Health Insurance Premium Payment (HIPP) Program

Does anyone in your family get Medicaid? Can anyone in your family get health insurance through work? If you answered yes to both of these questions, Medicaid might help pay for that private health insurance through the Health Insurance Premium Payment (HIPP) program.

What Is HIPP?

HIPP has the following benefits:

• Family members with Medicaid might have their doctor’s visits, co-payments, and deductibles covered through Medicaid.
• Family members with Medicaid can see doctors who accept your private health insurance plan. That plan might give them a wider selection of doctors to pick from. They will still need to pay a co-pay and meet any plan deductibles when they see these doctors.
• If Medicaid decides that it is cost-effective to do so, family members without Medicaid might be covered through HIPP on your private health insurance plan. They will still need to pay co-pays and meet the insurance plan deductible.

Who Can Get HIPP?

You can get HIPP if both of the following are true:

• Someone in your family gets Medicaid.
• Someone in your family can get private health insurance through work. This insurance plan will need to cover at least 60% of your medical expenses.

Once you submit an application for HIPP, Medicaid will compare the amount they would spend to pay your child’s medical expenses through Medicaid alone against the cost of the private health insurance premium for your family. If it is less expensive for them to cover the private insurance plan, then you will be approved for HIPP.

How Does HIPP Work?

When you get HIPP, you will pay your health insurance premium every month, and Medicaid will reimburse you (pay you back) for all or part of that premium through HIPP. Each month, you need to fax or mail in proof of your health insurance premium payment. A “premium” is the amount you, your employer, or both pay for your insurance each month. This should be a document that shows the month and year of the payment, the amount paid, and the name of the person who has the health insurance.

Some examples are:

• A pay stub showing that the premium was taken out of your check.
• The front and back of a cancelled check that shows your insurance payment.
• A bank statement showing that your health insurance payment was made.
• A signed letter from your employer or your health insurance company on their letterhead, which says you have paid your premium, what amount you paid, and the month of the payment.

Medicaid will then reimburse you for the premium through direct deposit, a check in the mail, or a payment right to your employer (for certain employers). Usually, you will get the reimbursement within 3 to 5 business days; they might have delays at some points in the year.

When your child sees a doctor that accepts both Medicaid and your family’s private health insurance, Medicaid will pay the co-pay and any expenses not covered by your private health insurance. However, if they see a doctor that does not accept Medicaid, you will still need to pay a co-pay and meet your insurance plan’s deductible. If your child gets Medicaid and needs a service that their private insurance does not cover, but Medicaid does cover, then Medicaid might pay for it. You will need to check with Medicaid to see what they will cover.

HIPP Is a Family Affair

HIPP is a payment program, not an insurance policy. When you get HIPP, Medicaid will pay your premium for your job’s health insurance plan. Since many employers offer health insurance plans that cover a whole family, HIPP might be able to cover the entire cost of your family plan’s premium if it is cost effective to do so. Even if the cost of your entire family’s monthly premium is not approved for HIPP, Medicaid will reimburse you for part of those costs each month.

You can read more about how HIPP can work for your family on the Texas Council on Developmental Disabilities website or on the How Does HIPP Work? web page.

HIPP and Other Medicaid Programs

If your child gets another Medicaid program, you should check with HIPP about the rules to see if your child can be in both programs. You can learn more about Medicaid health benefits programs and services on our Medicaid page.

If your child or anyone else in your family receives health care benefits or coverage through another program like STAR, STAR+PLUS, or the Children’s Health Insurance Program (CHIP), you should call HIPP at 1-800-440-0493 to see if getting HIPP would cause any problems with those other programs.

Can I Lose HIPP?

You can lose HIPP if someone in your family no longer gets Medicaid, or if HIPP is no longer cost-effective for the Medicaid program. If there is a change in your insurance, it might affect the amount HIPP will reimburse you or your ability to stay in the program. Call HIPP if there is any change in your private health insurance policy.

How Do I Apply for HIPP for My Family?

You can apply for HIPP online. Or you can print out the form and either fax it to 1-866-409-1188 (toll-free) or mail it to:

GET HIPP TEXAS
P.O. Box 201120
Austin, TX 78720-9774

You will also need to submit your employer’s insurance policy’s Summary of Benefits and Rate Sheet with your application. If you already get insurance through your employer, send a copy of your insurance card as well.

Your application will be reviewed, and you will receive a letter in the mail letting you know if your family is approved. It usually takes 1 to 2 business days for HIPP to process your application, and 5 to 7 business days after that to give you a decision. If you have questions, you can call Texas HIPP at 1-800-440-0493.