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

Childhood Cancer Lantern
Search Saved

Oregon program

Help with private health-plan premiums (HIPP)

Oregon can reimburse a private health-plan premium when someone covered has full Medicaid [HIPP].

What it is

Oregon can reimburse a private health-plan premium when someone covered has full Medicaid [HIPP].

A private-plan premium can remain a large bill when someone on the policy has full Medicaid. HIPP reviews whether Oregon can pay that premium back. The Medicaid member can be someone other than your child; CHIP does not qualify.

Eligibility rules
  • At least one person covered by the policy must have full Medicaid; CHIP and CAWEM do not qualify. The paid policy must provide comprehensive major medical coverage and pass Oregon’s cost-effectiveness review.
  • Court-ordered policies and policies receiving federal tax credits do not qualify.
  • The covered person cannot be on Medicare Part A, B or C.
What you get
  • The approved premium is reimbursed to the policyholder by monthly check.
  • Reimbursement starts with the month after approval.
What the help includes
  • The payment goes to the policyholder rather than the employer. Direct deposit is not offered.
If you decide to apply
  1. Ask the social worker whether HIPP could fit anyone on your private policy. If you decide to seek review, the counselor or work benefits office can help gather the records.
  2. Have the policy details, your premium and the employer's share ready for Oregon's online reimbursement portal.

HIPP: reimbursements.hipp@odhsoha.oregon.gov · Official page ↗

After you ask
  • The office allows up to 90 days after all materials arrive to process the request. If approved, reimbursement starts in the following month, not for premiums from before approval.
  • Oregon uses its Medical Savings Chart and may request a clinical review.
Good to know

An insurance offer alone is not enough. The policy must be active and paid, and at least one person it covers must have full Medicaid.

Other details
  • This premium review is separate from how the two insurers pay medical claims.

Federal background: Medicaid premium assistance.

Official sources
Ask your social worker

“If our child gets full Medicaid, could HIPP reimburse our private premium? What are the benefits and drawbacks of keeping both plans, and could you help request the review if it is worthwhile?”

Why I’m asking: I want to know whether keeping private coverage could cost us less each month.

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

Send the application with the premium amount, the employer's share and the policy details.

Your social worker

The social worker or the benefits office confirms the premium figures.

The care team

Records and letters when the application asks for them.

Who decides
The Office of Payment Accuracy and Recovery runs the cost-effectiveness test.
Ask HR
“Can you give me a written breakdown of the monthly premium and the employer's share for the plan covering my child?”

How to apply

First step: Apply at apps.oregon.gov/dhs/opar the week coverage is approved.

  1. Apply at apps.oregon.gov/dhs/opar the week the Oregon Health Plan is approved.
  2. Have the premium amount and what the employer pays ready; cost effectiveness turns on your share.
  3. Ask whether other family members can be included on the same policy.

Official application / program page ↗

Where it starts: Apply online at apps.oregon.gov/dhs/opar. Questions: reimbursements.hipp@odhsoha.oregon.gov.

What to gather

  • The premium amount and the employer's share, in writing
  • Policy documents and the insurance card
  • The Oregon Health Plan approval notice

How long: Up to 90 days once the office has everything; payments usually begin the month after approval.

What a yes looks like

A monthly cheque to the policyholder for the premium.

What a no looks like, and the next move

Usually a cost-effectiveness no. Ask for the calculation and whether adding other covered members changes it.

Watch out

  • CHIP does not count; this needs full coverage.
  • An offer is not enough: someone has to be enrolled and paying.
  • It is a cheque to the policyholder each month, not a payment to the employer, and there is no direct deposit.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

The premium paid back to the policyholder each month, from the month after approval. The office allows up to 90 days to process.

  • $90 — Published processing allowance once all materials arrive

Covers: Monthly reimbursement of the private premium · Cover for necessary non-Medicaid family members when the whole premium is still cost-effective

Legal protection: Keeps the private network while the Oregon Health Plan pays behind it

What it costs the family: Nothing to apply.

The eligibility facts, as published

Coverage
a covered child enrolled in a full-coverage Medicaid programme, excluding CHIP
Policy
a comprehensive major medical plan; not court-ordered; no federal tax credit on it; the covered person not on Medicare Part A, B or C
Cost effectiveness
decided with the Medical Savings Chart, with possible clinical review

The trap: An employer offer is not enough. Someone has to be enrolled and paying. And the reimbursement is a cheque to the policyholder, not a payment to the employer: there is no direct deposit.

Where I read this

← Back to your options