HIPP & CHIPRA: How to Get Reimbursed for Your Private Insurance Premiums

Yes, you read that right. If your child has Medicaid, the state might actually pay your private employer health insurance premiums for you. Here is how it works in Georgia and across the US.

When your child receives a life-changing diagnosis, one of the first things you realize is that private employer insurance rarely covers everything. To get the therapies and durable medical equipment (DME) your child needs, you often have to fight to get Medicaid as a secondary insurance (usually through a waiver like Katie Beckett).

But once you have both, the monthly premiums for your family's private insurance plan can still drain your budget.

Enter the best-kept secret of the special needs financial world: Premium Assistance Programs.

Instead of paying for 100% of your child's medical bills directly, many states have realized it is actually much cheaper for them to simply help pay your private insurance monthly premiums. You keep your private insurance, your child keeps Medicaid as a backup, and the state reimburses you for the health insurance deductions taken right out of your paycheck.

In Georgia, there are two main programs that do this: GA HIPP and GA CHIPRA.

The Georgia Programs: GA HIPP vs. GA CHIPRA

Both of these programs are administered by the Georgia Department of Community Health, and both have the same fantastic end goal: you submit your paystubs each month, and they mail or direct deposit a reimbursement check for your insurance premium.

However, they have slightly different eligibility rules.

1. GA HIPP (Health Insurance Premium Payment Program)

• What it is: A traditional Medicaid premium assistance program.

• Who it is for: Families where at least one person is enrolled in Medicaid, and the policyholder has access to an employer-sponsored group health insurance plan (including COBRA).

• The Main Requirement: It must be "cost-effective" for the state. This means the HIPP unit will review your child's medical expenses and determine: Is it cheaper for Georgia to pay this family's insurance premium than it is for Medicaid to pay for all of this child's therapies, medications, and equipment directly? If the answer is yes, you get approved.

2. GA CHIPRA (Children's Health Insurance Program Reauthorization Act Premium Assistance)

• What it is: A specific premium assistance program funded by federal CHIPRA dollars. Georgia was actually the first state in the country to implement this!

• Who it is for: Medicaid-eligible children under the age of 19.

• The Main Requirement: Unlike HIPP's complex "cost-effectiveness" test, GA CHIPRA has a more straightforward employer rule. To qualify, your employer must contribute at least 40% toward the cost of your family's health insurance premium. If your employer covers 40% or more, the state steps in to reimburse your portion of the premium.

Which One Should I Apply For?

The beautiful part of the Georgia system is that you don't necessarily have to choose. When you apply for premium assistance, the state will evaluate your application for both HIPP and CHIPRA and place you in the program that best fits your employer's plan and your child's medical costs.

The National Perspective: US HIPP and CHIP

If you live outside of Georgia, you will hear these acronyms used slightly differently. Because Medicaid and CHIP are federally funded but state-run, the rules change depending on where you live. Here is the national translation:

National HIPP (Available in Many States)

You do not have to live in Georgia to get your premiums reimbursed! Many states (including Texas, Pennsylvania, California, and Virginia) run their own HIPP programs.

• How it works nationally: The rules are generally the same across the board. If your child has Medicaid (usually through a waiver), and you have access to private employer insurance, your state will run a "cost-effectiveness" test. If paying your premium saves the state money, they will cut you a check.

• Advocate Tip: Search "[Your State] Medicaid HIPP program" to find your state's specific application portal.

National CHIP (Children's Health Insurance Program)

Nationally, if a doctor or social worker talks about "CHIP," they are not talking about a premium reimbursement check. They are talking about an actual health insurance plan.

• What it is: CHIP is the middle-ground insurance program for the United States.

• Who it is for: If you earn too much money to qualify for traditional Medicaid, but your child is uninsured because you cannot afford a private employer health plan, CHIP bridges the gap to ensure your child has healthcare coverage. (In Georgia, this insurance plan is called PeachCare for Kids).

• Advocate Tip: In almost all states, your child cannot have both CHIP and private employer insurance at the same time. CHIP is strictly for uninsured children.

How to Establish and Keep Your Coverage

If you are applying for premium assistance (like GA HIPP or GA CHIPRA), the paperwork is critical. Treat it like a monthly investigation.

1. Keep Your EOBs: You will need to show the state that your child actively uses their private insurance. Keep all of your Explanations of Benefits (EOBs) and paid claims to document ongoing treatments and prove cost-effectiveness.

2. Submit Promptly: Once approved, you are responsible for submitting proof of your premium payment (usually your paystubs showing the deduction) every single month. In Georgia, these must be received by the 15th of the month to get your reimbursement processed by the end of the month.

3. Always Use Both Cards: Even though the state is paying your premium, your private insurance is still your primary. When you go to the doctor or pharmacy, you must hand them both your private insurance card and your Medicaid card so you aren't hit with out-of-pocket co-pays.

Advocate Tip: Never drop your private employer insurance without talking to your state's HIPP/CHIPRA office first! If you drop your private insurance, you lose the reimbursement, and you could potentially disrupt your child's access to out-of-network specialists who only take your private plan.