- (a) “Cost effective” means that the cost to enroll an individual in an employer group health plan is likely to be less than the average medicaid expenditures for medicaid recipients with the same category of assistance, age, and sex.
- (b) “Cost effectiveness test” means the method by which the department determines if a recipient’s employer group health plan costs less than the expected medicaid expenditure.
- (c) “Department” means the New Hampshire department of health and human services.
- (d) “Employer group health plan” means any plan of, or contributed to by, an employer, including a self-insured plan, to provide health care to the employer’s employees, former employees, or the families of employees or former employees, and which meets section 5000(b)(1) of the Internal Revenue Code of 1986, and includes continuation coverage pursuant to Title XXII of the Public Health Services Act, section 4980B of the Internal Revenue Code of 1986, or Title VI of the Employee Retirement Income Security Act of 1974.
- (e) “Health insurance premium payment program (HIPP)” means a state and federal cost savings program administered by the department consistent with 42 U.S.C 1396e , which permits the use of medicaid funds to purchase employer group health plan coverage on behalf of eligible medicaid recipients if deemed cost effective.
- (f) “Medicaid” means the Title XIX and Title XXI programs administered by the department, which makes medical assistance available to eligible individuals.
- (g) “Policyholder” means the family member who owns the employer group health plan policy and is responsible for premium payment.
- (h) “Wrap-around services” means to the extent that an employer group health plan does not cover a benefit contained in the NH state medicaid benefit package, the service is covered by traditional medicaid so that the individual has access to the same services to which they are entitled if they were only covered by the state’s medicaid program.
Source. #10632, eff 7-1-14; ss by #14075, eff 9-20-24, EXPIRES: 9-20-34