Delaware is aging faster than most states. The population over 65 now represents 20% of all residents, compared to 16.84% nationally, making Delaware the eighth-oldest state in the country. More striking, between 2012 and 2022, Delaware's 65+ population grew by 51%—the third-fastest growth rate in the nation. By 2040, adults aged 60 and older will make up nearly 34% of Delaware's population, and the population aged 85 and older is projected to increase by more than 170%.

This guide covers everything agencies need to know about providing home health services in Delaware, from Division of Health Care Quality licensing requirements to Medicaid managed care programs and strategies for building a sustainable caregiver workforce in a small but rapidly aging state.

Delaware Home Health Agency Licensing Requirements

Home health agencies in Delaware must be licensed by the Office of Health Facilities Licensing and Certification (OHFLC) within the Division of Health Care Quality (DHCQ), part of the Delaware Department of Health and Social Services (DHSS). Regulations are established under Title 16 of the Delaware Administrative Code.

License types. Delaware distinguishes between several types of home care providers. Skilled Home Health Agencies (regulated under 3350) provide licensed nursing services, therapy, and home health aide services—these agencies can participate in Medicare and Medicaid. Home Health Agencies-Aide Only (regulated under 3351) provide home health aide services under nursing supervision but do not provide skilled nursing directly. Personal Assistance Services Agencies (PASA) provide non-medical services including assistance with activities of daily living, companion services, homemaker services, and medication reminders—no physician orders required.

Definition of home health agency. A "home health agency" or "HHA" means any business entity which provides, to an individual primarily in their place of residence, two or more home care services, one of which must be either licensed nursing services or home health aide services.

Application fees. For Skilled Home Health Agencies, a nonrefundable application fee is $500, with an annual licensure fee of $300. Personal Assistance Services Agencies pay $250 for application and licensure. Licenses are granted for a period of one year (12 months) to agencies in substantial compliance with regulations.

Administrator requirements. For PASA licensure, the administrator must have a GED and pass a background check. For Aide Only Home Health Agencies, a nurse supervisor with at least one year of supervisory experience is required, and the administrator must hold a bachelor's degree in a health-related field.

Application process. The initial application process for home care agencies involves multiple steps including submitting policies and procedures, completing background checks on all staff, and undergoing an initial survey. According to DHSS, initial licensure can take 9-12 months to complete.

Insurance requirements. Delaware requires agencies to maintain both General/Professional liability insurance and Workers' Compensation coverage.

Background check requirements. Delaware Code requires home health agencies to complete criminal background checks on all persons applying for positions. Additionally, all applicants for employment in home care agencies must submit to drug testing according to state law. The Background Check Center Helpline is (302) 421-7405.

Business formation requirements. Agencies need Secretary of State formation, Statement of Information, Employer Identification Number, State Tax ID, and a National Provider Identification number. A tangible business address is required—P.O. Boxes are not acceptable.

Contact information. The Office of Health Facilities Licensing and Certification can be reached at [email protected] or (302) 292-3030.

Home Health Aide Certification Requirements

Delaware home health aides must meet specific training and experience requirements to work in licensed agencies. The state follows federal minimum standards for Medicare-certified agencies while establishing clear pathways for HHA qualification.

Qualification pathways. To work as a home health aide in Delaware, an individual must meet one of three criteria: (A) have at least one year of practical experience in a Department-licensed or approved hospital, nursing home, or home care setting; (B) have satisfactorily completed an appropriate home care course which includes the training requirements contained within state regulations; or (C) be a student nurse pursuing a degree in nursing who has completed the clinical practicum portion of their training.

Training program requirements. Delaware requires HHA candidates to complete 75 classroom hours and 16 clinical hours before being qualified for certification. The state requires a high school diploma or GED as an educational prerequisite—stricter than some states that only require 9th-grade completion.

Continuing education. Delaware requires HHAs to complete 12 hours of continuing education every 12 months. Home Health Aides who experience a break in service greater than two years must repeat the full 75-hour training requirement.

Competency evaluation. After completing training, candidates must pass a competency examination to demonstrate proficiency in required skills. The exam includes both written and practical skills components.

Registry listing. Upon successful completion of training and examination, HHAs are listed on the Delaware Nurse Aide Registry, which serves as verification of their credentials for employers.

Certified Nursing Assistant (CNA) Requirements

Delaware maintains a robust CNA certification program managed by the Division of Health Care Quality, with testing administered by Prometric. CNAs play a critical role in home health, and many agencies employ CNAs to provide aide services.

