Department of Medical Assistance Services
HEALTH INSURANCE PREMIUM PAYMENT (HIPP) & HIPP For KIDS PROGRAMS
ABOUT HIPP

The Department of Medical Assistance Services (DMAS) administers two Medicaid programs that may reimburse part or a participant’s entire share of the employer sponsored group health insurance premiums. These programs are known as the Health Insurance Premium Program (HIPP) and HIPP for Kids. All applications are first evaluated for HIPP for Kids (HFK’s) and then HIPP, if applicants are not eligible for the HFK’s program. This insures that applicant’s circumstances are fully reviewed and every opportunity for eligibility is granted.

For the HIPP for Kids program, eligibility criteria include but are not limited to the following:

• a family member must be enrolled in full coverage Medicaid and be less than 19 years of age;

• the employer must pay at least 40% of the cost of the health insurance premium; and

• must be enrolled in a health plan that meets the definition of an a “qualified employer sponsored 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.

• Must not be a plan with deductibles that are equal to or exceed IRS High Deductible Health Plan limits.

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

The following is a link for regulatory actions for the HIPP for Kids Program:

http://leg1.state.va.us/cgi-bin/legp504.exe?000+reg+12VAC30-20-205

For the HIPP program, eligibility criteria include but are not limited to the following:

• a family member must be enrolled in full coverage Medicaid.

• the health plan must meet cost effectiveness evaluation

• must be enrolled in a health plan that meets the definition of an a “qualified employer sponsored 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; and

• Must not be a plan with deductibles that are equal to or exceed IRS High Deductible Health Plan limits.

The HIPP program was established under Section 1906 of the Social Security Act, with changes to the program effective October 1, 2009, as directed by the Virginia 2009 Appropriation Act, Chapter 781, and Item 306AAA.

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

http://leg1.state.va.us/cgi-bin/legp504.exe?000+reg+12VAC30-20-210

For additional information you may contact our toll-free helpline 1-800-432-5924 or send an email to

HIPPcustomerservice@dmas.virginia.gov
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
PROGRAM INFORMATION

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