NYSOH Assistor Certification Actual Practice Examination Comprehensive Test Bank | 100 Questions with Detailed Rationales Latest Update 2026 Edition Kongstvedt, P. R. (2020). Health Insurance and Managed Care: What They Are and How They Work (

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NYSOH Assistor Certification Actual Practice Examination Comprehensive
Test Bank | 100 Questions with Detailed Rationales Latest Update 2026
Edition


Kongstvedt, P. R. (2020). Health Insurance and Managed Care: What They
Are and How They Work (5th ed.). Jones & Bartlett Learning.**
-ISBN: 978-1284152098


SECTION 1: MEDICAID ELIGIBILITY AND ENROLLMENT
(Questions 1-20)




Question 1


A consumer asks the nurse about eligibility for Medicaid coverage for a
newborn under New York State guidelines. The nurse should explain that to
ensure the newborn's coverage is retroactive to the birth month, the family
must apply and have the newborn found eligible within what timeframe from
the date of birth?


A) 30 days
B) 45 days
C) 60 days
D) 90 days

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Correct Answer: C) 60 days
Rationale: Under the Child Health Plus newborn policy, a family must apply
for and have the newborn found eligible for coverage within 60 days of the
newborn's date of birth in order to be eligible to have the coverage go
retroactive to the first of the newborn's birth month . If the family applies
after 60 days, the newborn can still enroll but coverage will not be
retroactive to birth, and enrollment will follow the standard 15th of the
month rule .*


Question 2


A 25-year-old adult seeking health coverage through New York State of
Health asks the nurse about income eligibility for Medicaid. According to
current guidelines, what is the income eligibility threshold for adults aged 19-
64?


A) 0-100% Federal Poverty Level (FPL)
B) 0-138% Federal Poverty Level (FPL)
C) 0-150% Federal Poverty Level (FPL)
D) 0-200% Federal Poverty Level (FPL)


Correct Answer: B) 0-138% Federal Poverty Level (FPL)**


*Rationale: For adults aged 19-64, the income eligibility threshold for
Medicaid in New York State is 0-138% of the Federal Poverty Level (FPL) . This

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population includes parents and caretaker relatives, as well as non-disabled
childless adults. Medicaid eligibility is determined using Modified Adjusted
Gross Income (MAGI) methodology, which includes tax-exempt income and
Social Security income in the calculation .


Question 3


A family with an infant seeks information about Medicaid coverage. The
nurse correctly informs the family that infants are eligible for Medicaid at
what income level?


A) 0-138% FPL
B) 0-154% FPL
C) 0-223% FPL
D) 0-250% FPL


Correct Answer: C) 0-223% FPL**


*Rationale: Infants (children under age 1) and pregnant women are eligible
for Medicaid at higher income levels than other adults, specifically at 0-223%
of the Federal Poverty Level . This expanded eligibility recognizes the
importance of prenatal and infant care. Pregnant women also have access to
presumptive eligibility, allowing for immediate coverage while the full
application is processed .*

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Question 4


A 19-year-old college student living with parents in New York State asks
about Medicaid eligibility. The nurse should explain that 19-20 year olds
living with parents qualify for Medicaid at what income threshold?


A) 0-138% FPL
B) 0-154% FPL
C) 0-155% FPL
D) 0-223% FPL


Correct Answer: C) 0-155% FPL**


*Rationale: Young adults ages 19-20 who are living with their parents are
eligible for Medicaid up to 155% of the Federal Poverty Level . This extended
eligibility recognizes the transitional nature of this age group. It is important
to note that these individuals may remain on their parents' insurance until
age 26 under the Affordable Care Act, and should compare options to
determine the most cost-effective coverage .*




**Question 5**