Training program requirements. CNA training in Delaware is 150 hours total, comprising 75 hours of in-class instruction and clinical training components. Classroom training covers essential topics including physiology, medical terminology, infection control, nutrition, safety and emergency procedures, anatomy, personal care, patients' rights, law and ethics, and basic nursing principles. All CNA training programs must be approved by the Division of Health Care Quality before they can provide training.

Competency examination. The National Nurse Aide Assessment Program test includes written or oral questions plus a practical skills demonstration. Candidates must score 80% or higher on both components to pass. If you fail one component, you can retest up to three times. After three failures, you must complete another 150 hours of training before becoming eligible to retake the exam.

Background check requirements. All CNA candidates must undergo a criminal background check, which safeguards patient trust by screening for disqualifying offenses.

Alternative pathways. Eligible pathways to the Delaware CNA Registry include: new nurse aides who completed a state-approved 150-hour training program within the past 24 months; nursing students who completed a fundamentals course and supervised clinicals; RN or LPN graduates deemed eligible; out-of-state CNAs with active certification in another U.S. state; and lapsed Delaware CNAs who must retake the exam.

Renewal requirements. CNA certification must be renewed every 24 months. To qualify for recertification, a CNA must complete 24 hours of Department-approved continuing education and perform at least 64 hours of nursing-related services for pay under the supervision of a nurse during each 24-month certification period. The renewal fee is $25. If certification expires before renewal, you must retake the CNA exam through Prometric.

Reciprocity. Delaware allows CNAs from other states to transfer their licenses through reciprocity. To qualify, applicants must hold an active CNA license in good standing without disciplinary issues and have completed training that meets Delaware's minimum of 150 hours. Applicants must have work experience as a CNA within the last 24 months for at least three months full-time or at least 420 hours. The reciprocity fee is $30.

Delaware Nurse Aide Registry. The registry, managed by Prometric on behalf of DHSS Division of Health Care Quality, is the official record of CNAs authorized to work in state-licensed healthcare facilities. To verify if someone is a CNA in good standing, check the Delaware CNA Registry or call (302) 421-7400 extension 4.

Medicaid Reimbursement in Delaware

Delaware's Medicaid program operates through managed care, with home health services covered through the state's HCBS programs. The Division of Medicaid and Medical Assistance (DMMA) administers these programs.

Managed care structure. Delaware operates a managed care program where home health services are provided through contracted health plans. Major managed care organizations include Delaware First Health and AmeriHealth Caritas Delaware, which handle enrollment, care coordination, and provider payments.

Home and Community Based Services. DMMA provides Home and Community Based Services (HCBS) for individuals who meet institutional level of care but choose to receive care at home or in the community. Services include home health aide, personal care, homemaker, respite, and chore services.

HCBS rate study. DMMA, with support from Mercer, conducted a review of payment rates for HCBS including Attendant Care, Companion, Homemaker, Home Health Aide, Respite, and Chore services. The study examined reimbursement to direct support professionals serving Medicaid populations through managed care. Relevant service codes include S5152, S5130, S5120, S5135, G0156, S5150, and T1005 with various modifiers.

Fee schedule. Reimbursements are based upon a Medicaid fee schedule established by the Delaware Medical Assistance Program (DMAP). The fee development methodology considers each component of provider costs. The Agency's fee schedule rate was updated as of November 1, 2025.

Provider enrollment. Provider Relations helps DMAP providers enroll in the Medicaid program, respond to provider inquiries, verify client eligibility, and assist with electronic claims submission. They can be reached at (800) 999-3371.

Provider manuals. Home health providers may access the Delaware Medical Assistance Portal at medicaid.dhss.delaware.gov for provider manuals and documentation. According to the Provider Policy Manual, home health aide services are limited to a maximum of two hours per day. If a condition requires more than the maximum, prior authorization must be obtained by the HHA for additional units.

Medical necessity. The client must have a medical diagnosis and need medically oriented services to qualify for home health coverage. Services must be prescribed by a physician and included in a plan of care.

Medicare Home Health Coverage

Medicare remains a significant payer for home health services in Delaware, particularly given the state's high concentration of seniors. Agencies must understand Medicare requirements to effectively serve this population.

