We caregivers understand the dedication, late nights, and unwavering support required to care for a loved one. Caring for someone you love can be a stressful logistical and financial nightmare, especially when it comes to healthcare. The Health Insurance Premium Payment Program (HIPP Program) is meant to provide needed relief, helping you navigate the complexities of healthcare plans and reducing your monetary burden.
The Health Insurance Premium Payment (HIPP) Program is a type of Medicaid Premium Assistance Program that helps low-income families afford private health insurance by covering their premiums.
Eligible individuals or families with access to employer-sponsored or private insurance can use the program to reduce out-of-pocket expenses, as Medicaid covers these premiums when it is more cost-effective than traditional Medicaid coverage.
HIPP may also pay for deductibles and co-pays, making comprehensive healthcare more accessible for qualified participants. The program benefits both Medicaid and participants by potentially lowering the state's overall Medicaid costs.
Note: While the HIPP Program is a Medicaid Premium Assistance Program, not all Premium Assistance Programs are HIPP. Medicaid Premium Assistance Programs include several types of premium support programs across different states, designed to help people eligible for Medicaid afford private health insurance or other available plans. Other Medicaid Premium Assistance options may include programs like Medicaid Buy-In or similar state-specific options aimed at different populations.
The Health Insurance Premium Payment (HIPP) Program offers several key benefits:
Only Medicaid-eligible individuals, or a family member within their household, may qualify for the Health Insurance Premium Payment (HIPP) Program. To be eligible, the applicant must have private health insurance, usually through an employer, and this plan must be cost-effective for the state.
To apply, submit documentation on the care recipient's health condition, insurance policy details, and premium costs, which the state uses to determine if HIPP is a more affordable option for Medicaid.
The state evaluates the total expenses of the private plan, including premiums, deductibles, out-of-pocket costs, and administrative costs, against what Medicaid would typically pay. If the private insurance is deemed less costly, HIPP will reimburse the premiums, allowing Medicaid to support necessary care in a more cost-effective manner.
If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. Find the latest information, eligibility requirements, and application for your state at the links below:
Note: The above list of states is current as of January 31, 2024. Contact your State for more information on eligibility.
To see if any other states have added a premium assistance program since January 31, 2024, contact the U.S. Department of Labor or the Centers for Medicare and Medicaid Services.
Family caregivers may need to reach out to their loved one's Human Resources department or insurance representative to confirm continued access to health insurance, which is essential to prevent any lapse in treatment or medical services. When applying for the HIPP Program, whether online or by form, have the following documents ready: the application, an Employer Insurance Verification (EIV) Form, a summary of the private health insurance plan (including deductibles and co-pays), recent pay stubs, and a copy of the loved one's Medicaid insurance card.
If a family member loses their job and applies for new private insurance, caregivers may need to include additional documents like recent bank statements, a record of medical expenses, premium costs, and supporting physician reports. Consider the entire family's health insurance premium costs to select the most cost-effective coverage option for Medicaid support.
Participants in the Health Insurance Premium Payment (HIPP) Program may need to periodically renew their enrollment or undergo reassessment to ensure they continue meeting eligibility requirements. This process often includes submitting updated documents, such as recent pay stubs, proof of private health insurance, and any changes to the family's health care needs or insurance costs.
As part of this renewal, the state may conduct a cost-effectiveness review to confirm that the private insurance plan remains more affordable for Medicaid than direct coverage. This reassessment helps ensure that HIPP resources are directed effectively and allows Medicaid to determine if covering premiums for private insurance still aligns with program goals. Caregivers should stay informed about renewal timelines and be prepared to provide the necessary documentation to avoid interruptions in coverage.
If the caregiver or care recipient's employment status changes, such as through a job loss or job transition, it's essential to notify the state Medicaid office as soon as possible. A change in employment could impact insurance access or eligibility, and Medicaid may need to reassess the cost-effectiveness of the private plan or help transition to a new insurance option.
If there's a fluctuation in premiums, such as an increase during an employer's annual enrollment period, the state may need to reevaluate the plan's cost-effectiveness. Caregivers should submit documentation showing the new premium amount to ensure Medicaid coverage or reimbursement remains accurate.
Keep track of renewal deadlines and required documents to ensure timely submission. Regularly updating contact information and staying in communication with Medicaid or the insurance provider can help avoid unexpected interruptions.
If an employer alters or removes an insurance plan, it may affect HIPP eligibility. Notify Medicaid if your insurance options change so they can guide you on alternative coverage or, if applicable, shift to direct Medicaid coverage.
