NAVIGATOR STATE CERTIFICATION QUESTIONS
What are the types of assistants that may help Hoosiers? - Answers- Indiana
Navigators, Authorized Representatives and Health Insurance Agents
Another authorized consumer assistant title consumers may seeis Obama care
guidance Specialists (OGCs)? - Answers- False
Marketplace will automatically certify consumer assistants called federal navigators and
CACs, are they automatically valid in Indiana? - Answers- False
Auto Assignment - Answers- is the process by which an individual who does not select
a Hoosier Healthwise (HHW) or Healthy Indiana Plan (HIP) Managed Care Entity (MCE)
at the time of the HHW or HIP application, or within fourteen (14) days of the submission
of the application, is automatically assigned to a Managed Care Entity.
Behavioral & Primary Healthcare coordination Program (BPHC) - Answers- is a
program that provides access to Medicaid Rehabilitation Option (MRO) services to
individuals with Serious Mental Illness (SMI) whose income would otherwise be too high
to qualify for Medicaid coverage. A person deemed eligible for BPHC receives full
Medicaid benefits.
Benefits Portal - Answers- is a website developed and managed by the Indiana
Department of Family Resources (DFR) by which Hoosier insurance consumers may
apply for Indiana Health Coverage Programs (IHCPs) as well as check the status of
pending applications. The DFR Benefits Portal is located at
www.ifcem.com/CitizenPortal/application.do.
Care Management Organization (CMO) - Answers- is an organization contracted with
Indiana Health Coverage Programs (IHCPs) to perform the care management, prior
authorization, and utilization management of physical, behavioral, and transportation
services for members in Care Select. The CMO manages care for Care Select members
through its network of Primary Medical Providers (PMPs), specialists, and other
providers. Currently, MDwise and Advantage Health Solutions serve as Indiana's Care
Management Organizations.
Care Select - Answers- is an optional health care program for Indiana Medicaid
enrollees who have special health needs or would benefit from specialized attention.
Care Select includes comprehensive care coordination for members. Individuals eligible
for Care Select include those who are eligible for Medicaid on the basis of being aged,
blind, disabled, a ward of the court or foster child or a child receiving adoptive services
or adoption assistance and have a specific medical condition.
Children's Health Insurance Program (CHIP) - Answers- is a health coverage program
for children authorized in 1997 under Title XXI of the Social Security Act. CHIP provides
, health coverage to children whose income is too high to qualify for Medicaid. CHIP is
administered by states with joint funding from the federal government and the states.
States can implement CHIP though a Medicaid expansion, separate CHIP or
combination of the two approaches. Indiana operates CHIP through both a Medicaid
expansion and separate CHIP program.
Division of Family Resources (DFR)- - Answers- is a division of the Indiana Family and
Social Services Administration (FSSA), which establishes eligibility for Medicaid, the
Supplemental Nutrition Assistance Program (SNAP - food assistance), and the
Temporary Assistance for Needy Families (TANF - cash assistance). DFR also manages
the DFR Benefits Portal, where consumers may apply for an Indiana Health Coverage
Program (IHCP).
Who needs to be certified as an Indiana Navigator? - Answers- Individuals with denied,
revoked or suspended insurance or broker license, has been convicted of a
disqualifying felony or other crime made by Indiana department of Insurance (IDOI), or
individuals who fail to pay state income taxes or failed to pay child support, and those
who admit or have been convicted of unfair trade practice or fraud insurance business
practices
What is the Navigator certification process? - Answers- Apply, complete pre-certification
training and pass certification examination.
Authorized Representative - Answers- is an individual or organization designated by a
Medicaid or insurance affordability program applicant or beneficiary to act responsibly
on his or her behalf to assist with the individual's application and renewal of eligibility
and other ongoing communications. Authorized representatives may be authorized to
sign an application on the applicant's behalf, complete and submit a renewal form and
receive copies of the applicant or beneficiary's notices and other communications from
the Medicaid agency.
Eligibility Group - Answers- (also referred to as aid category) refers to a particular
group/category that is eligible for Medicaid. An individual is determined eligible for the
appropriate group/category based on factors of eligibility such as age, income,
pregnancy, disability or blindness. See Table 29 for the 2014 list of Medicaid eligibility
groups.
Eligibility Hierarchy - Answers- is the system used to determine a Medicaid applicant's
eligibility for the most comprehensive Medicaid benefit package, in the absence of a
stated preference.
Application Organizations (AOs) are - Answers- organizations with employees and/or
volunteers assisting Hoosier consumers with application in the federal marketplace,
qualifying health plans and cost lowering programs.
