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

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Pennsylvania program

Pennsylvania pays the work-plan premium (HIPP)

Help paying the work-plan premium after someone in your family has Medical Assistance. HIPP pays when the plan saves the state money.

What it is

Help paying the work-plan premium after someone in your family has Medical Assistance. HIPP pays when the plan saves the state money.

HIPP reviews the employer plan's premium and benefits against what MA would otherwise spend. If the plan saves the state money, the premium can be paid. The decision also changes how the MA member gets care, so the oncology billing check matters.

Eligibility rules
  • At least one family member must be enrolled in MA, and employer health insurance must be available.
  • The state compares the group-plan cost plus administration with expected MA costs. A high premium alone does not settle the answer.
What you get
  • The approved employer health-plan premium paid by the state.
  • Payment usually goes to the employer.
  • The amount follows the plan premium, with no published dollar cap.
What the help includes
  • HIPP pays the approved premium rather than a fixed grant. The state usually sends payment to the employer.
  • The MA member moves to fee-for-service MA, outside the HealthChoices plan. The hospital and oncology group need to accept that billing arrangement.
If you decide to apply
  1. Ask HR for the premium amount and plan summary for a HIPP review.
  2. Ask the financial counselor whether the oncology team bills MA directly.
  3. Complete form HS 1661 with help from the HIPP office if you choose to request the review.

Your county’s regional HIPP office is listed on the DHS HIPP page. · Official page ↗

After you ask
  • The DHS HIPP unit makes the cost-effectiveness decision after reviewing form HS 1661 and the plan documents.
  • The regional HIPP office confirms the decision timeline, when premium help starts and who receives it. It also decides whether any premiums already paid can be reimbursed. Written dates and the treatment team’s fee-for-service MA billing arrangements help you understand the change before relying on payment.
Good to know

Joining HIPP moves the MA member out of HealthChoices into MA billed directly. When the state finds the work plan cost-effective, participation becomes a condition of keeping MA.

Other details
  • A premium review is different from joining an ordinary HealthChoices plan. It can affect approvals and which billing office handles care.
  • Regional HIPP contacts include Allegheny, Montour and Cumberland: 1-800-684-7730; Philadelphia: 1-888-819-9206; Dauphin and Lehigh: 1-800-644-7730. The DHS HIPP page lists the office for each county.

Federal background: Medicaid premium assistance.

Official sources
Ask your social worker

“Could HIPP pay our work-plan premium, and what would changing the MA billing arrangement mean for treatment? Could you check that with the hospital before helping us request a review?”

Why I’m asking: The premium is a regular expense, but I do not want a billing change to disrupt care.

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

Get the premium and plan summary from HR and send the HIPP application (form HS 1661).

Your social worker

The social worker checks that the oncology group bills fee-for-service MA and helps time the application with the MA approval.

The care team

Records and letters when the application asks for them.

Who decides
The state Department of Human Services' HIPP unit runs the cost test.
Ask HR
“Can you give me the monthly premium for the medical plan and a plan summary for Pennsylvania's HIPP application?”

How to apply

First step: Discuss the work-plan premium and benefits with HR and the county’s regional HIPP office. If you choose a review, the office supplies the application route.

  1. Ask HR for the premium and a plan summary the week MA is approved.
  2. Send HS 1661 to the regional HIPP office.
  3. Confirm with the hospital that it bills fee-for-service MA.

Official application / program page ↗

Where it starts: Form HS 1661 by mail or through the HIPP office; call the HIPP hotline.

What to gather

  • The HIPP application (form HS 1661)
  • Premium amount and plan summary from HR
  • MA approval notice and ID numbers

How long: No published standard. Payments usually go straight to the employer once approved.

What a yes looks like

A letter saying the plan saves the state money and a premium payment schedule, with the child moved to fee-for-service MA.

What a no looks like, and the next move

'Not cost-effective.' Ask for the calculation; a new plan year or a change in the premium can change it.

Watch out

  • Joining HIPP automatically moves the child out of the HealthChoices plan into MA billed directly (fee-for-service). Confirm first that the hospital bills fee-for-service MA.
  • If the state finds the plan saves it money, joining HIPP becomes a condition of keeping MA.
  • The regional HIPP office confirms the decision deadline, payment start and any treatment of premiums already paid.

Dates that change this

2025-10-01: The cost-effectiveness method is the state plan amendment effective October 1, 2025 (approved February 24, 2026). (not yet confirmed against the final rule)

The numbers and the rules

The arcane layer, kept on purpose. Checked September 9, 2026.

What it is worth

The employer-plan premium paid by the state when the plan saves it money. No published dollar cap; the amount is the plan's premium.

Covers: Premium payment, usually sent to the employer; paid to the family when necessary · Premiums for non-MA family members when their enrollment is required to cover the MA member

What it costs the family: None.

The eligibility facts, as published

Medicaid member
at least one family member enrolled in MA
Employer plan
employer health insurance available
Cost effectiveness
costs to the state under the group plan plus administration likely lower than MA's cost for the condition (Attachment 4.22-C, TN 25-0022)
Delivery system condition
enrollment automatically disenrolls the member from managed care into fee-for-service MA
Participation
required as a condition of continued MA eligibility when found cost-effective

The trap: Joining HIPP automatically ends the child's HealthChoices plan and moves the child to MA billed directly (fee-for-service). Ask the hospital billing office whether it bills fee-for-service MA before you join. If the state finds the plan saves it money, joining is required to keep MA.

Where I read this

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