If your family has private health insurance through a job and your child also has Medicaid, you may be paying a health insurance premium every month.
What many families do not know is that Texas may be able to help pay that premium.
The program is called HIPP — Health Insurance Premium Payment.
If your family qualifies, HIPP may reimburse the cost of your private health insurance premium.
For some families, that can mean keeping the health insurance they already have while reducing how much they pay for it.
What Is HIPP?
HIPP is a Texas Medicaid program that helps eligible families pay for private health insurance.
Texas looks at whether paying your family’s private health insurance costs would cost Medicaid less than paying for the Medicaid member’s health care through Medicaid alone.
This is called being cost-effective.
If Texas determines that the insurance is cost-effective and your family meets the other requirements, HIPP may reimburse your family for the health insurance premium.
Who Should Ask About HIPP?
HIPP may be worth asking about if:
- your child has Medicaid;
- a parent or spouse has private health insurance available;
- your Medicaid-eligible child is covered, or can be covered, by that health insurance; and
- your family pays part of the insurance premium.
You do not have to decide for yourself whether the insurance is cost-effective.
Texas makes that determination.
Your job is to ask whether your family may qualify.
My Child Has Medicaid and I Have Insurance Through My Job. Can We Have Both?
Yes.
Having Medicaid does not necessarily mean your child has to give up private health insurance.
A Medicaid member can also have private health insurance.
When both cover the same medical service, the private insurance generally pays first and Medicaid follows Medicaid’s coordination-of-benefits rules.
So having employer health insurance should not stop you from asking whether your child may qualify for Medicaid or whether your family may qualify for HIPP.
Could HIPP Pay the Premium for the Whole Family?
Possibly.
This is one of the most important things families should know about HIPP.
If Texas determines that paying for the private insurance is cost-effective, HIPP may pay the private health insurance cost for the entire family, not only the family member who receives Medicaid.
For example, imagine that Mom receives health insurance through her employer.
Her plan covers:
- Mom;
- Dad;
- their 10-year-old daughter; and
- their 8-year-old son who receives Medicaid.
The family pays part of the insurance premium through Mom’s paycheck.
If the family applies for HIPP and Texas determines that paying for the employer health plan is cost-effective, HIPP may reimburse the family’s eligible premium cost.
That could make a meaningful difference in the family’s monthly expenses.
Does HIPP Mean We Lose Medicaid?
HIPP is a Medicaid program. Its purpose is to use available private health insurance when doing so is cost-effective for Medicaid.
A Medicaid-eligible family member can have private insurance and Medicaid at the same time.
This is important for families of children with disabilities because private insurance and Medicaid may play different roles in paying for health care and services.
What About Deductibles and Copays?
This is another important HIPP benefit to understand.
According to Texas HHSC, Medicaid-eligible HIPP participants do not have to pay out-of-pocket deductibles, copayments or coinsurance for Medicaid-covered health care services when they receive those services from a provider that accepts Medicaid.
Medicaid reimburses the provider for those expenses according to Medicaid rules.
Family members covered by the private insurance who are not Medicaid eligible remain responsible for the deductibles, copayments and coinsurance required by the private health insurance plan.
How Does Texas Decide Whether HIPP Will Pay?
Texas compares costs.
The state considers whether paying for the private insurance is less expensive than the projected Medicaid cost of providing care to the Medicaid member.
Texas considers the cost of the private health insurance, including applicable premiums and other health insurance costs, when determining whether participation is cost-effective.
This means two families with similar insurance premiums may receive different decisions because their circumstances are different.
How Does HIPP Reimbursement Work?
HIPP generally works as a reimbursement program.
That means the family may continue paying its portion of the health insurance premium and, after the required documentation is provided, receive reimbursement for the approved amount.
Families should keep records of their health insurance coverage and premium payments.
If you are approved, follow the HIPP program’s instructions about what documentation you need to submit and when you need to submit it.
What If My Employer Takes the Premium Out of My Paycheck?
That does not mean you should assume HIPP cannot help.
Many families pay their share of employer-sponsored health insurance directly through payroll deductions.
If your child has Medicaid and your family is paying for employer-sponsored health insurance, ask HIPP whether your coverage qualifies.
Let the program determine whether your family’s insurance meets the requirements.
What If My Child Has a Disability but Doesn’t Have Medicaid Yet?
HIPP is tied to Medicaid eligibility.
