2912.1 Referral Process

Staff should send HIPPS referrals in instances where KDHE-DHCF or contract staff become aware of a family where at least one family member is working (or eligible for COBRA coverage) and has high medical expenses, a serious illness, and/or has an employer who offers low cost family coverage. All Working Healthy recipients must be referred. All HCBS participants must also be referred if the individual or appropriate family member is employed. In these instances, staff should fill out the Health Insurance Premium Payment Information Form and send it to the HIPPS Unit.

The form should be completed as thoroughly as possible by the eligibility worker. It is not necessary to send the form to the client, but additional information not available on the Information Form may need to be obtained by the HIPPS unit, including information on pre-existing medical conditions. If information is known about such illnesses, a determination on the cost-effectiveness of the policy as described in item 2912.2 below can often be made quicker. The eligibility worker does not need to verify that coverage exists prior to sending in the HIPPS Information Form. The HIPPS unit will make a final determination on coverage availability. Referrals should be sent whenever an eligible individual or a legally responsible individual is employed. But no referral should be sent when it is known that coverage is not available (e.g., situations where the employment is part-time and the company only offers coverage to full-time employees.) Those persons whose only employment is in a sheltered workshop setting should not be referred unless it is known that health coverage may be available.

If the client is covered through a policy held by an absent parent, no referral should be sent. However, if the health insurance is available through an absent parent, but the child is not enrolled, a HIPPS referral should be sent. The policy will be reviewed and, if determined cost-effective, eligible children will be enrolled. If the agency is aware that the employed individual is not authorized to work in the country (according to INS) a referral shall not be made.

Failure to cooperate in providing information concerning the completion of the referral can lead to denial of eligibility as indicated in item 2912.2 below.

Once a completed referral is received by the fiscal agent from the individual or the Specialist and the availability of coverage is established, the fiscal agent contacts employers and insurance companies to determine cost, enrollment restrictions, restrictions on pre-existing conditions, etc. This information will be used to determine cost-effectiveness. Special forms have been developed to gather this information and it is likely that it could take a maximum of 90 days to complete. If any additional information is needed, eligibility staff may be contacted. Otherwise, eligibility staff will receive no additional feedback.

NOTE : Those persons whose only employment is in a sheltered workshop setting should not be referred unless it is known that health coverage may be available.