Hawaii Employer-Union Health Benefits Trust Fund

If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the U.S. Department of Labor, Employee Benefits Security Administration or call 1-866-444-EBSA (3272).

If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2018. Contact your State for more information on eligibility.

ALABAMA	ALASKA
Website: myalhipp.com Phone: 1-855-692-5447	Website: myakhipp.com/ Phone: 1-866-251-4861 Medicaid: dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
ARKANSAS	COLORADO
Website: myarhipp.com/ Phone: 1-855-692-7447	Medicaid Website: www.healthfirstcolorado.com/ Medicaid Phone: 1-800-221-3943 CHIP Website: www.colorado.gov/pacific/hcpf/child-health-plan-plus CHIP Phone: 1-800-359-1991
FLORIDA	GEORGIA
Website: flmedicaidtplrecovery.com Phone: 1-877-357-3268	Website: https://medicaid.georgia.gov/third-party-liability/health-insurance-premium-payment-program-hipp Phone: (678) 564-1162, ext. 2131
INDIANA	IOWA
Healthy Indiana Plan for adults 19-64 Website: www.in.gov/fssa/hip/ Phone: 1-877-438-4479 All other Medicaid Website: www.in.gov/medicaid/ Phone: 1-800-403-0864	Website: dhs.iowa.gov/hawki Phone: 1-800-257-8563
KANSAS	KENTUCKY
Website: www.kdheks.gov/hcf/Medicaid/ Phone: (785) 296-3512	Website: chfs.ky.gov/agencies/dms/Pages/default.aspx Phone: 1-800-635-2570
LOUISIANA	MAINE
Website: ldh.la.gov/index.cfm/subhome/1 Phone: 1-888-695-2447	Website: www.maine.gov/dhhs/ofi/ Phone: 1-800-442-6003
MASSACHUSETTS	MINNESOTA
Website: www.mass.gov/topics/masshealth Phone: 1-800-862-4840	Website: mn.gov/dhs/people-we-serve/seniors/health-care/health-care-programs/programs-and-services/medical-assistance.jsp Phone: 1-800-657-3739
MISSOURI	MONTANA
Website: dss.mo.gov/mhd/participants/pages/hipp.htm Phone: (573) 751-2005	Website: dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084
NEBRASKA	NEVADA
Website: dhhs.ne.gov/Pages/General-Medicaid-Information.aspx Phone: 855-632-7633 Lincoln: (402) 473-7000 Omaha: (402) 595-1178	Website: dhcfp.nv.gov/Pgms/CPT/HIPP/ Phone: 1-800-992-0900
NEW HAMPSHIRE	NEW JERSEY
Website: www.dhhs.nh.gov/ombp/medicaid/index.htm Phone: 603-271-5218 NH Medicaid Service Center: 1-888-901-4999	Medicaid Website: www.state.nj.us/humanservices/dmahs/clients/medicaid/ Medicaid Phone: (609) 631-2392 CHIP Website: www.njfamilycare.org CHIP Phone: 1-800-701-0710
NEW YORK	NORTH CAROLINA
Website: www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831	Website: medicaid.ncdhhs.gov/ Phone: (919) 855-4100
NORTH DAKOTA	OKLAHOMA
Website: www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-844-854-4825	Website: www.insureoklahoma.org/ Phone: 1-888-365-3742
OREGON	PENNSYLVANIA
Website: healthcare.oregon.gov Phone: 1-800-699-9075	Website: www.dhs.pa.gov/providers/Providers/Pages/Medical/HIPP-Program.aspx Phone: 1-800-692-7462
RHODE ISLAND	SOUTH CAROLINA
Website: eohhs.ri.gov/ Phone: 855-697-4347	Website: www.scdhhs.gov/ Phone: 1-888-549-0820
SOUTH DAKOTA	TEXAS
Website: dss.sd.gov/medicaid/default.aspx Phone: 1-888-828-0059	Website: hhs.texas.gov/services/financial/health-insurance-premium-payment-hipp-program Phone: 1-800-440-0493
UTAH	VERMONT
Medicaid Website: medicaid.utah.gov/ CHIP Website: chip.health.utah.gov/ Phone: 1-877-543-7669	Website: www.greenmountaincare.org/ Phone: 1-800-250-8427
VIRGINIA	WASHINGTON
Website: www.coverva.org/en/hipp Medicaid Phone: 1-800-432-5924 CHIP Phone: 1-855-242-8282	Website: www.hca.wa.gov/health-care-services-supports/program-administration/premium-payment-program Phone: 1-800-562-3022 ext 15473
WEST VIRGINIA	WISCONSIN
Website: mywvhipp.com/ Phone: 1-855-699-8447	Website: www.dhs.wisconsin.gov/badgercareplus/index.htm Phone: 1-800-362-3002
WYOMING
Website: wymedicaid.portal.conduent.com/ Phone: (307) 777-7531

To see if any other states have added a premium assistance program since July 31, 2018, or for more information on special enrollment rights, contact either:

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According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512.

The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email [email protected] and reference the OMB control number 1210-0137.

OMB Control Number 1210-0137 (expires 12/31/2019)