If your child has an intellectual or developmental disability but does not currently have Medicaid, your first step may be to find out whether your child could qualify for Medicaid.
Having private health insurance does not automatically prevent a child from qualifying for Medicaid.
There are different Medicaid eligibility pathways, and a child’s eligibility depends on the program and the family’s circumstances.
If you have been assuming:
“We already have insurance, so there is no reason to look into Medicaid,”
it may be time to ask.
What If Our Income Is Too High for Regular Medicaid?
Do not automatically assume the answer is no.
Texas has a program called Medicaid Buy-In for Children (MBIC) for certain children with disabilities whose families may have income that is too high for traditional Medicaid.
MBIC has its own eligibility requirements and may require a monthly premium.
HIPP can also interact with employer-sponsored insurance for eligible MBIC families.
If your child has a disability and you have been told that your income is too high for Medicaid, ask:
“Could my child qualify for Medicaid Buy-In for Children?”
Then, if your child becomes Medicaid eligible and you have qualifying employer-sponsored insurance, ask about HIPP.
A Simple Example
Imagine a family has a 12-year-old child with a developmental disability.
Dad works full time and has family health insurance through his employer.
The family pays several hundred dollars each month toward the premium.
Their child also qualifies for Medicaid.
The parents might assume:
“We already have insurance through Dad’s job. Medicaid has nothing to do with our insurance premium.”
But that family should ask about HIPP.
Texas may review the employer health plan and determine whether paying the family’s insurance premium is cost-effective.
If the family qualifies, HIPP may reimburse eligible premium costs.
The family should apply and allow the HIPP program to make the determination rather than assuming they will not qualify.
What Information Should I Gather Before I Apply?
It can help to have information about:
- the Medicaid member in your family;
- your private health insurance;
- the employer providing access to the insurance;
- who is covered under the policy;
- how much the family pays for the insurance; and
- proof of premium payments or payroll deductions.
The HIPP program may request additional information when reviewing your application.
How Do I Apply for Texas HIPP?
Texas Health and Human Services provides HIPP information and application assistance.
You can visit the Texas HHSC HIPP information page or call the HIPP program at:
800-440-0493
When you call, you can simply say:
“My child has Medicaid, and our family has private health insurance through work. Could we qualify for HIPP?”
You do not have to know whether your insurance is cost-effective before you call.
That is what the program reviews.
Don’t Cancel Your Private Insurance Before Asking Questions
If your child becomes eligible for Medicaid while already covered by private insurance, do not assume you need to immediately cancel the private coverage.
First, find out how the two types of coverage work together.
Ask about HIPP.
Ask how your child’s private insurance should be reported to Medicaid.
Ask which insurance should be presented when your child receives medical care.
Making those calls before changing coverage can help you better understand your family’s options.
Don’t Be Afraid to Ask
HIPP is the type of program many families may never hear about unless someone tells them.
If you have a child with Medicaid and your family is paying for private health insurance, ask:
“Could our family qualify for HIPP?”
The answer may be no.
The answer may be yes.
But don’t decide for yourself that your family will not qualify before you ask.
And if your child has a disability but does not currently have Medicaid because you thought having private insurance or earning too much automatically disqualified your child, ask about Medicaid eligibility too.
Knowing which questions to ask can help you discover programs you did not know were available.
At NUDO Homes, our goal is to help families understand the questions they can ask as they navigate Texas IDD and Medicaid services.
Official Resources
Texas Health and Human Services — Health Insurance Premium Payment (HIPP) Program
Texas HHSC provides information about HIPP eligibility, how the program works and how to apply.
Centers for Medicare & Medicaid Services — Coordination of Benefits and Third-Party Liability
Federal Medicaid guidance explains how Medicaid works when a person also has private health insurance.
Last reviewed: September 2026
This article provides general educational information and is not an eligibility determination. HIPP, Medicaid and Medicaid Buy-In for Children have specific eligibility and program requirements. Texas HHSC or its designated program administrator determines eligibility and whether private insurance is cost-effective for HIPP.
Texas also specifically recognizes the connection between Medicaid Buy-In for Children, employer-sponsored insurance and HIPP; HIPP reimbursement can affect the MBIC premium calculation. (Texas Health and Human Services)
.
Official pages: Texas HHSC — HIPP and Help Paying for Private Insurance and Medicaid.gov — Coordination of Benefits and Third-Party Liability.