Instructions for Submitting Office of AIDS (OA)
AIDS Drug Assistance Program (ADAP)
Health Insurance Premium Payment (HIPP) and
Medicare Premium Payment Program (MPPP) Documents

Purpose

This document provides instructions to Enrollment Workers (EWs) on how to submit HIPP and MPPP documents to ADAP. The instructions outline what is allowable and what will facilitate the most efficient processing.

Document Types and Item​s Needed for Submission  

ADAP document coversheets are optional when submitting work items via the ADAP Enrollment System (AES) but are required for faxes.

•  HIPP Only Application or Binder Payment Requ​est 
  

1. Client attestation (CDPH 8723) and
2. Billing documentation (i.e., billing statement, completed COBRA election notice, Covered California Program Enrollment Summary screenshot).

Binder payment - The initial (first) payment made to a health plan to ‘bind’ a client to the plan. If a client is re-enrolling in the same health plan at open enrollment, it is not considered a binder payment.

• ADAP/HIPP Application or Re-Enro​​llment  
  

1. Client attestation (CDPH 8723) and
2. Billing documentation (i.e., billing statement, completed COBRA election notice, Covered California Program Enrollment Summary screenshot).

• HIPP Supporting Documents/Premium Upd​​ate 
  

1. Supporting documents (i.e., billing statement, completed COBRA election notice, Covered California Program Enrollment Summary screenshot).

• ​MPPP Request for Enrol​​lment
  

1. Client attestation (CDPH 8723) and
2. AES case note (i.e., “Client enrolling in MPPP”).

EWs should never create a HIPP or MPPP work item and fax with the same HIPP/MPPP documentation. Submitting duplicate items will delay processing.

Preferred Method – Work Items

Submitting a work item via AES will facilitate the fastest processing of documents.

• Create a work item as instructed in the job aid; attach supporting documents to the work item as listed above.

Acceptable Method (Not Pref​erred) – Faxing

EWs should only fax if they are unable to submit via the AES due to issues (i.e., company IT restrictions or policies).

• ​Fax ADAP document coversheet and supporting documents to the ADAP Client Services Unit (CSU) at (844) 421-8008.

Unacceptable Methods

• ​​Faxing only the ADAP document coversheet (unless a MPPP application) to the ADAP CSU and does not include supporting documents.
  
• ​This document will not be processed. ADAP will follow up with the EW to submit the documents.
• ​Fax only the document coversheet (unless it is a MPPP application) to the ADAP CSU and uploads supporting documents to AES.
• ​This requires ADAP staff to conduct additional research and may delay the timeliness of processing.
• Attach HIPP/MPPP documents in AES with no work item or fax.
• ADAP will not know the documents were submitted and the documents will not be processed.​​