1. (FCRC) In the Screening subsystem on the Screener Generic screen, when an applicant answers "yes" to question 8, "Do you or your family member have a high cost medical condition?", HIPP Screen #1 will appear for entry. Give the applicant a copy of HFS 3459, Health Insurance Premium Payment (HIPP) Program.

    In the Eligibility subsystem, if question 8 on the Screener Generic screen is answered "yes", ask the applicant the questions on the following screens, HIPP Screens #1, #2, #3, and #4. Do this for all cases except:

    •  residents of long term care facilities,
    • Qualified Medicare Beneficiary (QMB) only applicants,
    • Specified Low-Income Beneficiary (SLIB) only applicants, and
    • Food Stamp only cases.
  2. (FCRC) Review answers to the HIPP inquiry questions during the eligibility interview.
  3. (FCRC) Explain the HIPP Program if the applicant answered "yes" to question 8.
  4. (System) Generates 2 copies of HFS 3459B after the Combined Application Form (CAF) at the end of the eligibility interview, when the HIPP SCREEN indicates an assistance unit member has a high-cost medical condition and has insurance available.

     (FCRC) If the benefit unit is enrolled, or can enroll, in a health insurance plan and someone has a high-cost medical condition, have the applicant sign both copies when the interview is completed. Place one copy in the case file and forward the other copy to the Financial Recovery Coordinator (FRC) to send to Springfield. Do not wait for the application to be approved. Forward the form to the FRC even if the applicant cannot provide all the information.

  5. (FCRC) Tell applicants that eligibility to receive medical is not affected if HFS pays their health insurance premiums.
  6. (FCRC) Use HFS 267, Instructions to Client, to request proof of health insurance coverage and medical costs.
  7. (FCRC) Explain to the applicant that cooperation in supplying information about the health plan and completing HFS 3459B are required to receive medical assistance.

    NOTE: If the policyholder is not an applicant or client and chooses not to cooperate, the client's eligibility is not affected.

  8. (FCRC) Ask the applicant to take HFS 3459B and have the policyholder sign it if they are not at the interview.
  9. (FCRC) Give the applicant HFS 267, if needed, to bring in any additional information about insurance coverage and medical costs.
  10. (FCRC) Copy the verifications and return the originals to the person, when the applicant sends in health insurance information and medical bills.

    Before case approval or certification (PE cases):

  11. (FCRC) Refer HFS 3459B and all available verifications to the Financial Recovery Coordinator (FRC) if the health coverage may cover:
    • a specified illness and the applicant is receiving treatment for the illness, or
    • prescribed drugs and the client is currently in a continuous drug use treatment program, such as AZT, insulin, and heart medication.
  12. (FRC) Immediately refer HFS 3459B and copies of verifications to the TPL Section-HIPP Unit for a decision on cost effectiveness. This ensures timely health insurance enrollment or payment of premiums if the plan is cost effective.
  13. (FCRC) File copies of verifications and HFS 3459B in the case record.

     At approval:

  14. (FCRC) Complete HFS 1442, Health Insurance Report (see WAG 26-03-01-a),if the applicant is currently enrolled in a health insurance plan. Mark "HIPP" in the upper right corner.

    NOTE: HFS 1442 is not required if the client is not enrolled in the health plan. 

  15. (FCRC) Give HFS 1442 to the FRC.