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Question 1

Which government program provides health coverage to low-income children, pregnant women, elderly adults, and people with disabilities in the US?

Accepted Answer

Medicaid

Answer

Medicaid is a joint federal-state program providing health coverage to eligible low-income populations including children, pregnant women, elderly, and disabled individuals.

Question 2

The Children's Health Insurance Program (CHIP) is designed to cover:

Accepted Answer

Children in families with incomes too high for Medicaid but who cannot afford private insurance

Answer

CHIP fills the gap for children whose family incomes exceed Medicaid limits but are still too low to afford private coverage.

Question 3

A CCM case manager is helping a client navigate a prior authorization denial. The appropriate next step is to:

Accepted Answer

File an appeal using clinical documentation supporting medical necessity

Answer

Appealing with supporting clinical documentation to establish medical necessity is the standard process for challenging prior authorization denials.

Question 4

The Affordable Care Act (ACA) marketplace special enrollment period (SEP) is triggered by which of the following?

Accepted Answer

A qualifying life event such as job loss, marriage, or having a baby

Answer

Qualifying life events — including loss of coverage, marriage, birth/adoption, or moving — trigger a Special Enrollment Period outside the annual open enrollment window.

Question 5

Pharmaceutical patient assistance programs (PAPs) are primarily offered by:

Accepted Answer

Drug manufacturers to provide free or reduced-cost medications to qualifying patients

Answer

Pharmaceutical manufacturers operate PAPs to provide medications at no or low cost to uninsured or underinsured patients who meet eligibility criteria.

(CCM) Certified Care Management Professional Practice Test

(CCM) Certified Care Management Professional Practice Test

CCM CCM Financial & Benefits Navigation 2