Mixed Deck — All ACA Topics Flashcards

Under the ACA, which federal agency oversees Medicaid program administration and expansion implementation?

Answer: The Centers for Medicare & Medicaid Services (CMS)

The Centers for Medicare & Medicaid Services (CMS) within HHS administers Medicaid at the federal level and oversees state implementation of ACA expansion.

What is the most common mistake professionals make when implementing health insurance coverage & enrollment strategies?

Answer: Developing contingency plans for high-probability risk scenarios

Developing contingency plans for high-probability risk scenarios is the correct approach because effective health insurance coverage & enrollment in the affordable care act certified field requires adherence to professional standards, evidence-based practices, and systematic methodology. This approach ensures consistent, high-quality outcomes while maintaining professional accountability.

Which ACA mechanism allows states to waive certain ACA requirements to implement alternative coverage approaches if they meet specific waiver criteria?

Answer: Section 1332 State Innovation Waivers

Section 1332 waivers allow states to waive certain ACA market rules and exchange requirements if the alternative plan meets coverage, affordability, and scope standards.

A client shares that they are undocumented but has a citizen child who needs coverage. What is the ethically correct course of action?

Answer: Enroll the child in CHIP or Marketplace coverage without disclosing the parent's status unnecessarily

Eligible children may receive coverage regardless of their parents' status, and assisters must protect client confidentiality and serve all eligible individuals.

Which of the following is a key performance indicator for evaluating professional ethics & standards effectiveness?

Answer: Prioritizing based on risk assessment and potential impact

Prioritizing based on risk assessment and potential impact is the correct approach because effective professional ethics & standards in the affordable care act certified field requires adherence to professional standards, evidence-based practices, and systematic methodology. This approach ensures consistent, high-quality outcomes while maintaining professional accountability.

A risk manager at an insurance company wants to quantify the impact of high-cost claimants on plan financials. Which metric is MOST relevant?

Answer: Concentration of claims among top 1–5% of enrollees

A small percentage of enrollees typically generate the majority of medical costs, so analyzing claims concentration helps quantify catastrophic risk exposure.

Which ACA provision was designed specifically to protect insurers from unexpectedly high claims in the first years of marketplace operation through a shared losses mechanism?

Answer: Risk Corridors

Risk corridors limited insurer losses by requiring HHS to cover a portion of losses exceeding a set threshold and collecting gains above another threshold.

Which tool or methodology is most appropriate for analyzing policies & regulations outcomes?

Answer: Maintaining professional boundaries while building collaborative relationships

Maintaining professional boundaries while building collaborative relationships is the correct approach because effective policies & regulations in the affordable care act certified field requires adherence to professional standards, evidence-based practices, and systematic methodology. This approach ensures consistent, high-quality outcomes while maintaining professional accountability.

A stakeholder engagement plan for an ACA outreach campaign should include which key element?

Answer: Identification of target audiences and their specific information needs

Effective stakeholder engagement plans identify audiences and tailor messaging to their specific needs and barriers.

Which scenario would require a affordable care act certified professional to escalate a tax credits & subsidies concern?

Answer: Creating feedback mechanisms that encourage continuous improvement

Creating feedback mechanisms that encourage continuous improvement is the correct approach because effective tax credits & subsidies in the affordable care act certified field requires adherence to professional standards, evidence-based practices, and systematic methodology. This approach ensures consistent, high-quality outcomes while maintaining professional accountability.

What is the 'no wrong door' policy under the ACA as it applies to Medicaid and Marketplace enrollment?

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.

Which penalty under ACA Section 4980H(a) applies when an ALE fails to offer minimum essential coverage to at least 95% of its full-time employees?

Answer: The 'A' penalty triggered if at least one full-time employee receives a premium tax credit

The 4980H(a) 'A' penalty is triggered when an ALE fails the 95% offer requirement and at least one full-time employee receives a premium tax credit on the Marketplace.

A Navigator is working with a client who qualifies for both Medicaid and marketplace coverage. What is the correct communication approach?

Answer: Explain both options objectively and help the client understand the differences in cost and coverage

Navigators must present all options objectively and cannot steer clients toward one program over another based on personal preference.

Under ACA quality standards, what is the minimum timeframe within which a health plan must complete an expedited internal appeal for urgent care situations?

Answer: 72 hours

For urgent/expedited appeals, plans must make a determination within 72 hours of receiving the appeal request.

What is the primary advantage of a Bronze plan for a relatively healthy individual?

Answer: Lower monthly premiums

Bronze plans offer the lowest monthly premiums of all metal tiers, making them cost-effective for individuals who rarely use healthcare services.

Which employer size is exempt from the ACA's employer shared responsibility provisions (employer mandate)?

Answer: Employers with fewer than 50 full-time equivalent employees

Employers with fewer than 50 full-time equivalent employees are not subject to the ACA employer shared responsibility provisions and face no penalties.

Which ACA rule prevents insurers from using 'death spirals' — where only sick people enroll, causing premiums to rise, driving healthy people out — by stabilizing the risk pool?

Answer: Community rating with age bands limited to 3:1

Community rating prevents insurers from charging sick enrollees more, while age bands (3:1 ratio) limit but don't eliminate age-based pricing variation.

In the context of affordable care act certified, which principle most directly governs compliance & consumer protections practices?

Answer: Applying evidence-based methodologies with peer-reviewed support

Applying evidence-based methodologies with peer-reviewed support is the correct approach because effective compliance & consumer protections in the affordable care act certified field requires adherence to professional standards, evidence-based practices, and systematic methodology. This approach ensures consistent, high-quality outcomes while maintaining professional accountability.

Under ACA ethics guidelines, when is it acceptable for a navigator to accept a tip from a grateful client?

Answer: Never; navigators may not accept compensation from clients

Navigators funded by federal grants are prohibited from accepting any payment, gifts, or tips from the clients they assist.

Which of the following is a best practice for following up with clients after ACA enrollment assistance?

Answer: Send a confirmation of enrollment details and remind clients of key dates like first premium payment deadlines

A timely follow-up confirming enrollment details and first payment deadlines reduces lapses in coverage due to missed initial premiums.