marketed by a manufacturer who does not participate in the Medicaid Drug Rebate Program
  • Any drug, device, or classes of drugs listed in Section 1927(d)(2)(B), (C), (H), or (K) of the Social Security Act
  • All Drug Efficiency Study Implementation (DESI) drugs, as defined by the FDA
  • Drugs that are lifestyle drugs or that are not medically necessary