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

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New York program

Help paying your work-plan premium (HIPP)

HIPP is Medicaid help with a work-plan premium when keeping that plan saves Medicaid money.

What it is

HIPP is Medicaid help with a work-plan premium when keeping that plan saves Medicaid money.

Keeping work insurance can leave a large monthly premium even after Medicaid starts. HIPP reviews whether Medicaid should pay that premium. The district checks the plan and whether keeping it costs Medicaid less.

Eligibility rules
  • Your child must be fully eligible for Medicaid. Coverage through the Children's Waiver counts.
  • The district checks whether the employer plan qualifies and is cost-effective for Medicaid.
What you get
  • Payment toward a qualifying work-plan premium after Medicaid approval.
  • The work plan remains the first insurer billed for care.
What the help includes
  • The approval should say which premium costs are included, who receives the payment and when it begins.
  • The work plan stays primary while Medicaid is the last payer.
If you decide to apply
  1. Ask the local Medicaid district about HIPP after your child's Medicaid is approved.
  2. Ask your benefits office to complete the employer-insurance information, including the medical premium per pay period.
  3. Have your child's Medicaid notice and the work plan's benefit information ready.

Medicaid helpline: 800-541-2831; NY State of Health form questions: 855-355-5777 · Official page ↗

After you ask
  • The local Department of Social Services reviews cost effectiveness under state Medicaid policy.
  • The office handling your Medicaid can identify the current premium-assistance form, where to send it and when to expect a decision.
Good to know

A premium-help request does not change who currently owes the work-plan premium. Payment arrangements need to be clear before you rely on them.

Other details
  • The Medicaid helpline and NY State of Health numbers are general contacts, rather than dedicated HIPP lines.
  • HIPP requires Medicaid eligibility and a finding that paying the other premium saves Medicaid money. Before any plan change, ask the office handling your Medicaid which form to use, whose premiums qualify, and whether your Medicaid plan must change. Its written approval should explain who receives payment, when it begins and any costs left to you.

Federal background: Medicaid premium assistance.

Official sources
Ask your social worker

“Could HIPP help pay our work-plan premium once Medicaid is approved? What would change about our child's coverage, and could you help us get a written review?”

Why I’m asking: We want to understand whether keeping the work plan can cost less without disrupting treatment.

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 for HIPP when Medicaid is approved, hand in the employer premium information, and keep paying the premium until the district takes over.

Your social worker

The social worker helps get the employer form completed and follows up with the district.

The care team

Records and letters when the application asks for them.

Who decides
The local Department of Social Services decides cost effectiveness under state Medicaid policy.
Ask HR
“Can you fill in the state's employer health-insurance form for Medicaid's premium help, and give me the medical-only premium per pay period?”

How to apply

First step: When Medicaid is approved, ask the local Department of Social Services for HIPP (or call 800-541-2831). Ask the employer's benefits office for the medical-only premium per pay period.

  1. Ask the district for HIPP the week the Medicaid approval arrives.
  2. Get the employer's medical-only premium per pay period from the benefits office.

Where it starts: Tick the premium-help option on the Medicaid application (DOH-4220) or ask the local district after approval; Medicaid helpline 800-541-2831.

What to gather

  • Employer premium information (medical-only, per pay period) on the state's employer form, DOH-5106
  • The plan's summary of benefits
  • The child's Medicaid ID
  • The Medicaid application itself (DOH-4220) already asks about help paying premiums

How long: A cost-effectiveness review by the district. The decision time was not found; ask when you file.

What a yes looks like

A notice naming the premium paid and to whom (insurer, employer or you).

What a no looks like, and the next move

"Not cost-effective" or "not fully on Medicaid". Ask what comparison they used and whether a new plan year reopens it.

Watch out

  • Medicaid first: HIPP cannot start before the child's Medicaid (the Children's Waiver counts) is approved.
  • Four things were not found in current rules: whether HIPP moves the child out of managed care, how much of a family premium it covers, the decision time, and how payment arrives. Ask the district all four.
  • A dedicated HIPP phone was not found. Start with the local district or the Medicaid helpline, 800-541-2831.
  • The current premium-assistance form is DOH-5106. Its questions go to NY State of Health at 1-855-355-5777; that is not a dedicated HIPP line. Family-premium scope and payment timing still need confirmation.

The numbers and the rules

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

What it is worth

Medicaid pays the work-plan premium when the plan passes its checks, keeping it is cheaper for Medicaid, and the child is fully on Medicaid. Payment can go to the insurer, the employer or you.

Covers: Premium payment for a qualified, cost-effective employer plan · Employer plan stays primary; Medicaid pays behind it

What it costs the family: None beyond keeping the plan in force.

The eligibility facts, as published

Medicaid
fully eligible first (the Children's Waiver counts)
Employer plan
qualified and cost-effective against the regional managed-care capitation rate (historical training)
Delivery system condition
NOT FOUND (whether managed-care members are excluded is unknown)
Family premium scope
NOT FOUND
Forms
DOH-5106, July 2026 revision, is available; it asks about employer coverage and directs questions to NY State of Health.

Decisions this site cannot make: Local district cost-effectiveness determination

Expect friction on: Employer premium information · Decision time not found

The trap: The current rules on whether HIPP moves a child out of managed care, how far it reaches a family premium, the decision time and how payment arrives were not found. Ask the district these four questions before counting on it.

Where I read this

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