If your employer just handed you a form labeled DHCS 9061, it’s a notice from the California Department of Health Care Services telling you that you may qualify for help paying your health insurance premiums after you lose your job. The program it points you to is called the Health Insurance Premium Payment program, or HIPP. You do not fill this form out and return it. It exists to let you know a benefit is available, and the next step, if you think you qualify, is to apply to HIPP directly.1Department of Health Care Services. DHCS 9061 – Notice to Terminating Employees
What the Notice Actually Says
DHCS 9061 is a one-page notice titled “Notice to Terminating Employees.” California employers are expected to hand it out when an employee is losing their job. The notice explains that DHCS may pay health insurance premiums through the HIPP program for people who are leaving a job and have a medical condition that requires ongoing physician treatment.1Department of Health Care Services. DHCS 9061 – Notice to Terminating Employees A Spanish-language version is published as DHCS 9061SP.2Department of Health Care Services. Health Insurance Premium Payment Web Forms
There is nothing on the notice for you to sign, no deadline printed on it, and no box to return it to. It is informational. The action, if you want it, happens on the DHCS website.
Whether You Qualify for HIPP
To get premium assistance through HIPP, you have to meet all of the following:1Department of Health Care Services. DHCS 9061 – Notice to Terminating Employees
- You have full-scope or fee-for-service Medi-Cal when you apply.
- You have a medical condition that requires a physician’s treatment.
- DHCS determines that paying your premiums is cost-effective compared to covering your care directly through Medi-Cal.
- You have a current health insurance policy that covers your condition, or you have COBRA, CAL-COBRA, or a COBRA conversion policy that is in effect or available to you when you apply.
- You are not enrolled in a Medi-Cal managed care plan, a prepaid health plan, a County Organized Health System, a Geographic Managed Care Program, the County Medical Services Program, or Medicare.
That last requirement is the one that surprises people. Most Medi-Cal recipients in California are in a managed care plan, and if you are, the standard HIPP program will not cover you. HIPP is built for people on fee-for-service Medi-Cal who also carry a separate private policy or COBRA continuation coverage. If you’re unsure which kind of Medi-Cal you have, your Medi-Cal enrollment paperwork or your county eligibility worker can tell you.
How to Apply
Applications go in online through the DHCS website. Start at the Department’s Health Insurance Premium Payment web forms page, which links to the application portal and the supporting forms.2Department of Health Care Services. Health Insurance Premium Payment Web Forms Any documents you upload need to be in PDF format. Have these ready before you start:
- Documentation of your current health insurance policy (or the COBRA offer you’ve received).
- Proof of your Medi-Cal enrollment.
- Information about the medical condition being treated.
You do not need the physical DHCS 9061 notice to apply. If your employer never gave you one, you can still submit an application through the portal.
OA-HIPP for HIV/AIDS Diagnoses
DHCS runs a separate program called OA-HIPP that pays monthly health insurance premiums for eligible California residents with an HIV/AIDS diagnosis. The forms are on the same DHCS web forms page. If you have an HIV/AIDS diagnosis and are losing employer-sponsored insurance, look at OA-HIPP before applying to the standard HIPP program to see which is the better fit.2Department of Health Care Services. Health Insurance Premium Payment Web Forms
If You’re the Employer Distributing the Form
Employers can download DHCS 9061 as a PDF from the Department of Health Care Services website.1Department of Health Care Services. DHCS 9061 – Notice to Terminating Employees The Spanish version, DHCS 9061SP, is on the HIPP web forms page.2Department of Health Care Services. Health Insurance Premium Payment Web Forms Give the notice to the employee at the time of termination.
A Note on a Different Form With a Similar Number
DHCS 9061 is sometimes confused with DHCS 6251, the Medi-Cal Estate Recovery Questionnaire. That is a completely different form, sent to the representative of a deceased Medi-Cal beneficiary to gather information about the estate.3Department of Health Care Services. Medi-Cal Estate Recovery Questionnaire If the document in front of you concerns a death in the family rather than a job loss, check the form number in the corner. 9061 is the termination notice; 6251 is the estate questionnaire, and the rules for responding to it are different.