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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M01 July 2025 Subchapter Subject Page ending with Page M0130 APPLICATION PROCESSING M0130.200 9 If the client is eligible for benefits to be used exclusively for the payment of medical expenses (i.e. an insurance settlement), but there is no TPL code for that benefit, the worker must email the information to the DMAS TPL Unit at TPLUnit@dmas.virginia.gov, or send the information to: DMAS Third Party Liability Section 600 East Broad Street, Suite 1300 Richmond, Virginia 23219 G. Health Insurance Premium Payment (HIPP) Program The HIPP program is a cost-savings program for individuals enrolled in Medicaid which may reimburse some or all of the employee portion of the employer group health insurance premium. Eligibility for HIPP is determined by the HIPP Unit at DMAS. Participation in HIPP is voluntary. The local DSS agency must give each applicant or enrollee who reports that he or someone in his family is employed more than 30 hours each week and is eligible for health insurance coverage under an employer’s group health plan must be given a HIPP Fact Sheet, which provides a brief description of the program and the contact information for the HIPP Unit at DMAS. The HIPP Fact Sheet is available at https://fusion.dss.virginia.gov/Portals/[bp]/Medicaid/Resources%20and%20Job%20A ids/MA%20Fact%20Sheets/HIPP%20Fact%20Sheet%2024_d032_03_0842-04- eng_.doc?ver=2024-07-15-082927-803. Enrollees and other members of the public may contact the HIPP Unit for additional information at hippcustomerservice@dmas.virginia.gov. If the health insurance policy holder lives outside of the home, a HIPP Consent Form must be completed by both the policy holder and the parent/authorized representative so the DMAS HIPP Unit can process the HIPP application. If the form is required, the DMAS HIPP Unit will send it to the applicant for completion. H. Verificatio n of Financial Eligibility Requirem ents The eligibility worker must verify the following financial eligibility requirements: • the value of all countable, non-excluded resources, if the reported values of the resources are not both reasonably compatible with electronic sources AND below the resource limit. In all situations the sources of the resources do not have to match. If the member attests to having resources below the limit and values received from electronic sources are above the limit, additional verification should be requested. Reasonable compatibility for resource evaluation is effective for all case actions as of June 3, 2024. • asset transfer information for individuals in need of long-term care services, including the date of transfer, asset value, and compensation received. • earned and unearned income. For all case actions effective August 26, 2022, if the income attested to by the applicant is within 20% of the income information obtained from electronic sources OR both sources are below the applicable income limit, no additional verification is required. If the attested income is under the income limit and the reasonable compatibility standard is not met, request verification of income and allow a minimum of 10 days to return. If the applicant meets a Medically Needy (MN) covered group, verification of income is required to determine spenddown liability. If the attested income is over the income limit and the individual does not meet a Medically Needy (MN) covered group, deny the application. The agency must utilize online systems information verifications that are available to the agency without requiring verifications from the individual or family. The agency has ready access to Supplemental Nutrition Assistance Program (SNAP) and TANF records, some wage and payment information, and