Health Insurance Premium Program

Overview

DMAS administers two Medicaid programs that may reimburse part of a participant’s entire share of the employer-sponsored group health insurance premiums. These programs are known as the Health Insurance Premium Program (HIPP) and HIPP for Kids. All applications are first evaluated for HIPP for Kids and then HIPP, if applicants are not eligible for the HIPP for Kids program. This ensures that applicants’ circumstances are fully reviewed and every opportunity for eligibility is granted. 

For the HIPP for Kids program

Eligibility criteria include, but are not limited to the following:

• A family member must be enrolled in full coverage Medicaid and be less than 19 years of age;
• The employer must pay at least 40% of the cost of the health insurance premium; and
• Must be enrolled in a health plan that meets the definition of an a “qualified employer sponsored plan” that qualifies as creditable coverage under the section 2701(c) (1) of the Public Health Service Act and must be offered to all individuals in a manner that would be considered nondiscriminatory eligibility.
• Must not be a plan with deductibles that are equal to or exceed IRS High Deductible Health Plan limits.

The HIPP for Kids program was established under Section 1906A of the Social Security Act and 2010 Appropriations Act, Chapter 874 Item 296 L.

View regulatory actions for the HIPP for Kids Program.

For the HIPP program

Eligibility criteria include, but are not limited to the following:

• A family member must be enrolled in full coverage Medicaid.
• The health plan must meet cost effectiveness evaluation
• Must be enrolled in a health plan that meets the definition of an a “qualified employer sponsored plan” that qualifies as creditable coverage under the section 2701(c) (1) of the Public Health Service Act and must be offered to all individuals in a manner that would be considered nondiscriminatory eligibility; and
• Must not be a plan with deductibles that are equal to or exceed IRS High Deductible Health Plan limits.

The HIPP program was established under Section 1906 of the Social Security Act, with changes to the program effective October 1, 2009, as directed by the Virginia 2009 Appropriation Act, Chapter 781, and Item 306AAA.

View regulatory actions for the HIPP Program.