Health Insurance Premium Payment Program
Report changes or ask a question about the HIPP program via email at email@example.com.
What is the HIPP program?
The Health Insurance Premium Payment (HIPP) program is one of the services available to people who get Medicaid (Title 19). The HIPP program is a way for the State of Iowa to save money.
How can I get HIPP?
- You or someone in your home has to have Medicaid.
- You must have medical insurance or be able to get it through your employer.
- The health plan must be cost-effective.
What is cost-effective and how is it determined?
"Cost-effective" means a determination has been made that a savings will accrue to the Department by paying the insurance premium, cost sharing, wrap benefits, and administrative cost instead of paying for the same care through Medicaid managed care.
To determine cost-effectiveness, the HIPP program totals together the member's health insurance premium cost to cover the Medicaid eligible members, plus the deductibles, out-of-pocket cost, and administrative cost and compares all of this to what the Department would pay to a managed care organization (MCO) (based on age, sex, aid type).
"Cost sharing" is the out-of-pocket cost that is not paid by the health insurance plan, but is the responsibility of Medicaid. For example, copayments and deductibles.
"Wrap around benefits" or "wrap" are services not covered by a commercial health insurance plan. For example, supported community living (SCL) services, case management, adult diapers, transportation, or school based services. Medicaid is typically the only payer for wrap around benefits.
What the HIPP program does not provide premium assistance for:
This list is not inclusive.
- Insurance for someone who does not live in your home.
- School plans based on enrollment or attendance as a student.
- An insurance plan that pays income to the policyholder or pays only limited amounts for services.
- Plans that are limited to a temporary period of time.
- Plans that have an absent parent as the policyholder, or when the policyholder is not part of your Medicaid household.
- An insurance premium that is used to reduce the Medically Needy spend down amount for Medicaid or used as a deduction in computing the client participation
- Anyone covered under Medicaid Kids with Special Needs (MKSN), Family Planning Program (FPP), or Health Insurance Plan Iowa (HIPIOWA).
- The insurance plan is a high deductible health plan, pursuant to the guidelines of the Internal Revenue Service (IRS).
- The insurance plan is a subsidized insurance plan purchased through a government-run health insurance exchange.
- Someone who has Medicare.
- Someone who is covered under the insurance plan and is not Medicaid-eligible on the date the decision regarding eligibility for the HIPP program is made.
- The health plan pays secondary to another plan.
You are required to report all changes to the Department within 10 days of the change. Changes may impact the benefit amount and who is considered HIPP eligible. The quickest way to report changes is to:
- Call the HIPP program at 1-888-346-9562
- Email: HIPP@dhs.state.ia.us
- Fax: 1-515-725-0725
- Call the number on the front of a HIPP notice.
You are required to report all changes that occur in your employment or health insurance, in your family and household.
Here are examples of some changes that need to be reported:
- Mailing address changes (state checks do not get forwarded).
- The health insurance ends, or the insurance carrier, premium or deductible, or coverage changes.
- The policyholder is not living with the Medicaid-eligible members.
- Medicaid-eligible member moves in or out of your home, or you are no longer responsible for their Medicaid case.
- The health insurance policy, paid by HIPP, is no longer primary for the HIPP eligible and enrolled members.
- Employment changes
What does HIPP need to determine cost-effective?
This list is not inclusive.
- Verification of the cost of all possible insurance plan options (e.g. single, employee/spouse, employee/children, family) or for an individual policy, the cost breakdown per individual.* **
- Complete summary of benefits and coverage for the health and prescription plan. This shows what your prescription and health insurance plan covers, including deductibles, copayments, coinsurance, and out-of-pocket costs.* **
- Pay stub containing a health insurance premium deduction or proof of payment (e.g., bank/credit card statement, endorsed check, payment receipt).
- Copy of the front and back of the health insurance and prescription cards.
- Employer issued COBRA continuation coverage letter.
* You may need to access your employer's website or contact your human resources department to get this information.
** You may need to contact your insurance agent or insurance company to get this information.
How do I apply for HIPP?
Call to complete an application referral over the phone:
Des Moines area: 515-974-3282
Print a HIPP application, fill it out and email or fax it in:
Print a HIPP application, fill it out and mail it in:
Iowa Medicaid Enterprise (IME)
PO Box 36476
Des Moines, IA 50315-9907
AIDS/HIV Health Insurance Premium Payment Program
The AIDS/HIV Health Insurance Premium Payment Program's goal is to ensure that persons living with AIDS/HIV-related illness can continue their health insurance coverage even though the person's ability to maintain the coverage is reduced because of their illness.
What services does the AIDS/HIV HIPP program provide?
The AIDS/HIV HIPP program helps persons living with AIDS/HIV-related illness by paying their health insurance premiums when they become too ill to work.
Who is eligible for services from the AIDS/HIV HIPP program?
To qualify for services under the AIDS/HIV HIPP program, the person must:
- Be ineligible for Medicaid
- Be a resident of Iowa
- Provide a doctor's certification that the person's ability to work is impaired due to AIDS or HIV-related illness.
- Be the policyholder of the health insurance plan or be a dependent on their spouse's health plan.
- Have "liquid" assets (cash, stocks, bank accounts, etc.) of less than $10,000.
- Meet the income limits.
What is the income limit for the AIDS/HIV HIPP program?
Gross income cannot exceed 300% of the federal poverty level for a household of the same size. Effective April 1, 2015, the monthly limits are:
- 1 Person Household - $2,943.00
- 2 Person Household - $3,983.00
How can I apply for the AIDS/HIV HIPP program?
An application is included in the program brochure called "The Iowa AIDS/HIV Health Insurance Premium Payment Program (Comm 99)". You may obtain a brochure by calling or visiting your local county Department of Human Services Office or by calling the toll-free HIPP customer service number at 1-888-346-9562.
How is the Program Structured?
The AIDS/HIV program is administered by the staff of the HIPP Program Unit in Des Moines. The HIPP program is part of the Iowa Medicaid Enterprise.
What If I Have More Questions?
You can call the toll-free HIPP customer service number at 1-888-346-9562. All communications regarding this program will be held in the strictest confidence.