If an eligible participant's employer offers employer-sponsored health insurance and the DMS determines that it is cost effective, the individual must participate in the employer-sponsored insurance. The Department of Social Services will pay the participant's portion of the premiums, co-payments, and any other costs associated with participation in the employer-sponsored health insurance.
If a participant's employer offers employer-sponsored health insurance, refer the participant to the existing Health Insurance Premium Payment program (HIPP), using form HIPP-1. HIPP staff will determine whether it is cost effective for HIPP to pay the individual's insurance premium. If so, Medicaid will pay the participant's portion of the insurance premiums, co-payments and other costs for Medicaid covered services associated with participation in the employer-sponsored health insurance.