Health Insurance Premium Payment Program

The Form 124 - Health Insurance Premium Payment (HIPP) Referral is used to notify DCH via HMS of the potential purchase of an A/R’s health insurance. HIPP referrals may come from DFCS, a hospital, or other medical providers.

When DCH/HMS receives a referral for a “priority” applicant (person has cancer, diabetes, etc.), a decision is normally pended for 30 days awaiting the outcome of the Medicaid determination. If the applicant is not approved for Medicaid within the 30 days, the HIPP request is denied, and the applicant is sent a denial letter.

If the referral is for a “non-priority” applicant, then a survey letter is sent to the applicant requesting the name of the employer, insurance company, etc. The applicant has 30 days from the date of the survey letter to return the letter to HMS. If the applicant is not made eligible for Medicaid by the time the survey letter is received by HMS, the HIPP referral is denied, and a denial letter is mailed to the applicant. If the applicant is made eligible for Medicaid by the time the survey letter is returned, the approval process for HIPP begins. If the applicant fails to return the survey letter within the 30 days from the date on the letter, the HIPP referral is denied, and a denial letter is mailed to the applicant. The earliest HIPP payments will begin is the first month of Medicaid eligibility. Payments are not made for any month(s) in which the A/R is not Medicaid eligible. HIPP payments are not retroactive.

Do NOT make HIPP referrals for an A/R:

with no health insurance or no access to health insurance

whose only insurance is a Medicare Supplement

whose only insurance is a per-diem (a policy that reimburses the policyholder a contractual amount per day for specified medical services or procedures) or cancer policy

who is eligible only for Q-Track

who does not have ongoing Medicaid coverage (for example, approved for three months prior only)

who is Medically Needy spenddown eligible, and spenddown is met at or near the end of a budget period A referral should be made if the A/R is de facto eligible or spenddown eligible for multiple budget periods.

whose coverage is through a non-custodial parent

who is a refugee

whose employer information is unavailable

when the name of the policy holder is not known

when there is no known person to contact for referral.

Refer only the primary policy to HIPP if an A/R has multiple health insurance policies.

Complete a Form 124 - Health Insurance Premium Payment (HIPP) Referral , if appropriate, and forward the original to Health Management Systems or document why a HIPP referral was not made.

Mail or fax the HIPP Referral Form along with Form DMA 285, Health Insurance Information Questionnaire, to:

Health Management Systems 100 Crescent Centre Pkwy, Suite 1000 Tucker, Georgia 30084 Phone 678-564-1162, Press 1 Email: hippga@gainwelltechnologies.com

or

fax # 800-817-1769

If a TPL pays DCH more than the amount DCH paid for all other services, including HIPP expenses, DCH will issue a refund to the A/R and notify the county via the state office of the refund. Refer to Section 2499 - Treatment of Income for Medical Assistance for treatment of refunds from DCH.