Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: KIM EVANS, DIRECTOR
SUBJECT: HEALTH INSURANCE PREMIUM PAYMENT (HIPP) APPLICATIONS UPDATED IN FORMS MANUAL
FORM REVISION #18
The purpose of this memo is to notify staff that the following HIPP applications have been updated in the Forms Manual:
- HIPP-1 General Application for HIPP-MO HealthNet eligible only
- HIPP-1 (Spanish)
- HIPP-A Application for individuals with HIV/AIDS
- HIPP-A (Spanish)
The updated forms are dated August 2019. Any HIPP forms with previous dates should be destroyed.
- Review this memorandum with appropriate staff.
- Destroy all HIPP forms prior to the 8/2019 date.