Cost Avoidance /Health Insurance Premium Payment
Cost Avoidance is responsible for the identification and utilization of private health insurance coverage. The goal is to maximize cost avoidance for medical services, through the accurate documentation of Medi-Cal beneficiaries other health coverage and by paying health insurance premiums on behalf of eligible Medi-Cal beneficiaries, when it is cost-effective.
Health Insurance Premium Payment Program (HIPP):
Health Insurance Premium Payment Program pays private health insurance premiums for certain high cost Medi-Cal beneficiaries.
Under Federal and State law, the Medi-Cal program provides financial assistance to certain Medi-Cal beneficiaries by purchasing private or employer related health coverage, when it is available and cost-effective. By purchasing health coverage for Medi-Cal beneficiaries, the Medi-Cal program defers the cost of medical care to private health insurance carriers or plans.
The Health Insurance Premium Payment Program is not an entitlement program; therefore, there are no appeal rights. Each applicant must meet all of the program eligibility requirements. Once approved for the Health Insurance Premium Payment Program, each enrollee is re-evaluated annually to determine ongoing Health Insurance Premium Payment Program eligibility.
To enroll in the State's Health Insurance Premium Payment Program, beneficiaries must:
- Currently be on Medi-Cal;
- Have a high-cost medical condition; Back to Top
- Be determined cost-effective for the Health Insurance Premium Payment Program;
- Have either current health coverage or access to health coverage through an employer at the time of application (The policy must cover the high-cost medical condition);
- Not be enrolled in a Medi-Cal managed care plan;
- Not be enrolled in a County Organized Health Plan;
- Not be Medicare eligible; and
- Not have an insurance policy issued through the California Managed Risk Medical Insurance Board including Post-Graduate plans.
To obtain an application for the HIPP Program, please go to the following link.
Health Insurance Premium Payment Application (ENG.PDF)
Health Insurance Premium Payment Application (SP.PDF)
Medi-Cal beneficiaries who have a diagnosis of HIV/AIDS or pregnancy are automatically determined cost-effective for the Health Insurance Premium Payment Program if all program eligibility requirements are met.
Any questions about the Health Insurance Premium Payment Program should be directed to:
The Health Insurance Premium Payment Program's toll free number at 1-866-298-8443