NUR 621 STAFFING MODEL FOR A 30-BED
SKILLED NURSING FACILITY FLASHCARDS AND
NURSING ADMINISTRATION REVIEW 2026
◉ Medicare Part D. Answer: Large expansion of Medicare passed in
2003 under President Bush.
Prescription drug plan. Cost estimate $92 billion in 2018
$400 annual deductible.
Avg ̴$40/mo premium. Varies with plan, income.
Pays 75% of drug costs, up to $2970 per year (now $3700 per year).
Then nothing until costs reaches $4750 at which point Medicare
pays 95%.
Donut Hole (the hole between what Medicare D will pay for and
what the pt has to pay for)
ACA trying to close that hole by raising the amount Medicare D will
pay
◉ Medicaid. Answer: Federal health insurance program for certain
low-income and disabled individuals.
Funded jointly by federal and state governments (50-80% federal).
Managed by states.
Eligibility largely determined at state level.
,25% of all children covered by Medicaid.
50% of all Medicaid recipients are children.
Account for only 20% of cost.
◉ Medicaid Eligibility. Answer: Highly Variable
For adults, usually based on % of FPL (federal poverty level)
FPL is $12K for one adult. $20K for family of 3.
Examples:
AL - Parents - 18%; Childless adults - 0%.
32 states expanded Medicaid thru ACA, 138% for parents and
childless adults.
NC - Parents - 44%; Childless adults - 0%.
◉ Who is eligible?. Answer: Those with low a income and are:
Children
Pregnant
Adult with dependent children
Disabled
Blind
States may apply to CMS to expand coverage to other groups. Some
do, some don't.
,◉ What does Medicaid cover?. Answer: Hospital
MD visits
Rx
Vision
Dental
Home health
Nursing home care (60% of this population receive Medicaid
benefits)
◉ Children's Health. Answer: Children's Health Insurance Program
(CHIP).
Covers about 8 million children who do not qualify for Medicaid.
Jointly funded by Federal and State governments.
Coverage similar to Medicaid.
Costs capped at 5% of family income.
◉ Patient Protection and Affordable Care Act (ACA). Answer: Passed
into law in 2010.
Most provisions in effect by 2014.
, ◉ ACA Provisions. Answer: Individual mandate - all individuals must
purchase health insurance or pay penalty (with exceptions for
religion or financial hardship).
Businesses with more than 50 employees must offer health
insurance or pay penalty.
Small businesses receive tax credits for offering health insurance to
employees.
◉ ACA Court Challenges. Answer: Constitutionality of law
challenged by an independent business group.
Supreme Court heard case in 2012.
Upheld most elements of law, including individual mandate.
King v Burwell (2015) - challenged subsidies in states that use
federal exchange.
◉ SCOTUS did strike down this important provision.... Answer:
Mandated Medicaid expansion by states.
States opting out of expansion will have residents in an insurance
"gap" comprised of non-disabled, non-elderly adults under 138%
FPL but over state Medicaid threshold.
◉ Changes in coverage under ACA. Answer: In 2012, about 50
million Americans uninsured.
SKILLED NURSING FACILITY FLASHCARDS AND
NURSING ADMINISTRATION REVIEW 2026
◉ Medicare Part D. Answer: Large expansion of Medicare passed in
2003 under President Bush.
Prescription drug plan. Cost estimate $92 billion in 2018
$400 annual deductible.
Avg ̴$40/mo premium. Varies with plan, income.
Pays 75% of drug costs, up to $2970 per year (now $3700 per year).
Then nothing until costs reaches $4750 at which point Medicare
pays 95%.
Donut Hole (the hole between what Medicare D will pay for and
what the pt has to pay for)
ACA trying to close that hole by raising the amount Medicare D will
pay
◉ Medicaid. Answer: Federal health insurance program for certain
low-income and disabled individuals.
Funded jointly by federal and state governments (50-80% federal).
Managed by states.
Eligibility largely determined at state level.
,25% of all children covered by Medicaid.
50% of all Medicaid recipients are children.
Account for only 20% of cost.
◉ Medicaid Eligibility. Answer: Highly Variable
For adults, usually based on % of FPL (federal poverty level)
FPL is $12K for one adult. $20K for family of 3.
Examples:
AL - Parents - 18%; Childless adults - 0%.
32 states expanded Medicaid thru ACA, 138% for parents and
childless adults.
NC - Parents - 44%; Childless adults - 0%.
◉ Who is eligible?. Answer: Those with low a income and are:
Children
Pregnant
Adult with dependent children
Disabled
Blind
States may apply to CMS to expand coverage to other groups. Some
do, some don't.
,◉ What does Medicaid cover?. Answer: Hospital
MD visits
Rx
Vision
Dental
Home health
Nursing home care (60% of this population receive Medicaid
benefits)
◉ Children's Health. Answer: Children's Health Insurance Program
(CHIP).
Covers about 8 million children who do not qualify for Medicaid.
Jointly funded by Federal and State governments.
Coverage similar to Medicaid.
Costs capped at 5% of family income.
◉ Patient Protection and Affordable Care Act (ACA). Answer: Passed
into law in 2010.
Most provisions in effect by 2014.
, ◉ ACA Provisions. Answer: Individual mandate - all individuals must
purchase health insurance or pay penalty (with exceptions for
religion or financial hardship).
Businesses with more than 50 employees must offer health
insurance or pay penalty.
Small businesses receive tax credits for offering health insurance to
employees.
◉ ACA Court Challenges. Answer: Constitutionality of law
challenged by an independent business group.
Supreme Court heard case in 2012.
Upheld most elements of law, including individual mandate.
King v Burwell (2015) - challenged subsidies in states that use
federal exchange.
◉ SCOTUS did strike down this important provision.... Answer:
Mandated Medicaid expansion by states.
States opting out of expansion will have residents in an insurance
"gap" comprised of non-disabled, non-elderly adults under 138%
FPL but over state Medicaid threshold.
◉ Changes in coverage under ACA. Answer: In 2012, about 50
million Americans uninsured.
