“What Makes a Case Cost-Effective and HIPP Eligible?”

“What does it mean to have a case that is cost-effective?”
A case is cost-effective if it is determined that the State will save money by paying the annual cost of your health insurance premium. Further, your case is cost-effective if the annual cost of your health insurance premium is less that the annual cost of your Medicaid dependent’s medical expenses, out-of-pocket costs, and applicable administrative costs.

Your case has a good chance of being cost-effective if you have several Medicaid dependents, or if one or more of your Medicaid dependents has a high-cost medical condition.

“Does my Medicaid dependent need to have a catastrophic illness to be eligible for HIPP?”
No. Any individual with a high-cost medical condition will be considered for the HIPP program.

“Will you give me some examples of a high-cost medical condition?”
When a pre-qualified applicant has a high-cost medical condition, there is a good chance their case will be cost-effective, and therefore, eligible for HIPP enrollment. An applicant with high medical costs may have a catastrophic illness, but high costs may also be associated with other types of conditions, including:

• Asthma
• Autism
• Cancer
• Cerebral palsy
• Diabetes
• Lou Gehrig’s disease
• Low birth weight babies in Intensive Care Unit
• Muscular dystrophy
• Pregnancy