HIPP is the Texas Medicaid program that helps families pay for employer-sponsored health insurance premiums. It is for families with at least 1 person who gets Medicaid.
People enrolled in any Medicaid program, except for the Children's Health Insurance Program (CHIP) and STAR Health managed care program, are eligible to enroll in HIPP.
There are no age restrictions in the HIPP program. The family member who has Medicaid and the family member who can get employer-sponsored health insurance can be any age.
If you can answer “Yes” to these questions, you should apply for HIPP:
You might be able to get HIPP if it costs Medicaid less to cover you or your family under employer-sponsored health insurance than it costs to cover family members who have Medicaid.
Employer-sponsored health insurance is a group health plan you can get through your job. The family member who gets Medicaid must be able to get coverage on this plan.
There are many benefits to getting HIPP if you or a family member qualify:
Every insurance plan has a different premium cost and covers different things. To join HIPP, your employer-sponsored health insurance plan must pay at least 60 percent of the costs when you:
This information is covered in the summary of benefits available from your employer.
HIPP will need the following information for your enrollment:
Once your complete documentation is received, Texas Health and Human Services (HHS) will review your case to determine your eligibility for the Medicaid HIPP program.
If you don’t already have employer-sponsored health insurance, talk to your employer to find out if you can sign up. There are several ways you can do this.
Some jobs will only allow you to sign up for insurance at a certain time. This is called open enrollment. If that happens at your job, just contact HHS 1 month before open enrollment begins.
You may not have to wait for your company’s open enrollment. Employers also must let you make changes for what are called qualifying events. Under state law, eligibility for HIPP is considered a qualifying event. That means you can sign up any time.
COBRA (Consolidated Omnibus Budget Reconciliation Act) is a type of health insurance you can get if you leave a job where you had insurance. If you have COBRA coverage, send us your COBRA rates. We will look at the rates and let you know if you can join HIPP.
To apply, you can either complete the application form or call 800-440-0493. You also will need to submit the following required items:
You can use any of the following as proof of payment:
You can’t use the following as proof of payment:
The application process is not complete without the required items. You cannot substitute anything else for the required items. You will also need to update the rate sheet every time you reapply for HIPP. Please visit the How to Reach HIPP page for fax and email information.
If your insurance rates change, let us know as soon as possible and send us a new rate sheet. Keeping your HIPP records up to date helps us send payments to you on time.
After we review your case, we will let you know if your family can get HIPP.
You can print HIPP forms by clicking the links below.
Form 5021, HIPP Consent
Use this if you want another person to be able to talk to us about your family’s case.
Form 5022, HIPP Direct Deposit
Use this if you want your premium reimbursement to go to your checking or savings account.
Form 5026 HIPP Summary of Insurance Expenditure Request
This form is used to tell the HIPP program what the employer sponsored insurance paid for the Medicaid recipients in the past year.
Fax Cover Sheet
Use this when faxing anything to HIPP.
Once your HIPP program case is approved for renewal each year, you will need to continue submitting a proof of health insurance payment each month.
In most cases, your employer will take the health insurance premium amount out of each paycheck. A proof of this payment must be submitted to HIPP, and HIPP will reimburse the employee’s portion of the health insurance premium amount.
Please see “How to Apply for HIPP” for information about what can and can’t be used as proof of payment.
It’s best to send HIPP your proof of payment the same month you pay your health insurance premium. However, you may submit your proof of payment within 3 months from the month of coverage. Proof of payment received after this will not be reimbursed.
HIPP determines the month of reimbursement based on the latest date on the proof of payment.
In most cases, HIPP processes reimbursements within 7 working days after receiving a valid proof of payment. Reimbursements are normally sent out on Tuesdays and Thursdays. HIPP can reimburse you by mailing a check or direct depositing the amount into a savings or checking account.
During HIPP enrollment or re-enrollment, it can take up to 30 working days from the time HIPP receives all required documentation to process your health insurance information.
If you have not received your reimbursement check within two weeks after the date HIPP mailed your check, please fill out and submit the Stop Payment Form to HIPP. A new check will be sent to you after the completed Stop Payment Form has been received and processed.
With direct deposit, HIPP deposits your health insurance premium payment straight into the checking or savings account you choose.
To set up a direct deposit, send HIPP the following:
