• have a high-cost medical condition such as HIV/AIDS, cancer, pregnancy and organ transplantation; and
• be insured under a private health insurance policy that does not exclude the individual’s high-cost medical condition. The policy can be individual, group, continuation coverage such as COBRA, Cal-COBRA or OBRA (for self-insured trusts) or COBRA conversion policy.

Those ineligible for the HIPP program include individuals enrolled in:

• Medi-Cal Managed Care program;
• Medi-Cal prepaid health plan;
• County Organized Health System (COHS);
• County Health Initiative;
• Geographic Managed Care Program of the County Medical Services Program (CMSP); and
• California’s Major Risk Medical Insurance Pool (MRMIP).

• Medi-Cal/HIPP Department of Health Care Service Form 6155 (Health Insurance Questionnaire);
• Medi-Cal/HIPP Department of Health Care Service Form 6172 (HIPP application);
• An insurance policy or description of benefits from the insurer or employer;
• A physician letter of diagnosis of high-cost medical condition; and
• A premium payment notice or election form from COBRA or Cal-COBRA.

A major difference between Medi-Cal and Medi-Cal/HIPP is that Medi-Cal will pay health care costs billed up to three months before the application date, while Medi-Cal/HIPP only covers insurance premiums and does not make retroactive payments.

To avoid a share of cost or higher share of cost, you may want to consider enrolling in the 250% California Working Disabled Program (250% CWD) and pay a small premium instead. This will allow you to continue using private health insurance and Medi-Cal coverage.

Note: You will need to continue to meet the asset requirements under your Medi-Cal eligibility category.