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Health Insurance Premium Payment (HIPP) Program / Cost Avoidance

The Health Insurance Premium Payment (HIPP) program defers medical costs from Medi-Cal by reimbursing certain Medi-Cal beneficiaries’ private or employer-related health insurance premiums when it is cost effective.

Each applicant must meet all of the program’s eligibility requirements; if approved, each case is periodically re-evaluated to determine ongoing HIPP program eligibility. Please note that HIPP is not an entitlement program; therefore, there are no appeal rights.


Requirements for HIPP:

  • Full scope or fee-for-service Medi-Cal
  • A high cost medical condition that requires on-going treatment from a medical provider
  • Current health insurance coverage (or access to health coverage through an employer at the time of application) – policy must cover the health condition

 

*Health insurance coverage must not be court-ordered - The California Department of Child Support Services reports any court-ordered
  medical insurance to DHCS.

  

You are not eligible for HIPP if you are eligible for or enrolled in either of the following:

  • Medicare
  • TRI-CARE (formerly known as CHAMPUS)

  

Quick Reference Links

HIPP Application Form - Fillable

HIPP Application and Forms (PDF)
Solicitud y Formas para el Programa HIPP

Frequently Asked Questions (FAQ)

HIPP State Plan Amendment.pdf

 

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Last modified on: 3/25/2014 1:54 PM