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MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL C-620 Division of Welfare and Supportive Services GENERAL ELIGIBILITY REQUIREMENTS Medical Assistance Manual HEALTH INSURANCE PREMIUM PAYMENT 23 Dec 22 MTL 07/23 The case manager will forward the customer Form NMO-5000, HIPP Application and the customer will mail the completed HIPP form to the address provided on the HIPP application. Note: The NMO-5000 is not required if the individual is: • eligible for Nevada Check Up; • enrolled in a Managed Care Organization (MCO); • receiving unemployment benefits; • eligible for Medicare. HIPP is a cost-savings program that identifies Medicaid recipients who have access to group health insurance available through an employer. The program assists eligible recipients in paying private insurance premiums they otherwise may not be able to afford when it is determined to be cost-effective. It also benefits the recipients because they have more doctors to choose from and other medical services may be covered through private insurance that are not covered by Medicaid. The DHCFP HIPP website can be accessed at http://dhcfp.nv.gov/Pgms/CPT/HIPP/. This website can be used to gather information as well as download English/Spanish applications and brochures. This website can also be provided to recipients for easy access to program information, applications, brochures and fiscal intermediary contact information. Form NMO-5000 must be completed and forwarded to the fiscal intermediary to make this determination. Note: See NMO Form 5000 for fiscal intermediary address. If the health insurance is determined to be cost effective, premiums will be paid to the employer or insurance carrier through Medicaid. Premiums which can only be paid through a payroll deduction will be reimbursed directly to the customer. These reimbursements are exempt income to the customer. C-700 MEDICARE BUY-IN The Buy-In process is the system that allows the state to pay Medicare Part A and B premiums directly to Medicare for eligible individuals. DWSS is responsible for approving eligibility for Buy-In; however, DHCFP processes the Buy-In accretion/deletion file exchange with CMS. The state of Nevada has elected to pay the Part B premium for all Medicaid eligible individuals as well as Medicare only recipients who qualify for QMB, SLMB, or QI. In most instances, there is no premium associated with Medicare Part A; however, there are some individuals who must pay a premium for Part A. Those who must pay for this premium have a suffix "M" on their Medicare claim number. The state of Nevada has elected to pay the Part A premium for recipients who do not have free Part A if they are approved in the QMB category of eligibility.