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 related programs that may reimburse part or a participant’s entire share of employer sponsored group health insurance premiums. These programs are known as the Health Insurance Premium Program (HIPP) and HIPP for Kid (HFK) Program. All applications are first evaluated under HFK then, if needed for applicants determined ineligible for HFK, HIPP. This sequential evaluation process insures that applicant’s circumstances are fully reviewed and every opportunity for eligibility is granted.

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

• 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; and

• 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 HFK program was established under Section 1906A of the Social Security Act and the Virginia 2010 Appropriations Act, Chapter 874 Item 296 L.

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 member must be living in the same household as the policy holder of the employer group health insurance or provide a Consent Form signed by the responsible individual;

• be enrolled in the comprehensive employer health insurance plan.

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, Item 306AAA.

The following links are for State regulations that govern the HIPP Programs:

HFK

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

HIPP

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

For additional information regarding the HIPP Programs 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
HIPP/HFK’s Policy Holder Information Change Form (to report changes)
PROGRAM INFORMATION

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