General Qualifications

“Am I required to be on Medicaid to qualify for WV HIPP?”
Yes. According to state law, all WV HIPP applicants must be active Medicaid recipients or have dependents that are active Medicaid recipients. Click here to learn more about qualifying for Medicaid.

“Am I required to be a West Virginia resident to qualify for WV HIPP?”
Yes. According to state law, all WV HIPP participants must live in the State of West Virginia.

“Can I be a WV HIPP member if I have access to Medicare?”
Typically, Medicare applicants do not qualify for HIPP, but in rare cases, a Medicare recipient may be found eligible for program benefits. To be found eligible, a Medicare applicant must have access to a self-funded policy, an employer-sponsored policy, or COBRA.  They cannot be a member of Medicare Buy-In and their application must be found to be cost-effective.

If you are a Medicare recipient and would like to apply to HIPP, please call our office toll-free at 1-855-MyWVHIPP (1-855-699-8447) for more information.

“Do I need to be enrolled in a health insurance policy before applying to HIPP?”
No. An applicant must have access to a health insurance policy that is either self-funded or provided by an employer or COBRA. If preferred, you may enroll in a health insurance policy after it is determined that you qualify for the WV HIPP program.

“Would I qualify for HIPP if my employer’s open enrollment has passed?”
Medicaid recipients that have access to employer-sponsored insurance or COBRA may apply to HIPP before enrolling in the employer’s insurance program. If you qualify for HIPP, federal law makes it possible for you to enroll in employer-sponsored health insurance at any time of the year, even outside of your employer’s open enrollment period.

“Do I automatically qualify for HIPP if I have access to insurance and have at least one Medicaid dependent?”
No, you would pre-qualify for HIPP if you have access to insurance and have at least one Medicaid dependent. (This does not include those with limited access to Medicaid, such as those with Family Planning Only and Payee Only.) Pre-qualifying for HIPP means that your case meets the minimum requirements to be considered for HIPP enrollment. If your case is found to be cost-effective, you will be enrolled in HIPP. If your case is not found to be cost-effective, your application will be denied. You will receive a letter by mail notifying you of your case determination.

“Can I be a HIPP member if I am unemployed or have recently lost my job?”
HIPP membership requires that you have access to insurance. If you do not have a self-funded policy, employer-sponsored insurance (ESI) or ESI through COBRA is necessary. In some cases, former employers will offer you COBRA benefits for up to 18 months after leaving a job. COBRA provides a continuation of employer-sponsored insurance that would otherwise end once the employee is terminated from his/her job. If you successfully transition onto COBRA, your HIPP eligibility should not be affected.