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HIPP Program FAQ

  • What is HIPP?  
    • The Health Insurance Premium Payment program, also known as HIPP, is a cost containment program that helps maintain premium payments for eligible Medicaid beneficiaries who retain their private health insurance. 
    • There are no age restrictions in the HIPP program. The family member who has Medicaid and the family member who can get employer-sponsored health insurance can be any age. 
  • Will HIPP affect my Medicaid eligibility?  
    •  No - Adult and child(ren) will remain Medicaid eligible.  
  • Am I eligible for HIPP?  
    •  You might qualify fort HIPP if you meet the following criteria: 
      • You have a household member currently enrolled in a Medicaid program.
      • You have access to a group health insurance plan or COBRA maintained through an employer.
      • My health insurance meets criteria, including cost-effectiveness.
  • What does cost-effectiveness mean?  
    • HIPP participants must be cost-effective, which means Medicaid savings must exceed premium and deductible amounts. "Cost-effective" means that it costs less to buy health insurance to cover medical care cost. 
    • ​​​​​The following are requirements of cost effectiveness: 
      • Must be a Vermont Medicaid member
      • Must have active private health insurance
      • Must have recent medical claims history
  • What are the common characteristics of a cost-effective Medicaid member?  
    • Some cost-effective Medicaid members are diagnosed with chronic medical conditions or may require long-term treatment, both of which may result in extensive medical costs. 
  • What are common qualifying conditions?  
    • Common long-term, cost-effective conditions include, but are not limited to: 
      • Cancer
      • Autism
      • Chronic health problems
      • HIV/AIDS
      • Children with special needs
    • Common short-term, cost-effective conditions include, but are not limited to: 
      • High-risk pregnancies
      • Seasonal conditions like asthma and allergies
      • Upcoming surgeries and diagnostic testing
  • What is COBRA?  
    • COBRA Insurance is your employer-sponsored health insurance coverage which could be available for purchase after you quit or lose your job. This coverage is through a federal law known as COBRA.  
  • Who can get HIPP?  
    • If you can answer “Yes” to these questions, you should apply for HIPP: 
      • Does anyone in your family get Medicaid?
      • Can someone in your family get health insurance at work?
    • You might be able to get HIPP if it costs Medicaid less to cover you or your family under employer-sponsored health insurance than it costs to cover family members who have Medicaid. 
    • Employer-sponsored health insurance is a group health plan you can get through your job. The family member who gets Medicaid must be able to get coverage on this plan. 
  • What are the benefits of getting HIPP?  
    • There are many benefits to getting HIPP if you or a family member qualify: 
      • Your family can choose from more doctors than with Medicaid alone.
      • HIPP can pay your portion of the employer-sponsored health insurance premiums for the entire family.
      • You won’t lose your Medicaid benefits.
  • How does HIPP work?  
    • Every insurance plan has a different premium cost and covers different things. To join HIPP, your employer-sponsored health insurance plan must pay at least 60 percent of the costs when you: 
      • Visit the doctor.
      • Buy medicine.
      • Get care outside the hospital.
      • Have lab tests or X-rays.
      • Are in the hospital.
    • This information is covered in the summary of benefits available from your employer. 
  • Am I responsible to pay any co-pays or deductibles required by my employer insurance?  
    • No! The member remains on Medicaid and, therefore, cannot be billed for any service administered by a participating Medicaid provider. 
  • Who does the HIPP program pay?  
    • When a case is determined to be cost-effective, DVHA works with the employer and the client to enroll the member(s) in the employer insurance. HIPP premium payments are usually sent directly to the member; however, payment can be made to the Insurance Company or Employer when necessary.
  • What type of documentation will I need to apply for HIPP?  
    • HIPP will need the following information for your enrollment: 
      • Insurance rate sheet.
      • Insurance card.
      • Proof of payment (if enrolled).
  • Where should a Medicaid member submit their HIPP referral form?  
    • Simply fill out a quick referral form and we'll get back to you.   

    • Form can also be mailed or faxed to: 

      Fax: 802-879-8224

      Mail: Department of Vermont Health Access

              NOB 1 South, 280 State Drive

              Waterbury, Vermont 05671-4020