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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 family’s 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. M‘s 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 can’t afford to pay the employee’s share of the
premium.
Two of the children have serious medical conditions that require frequent
treatment and hospitalization. The private insurance available through Mr.
M’s 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 children’s 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 don’t 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 or fill out the
Peer Support Request now (be sure and
note on the form that you want a match on the HIPP process).
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
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trust is the only estate planning option that protects assets, enables the
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