Texas program
Help paying your employer-plan premium (Texas HIPP)
Help paying an employer-plan premium when someone in the family has Medicaid.
What it is
Help paying an employer-plan premium when someone in the family has Medicaid.
HIPP reviews the work plan and its premium after Medicaid is in place. The employer plan pays first. Reimbursement can help preserve that plan’s doctors while Medicaid helps with covered costs.
Eligibility rules
- Someone in the home must have Medicaid and the child must be enrolled in the employer plan. HHSC must find the arrangement cost-effective.
- CHIP and STAR Health are excluded.
What you get
- Repayment of an approved employee premium each month.
- With MBIC, a separate premium schedule of $0 to $70 when HIPP pays.
What the help covers
- HIPP reimburses the approved employee share for covered family members. It does not replace the employer policy.
- A lapse in the work plan ends the coverage and the premium reimbursement.
If you decide to apply
- Ask the hospital financial counselor to help with the HIPP application after Medicaid approval.
- Have the employer rate sheet, coverage information and proof of premium payments ready.
- Ask HIPP how approval would affect your child’s STAR Kids enrollment and service coordinator.
HIPP application; 800-440-0493 · Official page ↗
After you apply
- HHSC’s HIPP unit reviews the employer information. Proof of premium payments supports reimbursement.
- Before changing coverage, your social worker can ask HIPP and STAR Kids to confirm in writing which plan will handle services, whether enrollment or your service coordinator will change, and where the hospital and pharmacy should send claims. HIPP approval alone does not establish those arrangements.
Good to know
Reimbursing a family premium does not give the parents Medicaid.
Other details
- For MBIC with employer coverage, premiums are $0 without HIPP; with HIPP they can be $0–$70 by income range.
Federal background: Medicaid premium assistance.
Official sources
“Would HIPP reimburse our work premium, what would happen to the buy-in premium and service coordinator, and could you help with the paperwork?”
Why I’m asking: I want to compare the savings with any changes to our child’s coverage.
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
Keep the plan active, send the employer rate sheet and proof of each premium payment.
Your social worker
Times the HIPP request after the Medicaid approval and reconciles the MBIC premium change.
The care team
Nothing unless HIPP asks for clinical-cost information.
- Who decides
- HHSC HIPP unit
- Ask your social worker
- “Should HIPP go in now that Medicaid is approved, and can you help get the employer rate sheet?”
How to apply
First step: After the Medicaid approval, call HIPP at 800-440-0493 and download the application. Ask HR for the plan rate sheet and the employer's contribution.
- Call 800-440-0493 after the Medicaid approval.
- Get the employer rate sheet and contribution letter.
Official application / program page ↗
Where it starts: HIPP application; 800-440-0493
What to gather
- Medicaid approval
- Employer benefit summary and rate sheet
- Pay stubs showing the premium deduction
How long: No published decision time. Reimbursement follows within seven working days of acceptable proof of payment.
What a yes looks like
An approval naming the reimbursable premium and the proof schedule.
What a no looks like, and the next move
Ask for the cost-effectiveness reason and whether the coverage tier submitted was right.
Watch out
- Keep the employer plan active during review. A lapse ends both the plan and HIPP.
- No current rule removes a HIPP child from STAR Kids (only CHIP and STAR Health are ineligible), but confirm at 800-440-0493 before accepting: “Will HIPP change my child's enrollment or service coordinator?”
- Reimbursement covers the premium for covered family members. It does not make the parents Medicaid recipients.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 8, 2026.
What it is worth
Reimbursement of the approved employee premium each month when keeping the employer plan is cost-effective for Medicaid. With MBIC the premium tier drops to $0–$70.
- Premium reimbursement — Premium reimbursement
Covers: Employer plan stays primary. Medicaid pays second
What it costs the family: None. The premium is reimbursed after proof of payment.
The eligibility facts, as published
- Medicaid in home
- yes
- Employer plan enrolled
- yes
- Cost effective
- yes
- Ineligible
- CHIP and STAR Health only
- Hipp delivery system condition
- none found in current rules; confirm by phone
The trap: Keep the employer plan active during review. A lapse ends both the plan and HIPP.
Where I read this
- Health Insurance Premium Payment Program — Texas Health and Human Services, read August 27, 2026
- 1 TAC 353.1203 (STAR Kids enrollment) and 354.2361 (HIPP eligibility) — Texas Administrative Code (Cornell LII reproduction), read September 7, 2026
- Appendix XXXI Budget Reference Chart — Texas Health and Human Services, read August 27, 2026
- Coordination of Benefits and Third Party Liability — Centers for Medicare & Medicaid Services, read August 27, 2026