The Health Insurance Premium Payment (HIPP)

Program for Texas Medicaid Recipients and Family

What is HIPP?

The Health Insurance Premium Payment (HIPP) Program is a Medicaid program that pays for the cost of medical premiums.  The program reimburses qualified Medicaid families for health insurance payments obtained through their employer.

How Do I Qualify?

TMHP establishes the actual Medicaid expenditures for the past year of the Medicaid recipient in your family.  The past Medicaid payments for your household are compared with the cost of the premiums, coinsurance, deductibles, and other cost sharing for the best policy your employer offers (covers the most services).  If the cost of the insurance is less than what TMHP and HHSC would spend in Medicaid payments, the insurance policy is cost-effective.

I Have Medicaid; Why Do I Want Health Insurance?

The main reason TMHP wants to buy private health insurance for people getting Medicaid is that it will help lower costs to the Medicaid program.  However, there are several reasons why having insurance may be good for you. 

  1. The policy may cover services that may not be covered under Medicaid.
  2. Members of your family who are not eligible for Medicaid may be covered under the private health insurance plan.
  3. You will have private health insurance available to you if you lose Medicaid eligibility.  (However reimbursement for the premiums will not  be made by TMHP.)

I Have Private Health Insurance; Can I Be Eligible for Medicaid?

The fact that you have private health insurance coverage does not affect your eligibility for Medicaid.  Medicaid will still pay for covered services that are not payable by the private insurance plan, up to the Medicaid reimbursement rate.

What If I Don't Want Private Health Insurance?

If TMHP has determined that the employer based group health insurance available to you is cost effective, you are required to participate in the plan as a condition of Medicaid eligibility.  If you voluntarily drop the insurance coverage or fail to provide information necessary to determine cost effectiveness, your Medicaid benefits may be canceled.

How Long Will TMHP Pay for My Insurance?

TMHP will continue to pay for private health insurance as long as you or a member of the family is eligible for Medicaid and remain cost-effective.

How Will the Premiums Be Paid?

You will be requested to send proof of payment and insurance coverage for Medicaid recipient to TMHP.  Information mailed to TMHP will not be returned so please make sure to send copies if you want to keep the original.   Once proof of payment and insurance coverage is received and processed, reimbursement will be made.

  


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