Delaware

Key Provisions

• Delaware has not passed any laws that specifically define or regulate Direct Primary Care, meaning practices operate under the state's existing legal framework for medical services and general contract law.
• The Delaware Department of Insurance (DOI) has not issued a formal opinion classifying DPC membership agreements as insurance products. This allows practices to offer services for a flat monthly fee without being subject to the complex regulations governing health insurance carriers.
• All physicians providing DPC services must adhere to the same professional, ethical, and licensing standards set by the Delaware Board of Medical Licensure and Discipline that apply to all medical practitioners in the state.
• DPC patient agreements function as private contracts. These agreements must clearly detail the scope of included services, the membership fee structure, and explicitly state that the DPC membership is not a comprehensive health insurance plan and does not cover specialty, hospital, or emergency care.
• While a state-level issue is absent, a significant federal change impacts Delaware practices. Effective January 1, 2026, the Omnibus Budget Bill of Bipartisan Agreement (OBBBA) allows patients to use Health Savings Account (HSA) funds to pay for DPC fees, up to $150 per month for an individual and $300 per month for a family.

Medicaid Provisions

Delaware's efforts to reform primary care, such as Senate Bill 120, have focused on value-based payment models and achieving reimbursement parity within the Medicaid system. However, these initiatives do not currently include provisions for integrating Direct Primary Care models into the state's Medicaid or state employee health plans. DPC is not a covered service under Delaware Medicaid.