CEC Verification and Documentation Requirements 1 — Questions and Answers
Question 1: When the Marketplace finds a data inconsistency related to an applicant's income, what is the FIRST action taken?
- The application is immediately denied
- The applicant is notified and given an opportunity to resolve the inconsistency (Correct answer)
- The case is referred to the IRS for investigation
- Enrollment is suspended pending a federal audit
Correct answer: The applicant is notified and given an opportunity to resolve the inconsistency
Federal regulations require that applicants be notified of any inconsistency and given a reasonable period to provide documentation to resolve it before any adverse action is taken.
Question 2: How long does a Marketplace applicant typically have to submit documentation to resolve a data inconsistency after receiving notice?
- 15 days
- 30 days
- 90 days (Correct answer)
- 60 days
Correct answer: 90 days
Applicants are generally given 90 days to provide documentation resolving a data inconsistency before the Marketplace changes their eligibility determination.
Question 3: Which federal agency's records does the Marketplace primarily use to verify Social Security numbers?
- Department of Homeland Security (DHS)
- Internal Revenue Service (IRS)
- Social Security Administration (SSA) (Correct answer)
- Centers for Medicare & Medicaid Services (CMS)
Correct answer: Social Security Administration (SSA)
The Marketplace uses the Social Security Administration's data hub to electronically verify Social Security numbers provided on applications.
Question 4: Which document is MOST commonly used to verify current wages from an employer during a Marketplace application?
- Prior-year federal tax return (Form 1040)
- Recent pay stubs from the past 30 days (Correct answer)
- A letter from a doctor confirming employment
- Form W-9 from the employer
Correct answer: Recent pay stubs from the past 30 days
Recent pay stubs (generally from the past 30 days) are the primary documentation used to verify current employment income for Marketplace eligibility purposes.
Question 5: What happens to an enrollee's Marketplace coverage if they fail to resolve an income inconsistency within the required timeframe?
- Their coverage is immediately terminated
- Their premium tax credit is reduced to zero permanently
- Their eligibility is redetermined based on the data sources the Marketplace has on file (Correct answer)
- They are enrolled in Medicaid automatically
Correct answer: Their eligibility is redetermined based on the data sources the Marketplace has on file
If the inconsistency is not resolved, the Marketplace redetermines eligibility using available federal data sources, which may result in a change to the tax credit amount or other eligibility findings.
Question 6: Which document is an acceptable proof of U.S. citizenship for Marketplace enrollment?
- State-issued driver's license
- U.S. passport or U.S. birth certificate (Correct answer)
- Permanent Resident Card (Green Card)
- Employment Authorization Document (EAD)
Correct answer: U.S. passport or U.S. birth certificate
A U.S. passport or U.S. birth certificate are primary documents that establish U.S. citizenship for Marketplace enrollment eligibility purposes.
Question 7: What is the primary method the federally facilitated Marketplace (FFM) uses to verify applicant information at the time of application?
- Manual review of paper documents submitted by applicants
- In-person interviews at local Social Security offices
- Electronic data matching through the Federal Data Services Hub (Correct answer)
- Phone verification with the applicant's employer
Correct answer: Electronic data matching through the Federal Data Services Hub
The FFM uses the Federal Data Services Hub to electronically verify applicant information—such as income, citizenship, and immigration status—in real time with federal agencies.
CEC Verification and Documentation Requirements 1
When the Marketplace finds a data inconsistency related to an applicant's income, what is the FIRST action taken?