Health Insurance Premium Payment Program

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-7.007Health Insurance Premium Payment Program

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 40 No. 211, October 29, 2014 issue of the Florida Administrative Register.

              (1) Under the Health Insurance Premium Payment (HIPP) program, the Agency for Health Care Administration (AHCA) shall provide financial assistance to recipients in order to obtain or maintain Employer Sponsored Insurance (ESI) coverage pursuant to sections 409.9122(14) and 409.977(4), Florida Statutes F.S. This includes the recipient’s share of the ESI premiums, copayments, deductibles, coinsurance, and other cost sharing obligations for items and Medicaid services and items covered under the State Plan. The amount of financial assistance provided for each recipient may not exceed the amount of the Medicaid managed care premium that would have been paid for that recipient.

              (a) The recipient’s health care services will be covered through their ESI primary coverage.  Medicaid will cover the lesser of the ESI required copayments, deductibles, or coinsurance, up to the Medicaid fee when the recipient’s ESI provider is also a Medicaid enrolled provider. Medicaid will deduct any applicable Medicaid copay for covered state plan services. If a recipient chooses to utilize  non-Medicaid providers, only the ESI coverage will apply and the recipient may be subject to ESI required copayments, deductibles, or coinsurance.

              (b) Medicaid will cover any state plan services that are not provided by the recipient’s ESI when those services are provided by an enrolled Medicaid provider.

(2) Participation in the HIPP program.

(a) Recipients must enroll in or be enrolled in and maintain their ESI coverage during the period of participation. Recipients will be identified by AHCA, or its designee, and will be sent an enrollment package.

(2)(b) through (3)(b) No change.

(4) HIPP Ppremium payments.

(a) Any financial assistance provided towards the payment of a recipient’s share of the ESI premium shall be in the form of a reimbursement issued after AHCA’s receipt of the proper documentation. Recipients must pay their ESI premium and submit a request with supporting documentation for reimbursement to AHCA, or its designee.