CACs CAC Roles and Responsibilities 3 — Questions and Answers
Question 1: A CAC's certification has lapsed. What happens to their authority to provide consumer assistance?
- They may continue assisting consumers for up to 90 days during renewal
- Their authority to assist consumers is suspended until recertification is complete (Correct answer)
- They may only assist existing clients, not new consumers
- They can assist consumers if supervised by a certified CAC
Correct answer: Their authority to assist consumers is suspended until recertification is complete
CACs must maintain current certification to provide assistance; a lapsed certification suspends their authority to assist consumers.
Question 2: Which entity is ultimately responsible for monitoring CAC compliance with federal rules?
- The consumer who received assistance
- The CAC's sponsoring organization and CMS (Correct answer)
- The state Department of Insurance only
- The individual insurance carriers operating in the Marketplace
Correct answer: The CAC's sponsoring organization and CMS
Both the CAC's sponsoring organization and CMS share oversight responsibility for ensuring CAC compliance with federal requirements.
Question 3: A consumer visits a CAC seeking help enrolling in Medicaid. The CAC determines the consumer appears eligible. What should the CAC do?
- Inform the consumer that Medicaid is outside a CAC's scope and refer them elsewhere
- Assist the consumer in applying for Medicaid through the appropriate state or Marketplace pathway (Correct answer)
- Enroll the consumer in a QHP temporarily while Medicaid eligibility is determined
- Tell the consumer to contact a licensed insurance broker for Medicaid assistance
Correct answer: Assist the consumer in applying for Medicaid through the appropriate state or Marketplace pathway
CACs are authorized to assist consumers with Medicaid applications and must help facilitate access to all available coverage options.
Question 4: A CAC notices that a client's application may qualify them for CHIP for their children but a QHP for the adults. What should the CAC do?
- Enroll the entire family in a QHP to simplify the process
- Explain the options and help the family apply for both programs as appropriate (Correct answer)
- Decline to assist with the children since CHIP is a separate program
- Only enroll the adults in a QHP since that is the primary Marketplace product
Correct answer: Explain the options and help the family apply for both programs as appropriate
CACs must inform consumers of all coverage options for which they appear eligible and assist them in applying accordingly.
Question 5: What is the significance of a CAC keeping their training certificates and documentation organized?
- It is optional but helps improve client relationships
- It demonstrates compliance and supports oversight by CMS and the sponsoring organization (Correct answer)
- It is required only if the CAC works in a federally-facilitated Marketplace state
- It is solely for the CAC's personal professional development records
Correct answer: It demonstrates compliance and supports oversight by CMS and the sponsoring organization
Maintaining organized training records demonstrates compliance and is necessary for audits and oversight by CMS and sponsoring organizations.
Question 6: When is a CAC allowed to share a consumer's personally identifiable information (PII) with a third party?
- Whenever the sponsoring organization requests it for reporting purposes
- Only with the consumer's written consent or as required by law (Correct answer)
- When doing so would benefit the consumer's enrollment outcome
- At any time, since CACs are not bound by HIPAA
Correct answer: Only with the consumer's written consent or as required by law
CACs may only share consumer PII with explicit written consent from the consumer or when legally required, consistent with federal privacy standards.
Question 7: A consumer wants to enroll in a Marketplace plan but also wants the CAC to help them dispute a prior insurer claim denial. What should the CAC do?
- Handle both tasks as part of comprehensive consumer assistance
- Assist with Marketplace enrollment but refer the consumer to appropriate resources for the claim dispute (Correct answer)
- Refuse all assistance until the claim dispute is resolved
- File an appeal with the insurer on the consumer's behalf as part of post-enrollment follow-up
Correct answer: Assist with Marketplace enrollment but refer the consumer to appropriate resources for the claim dispute
CACs assist with Marketplace enrollment; claim disputes with insurers are outside their scope and should be referred to appropriate advocates or state resources.
CACs CAC Roles and Responsibilities 3
A CAC's certification has lapsed.
What happens to their authority to provide consumer assistance?