Yes, in most cases. You will pay for the health insurance, usually by having money taken out of your paycheck. LaHIPP will send you a check every month for all or part of what you pay for the insurance.

In other cases, LaHIPP will send the check directly to the employer or insurance company.

You may be paid for medical services received up to 3 months* before you applied if:

• you are eligible for the date the service was received, and
• you used a Medicaid provider, and
• the service is covered by the Medicaid program.

*This does not apply to the LaCHIP Affordable Plan.

You may be eligible to be paid back for medical services received up to three months before you applied if:
-You are eligible on the date the service was received, and
-You used a Medicaid provider, and
-The service is covered by the Medicaid Program.

You may use any doctor who is enrolled as a Medicaid provider.

You must have Medicare Hospital Insurance (Part A). If you are not sure if you have it, look on your Medicare card or call Social Security toll-free at 1-800-772-1213.

Yes.  If LaHIPP is paying for your insurance and it changes or you change jobs, you must tell LaHIPP and Medicaid right away.  It is important to call LaHIPP before YOU decide to make any changes to the insurance.

You must call LaHIPP, and Medicaid at the Medicaid hotline number at 1-888-342-6207 to let them know about the change.  

Individuals who receive Supplemental Security Income (SSI) from the Social Security Administration (SSA) automatically receive Medicaid coverage.

Families who get financial help from the Office of Family Support (OFS) through the FAMILY INDEPENDENCE TEMPORARY ASSISTANCE PROGRAM (FITAP) are deemed eligible for Medicaid.

Individuals or families who do not receive SSI or FITAP cash MAY also qualify for Medicaid coverage IF the individual or family belongs to one of the following coverage groups:

• individuals who are disabled according to the Social Security Administration’s definition
• individuals who have corrected vision no better than 20/200
•  low income parents of children under age 19
• children under age 19
• pregnant women
• certain women who have been found to need treatment for breast and/or cervical cancer
• certain individuals who have Medicare

To get health coverage through Medicaid Purchase, you must

 

	have a severe disability (one that matches Social Security standards);   Do I have to be receiving or received Social Security Disability or Supplemental Security Income to qualify for this program? NO, all you need is to meet the disability standards. (See http://www.socialsecurity.gov/disability/professionals/bluebook for Social Security's disability criteria.)
	work;
	be at least age 16 but not yet age 65;
	have COUNTABLE monthly income that is less than $2,257;
	have COUNTABLE assets that are less than $25,000;
	take other health insurance coverage, if you can get it at no cost to you;
	and pay a premium when your COUNTABLE monthly income is more than $1,354.

We COUNT less than half of the money you earn (work for) and all but $20 of any other money you get.

Income limits go up each year in April.

LaHIPP will do a review of what the insurance costs and what it covers. LaHIPP then decides if it is “cost effective” for Louisiana Medicaid to pay the health insurance for the person who is working and the person who gets Medicaid. Cost effective means that it would cost less for Louisiana Medicaid to pay for the health insurance premium than it would be for Medicaid to pay the medical expenses of the person who gets Medicaid.

A Medical Eligiblity Card is issued to eligible individuals which identifies them as covered by Medicaid.  This card allows a person to receive medical services from a provider if:

1.  he/she is Medicaid eligible on the date the service is received, and
2.  the provider accepts Medicaid, and
3.  the service is covered by the Medicaid Program, and
4.  the provider agrees to bill Medicaid for the service and to accept the payment (along with any insurance payment) as payment in full.

Medicaid recipients must always ask the medical services provider about coverage, limitations and/or restrictions before receiving a service.  The card must be shown each time a service is received.

Medically Needy provides Medicaid eligibility to qualified individuals and families who may have too much income to qualify for regular Medicaid programs.  Individuals and families who meet all Medicaid program requirements, except that their income is above those program limits, can spend-down or reduce their income to Medicaid eligibility levels using incurred medical expenses.

This question is not easy to answer, because everyone’s case is different.  There are many things that can happen to affect how long the premium will be paid.  The health insurance must always be

cost-effective.  LaHIPP makes reviews when there are changes in your job or insurance, when your Medicaid case is renewed, and during open enrollment of your job’s insurance.

Good News -- The premiums will be paid for at least 6 months, once approved by LaHIPP for payment of your insurance premiums.

After a review is done by LaHIPP, payment of the premiums will be made as long as the insurance continues to be cost-effective.   

Your “premium” (what you pay each month) is based on your countable income – not your age or health condition.

	Countable Income	Monthly Premium
	less than $1,354	$0
	$1,354 to $1,805	$80
	$1,805 to $2,257	$110

You will get a letter from the local Medicaid office that tells you how much you owe when you are first approved and then again any time there is a change in your monthly premium.

