WAG 23-08-01

The Health Insurance Premium Payment (HIPP) Program pays health insurance premiums for some clients who have high medical expenses and who have private health insurance available. The health insurance the client is eligible for must be cost-effective. The insurance can be available directly to the client or through someone else, such as a parent. The client may or may not be currently enrolled in the health plan.

Clients must cooperate with HIPP to be eligible for medical. Clients with high cost medical conditions must provide information for any health plan that they:

  • are enrolled in; or
  • are eligible to enroll in but are not; or
  • may enroll in due to loss of employment, layoff, or retirement (COBRA or conversion policy).

HIPP is limited to clients who have high cost medical conditions, such as:

  • severe arthritis;
  • cancer;
  • heart ailment or defect;
  • liver disease;
  • kidney disease;
  • brain disease or disorder;
  • neurological disease or disorder;
  • diabetes;
  • AIDS;
  • organ transplant;
  • any other medical condition requiring high cost ongoing medical treatment, such as pregnancy.

Explain HIPP to the client at intake, REDE, or when the client reports a new job, loss of a job, or a policy they are allowing to lapse. HIPP is available to all clients receiving cash or medical except for the following:

  • clients enrolled in spenddown;
  • Qualified Medicare Beneficiaries (QMB) only;
  • Specified Low-Income Medicare Beneficiaries (SLIB) only;
  • residents of long term care facilities; or
  • clients enrolled in a health plan as a requirement of a child support order.

The Third Party Liability Section of the Bureau of Collections (BOC) runs HIPP and decides the cost-effectiveness of each health insurance policy on a case-by-case basis. When the health plan is cost-effective, HFS pays the premium to the:

  • health insurance carrier;
  • employer;
  • union or other organization; or
  • client (reimbursement only).