HIPP Program

What is the Health Insurance Premium Payment Program (HIPP) Program?

The Health Insurance Premium Payment (HIPP) program is a Medicaid program that may pay for the cost of your private health insurance premiums, when it is found to be cost-effective.  If you or someone else in your family is on Medicaid or eligible for Medicaid, and health insurance is available to you through an employer or a private plan, the HIPP Program will determine if it would be cheaper to pay for the health insurance premiums instead of having Medicaid pay for all the medical bills.

The HIPP Program is advantageous to the Department of Medical Assistance (DMA) and to the taxpayer because it enables the Medicaid agency to shift some of the costs of care to liable third parties. Providers of medical care benefit from the HIPP program because insurance payments for the cost of care are usually more than what Medicaid would pay.

HIPP has potential significance for families with minor children under age 19 who qualify for Medicaid but whose parents have access to private insurance. If a child qualifies for HIPP and the familys private insurance plan also covers the entire family, the advantage is that parents and other siblings, which may not be directly covered by Medicaid, may also benefit. In such instances, the premium for the entire family is paid.

Who is eligible to receive services from the HIPP Program?

At least one person living in the family household must be a recipient of Medicaid or be Medicaid eligible.  Health insurance must be available to cover the Medicaid recipients through an employer or a private policy.  For example, the HIPP Program may pay for health insurance premiums for an employed parent who covers their Medicaid-eligible children under a family insurance policy.  Emphasis has been placed on the payment of group health insurance premiums, but premiums for cost-effective private policies, conversion policies, or COBRA extensions may also be paid by the DMA.

What does cost-effective mean and how is it determined?

"Cost-effective" means that the costs to the Medicaid agency for the health insurance premium, the coinsurance, and the deductible are expected to be less than the total cost of care with Medicaid funds.  DMA determines the average amount of Medicaid funds spent on a household like yours. DMA also considers the specific health related needs of your household. For example, if a member of your household has a medical condition requiring frequent treatment, DMA considers this. The expected Medicaid payments for your household are compared to the services covered under the policy and the cost of the premiums. If the cost of the insurance is less than what DMA would spend in Medicaid funds for those same services, the insurance is cost effective.

If I have private health insurance, can I be eligible for Medicaid?

The fact that you may have private health insurance does not affect your eligibility for Medicaid. Medicaid will still pay for covered services not payable by the private health insurance plan, up to the Medicaid reimbursement rate.

If I have Medicaid, why do I want private health insurance?

There are several reasons why having private health insurance may be good for you.

1. The policy may cover services not covered under Medicaid. The combination of Medicaid and a private plan usually provides excellent medical coverage.

2. Members of your family who are not eligible for Medicaid may be covered under the private health insurance plan when DMA determines that buying a family plan for the Medicaid eligible persons is cost-effective.

3. Continued enrollment in a private health insurance plan can help you meet your pre-existing waiting periods, deductibles, and out of pocket maximums for a time when you may no longer be covered by Medicaid. If you lose your Medicaid eligibility, you may pay the premiums through your employer, and still keep your private health insurance.

Example

Mr. and Mrs. M have three children. The children are all eligible for Medicaid. Mr. Ms employer offers group health insurance to its employees. The employer pays for half of the premium and the employee pays the other half. Mr. M states he cant afford to pay the employees share of the premium.

Two of the children have serious medical conditions that require frequent treatment and hospitalization. The private insurance available through Mr. Ms employer would cover these services. DMA determines that it would cost less to pay the private insurance premium for the whole family than to pay the childrens bills directly through Medicaid. By purchasing a family plan to cover the children, Mr. and Mrs. M will also have insurance coverage, even though they are not eligible for Medicaid.

What if I dont want private health insurance?

Enrollment or continued enrollment in cost-effective plans is a condition of Medicaid eligibility. If the Medicaid recipient has access to enrollment in a cost-effective plan or is enrolled in a cost-effective group health insurance plan, enrollment must be initiated or continued. Failure to do so may result in the loss of Medicaid benefits.

How long will DMA pay for my insurance?

DMA will continue to pay for private health insurance as long as you are eligible for Medicaid and as long as it is still cost-effective.

How are payments made?

Payments for cost-effective insurance premiums begin upon the completion of the referral process. The DMA prefers to pay premiums directly to the insurance company or the employer, but when this is not possible, recipients will be reimbursed for health plan payroll deductions. The reimbursements are made to recipients in the month following the payroll deductions. Premiums will be paid for Medicaid recipients as long as the policies are cost-effective.

How do I apply?

Referrals are sent to the HIPP Unit for cost-effectiveness determinations. County Department of Family and Children Services case directors are the primary source of referrals, but any Medicaid recipient may complete their own referral form.   For information or an application, you may contact your county Department of Family and Children Services or the HIPP unit at the DMA at 404-525-3660.

For More Information:

If you would like to talk with another parent that has already applied for the HIPP program, contact Parent to Parent of Georgia to request a parent match.

Atlanta and local calling area: 770-451-5484                                      Macon calling area: 478-934-3694       
Statesboro calling area: 912-489-1904

Toll-Free Statewide: 800-229-2038