Short answer: When HHSC finds it cost-effective, Texas HIPP reimburses the employee’s share of the employer plan premium for a Medicaid member, plus that member’s deductibles, copays and coinsurance for services Medicaid would cover.
Under Texas law, HHSC identifies Medicaid members who can enroll in an employer group health plan and decides whether enrolling them is cost-effective. If it is, the state pays:
- the employee’s share of required premiums for the Medicaid member’s coverage, and
- the member’s cost sharing for items and services Medicaid otherwise covers.
If the plan only allows the Medicaid member to enroll alongside a non-Medicaid family member (for example, the employee), HHSC can also pay that family member’s premium when cost-effective, but not that person’s deductibles or copays. The Medicaid member keeps Medicaid, which pays after the employer plan.
Families can reach Texas HIPP at 1-800-440-0493. HIPP is not automatic: gather the plan’s premium breakdown and benefit summary and let HHSC evaluate it.