Using Medicaid: MCOs, Providers, Rides, Language & Appeals

This is the practical layer: choosing and using an MCO, finding a provider who is accepting patients, arranging transportation, getting language assistance, and challenging an adverse Medicaid decision. [DE-N1, DE-N2, DE-N3, DE-N4, DE-N7]

A benefit on paper can still be hard to use. After birth you may need OB, primary, dental, behavioral, pharmacy and doula care plus transportation, newborn coverage and paperwork help.

Most full-benefit members receive care through the Diamond State Health Plan and one of three MCOs. Non-emergency medical transportation is available statewide to fully eligible Medicaid and DHCP members for covered services when transportation is needed. Language and hearing rights apply under program rules. [DE-N1, DE-N4, DE-N7]

MCO Member Services and care coordination; a provider search that filters by plan, ZIP or county, specialty, gender, language, accessibility and TTY; non-emergency medical transportation through Modivcare; language resources; and a fair hearing when a benefit is denied, suspended, delayed, reduced or terminated. [DE-N3, DE-N4, DE-N6, DE-N7]

These supports apply while you are an applicant or member and the benefit is active. NEMT applies to qualifying trips. The current fair-hearing timeframe is 90 days from the Notice of Action. [DE-N7]

NEMT is Medicaid-covered for eligible trips, language assistance is provided through DSS and Medicaid, and member-navigation calls carry no separate fee.

For MCO selection, call 1-800-996-9969, TTY 711. Use the Medicaid portal provider search, then confirm directly with the provider and your MCO. For transportation, call Modivcare at 1-866-412-3778 and book routine rides at least 3 days ahead. For a fair hearing, follow the instructions on your Notice of Action by email, fax, mail or in person. [DE-N2, DE-N3, DE-N4, DE-N7, DE-N8]

Your Medicaid information, location and the service you need; for NEMT, your eligibility and appointment details; for a hearing, your Notice of Action, case information and evidence.

A directory listing does not guarantee a provider is accepting new patients. NEMT is not on-demand or emergency transportation and generally needs 3 days' notice. The hearing deadline is strict, and asking a caseworker to reconsider does not replace a formal appeal.

This layer supports every other profile: your MCO can help with providers, behavioral health, doula services and nutrition screening; Modivcare handles appointment rides; and the fair-hearing process addresses adverse decisions.

MCO Member Services numbers: AmeriHealth Caritas Delaware 1-844-211-0966; Delaware First Health 1-877-236-1341; Highmark Health Options 1-844-325-6251. If you do not know your plan, use the Member Portal or the Health Benefits Manager. [DE-N1, DE-N2]

Provider search includes a language filter, and translated materials and interpreters are available — request a qualified interpreter. Cultural concordance is a separate question.

If Medicaid ends or is denied, use ASSIST and screening for other coverage, and request a fair hearing if the decision is wrong. Delaware 211 can connect you to community resources.