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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 a HIPP Program, which would pay for your health insurance premiums and certain outpatient medical out-of-pocket (MOOP) costs. HIPP programs 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 a HIPP program.

To be eligible for a 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, 2023 through January 31, 2024.

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) ($20,121 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), to help pay for your insurance premium. 

If you qualify for APTC, you must accept the full amount to qualify for HIPP Programs. 

Clients who received an APTC must file a federal tax return  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 (received too much APTC) or is owed a refund (did not receive enough APTC), requests to resolve over or underpayments may be submitted directly to Pool Administrators Inc. (PAI).

  • APTC Refund – This means that HIPP overpaid the monthly premiums, therefore the APTC refund (for the applicable months) must be returned to HIPP.

  • APTC Tax Liability – This means that HIPP underpaid premiums because your actual income was higher than the income you reported to Covered California and you received too much financial assistance . Therefore, 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 (SSN) and the joint filer's SSN

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

How to Apply for Covered California 

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:

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 (CDPH 8723) (PDF)​ with all applicable boxes checked and required fields (i.e., family size)
  • Current health insurance plan billing statement(s) (for medical, dental, and/or vision-combination plans, as applicable)
  • Covered California "Current Enrollment"  "Confirmation 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 California Premium Credit amount
    • plan effective/start date
    • enrollment confirmation number (if available)
    • 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. 

Premium Payment

CDPH recommends you make the initial premium payment on your own to secure the health insurance policy if possible. This will ensure you are enrolled into the health plan with a January 1, 2024 start date.

Do you need CDPH to pay your initial Covered California insurance premium payment? If so: 

  • Complete the HIPP Program enrollment within two business days after enrollment into Covered California. 
  • Submit documents to the CDPH Medication Assistance Program by November 30, 2023, for a January 1, 2024 start date.  If you submit documentation to CDPH after this date, it is recommended you make the initial premium payment to secure your health insurance. Otherwise, you may not receive a January 1, 2024 effective date.

HIPP for Non-Covered California Health Plans

CDPH recommends contacting the health insurance plan directly to inquire about their open enrollment period dates and to determine if you are eligible for their non-Covered California plans. CDPH has established a process to make your initial premium payment with the following non-Covered California Health plans: 

  • Anthem Blue Cross
  • Blue Shield of California
  • Kaiser

These three plans also accept clients with no SSN.

All clients enrolling in a non-Covered California health plan, including health plans not listed above should work with their Enrollment Worker to submit the following documents to apply for the HIPP Program: 

  • Medication Assistance Program Client Attestation Form (CDPH 823 (PDF) (with all applicable boxes checked)
  • Health insurance plan billing statement (if already enrolled in plan)
  • Medication Assistance Program Fax Coversheet (CDPH 8730) (PDF), if faxing
  • Complete and signed paper application, if using the Blue Shield or Kaiser paper application process and the HIPP Program is paying the first premium.  

Please refer to the table below for important dates.

​Health Plan
​Non-Covered California Open Enrollment Period
​Submit Application
 Online
​Submit Paper Application
​Coverage Start Date
​Anthem Blue Cross
​November 1, 2023 to January 31, 2024
Not applicable​​Submit to Anthem by December 15, 2023
​January 1, 2024
​Blue Shield
​November 1, 2023 to January 31, 2024
​By December 15, 2023
​Submit to CDPH by November 30, 2023
​January 1, 2024
​Kaiser
​November 1, 2023 to January 31, 2024
​By December 15, 2023
​Submit to CDPH by November 30, 2023
​January 1, 2024

Choosing a Health Plan    

The link below provides “report cards” for various Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans. This information may assist in your health plan selection process. 

How to Submit Documents

Work with your local Medication Assistance Program Enrollment Worker to submit documents electronically (this is the fastest and preferred method), or  

Email, fax, or mail the documents to CDPH: 

  • Fax:                 (844) 421-8008
  • Email:            CDPHMedAssistFax@cdph.ca.gov
  • Mail:               CDPH – Insurance Assistance
                             P.O. Box 997426, MS 7704
                             Sacramento, CA 95899

Tax Penalty

Having health coverage is the law. If you don’t have it, you may have to pay a penalty to the California Franchise Tax Board. The penalty for not having coverage the entire year will be at least *$850 per adult, and $425 per dependent child under 18 in the household, when you file your 2023 state income tax return in 2024. 

The penalty will be applied by the California Franchise Tax Board. For additional information or questions regarding this tax penalty, please visit the State of California State Franchise Tax Board and use their Penalty Estimator Tool, or contact your tax advisor.

​Questions?

For questions about program eligibility and enrollment, please call: 

  • Your local Medication Assistance Program Enrollment Worker, or 
  • The Medication Assistance Program Client Services call center at (844) 421-7050. Client Services staff are available Monday–Friday, 8 A.M.–5 P.M. (excluding holidays).

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