If you are required to pay for your coverage, you will get a bill each month for your premium.

Before you sign your baby up on your insurance, contact LaHIPP to let them know you had the baby.

This means that your local Medicaid office let LaHIPP know that you have or there may be health insurance available from a job.

You must fill out the application for LaHIPP, and take the Employer Health Insurance Information Form to your job for them to fill out.  Federal law says that you must give LaHIPP information about health insurance from your job.  If you do not, your Medicaid may stop.

Return these two forms after they are completed and copies of your health insurance cards and insurance plan, if you have them, to LaHIPP.  The forms must be returned to LaHIPP by the due date shown on the letter you got from LaHIPP.  Your employer can send the Employer Health Insurance Information form and insurance plan directly to LaHIPP.   

If you have questions or need help with the application, please call LaHIPP at 1-888-342-6207.  Forms can be faxed to LaHIPP.  The fax number is on the letter you got from LaHIPP.

LaHIPP can help pay your share of the insurance premium.  The LaHIPP worker will look at what insurance plans your employer offers.  They will then decide if it is cost effective to pay for your share of the premium.  If it is cost effective, the children will have health insurance and Medicaid and you will be covered, too.  

Let your local Medicaid office know now about the insurance, so they can tell LaHIPP.

Being able to keep a health insurance from a job you no longer have is called COBRA. Call LaHIPP so that they can decide if it is still cost-effective for them to pay the insurance premiums. 

Prior to making any changes to your health insurance, LaHIPP must be contacted.  LaHIPP must be told of the following changes:

• Losing a job;
• Getting a new job;
• Changes in the insurance carrier/company;
• Changes in who is covered on the insurance (adding or removing someone);
• Changes in the cost of the insurance;
• Changes in the open enrollment period of your insurance plan;
• Changes in your mailing address;
• Changes in your job’s mailing address; and
• If your Medicaid ends.

Cost effective means that it would cost less for Medicaid to pay the health insurance premium for the person who gets Medicaid than it would be for Medicaid to pay for the cost of the same person’s medical expenses if they didn’t have insurance.

No.  If you or someone in your family is working and has Medicaid, the Federal government requires that you give Medicaid all job insurance information.  If you do not cooperate in giving Medicaid this information, you could lose your Medicaid.  If you think that participating in LaHIPP will cause a hardship, then you can ask LaHIPP to excuse you from participating.

   bank accounts;

   stocks, bonds, and other cash resources;

   cars, trucks, boats,  and other vehicles;

   property, including heir or estate property; and

   anything else you own.

                GOOD NEWS!

Your home, one vehicle, any life insurance policies, medical savings and retirement accounts, and your spouse’s share of any community property will not count in this program.

If you think the decision we make is unfair, incorrect, or is made too late, you may ask for a Fair Hearing by calling or writing to your local Medicaid office. You may also write directly to Louisiana Department of Health and Hospitals, Bureau of Appeals at P.O. Box 4183, Baton Rouge, LA  70821-4183.

Your resources (the things you own) are things like:

• cars, trucks, boats, and other vehicles
• all property, including houses and heir property or estate property
• all types of bank accounts, stocks, bonds, or other cash holdings
• life or burial insurance
• anything else of value

Some things (like the home you live in, one car, burial plots, furniture, and some life insurance) are not counted.

This plan gives full medical coverage that includes

 

prescription drugs,

 

hospital care,

doctor services,

 

medical equipment and supplies,

 

medical transportation,

1.   Qualified Medicare Beneficiary (QMB)

Income Limits:

• Individual gross income is less than $903
• Couples gross income is less than $1,215

Countable Resource Limits:

• Individual - $4000
• Couples - $6000

Benefits:

• Pays for your Medicare Premiums, deductibles, and co-insurance.
• Pays your Medicare Prescription Drug Plan monthly premium (up to $35).

2.   Specified low-Income Medicare Beneficiary (SLMB)

Income Limits:

• Individual gross income is less than $1,083
• Couples gross income is less than $1,457

Countable Resource Limits:

• Individual - $4000
• Couples - $6000

Benefit:

• Pays for your Medicare Part B premium.
• Pays your Medicare Prescription Drug Plan monthly premium (up to $35).

 

3.   Qualified Individual (QI-1)

Income Limits:

• Individual gross income is less than $1,219
• Couples gross income is less than $1,640
• Countable Resource Limits:
• Individual - $4000
• Couples - $6000

Benefit:

• Pays for your Medicare Part B premium.
• Pays your Medicare Prescription Drug Plan monthly premium (up to $35).

.

