Families with at least one person who gets Medicaid may be eligible to enroll in the Health Insurance Premium Payment (HIPP) program. HIPP covers the premium or part of the premium for employer-sponsored health insurance. If it is found to be cost-effective, HIPP may cover the health insurance premium for the Medicaid member and their family. People with both Medicaid and HIPP coverage don’t have to pay deductibles, co-payments, or co-insurance when they receive Medicaid-covered services from a provider that accepts Medicaid. The provider is reimbursed for these expenses by Medicaid.
Families say that it is pretty easy to participate. The State determines eligibility annually or when there is a change in the family’s insurance information, like premium or insurance company changes. Once enrolled, the reimbursement process just involves faxing in a pay stub once a month. The premium reimbursement can be direct deposited into a personal bank account.
Some people enrolled in a 1915(c) waiver for people with intellectual and developmental disabilities (IDD) and also people who reside in a community-based intermediate care facility for individuals with an intellectual disability or related conditions (ICF/ID) receive acute care services through the STAR+PLUS Medicaid managed care program. Acute care services include doctor’s visits, hospital visits, and prescription drugs. The 1915(c) waiver programs are:
- Community Living Assistance and Support Services (CLASS),
- Deaf Blind with Multiple Disabilities (DBMD),
- Home and Community-based Services (HCS), and
- Texas Home Living (TxHmL).
People with disabilities may be eligible for HIPP if they are:
- enrolled in a 1915(c) waiver program or reside in an ICF/ID,
- enrolled in STAR+PLUS, and
- have access to employer-sponsored health insurance.
If this is the case, HIPP will reimburse clients for employer-sponsored health insurance premiums.
If a person is enrolled in both STAR+PLUS and HIPP:
- The State will cover the premiums for the employer-sponsored health insurance for Medicaid-covered services provided by a Medicaid provider,
- STAR+PLUS managed care organizations (MCOs) will cover cost-sharing related to the employer-sponsored insurance for Medicaid-covered services provided by a Medicaid provider,
- STAR+PLUS MCOs will also cover Medicaid-covered medical services provided by a Medicaid provider not available through the employer-sponsored health insurance, and
- The 1915(c) waiver programs and ICF/ID will provide long-term services and supports.
People enrolled in both STAR+PLUS and HIPP can have two separate primary care providers (PCPs) – one for each program. However, people are responsible for all associated costs related to their employer-sponsored health insurance, not covered by Medicaid, or if the PCP or specialist they visit are not Medicaid-enrolled providers.
People enrolled in STAR Medicaid cannot also be enrolled in HIPP. If a person is approved for HIPP and they are already enrolled in STAR, they will automatically be switched from STAR to traditional Medicaid.
To learn more about the HIPP program, and to apply, go to getHIPPTexas.com. If you have questions about HIPP and Medicaid coverage, call the HIPP helpline at 1-800-440-0493.