Eligibility requirements. To qualify for Medicare home health coverage, beneficiaries must be homebound (meaning leaving home requires considerable effort due to illness or injury), need skilled nursing care on an intermittent basis or require physical therapy, speech-language pathology services, or continued occupational therapy, have a physician certify the need for home health care and establish a plan of care, and receive services from a Medicare-certified home health agency.

Medicare certification. Agencies seeking to serve Medicare beneficiaries must obtain Medicare certification through CMS in addition to their Delaware state license. This requires meeting federal certification standards through surveys and demonstrating compliance with Conditions of Participation.

2025 rate updates. CMS's Calendar Year 2025 Home Health Prospective Payment System Final Rule set the 30-day standard payment rate at $2,057.35, up from $2,038.15 in 2024. Medicare payments to home health agencies in 2025 are estimated to increase in aggregate by 0.5%, or $85 million, compared to 2024.

Labor Laws and Wage Requirements

Delaware has established a minimum wage above the federal level, with specific considerations for home care workers under both state and federal law.

State minimum wage. As of January 1, 2025, Delaware's minimum wage is $15.00 per hour—a significant increase from previous years reflecting Delaware's efforts to provide fair wages and keep up with rising living costs. Tipped employees have a minimum cash wage of $2.23 per hour, with rules ensuring total earnings meet minimum wage.

Overtime requirements. Delaware does not have state-based overtime laws. Instead, the federal Fair Labor Standards Act (FLSA) applies. Under the FLSA, employers must pay non-exempt workers 1.5 times their regular rate of pay for any hours worked over 40 in a week. For employees earning the $15.00 minimum wage, the overtime rate is $22.50 per hour.

Domestic worker considerations. Under Delaware law, various employees are exempt from minimum wage requirements, including domestic service employees in private homes. Home care workers employed directly by households may fall under this exemption. However, those employed by agencies are generally covered under standard wage laws. Additionally, federal FLSA protections may apply depending on the specific employment arrangement.

Exemptions from overtime. Employees exempt from FLSA overtime include: administrative, executive, and professional employees earning at least $684 per week; highly-compensated employees earning at least $107,432 per year; outside salespersons; and computer professionals earning at least $684 per week or $27.63 per hour.

Home health aide wages in Delaware. According to Indeed, the average salary for a Home Health Aide in Delaware is $15.47 per hour, with an average of $4,000 in overtime per year. Some employers advertise starting wages at $17 per hour plus cash incentives, positioning these as among the highest wages in the state for this occupation.

Delaware's Workforce Challenges

Delaware faces significant home health workforce challenges driven by its rapidly aging population, geographic distribution of healthcare providers, and competition for workers in a small state.

Rapidly aging population. Delaware's 65+ population represents 20% of all residents—compared to 16.84% nationally—making it the eighth-oldest state in the country. Between 2012 and 2022, Delaware's senior population grew by 51%, the third-fastest growth rate in the nation. By 2040, adults aged 60 and older will make up nearly 34% of the population, with the 85+ population projected to increase by more than 170%.

Dependency ratios. Delaware's old-age dependency ratio is 31.9 persons aged 65 or over per 100 persons aged 15-64. The total dependency ratio is 59.3, and the potential support ratio (working-age population per elderly person) is just 3.1—meaning fewer workers available to care for each senior.

Healthcare system strain. Delaware has quietly become one of the fastest-aging states, reshaping how health care is delivered. As more retirees settle in the state and longtime residents grow older, the strain on hospitals, primary care providers, and long-term care systems is mounting.

Geographic maldistribution. Delaware has significant "maldistribution" of healthcare providers—a large percentage of healthcare practitioners are located in New Castle County, which has numerical advantages over Kent and Sussex Counties in both gross numbers and provider-to-population ratios. This creates access challenges for seniors in less populated counties.

Declining home health aide availability. Delaware is one of 16 states with declines of 10% or more in access to home health aides since 2019, indicating a worsening workforce shortage despite growing demand.

National context. All 50 states reported workforce shortages in 2024, with the most common shortages among direct support professionals and personal care attendants (48 states each), followed by nursing staff and home health aides (47 states each). By 2030, demand for home health care is anticipated to grow by 46% nationally, with more than 1 million new home care jobs needing to be filled.

Family caregiver supports. Delaware has approximately 124,000 family caregivers. The state is one of only seven with statewide laws protecting caregivers from discrimination in the workplace, and one of twelve states with paid family leave laws allowing paid time off for caregiving.

AARP state ranking. Delaware ranks #17 nationally for long-term care services and supports for older Americans according to AARP's scorecard, indicating a moderate performance compared to other states.

