California program
Help with a private insurance premium (HIPP)
Help paying back an approved private-insurance premium when Medi-Cal pays bills directly and the state finds keeping that plan saves money.
What it is
Help paying back an approved private-insurance premium when Medi-Cal pays bills directly and the state finds keeping that plan saves money.
HIPP can pay back an approved private premium, but it has a narrow fit in California. Your child needs Medi-Cal that pays bills directly. DHCS must also find the coverage eligible and the premium cost-effective; having two plans alone is not enough.
Who can get it
- Fee-for-service Medi-Cal is required. Medi-Cal managed care, Medicare and TRICARE members are excluded.
- DHCS must find the private coverage eligible and worth paying for under its cost test. It is not necessarily limited to work insurance. Ask HIPP to check your exact coverage, premium invoice and benefit summary.
What you get
- You pay the approved private premium first; HIPP pays it back monthly.
- Private insurance stays first, with Medi-Cal paying under its own coverage rules.
If you decide to apply
- Ask the county worker whether Medi-Cal pays your child’s bills directly before completing HIPP form DHCS 6172.
- Have ready: the county notice and aid code, your Medi-Cal number, premium invoice, employer rate sheet, plan benefit summary and form DHCS 6172.
916-445-8322 · Official page ↗
What happens next
- HIPP can confirm its review status, received date and any missing documents. HIPP can explain its expected decision timing.
- Written approval states the reimbursement amount and required proof of payment.
Good to know
Joining a different Medi-Cal arrangement to seek premium help can disrupt care. The existing plan and treatment access need review first.
What else to know
- The family pays the premium before reimbursement. A premium-payment application does not guarantee reimbursement.
- Ask the county to check the aid code and how Medi-Cal pays for care, even when CCS handles the cancer care.
Federal background: Medicaid premium assistance. California HIPP excludes members enrolled in a Medi-Cal health plan. Help paying the work-plan premium (HIPP).
Official sources
“Could HIPP help with a private premium under our child’s Medi-Cal arrangement? What would we pay first, and could you help check the rules before we decide whether to apply?”
Why I’m asking: I want to know whether help with a private premium fits our child’s Medi-Cal arrangement.
More background and detailed requirements
Additional program information and published rules
Who does what
The three parts, side by side. The agency decides; nobody on this page does.
You
Ask the county whether your child is in fee-for-service Medi-Cal. If yes, send the application with the premium proof and the employer's benefit summary.
Your social worker
The social worker can read the aid code on the county notice and tell you whether the child is fee-for-service or in a plan.
The care team
Records and letters when the application asks for them.
- Who decides
- DHCS HIPP, after the county confirms fee-for-service Medi-Cal
- Ask your social worker
- “Does Medi-Cal pay my child's bills directly, or through a health plan? If directly, can you help me request payment of our work-plan premium?”
How to apply
First step: Ask the county whether Medi-Cal pays your child's bills directly. If so, contact hipp@dhcs.ca.gov about help paying the work-plan premium.
- Ask the county whether the child’s aid code is fee-for-service.
- Only then: the application with the premium proof.
Where it starts: Send the premium-payment application
What to gather
- The county notice with the aid code
- Premium invoice and the employer's rate sheet
- The plan's benefit summary
- Medi-Cal number
- Form DHCS 6172
How long: No published processing time. Ask for a written received date.
What a yes looks like
A written premium approval with the reimbursement amount and proof instructions.
What a no looks like, and the next move
A letter naming the delivery system (managed care) or the cost test. The managed-care reason cannot be fixed by the family.
Watch out
- Managed care, Medicare and TRICARE members are excluded. Ask the county which aid code your child has and whether it is fee-for-service before spending time on the form.
- Do not drop the employer plan or disenroll from the Medi-Cal plan to chase help paying the work-plan premium. Treatment continuity comes first.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 8, 2026.
What it is worth
The approved private premium, reimbursed monthly, if the child is in fee-for-service Medi-Cal and the cost test passes.
Covers: Private plan stays primary. Medi-Cal coordinates
What it costs the family: The family pays the premium first and is reimbursed under the program rules.
The eligibility facts, as published
- Medi cal delivery system
- fee-for-service only. Managed care excluded
- Excluded
- Medi-Cal managed care; Medicare; TRICARE
- Cost effectiveness
- DHCS test
Decisions this site cannot make: Fee-for-service status · DHCS cost-effectiveness
Expect friction on: Nearly every child is in managed care · Employer premium documentation
The trap: Dropping the work plan or disenrolling from the Medi-Cal plan to chase help paying the work-plan premium. Treatment continuity comes first.
Where I read this
- Health Insurance Premium Payment Program — California Department of Health Care Services, read August 27, 2026
- Health Insurance Premium Payment Program / cost avoidance — California Department of Health Care Services, read September 8, 2026
- SPA CA 14-0027 approved package (HIPP cost-effectiveness) — California Department of Health Care Services, read September 8, 2026
- Coordination of Benefits and Third Party Liability — Centers for Medicare & Medicaid Services, read August 27, 2026