ACA ACA Medicaid Expansion & Public Programs 2 — Questions and Answers
Question 1: Under the ACA, what is the Children's Health Insurance Program (CHIP) primarily designed to cover?
- Children in families earning below 100% FPL who qualify for Medicaid
- Uninsured children in families with incomes too high for Medicaid but who cannot afford private coverage (Correct answer)
- Children of federal employees not covered by employer plans
- Foster children in state custody regardless of income
Correct answer: Uninsured children in families with incomes too high for Medicaid but who cannot afford private coverage
CHIP covers uninsured children in low-to-moderate income families that earn too much to qualify for Medicaid but cannot afford private insurance.
Question 2: What ACA provision requires states to maintain Medicaid and CHIP eligibility for children at levels in effect on the date of enactment?
- The maintenance of effort (MOE) requirement (Correct answer)
- The minimum essential coverage mandate
- The benchmark benefit requirement
- The state plan amendment process
Correct answer: The maintenance of effort (MOE) requirement
The ACA's maintenance of effort (MOE) requirement prohibits states from restricting Medicaid and CHIP eligibility for children below levels in place on March 23, 2010.
Question 3: Under the ACA, what is 'presumptive eligibility' in the context of Medicaid?
- A process allowing qualified entities to temporarily enroll individuals in Medicaid pending full eligibility determination (Correct answer)
- Automatic Medicaid enrollment for all individuals below the poverty line
- A waiver program for states to expand eligibility beyond ACA limits
- The practice of denying coverage based on presumed income
Correct answer: A process allowing qualified entities to temporarily enroll individuals in Medicaid pending full eligibility determination
Presumptive eligibility allows qualified entities (such as hospitals) to make a temporary Medicaid eligibility determination so individuals can receive immediate coverage while the full application is processed.
Question 4: Which ACA section established the Basic Health Program (BHP), an optional coverage alternative for states serving low-income residents?
- Section 1331 (Correct answer)
- Section 1402
- Section 2001
- Section 1311
Correct answer: Section 1331
ACA Section 1331 established the Basic Health Program, which allows states to create a state-administered coverage program for residents earning between 133–200% FPL instead of enrolling them in Marketplace plans.
Question 5: Under the ACA Medicaid expansion, which income verification method is primarily used during the application process?
- Paper tax returns submitted by mail
- Real-time electronic data matches using federal data sources like SSA and IRS (Correct answer)
- Employer verification letters only
- State agency interviews with case workers
Correct answer: Real-time electronic data matches using federal data sources like SSA and IRS
The ACA requires states to use real-time electronic data matches with federal sources such as the SSA and IRS to verify income during the Medicaid application process.
Question 6: What is the 'no wrong door' policy under the ACA as it applies to Medicaid and Marketplace enrollment?
- Individuals can apply for coverage through any channel—Marketplace, state Medicaid agency, or other entry points—and be connected to the right program (Correct answer)
- All health plans must accept any applicant regardless of health status
- States cannot deny Medicaid applications submitted outside office hours
- Individuals can switch between Medicaid and Marketplace plans at any time
Correct answer: Individuals can apply for coverage through any channel—Marketplace, state Medicaid agency, or other entry points—and be connected to the right program
The 'no wrong door' policy ensures that regardless of where a person applies for health coverage, they will be screened and connected to the appropriate program, whether Medicaid, CHIP, or a Marketplace plan.
ACA ACA Medicaid Expansion & Public Programs 2
Under the ACA, what is the Children's Health Insurance Program (CHIP) primarily designed to cover?