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Home»Member Services»Medicaid Programs»Health Insurance Premium Payment Program


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HEALTH INSURANCE PREMIUM PAYMENT PROGRAM

Report changes or ask a question about the HIPP program via email
at hipp@dhs.state.ia.us.


WHAT IS THE HIPP PROGRAM?

The Health Insurance Premium Payment (HIPP) program is one of the services
available to people who get Medicaid (Title 19). The HIPP program is a way for
the State of Iowa to save money.
 


HOW CAN I GET HIPP?

 * You or someone in your home has to have Medicaid.
 * You must have medical insurance or be able to get it through your employer.
 * The health plan must be cost-effective.

 


WHAT IS COST-EFFECTIVE AND HOW IS IT DETERMINED?

"Cost-effective" means a determination has been made that a savings will accrue
to the Department by paying the insurance premium, cost sharing, wrap benefits,
and administrative cost instead of paying for the same care through Medicaid
managed care.

To determine cost-effectiveness, the HIPP program totals together the member's
health insurance premium cost to cover the Medicaid eligible members, plus the
deductibles, out-of-pocket cost, and administrative cost and compares all of
this to what the Department would pay to a managed care organization (MCO)
(based on age, sex, aid type).

"Cost sharing" is the out-of-pocket cost that is not paid by the health
insurance plan, but is the responsibility of Medicaid. For example, copayments
and deductibles.

"Wrap around benefits" or "wrap" are services not covered by a commercial health
insurance plan. For example, supported community living (SCL) services, case
management, adult diapers, transportation, or school based services. Medicaid is
typically the only payer for wrap around benefits.

 


WHAT THE HIPP PROGRAM DOES NOT PROVIDE PREMIUM ASSISTANCE FOR:

This list is not inclusive.

 * Insurance for someone who does not live in your home.
 * School plans based on enrollment or attendance as a student.
 * An insurance plan that pays income to the policyholder or pays only limited
   amounts for services.
 * Plans that are limited to a temporary period of time.
 * Plans that have an absent parent as the policyholder, or when the
   policyholder is not part of your Medicaid household. 
 * An insurance premium that is used to reduce the Medically Needy spend down
   amount for Medicaid or used as a deduction in computing the client
   participation
 * Anyone covered under Medicaid Kids with Special Needs (MKSN), Family Planning
   Program (FPP), or Health Insurance Plan Iowa (HIPIOWA).
 * The insurance plan is a high deductible health plan, pursuant to the
   guidelines of the Internal Revenue Service (IRS).
 * The insurance plan is a subsidized insurance plan purchased through a
   government-run health insurance exchange.
 * Someone who has Medicare.
 * Someone who is covered under the insurance plan and is not Medicaid-eligible
   on the date the decision regarding eligibility for the HIPP program is made.
 * The health plan pays secondary to another plan.

 


REPORTING CHANGES

You are required to report all changes to the Department within 10 days of the
change. Changes may impact the benefit amount and who is considered HIPP
eligible. The quickest way to report changes is to:

 * Call the HIPP program at 1-888-346-9562
 * Email: HIPP@dhs.state.ia.us
 * Fax: 1-515-725-0725
 * Call the number on the front of a HIPP notice.

You are required to report all changes that occur in your employment or health
insurance, in your family and household.

Here are examples of some changes that need to be reported:

 * Mailing address changes (state checks do not get forwarded).
 * The health insurance ends, or the insurance carrier, premium or deductible,
   or coverage changes.
 * The policyholder is not living with the Medicaid-eligible members.
 * Medicaid-eligible member moves in or out of your home, or you are no longer
   responsible for their Medicaid case.
 * The health insurance policy, paid by HIPP, is no longer primary for the HIPP
   eligible and enrolled members.
 * Employment changes

 


WHAT DOES HIPP NEED TO DETERMINE COST-EFFECTIVE?

This list is not inclusive.

 * Verification of the cost of all possible insurance plan options (e.g. single,
   employee/spouse, employee/children, family) or for an individual policy, the
   cost breakdown per individual.* **
 * Complete summary of benefits and coverage for the health and prescription
   plan. This shows what your prescription and health insurance plan covers,
   including deductibles, copayments, coinsurance, and out-of-pocket costs.* **
 * Pay stub containing a health insurance premium deduction or proof of payment
   (e.g., bank/credit card statement, endorsed check, payment receipt).
 * Copy of the front and back of the health insurance and prescription cards.
 * Employer issued COBRA continuation coverage letter.

* You may need to access your employer's website or contact your human resources
department to get this information.

** You may need to contact your insurance agent or insurance company to get this
information.

 

QUESTIONS?

Toll-free: 1-888-346-9562
Fax: 515-725-0725
Email: hipp@dhs.state.ia.us 

 

HOW DO I APPLY FOR HIPP?

Call to complete an application referral over the phone:
Des Moines area: 515-974-3282
Toll-free: 1-888-346-9562.
 
OR
Print a HIPP application, fill it out and email or fax it in:
Email: hipp@dhs.state.ia.us
Fax: 515-725-0725
 
OR 
Print a HIPP application, fill it out and mail it in:
Mail to:
Iowa Medicaid Enterprise (IME)
HIPP Unit
PO Box 36476
Des Moines, IA 50315-9907 
 
 


AIDS/HIV

If you are living with AIDS/HIV-related illness there is a special program to
assist you with premiums for your health insurance. Visit the AIDS/HIV HIPP
Program webpage for more information.

 

 

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