Strategies for Delaware Agencies

Given Delaware's specific market dynamics—a rapidly aging population, geographic concentration of workers, and a small but competitive labor market—agencies must adopt targeted strategies to succeed.

Competitive compensation is essential. With Delaware's minimum wage at $15.00 per hour, agencies paying near-minimum will struggle to attract workers. The average HHA wage of $15.47 per hour is only slightly above minimum wage. Leading employers offering $17+ per hour with incentives are setting the market standard agencies must match or exceed.

Address geographic distribution. Since healthcare workers concentrate in New Castle County, agencies serving Kent and Sussex Counties face additional recruitment challenges. Consider transportation assistance, mileage reimbursement, or recruiting specifically from underserved areas.

Build training partnerships. With the 150-hour CNA training requirement and 75-hour HHA training requirement, partnering with approved training programs can help build your workforce pipeline. Consider sponsoring students or offering guaranteed employment upon completion.

Leverage family caregiver protections. Delaware's strong family caregiver protections and paid family leave laws mean many potential caregivers may have experience caring for family members. Target recruitment messaging to this population who may be ready to transition to professional caregiving.

Focus on retention. Given Delaware's small labor market and workforce shortages, retention is paramount. Every caregiver who leaves requires recruiting from a limited pool. Invest in onboarding, consistent scheduling, supervisor support, and recognition programs.

Create career pathways. The lack of career advancement is a documented retention barrier nationally. Create clear pathways from HHA to CNA to higher credentials. Delaware's training requirements create natural stepping stones—help workers move through them.

Monitor managed care relationships. With Delaware's Medicaid operating through managed care, relationships with Delaware First Health and AmeriHealth Caritas Delaware are critical. Understand their rates, requirements, and referral processes.

Stay engaged with regulatory developments. The HCBS rate study could result in payment changes. Monitor DMMA announcements and participate in stakeholder processes when possible.

Key Resources and Contacts

Agencies operating in Delaware should maintain relationships with these key regulatory and support organizations:

Division of Health Care Quality - Office of Health Facilities Licensing and Certification
State Licensing Section
Phone: (302) 292-3030
Email: [email protected]
Website: dhss.delaware.gov/dhcq

Delaware Nurse Aide Registry (Prometric)
CNA certification and reciprocity
Phone: (302) 421-7400 ext. 4
Website: registry.prometric.com/publicDE

Background Check Center
Phone: (302) 421-7405

Division of Medicaid and Medical Assistance (DMMA)
Delaware Medicaid
Provider Relations: (800) 999-3371
Website: dhss.delaware.gov/dmma
Provider Portal: medicaid.dhss.delaware.gov

Delaware First Health
Managed Care Organization
Website: delawarefirsthealth.com

AmeriHealth Caritas Delaware
Managed Care Organization
Website: amerihealthcaritasde.com

Division of Industrial Affairs
Wage and Hour Section
Minimum wage and labor law information
Website: industrialaffairs.delaware.gov/wage-hour

Business First Steps
State of Delaware business licensing portal
Website: firststeps.delaware.gov

The Bottom Line

Delaware presents both significant opportunities and real challenges for home health agencies. The state's rapidly aging population—with 20% already over 65 and the senior population growing at the third-fastest rate in the nation—ensures sustained and growing demand for services. The regulatory environment through the Division of Health Care Quality provides clear pathways for licensing, and the managed care Medicaid structure offers predictable contracting relationships.

However, the workforce challenge is significant. Delaware is one of 16 states with declining access to home health aides since 2019. The small state means a limited labor pool, and geographic maldistribution of healthcare workers creates particular challenges for agencies serving Kent and Sussex Counties. Competition for workers is fierce in a state where caregivers can easily access opportunities across county lines.

Success in Delaware requires understanding DHCQ licensing requirements and the distinction between skilled, aide-only, and PASA license types, navigating the managed care Medicaid structure effectively through relationships with contracted health plans, offering competitive compensation that meaningfully exceeds the $15.00 minimum wage, developing recruitment strategies that account for Delaware's geography and workforce distribution, and building retention programs that reduce turnover in a market where every departure is costly.

The demand for home health services in Delaware will continue accelerating as the population ages. Agencies that invest in competitive wages, build strong training partnerships, create career pathways, and develop supportive workplace cultures will be best positioned to meet this growing need while building sustainable businesses in the First State.