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

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West Virginia program

Help paying the work-plan premium (HIPP)

HIPP reimburses a work-plan premium when keeping that insurance saves Medicaid money.

What it is

HIPP reimburses a work-plan premium when keeping that insurance saves Medicaid money.

Work insurance and Medicaid can work together. HIPP compares the premium and other costs with what Medicaid would otherwise pay. Your child’s treatment costs can matter to the family-based review.

Eligibility rules
  • There is no separate HIPP income test. Medicaid eligibility comes first.
  • The state compares premiums, cost sharing, extra Medicaid benefits and administration with equivalent Medicaid services. A high-cost condition can support a family-based comparison.
What you get
  • Reimbursement of an approved work-plan premium to the person who holds the policy.
  • Medicaid benefits that fill covered gaps in the work plan.
  • Premium help for other family members when the state finds it saves money.
What the coverage means
  • Participation is voluntary. You can ask about HIPP before enrolling in the employer plan.
  • Premium reimbursement requires an approved arrangement that saves Medicaid money. The HIPP office confirms the first covered month, reimbursement dates and premiums you must pay first. An expected reimbursement does not suspend the work plan’s premium deadline.
If you decide to apply
  1. Ask the Medicaid worker or hospital financial counselor for a HIPP review.
  2. Have the work plan’s premium, benefit summary and family coverage details ready.

Department of Human Services general help: 1-877-716-1212 · Official page ↗

After you apply
  • Ask the Medicaid worker or the financial counselor for the HIPP form; the general Medicaid line is 1-877-716-1212.
Good to know

Premium help does not pay deductibles or coinsurance for relatives who are not on Medicaid.

Other details
  • The HIPP office can confirm the approved premium amount, payment method and reimbursement dates in writing before you rely on premium help.
  • The premium-assistance state-plan amendment took effect January 1, 2022. Cost effectiveness is reviewed at least every six months; that review schedule is separate from reimbursement dates.

Federal background: Medicaid premium assistance.

Official sources
Ask your social worker

“Could Medicaid reimburse our work-plan premium, and what costs would still be ours? If the review is worthwhile, could you help us find the right office and submit the plan details?”

Why I’m asking: Keeping work coverage may help with treatment access, but the premium still strains our budget.

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 plan's premium and benefit information and keep paying the premium until reimbursement starts.

Your social worker

The hospital financial counsellor knows who currently takes these applications.

The care team

Nothing.

Who decides
The Bureau for Medical Services, through its premium-assistance contractor.
Ask your social worker
“My child is on Medicaid and I pay a premium at work. Can we apply for the premium payment programme, and is there a family-based test because of my child's care?”

How to apply

First step: Ask the Medicaid worker or hospital financial counsellor for the premium payment programme as soon as your child's Medicaid is approved.

  1. Ask for the premium payment programme by name once your child's Medicaid is approved.
  2. Have the employer plan's premium and benefit summary ready: the whole test is a cost comparison.
  3. Ask whether a family-based test applies, since your child's care is high cost.

Official application / program page ↗

Where it starts: Ask your social worker or Medicaid worker to confirm the current HIPP operator and form; DoHS general assistance is 1-877-716-1212.

What to gather

  • The employer plan's premium amount
  • The plan's benefit summary
  • Your child's Medicaid approval notice

How long: The programme's own site says no longer than 30 business days after a complete application. It is undated, so treat it as the programme's own description.

What a yes looks like

A monthly reimbursement to the policyholder, paid near the first or on the fifteenth.

What a no looks like, and the next move

A no usually means the sum did not come out cheaper. Ask whether a family-based test was run.

Watch out

  • It pays the premium, not the deductible or coinsurance, for a family member who is not on Medicaid.
  • You can ask before you have enrolled in the plan at work.
  • The published operator and form are out of date; ask the Medicaid worker who takes the application now.

Dates that change this

2026-09-11: The programme's own website is undated and its current operator and contract are unknown. The rules below come from the state plan amendment approved in 2022. (not yet confirmed against the final rule)

The numbers and the rules

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

What it is worth

Medicaid pays the work-plan premium when that is cheaper for the state, and wraps the benefits the work plan leaves out.

Covers: The premium reimbursed to the policyholder by cheque or direct deposit · A Medicaid wrap for benefits the employer plan does not provide · Premiums for family members who are not on Medicaid, where that is cost-effective

Legal protection: Enrolment is voluntary

What it costs the family: Nothing beyond the deductible and coinsurance, which are not paid for a family member who is not on Medicaid.

The eligibility facts, as published

Income
no separate income test: the child's Medicaid eligibility carries it
Test
cost effectiveness against equivalent Medicaid services, including cost sharing, the wrap and administration
Family test
a family-based test where a family member has a high-cost condition

Decisions this site cannot make: Cost-effectiveness determination

Expect friction on: The Medicaid worker or DoHS general assistance confirms the current HIPP operator, form and contact. · The delivery-system conditions are unknown

The trap: Ask even if you have not enrolled in the work plan yet: the programme's own pages say you can enrol in a policy after it decides you are approved.

Where I read this

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