HEALTH INSURANCE PREMIUM PAYMENT (HIPP) & HIPP For KIDS PROGRAMS

ABOUT HIPP

The Commonwealth of Virginia has two Medicaid related premium assistance programs that are administered by the Department of Medical Assistance Services (DMAS):

The Health Insurance Premium Payment (HIPP) For Kids Program which is a premium assistance program for those members under the age of 19 who are eligible for or enrolled in “qualified employer-sponsored coverage,” and:

- The Health Insurance Premium Payment Program when determined to be cost effective is a cost saving program for Medicaid members and reimburses some or all of the employee portion of the group health insurance premium for members who have employer sponsored group health insurance available to them through their own or their family member’s employment.

- All applications for premium assistance are first evaluated for the HIPP for Kids program. If it is determined that the eligibility criteria for the HIPP for Kids program are not met, the application is automatically evaluated for the HIPP program.

The HIPP program is established under Section 1906 of the Social Security Act. Effective July 23, 2009, the HIPP program became an optional program under the Medicaid Program. The Virginia Administrative Code (VAC); 12VAC30-20-210; State method on cost effectiveness of employer-based group health plans; 12VAC30-20-211 (Emergency Regulations), State method on cost effectiveness of employer-based group health plans – individual and family plans; 12VAC30-130-750, Time frames for determining cost effectiveness; and 12VAC30-130-790, Information required of applicants and recipients.

The HIPP for Kids program is established under Section 1906A of the Social Security Act (SSA),the 2010 Appropriations Act, Chapter 874 Item 296 L; and the VAC; 12VAC30-20-205, Heath Insurance Premium Payment Program for Kids (Fast Track Regulation).

The following is a link for regulatory actions for the HIPP Programs:

Virginia Regulatory Town Hall

For the HIPP For Kids program, the Medicaid eligible must be under the age of 19, the employer must contribute at least 40% towards the cost of the health insurance premium, must offer qualified employer-sponsored health plan that qualifies as creditable coverage under the section 2701(c)(1) of the Public Health Service Act and must be offered to all individuals in a manner that would be considered nondiscriminatory eligibility.

The HIPP For Kids program is established under Section 1906A of the Social Security Act and 2010 Appropriations Act, Chapter 874 Item 296 L.

The HIPP and HIPP For Kids Program use the same Application and Employer Insurance Verification (EIV) Forms.

ADDRESS & CONTACT INFORMATION

How To Send Information/Documents/Verifications To The HIPP Unit

FORMS

Cost Sharing Expense Form
HIPP/HIPP for Kids App/Renewal/EIV
HIPP Consent Form Family Member/Policy Holder
HIPP For Kids Policy Holder Information Change Form (to report changes)
HIPP Policy Holder Information Change Form (to report changes)

PROGRAM INFORMATION

HIPP Programs Comparison Chart
HIPP Programs Policy Manual
HIPP Documentation Requirement for Retirees

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