Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
Search Saved

Illinois program

Help with a private health-plan premium (Health Insurance Premium Payment Program)

Illinois can help pay an eligible private health-plan premium when Medicaid and cost-saving rules are met.

What it is

Illinois can help pay an eligible private health-plan premium when Medicaid and cost-saving rules are met.

HIPP can review available private insurance while Medicaid is being decided. Employer plans, individual coverage and COBRA can be considered. HFS pays eligible premiums only after Medicaid eligibility and the state’s cost comparison are approved.

Eligibility rules
  • Medicaid eligibility is required before premium payment. HFS’s Bureau of Collections decides whether paying for the private coverage is cost-effective.
  • Coverage for other family members is paid only when their enrollment is necessary to cover the HIPP participant.
  • HIPP may review private insurance that is available to your child even before the child enrolls in that insurance. A DHS referral can begin while Medicaid is being decided. HFS must establish Medicaid eligibility and find the private coverage cost-effective before paying eligible premiums; the family should not change plans based on a referral alone.
What you get
  • Payment or reimbursement of an eligible private-plan premium.
  • Reimbursements processed once your premium payments total at least $50.
What the help includes
  • Payment can go to the insurer, employer, union or parent. The approval identifies the recipient and starting month.
  • The program reviews the medical premium; HR can separate it from other payroll deductions.
If you decide to apply
  1. Discuss available private coverage with the social worker. If a HIPP review fits, have the plan summary and medical-only premium ready.
  2. Ask your DHS caseworker or DSCC coordinator about a HIPP referral, or use the HFS Bureau of Collections portal.
  3. Have the Medicaid case number, insurance details and premium records ready.

HFS HIPP: 217-524-8268 · Official page ↗

What happens next
  • A DHS referral uses form HFS 3459B. A refusal based on cost can be discussed using the state’s comparison figures.
  • The HIPP reviewer can confirm receipt, identify missing premium or plan records, and give a status-check date. Premium payment starts only when HFS confirms approval and the payment arrangements.
Good to know

HIPP excludes spend-down cases and coverage required by a child-support order. Approval depends on the state’s cost comparison.

Other details
  • An increase in expected treatment costs can change the cost comparison.
  • HFS can explain enrollment requirements before you make a private-insurance decision.

Federal background: Medicaid premium assistance for employer coverage.

Official sources
Ask your social worker

“Could HIPP help with a private-plan premium while Medicaid is being reviewed? What are the tradeoffs, and could you help us request a review if it fits?”

Why I’m asking: I want to compare the cost of available private coverage and understand whether Medicaid could help with its premium.

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

The social worker can help discuss a referral while Medicaid is pending and gather the available private policy and premium information.

Your social worker

The social worker or DSCC care coordinator sends the state referral form and chases the decision.

The care team

Records and letters when the application asks for them.

Who decides
The Healthcare and Family Services Bureau of Collections decides whether the plan saves the state money.
Ask HR
“Can you help us compare premium help for the private coverage available to us and decide whether a referral makes sense while Medicaid is pending?”

How to apply

First step: The social worker can help ask HFS at 217-524-8268 whether a premium review is worth starting while Medicaid is pending or approved.

  1. The social worker can help discuss a referral while Medicaid is pending and gather the available private policy and premium information.
  2. Ask HIPP whether the child must already be enrolled in the private plan.

Official application / program page ↗

Where it starts: Apply on the HFS BOC portal or call 217-524-8268; a DHS caseworker uses form HFS 3459B to refer you.

What to gather

  • Available employer, individual or COBRA policy summary
  • The medical premium and payment schedule for the available policy
  • Medicaid application or case information
  • Insurance card
  • The state referral form (HFS 3459B), which the social worker or DSCC care coordinator sends

How long: HFS confirms private enrollment requirements and the expected decision date for your case. No guaranteed decision clock is established here.

What a yes looks like

An approval letter naming who is paid (insurer, employer, union or you) and from which month.

What a no looks like, and the next move

Usually "not cost-effective". Ask for the comparison figures and reapply if the child's expected costs change (a transplant, a relapse).

Watch out

  • You can start a referral while Medicaid is pending. Payment depends on Medicaid eligibility and HFS finding the private policy cost-effective.
  • HFS can consider available private coverage before enrollment; it is not limited to an employer plan. HFS confirms the policy and enrollment steps before payment.
  • Spend-down cases and plans required by a child-support order are excluded.
  • HFS confirms private enrollment requirements and the expected decision date for your case. No guaranteed decision clock is established here.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 10, 2026.

What it is worth

HFS can pay or reimburse premiums for cost-effective employer, individual or COBRA coverage. A referral can start while Medicaid is pending; payment requires Medicaid eligibility and HFS approval.

  • $50 — Reimbursement processed once your premium payments total

Covers: Premium paid to the carrier, employer or union, or reimbursed to the parent

What it costs the family: None.

The eligibility facts, as published

Medicaid first
A referral can start while Medicaid is pending. Medicaid eligibility and a cost-effective private policy are required for payment; HFS can consider available coverage before private enrollment. Employer, individual and COBRA coverage may be considered.
Cost effectiveness
case-by-case by the Bureau of Collections Third Party Liability Section
Exclusions
spenddown clients; QMB-only and SLIB-only Medicare cases; long-term-care residents; coverage required by a child-support order
Non medicaid family members
premium paid only when their enrollment is necessary to cover the HIPP participant
Delivery system condition
none found (no fee-for-service-only rule)

Decisions this site cannot make: Cost-effectiveness decision by HFS Bureau of Collections

Expect friction on: Decision time not published

The trap: A referral can start before Medicaid is decided and before private enrollment. HFS must confirm Medicaid eligibility, the policy and cost-effectiveness before paying premiums.

Where I read this

← Back to your options