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417 (07/2026) Chapter 2:Eligibility • Section 6: Non-financial eligibility • Provide information for any third-party payments for medical care. This includes, but is not limited to:
Cost-effective, employer-sponsored health insurance. The individual is not expected to incur a cost, but they can be reimbursed by HIG. HIG will also determine whether or not the insurance is cost-effective.
Coverage under Medicare
Coverage under Tri-Care
A claim for damages from personal injuries Note: Effective July 1, 2024 pursuit of cost-effective employer sponsored insurance (ESI) is not an eligibility requirement for MAGI or non-MAGI programs. ODHS|OHA may not refer a case for medical support enforcement on a child based solely on health care services which they are eligible for or receiving through an Indian Health Program provided by the Indian Health Service. Note: Medical-only individuals may not be disqualified for failure to pursue a cash child support order. They are required to cooperate with paternity and medical support only. The penalty for failure to cooperate with medical coverage is ineligibility for the legally responsible adult. A person can be penalized only if they have the legal right to obtain the health insurance. This means that individuals who cannot enroll in cost-effective employer-sponsored insurance for themselves are not disqualified. For example, if a spouse is unable to enroll on their own behalf, the spouse is not disqualified. End the noncooperation penalty when the individual provides evidence that they are willing to cooperate. Good cause for failing to pursue health care coverage and medical support Good cause includes the following: • Complying would result in emotional or physical harm to the individual or anyone on whose behalf that individual’s cooperation is required. • A child was conceived as a result of incest or rape and cooperating would cause harm to the individual, the child or the spouse. • Legal proceedings are pending for an adoption of a child. • A parent is being helped by a social service agency to help decide if a child should be released for adoption. • The individual is pregnant. Reimbursement of cost effective, employer-sponsored Health Insurance Premium Payment (HIPP) The HIPP program provides premium reimbursement to eligible policyholders who are paying for individuals also covered by Medicaid. Eligibility for the HIPP program is determined by a HIG premium