Medication Assistance Program - Uninsured Clients

Overview

You are enrolled in the California Department of Public Health (CDPH), Medication Assistance Program which pays for the full cost of your monthly prescription drugs. This page provides information on additional assistance programs that you may be eligible for. 

Health Insurance Premium Payment (HIPP) Program 

You may qualify for the HIPP Program, which would pay for your health insurance premiums and certain outpatient medical out-of-pocket costs. The HIPP program pays up to $1,938 towards your monthly insurance premium if you are enrolled in a health plan. There is no cost to enroll in the HIPP program.

To be eligible for the HIPP Program, you must:

• Be enrolled in the Medication Assistance Program, and
• Be enrolled in health insurance with a Covered California plan or a non-Covered California plan 

Covered California Health Insurance Plans

Open enrollment for Covered California is November 1, 2022 through January 31, 2023.

You can obtain a health insurance plan through Covered California if you:

• Are a lawfully present California resident.
  
• Have income over 138% of the Federal Poverty Level (FPL) ($18,755 or more per year for a single person with no dependents). 

*Individuals who are not lawfully present may qualify for a non-Covered California plan. Please refer to the HIPP for non-Covered California Health Plans section below. 

Covered California Premium Assistance

You may qualify for an Advanced Premium Tax Credit (APTC), and/or the State Premium Assistance Subsidy Program, to help pay for your insurance premium. 

If you qualify for State Premium Assistance Program and/or APTC, you must accept the full amount to qualify for the HIPP Program. 

Clients who received an APTC must file a federal tax return in order to determine if the APTC amount on their tax return is less than or more than their APTC. The client will either have a balance due or receive a refund. If an ADAP client has a liability to be paid or is owed a refund, these requests may be submitted directly to Pool Administrators Inc. (PAI).

• APTC Refund – This means that OA-HIPP overpaid the monthly premiums, therefore the APTC refund (for the applicable months) needs to be returned to OA-HIPP.
• APTC Tax Liability – This means that OA-HIPP underpaid in premiums because your actual income was higher than the income you reported to Covered California and you received too much financial assistance . Therefore, OA-HIPP will send a payment to the Internal Revenue Service (IRS) to cover the tax liability (for the applicable months) on the client's behalf upon receipt of the tax documentation and identification of the tax liability.
• Clients must provide the documentation listed below to PAI. Note that taxes filed electronically must include the electronic signature page.
• Form 8962 (Premium Tax Credit)
• Form 1095 A (Health Insurance Marketplace statement provided to the client by Covered California)
• IRS tax return including the client's social security number and the joint filer's social security number.

These documents may be submitted to PAI via the following methods:

• Fax:         (860) 986-6205
• Email:     PAI_CDPH@pooladmin.com

• Mail:        Pool Administrators Inc., ATTN: CDPH
                     628 Hebron Avenue, Suite 502
                     Glastonbury, CT 06033

Visit the Covered California website to apply: 

Enrolling in the HIPP Program with a Covered California Health Plan

After enrolling into a Covered California Health Plan, the fastest way to enroll into the HIPP Program is to work directly with your local Medication Assistance Program Enrollment Worker. For a list of Enrollment Workers in your area, click the following link:

• Certified Covered California Enrollment Site List
  
• Enrollment Site Locator Map
  

Covered California HIPP Program applicants should work with their Enrollment Worker to submit the following documents to apply for the HIPP Program:

• Medication Assistance Program Client Attestation Form (PDF)(with all applicable boxes checked and required fields (i.e., family size))
• Health insurance plan billing statement 
• Covered California Welcome Letter or the Covered California “Current Enrollment” page with the following information: 
• your name (names of those covered by the plan)
• premium amount
• name of the health plan
• APTC and/or State Premium Assistance Subsidy Program amount
• plan effective/start date
• enrollment confirmation number
• health plan billing address (if available). 
• If you are enrolling in a dental and/or vision plan, be sure the documents include information for those plans as well.