Mixed Deck — All CEC Topics Flashcards

An applicant states they are a lawfully present non-citizen. Which immigration status would make them eligible for Marketplace coverage but NOT for Medicaid/CHIP under the standard 5-year bar?

Answer: Lawful Permanent Resident within their first 5 years in that status

Lawful Permanent Residents are subject to a 5-year waiting period before qualifying for federally funded Medicaid, but they are eligible for Marketplace coverage immediately.

Under federal regulations, how long must certified enrollment counselors (Navigators/Assisters) retain applicant records and documentation?

Answer: 5 years

Federal Navigator regulations generally require that records related to enrollment assistance be retained for a minimum of 5 years to support oversight and auditing requirements.

What does 'minimum necessary' mean in the context of HIPAA privacy rules for enrollment counselors?

Answer: Access or share only the amount of PHI needed to complete the task

The minimum necessary standard requires that access to PHI be limited to only what is needed to accomplish the intended purpose.

Under FERPA, which of the following is considered 'directory information' that may be disclosed without consent unless the student opts out?

Answer: Student's name, address, and enrollment status

FERPA permits schools to designate certain non-sensitive data such as name, address, and enrollment status as directory information, which may be released without prior consent unless the student opts out.

During a phone enrollment session, a client seems distressed and repeatedly asks the same question. The BEST response is to:

Answer: Pause, acknowledge the client's concern, and clarify the information calmly

Pausing and acknowledging distress demonstrates empathy and helps de-escalate while addressing the confusion.

Which federal program provides health coverage specifically to low-income pregnant women who do not otherwise qualify for Medicaid?

Answer: CHIP Perinatal

CHIP Perinatal (or unborn child option) allows states to extend CHIP coverage to unborn children of low-income women who don't qualify for Medicaid.

A student submits a complaint alleging that an enrollment counselor made false promises about job placement assistance. Which federal agency is primarily responsible for investigating such complaints against institutions?

Answer: Department of Education's Federal Student Aid office

The Department of Education's Federal Student Aid (FSA) office oversees institutional compliance with Title IV regulations, including prohibitions on misrepresentation in student recruiting.

A Marketplace applicant's employer offers health coverage. The enrollment counselor must assess affordability. For 2024, employer-sponsored coverage is considered unaffordable if the employee-only premium exceeds what percentage of household income?

Answer: 8.39%

For 2024, the ACA affordability threshold is 8.39% of household income for the employee-only premium.

Which action BEST supports language access for clients with limited English proficiency under federal guidelines?

Answer: Offering free language assistance services proactively in the client's identified language

Federal civil rights laws require meaningful access to services, including proactive language assistance at no cost to the client.

Which of the following is an example of a 'social engineering' attack that enrollment counselors should be trained to recognize?

Answer: A caller claiming to be a government official and requesting an applicant's SSN

Social engineering involves manipulating individuals into divulging confidential information by impersonating trusted authorities.

Which of the following does NOT qualify as a life event for a Special Enrollment Period?

Answer: Choosing to leave a job voluntarily without losing coverage

Voluntarily leaving a job without losing health coverage does not trigger a SEP because coverage was not involuntarily lost.

An applicant's income information collected for APTC eligibility may NOT be shared with:

Answer: A commercial lender without the applicant's consent

Income data collected for Marketplace eligibility determinations cannot be shared with commercial lenders, as that falls outside the permitted uses of enrollment data.

Which document is typically required to verify a qualifying life event for a Special Enrollment Period?

Answer: Documentation such as a marriage certificate, birth certificate, or loss-of-coverage letter

Applicants must provide supporting documentation that matches the qualifying life event, such as a marriage certificate or loss-of-coverage notice.

What action must an enrollment counselor take before accessing a consumer's Marketplace account on their behalf?

Answer: Obtain written or documented consent from the consumer

Enrollment counselors must obtain documented consumer consent before accessing or making changes to a consumer's Marketplace account.

An enrollment counselor working for a Navigator organization receives a large gift basket from a local insurance broker who wants referrals. What should the counselor do?

Answer: Decline the gift and report the offer to their supervisor, as it represents a potential conflict of interest

Accepting gifts from anyone seeking referrals creates a conflict of interest; the counselor must decline and report the offer to maintain impartiality and comply with assister standards.

A consumer reports a loss of job-based health coverage that will take effect in 45 days. As a Certified Enrollment Counselor, what should you advise them regarding their enrollment options?

Answer: They can apply for a Special Enrollment Period now, as they expect to lose coverage within the next 60 days.

A consumer who expects to lose qualifying health coverage within the next 60 days is eligible to apply for a Special Enrollment Period (SEP). This allows them to enroll in a new Marketplace plan before their current coverage ends, preventing a gap in coverage.

A Certified Application Counselor (CAC) is prohibited from doing which of the following?

Answer: Charging consumers a fee for enrollment assistance

CACs are prohibited from charging consumers fees for their enrollment assistance services, as they must provide help free of charge.

Which of the following best describes the 'navigator' role regarding serving underserved populations?

Answer: Navigators provide free, unbiased enrollment assistance and are required to conduct outreach to underserved and hard-to-reach communities

Navigator grants require recipients to conduct public education and outreach with a focus on underserved, vulnerable, and hard-to-reach populations at no cost to clients.

Under the ACA's employer mandate, which employers are required to offer minimum essential coverage to full-time employees?

Answer: Employers with 50 or more full-time equivalent employees

Applicable Large Employers (ALEs) with 50 or more full-time equivalent employees must offer MEC to full-time employees or face potential employer shared responsibility payments.

A student who is 17 years old and applying to college asks a counselor to keep their application details confidential from their parents. Under FERPA, the counselor should:

Answer: Inform the student that parents retain FERPA rights for dependent minors under 18

FERPA transfers rights to the student once they enroll in a postsecondary institution, but for applicants who are still eligible dependents, parental rights may still apply.