Even if your income is more than these amounts, you may still qualify.  You can receive these deductions from your total income:

• $90 for each employed person
• Disregard of educational income
• Disregard of child support paid outside your home
• Up to $50 for child support received
• Up to $200/month for child care payments for EACH child under age 2
• Up to $175/month for child care payments for EACH child over age 2 
  

Take it to your job’s human resource office.  They must fill out this form.  They can send the completed form by mail or fax to LaHIPP or you can send it to LaHIPP.  A copy of the health insurance plan will also be needed.

Call LaHIPP right away. You will have to send the check back to LaHIPP. If you have already cashed or deposited the check, call LaHIPP so you can repay the money.

You can have other insurance coverage in addition to LaMOMS.  Your other insurance will pay first, and then Medicaid will cover the amount that is left, up to the Medicaid allowed amount.

Call the LaHIPP phone number on the letter you got or call Medicaid's toll free number at

1-888-342-6207.

    Social Security number;

    proof of your total income for the last month.

    Medicare and any other health insurance card; and

   alien registration card or immigration papers, if you

       are not a U.S. citizen.

Send copies of as many of these items as soon as you can. Do not wait to send in the form. We can give you more time to give us any missing information after we get your application.

Not all Medicaid programs give full coverage.  Full coverage Medicaid is the most complete or total coverage available from Medicaid.  Most medical services should be covered and paid by Medicaid.  If you have questions about what type of coverage you have, please call your local Medicaid office or the Medicaid hotline number at 1-888-342-6207. The 1-888 number is a free call. 

LaHIPP stands for Louisiana Health Insurance Premium Payment and is a part of Louisiana Medicaid.  It may pay some or all of the health insurance premiums for an employee and their family if they have insurance available through their jobs and someone in the family has Medicaid.  Those getting Medicaid will also be able to have health insurance.  

Launched on January 1, 2003, LaMOMS is no-cost health coverage for any pregnant women, married or single, who fall into new expanded income guidelines.  For example, a woman in a family of four (the unborn child is included in the family size) can have a monthly household income up to $3,225 and still qualify for this program.

Medicare has provided millions of senior citizens and people with disabilities with access to health care that they would not otherwise have had.  Congress has also created the Medicare Savings Program to protect low-income seniors and people with disabilities from the significant and growing costs required to receive Medicare coverage.

The Medicare Catastrophic Coverage Act of 1988 added a limited range of Medicaid benefits to a group of eligible persons called Qualified Medicare Beneficiaries (QMB).  In 1990 Congress increased Medicare cost-sharing amounts to a group called Specified Low-Income Medicare Beneficiaries (SLMB).  There is also a group know as Qualified Individuals (QI-1).

Persons who have Medicare Hospital Insurance (Part A) and income and resources that place them in one of these three groups can receive help with the payment of their Medicare premiums and, in some cases, their deductibles & co-payments along with payment of their monthly premium (up to $35) for the Medicare Prescription Drug Plan (Medicare Part D).

We will make a prompt decision and you will be notified no later than 45 days after we get your application.

Coverage can start as early as three months before the month we get your application (if you were pregnant during that time period).  DON'T WAIT!  Get the form to us as soon as you can.

The federal government administers Medicare.  Medicare is not based on financial need, but is generally linked to receipt of Social Security benefits based on being age 65 or older or having a disability. 

Medicaid is an assistance program administered on a state-by state basis.  Medicaid  eligibility is based mainly on financial need.

Payments can be sent to:

Office of Group Benefits

MPP Premium Unit

PO Box 66127

Baton Rouge, LA  70896-6127

Medicaid has established an Eligibility Call Center. If you have any questions regarding eligibility please call:

Toll-Free
1-888-342-6207 or 1-877-242-2447

Baton Rouge Area
(225) 342-0555

First, someone in the home must have full coverage Medicaid.  Then, that person and other people in the home like the working person, parents, legal guardians, step-parents, step-children, brothers and sisters, and grandparents may be reviewed for LaHIPP.  In order for someone to be reviewed for LaHIPP, the job must offer a health insurance plan that would cover them. Retirees and people who have recently lost a job who can get COBRA can also be reviewed for LaHIPP.

LaHIPP can help you in many ways.

• LaHIPP may pay all or some of the premium of health insurance from a job.
• LaHIPP may also cover other persons in your family under your health insurance who would not otherwise be eligible for Medicaid.
• The health insurance from your job may cover services that are not covered under the Medicaid program.

The health insurance may cover services that Medicaid doesn’t cover. It saves you money by lowering what you would pay such as co-payments (amount that insurance will not pay) and deductibles (amount you pay before insurance pays). LaHIPP saves Louisiana money by lowering the amount it spends on Medicaid, because the insurance will pay first.