Indiana Navigators never suggest specific health plans? - Answers- True
What are the types of assistants that may help Hoosiers? - Answers- Indiana
Navigators, Authorized Representatives and Health Insurance Agents
Another authorized consumer assistant title consumers may seeis Obama care
guidance Specialists (OGCs)? - Answers- False
Marketplace will automatically certify consumer assistants called federal navigators and
CACs, are they automatically valid in Indiana? - Answers- False
Auto Assignment - Answers- is the process by which an individual who does not select
a Hoosier Healthwise (HHW) or Healthy Indiana Plan (HIP) Managed Care Entity (MCE)
at the time of the HHW or HIP application, or within fourteen (14) days of the submission
of the application, is automatically assigned to a Managed Care Entity.
Behavioral & Primary Healthcare coordination Program (BPHC) - Answers- is a
program that provides access to Medicaid Rehabilitation Option (MRO) services to
individuals with Serious Mental Illness (SMI) whose income would otherwise be too high
to qualify for Medicaid coverage. A person deemed eligible for BPHC receives full
Medicaid benefits.
Benefits Portal - Answers- is a website developed and managed by the Indiana
Department of Family Resources (DFR) by which Hoosier insurance consumers may
apply for Indiana Health Coverage Programs (IHCPs) as well as check the status of
pending applications. The DFR Benefits Portal is located at
www.ifcem.com/CitizenPortal/application.do.
Care Management Organization (CMO) - Answers- is an organization contracted with
Indiana Health Coverage Programs (IHCPs) to perform the care management, prior
authorization, and utilization management of physical, behavioral, and transportation
services for members in Care Select. The CMO manages care for Care Select members
through its network of Primary Medical Providers (PMPs), specialists, and other
providers. Currently, MDwise and Advantage Health Solutions serve as Indiana's Care
Management Organizations.
Care Select - Answers- is an optional health care program for Indiana Medicaid
enrollees who have special health needs or would benefit from specialized attention.
Care Select includes comprehensive care coordination for members. Individuals eligible
for Care Select include those who are eligible for Medicaid on the basis of being aged,
blind, disabled, a ward of the court or foster child or a child receiving adoptive services
or adoption assistance and have a specific medical condition.
Children's Health Insurance Program (CHIP) - Answers- is a health coverage program
for children authorized in 1997 under Title XXI of the Social Security Act. CHIP provides
, health coverage to children whose income is too high to qualify for Medicaid. CHIP is
administered by states with joint funding from the federal government and the states.
States can implement CHIP though a Medicaid expansion, separate CHIP or
combination of the two approaches. Indiana operates CHIP through both a Medicaid
expansion and separate CHIP program.
Division of Family Resources (DFR)- - Answers- is a division of the Indiana Family and
Social Services Administration (FSSA), which establishes eligibility for Medicaid, the
Supplemental Nutrition Assistance Program (SNAP - food assistance), and the
Temporary Assistance for Needy Families (TANF - cash assistance). DFR also manages
the DFR Benefits Portal, where consumers may apply for an Indiana Health Coverage
Program (IHCP).
Who needs to be certified as an Indiana Navigator? - Answers- Individuals with denied,
revoked or suspended insurance or broker license, has been convicted of a
disqualifying felony or other crime made by Indiana department of Insurance (IDOI), or
individuals who fail to pay state income taxes or failed to pay child support, and those
who admit or have been convicted of unfair trade practice or fraud insurance business
practices
What is the Navigator certification process? - Answers- Apply, complete pre-certification
training and pass certification examination.
Authorized Representative - Answers- is an individual or organization designated by a
Medicaid or insurance affordability program applicant or beneficiary to act responsibly
on his or her behalf to assist with the individual's application and renewal of eligibility
and other ongoing communications. Authorized representatives may be authorized to
sign an application on the applicant's behalf, complete and submit a renewal form and
receive copies of the applicant or beneficiary's notices and other communications from
the Medicaid agency.
Eligibility Group - Answers- (also referred to as aid category) refers to a particular
group/category that is eligible for Medicaid. An individual is determined eligible for the
appropriate group/category based on factors of eligibility such as age, income,
pregnancy, disability or blindness. See Table 29 for the 2014 list of Medicaid eligibility
groups.
Eligibility Hierarchy - Answers- is the system used to determine a Medicaid applicant's
eligibility for the most comprehensive Medicaid benefit package, in the absence of a
stated preference.
Application Organizations (AOs) are - Answers- organizations with employees and/or
volunteers assisting Hoosier consumers with application in the federal marketplace,
qualifying health plans and cost lowering programs.
Indiana Navigators never suggest specific health plans? - Answers- True
