South Carolina program
Help paying your work-plan premium (HIPP)
Healthy Connections can pay a private insurance premium when keeping that plan saves the state money.
What it is
Healthy Connections can pay a private insurance premium when keeping that plan saves the state money.
A private premium can take a large part of your pay. HIPP checks whether paying it costs the state less than covering the care itself. Being enrolled in a Medicaid health plan prevents this route while that enrollment continues.
Eligibility rules
- Your child must receive fee-for-service Medicaid rather than be enrolled in a Medicaid managed-care plan.
- The state’s savings must exceed the premium, deductible and its administrative costs. Recent claims help the state assess that.
What you get
- Payment of the approved private-plan premium.
- Your private insurance stays in place and continues paying first.
What the help includes
- Payment can go to the family, continuation administrator or insurer.
- The amount depends on the actual premium and the state’s cost-effectiveness review.
If you decide to apply
- Ask the financial counselor whether your child’s Medicaid coverage fits HIPP.
- If your family decides to request a HIPP review, the social worker can help assemble the referral form, insurance card, premium statement and recent claims.
HIPP · 888-289-0709, option 5 then option 4 · fax 803-462-2580 · Official page ↗
If you decide to go ahead
- The referral includes insurance, claims and premium documents. A request for missing documents may give you 30 days to respond.
- If HIPP asks for more documents, you have 30 days to send them. Ask which premium month an approval would start from before you count on the money.
Good to know
An insurance offer alone does not qualify. HIPP needs active coverage and does not pay premiums for past months.
Other details
- Keeping the private plan also keeps its network and coverage rules.
- Changing Medicaid plans solely to seek HIPP could affect care access; the financial counselor can compare the full picture.
Federal background: Medicaid premium assistance.
Official sources
“Could HIPP take over our private premium, and would our child’s Medicaid arrangement fit? Could you help compare any effect on the care team before we decide?”
Why I’m asking: I want to know whether keeping our private plan could cost us less.
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 referral form with the premium statement, the insurance card and claims information.
Your social worker
The hospital's financial counsellor can tell you which side of Medicaid your child is on.
The care team
Records and letters when the application asks for them.
- Who decides
- The Department of Health and Human Services, on a cost-effectiveness test.
- Ask the agency
- “My child is on Healthy Connections and we still pay a work-plan premium. Is my child on fee-for-service, and can the premium-payment programme take it over?”
How to apply
First step: Call 888-289-0709, option 5 then option 4, and ask for the referral form.
- Ask first whether your child is in a Medicaid health plan or on the fee-for-service side; only the second one fits.
- Send the referral form with the premium statement and the insurance card.
Official application / program page ↗
Where it starts: Complete the referral form and send it with the insurance, claims and premium documents. Call 888-289-0709, option 5 then option 4, or fax 803-462-2580.
What to gather
- The premium statement from the employer or insurer
- The insurance card
- Recent claims or explanation-of-benefits letters
How long: No decision deadline is published. A letter can ask for missing documents within 30 days.
What a yes looks like
Cheques arriving for the premium amount, to you, the continuation administrator or the insurer.
What a no looks like, and the next move
Usually either the fee-for-service rule or the savings test. Ask which, in writing.
Watch out
- A child in a Medicaid health plan does not fit while enrolled. Ask which side your child is on first.
- An employer offer nobody took up is not enough; the insurance has to be active.
- Premiums are not paid for months already gone.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 11, 2026.
What it is worth
The state can take over a private premium, but only for a child on the fee-for-service side of Medicaid.
Covers: Payment of the private health-plan premium, by cheque to the family, the continuation administrator or the insurer
Legal protection: Keeping the private plan means the private network and the private plan's own rules stay in place
What it costs the family: No cost to apply. The amount paid is the premium itself; no published schedule exists because it is whatever the plan charges.
The eligibility facts, as published
- Who
- a Medicaid beneficiary on the fee-for-service side who keeps active private insurance
- Test
- the state's savings must be more than the premium, the deductible and the department's administrative costs
- Evidence
- recent medical claims history on record
- Processing standard
- NOT FOUND; the 30-day letter in the guidance is about missing documents
The trap: Premiums are never paid for months already gone. The 30-day letter families hear about is the deadline for sending missing documents, not a decision deadline.
Where I read this
- SCDHHS — Health Insurance Premium Payment Frequently Asked Questions — South Carolina Department of Health and Human Services, read September 10, 2026
- SCDHHS — Health Insurance Premium Payment (HIPP) — South Carolina Department of Health and Human Services, read September 10, 2026