Ahead of the Midterms, Voters across Parties See Costs as their Top Health Care Concern

From Kaiser Health News is this poll deciphering where the public sits ahead of Midterms. What is there top healthcare concern? Costs. Get all the information in this article.

At a time when the Trump Administration is encouraging state efforts to revamp their Medicaid programs through waivers, the latest Kaiser Family Foundation tracking poll finds the public splits on whether the reason behind proposals to impose work requirements on some low-income Medicaid beneficiaries is to lift people out of poverty or to reduce spending.

The Centers for Medicare and Medicaid Services in January provided new guidance to states and has since approved such waivers in two states (Kentucky and Indiana). Eight other states have pending requests

When asked the goal of work requirements, four in 10 (41%)  say it is to reduce government spending by limiting the people enrolled in the program, while a third (33%) say it is to lift people out of poverty as proponents say.

While larger shares of Democrats and independents say the reason is to cut costs, Republicans are more divided, with roughly equal shares saying it is to lift people out of poverty (42%) as to reduce government spending (40%). People living in the 10 states that have approved or pending work requirement waivers are similarly divided, with near-equal shares saying the goal is to lift people out of poverty (37%) as to reduce government spending (36%). This holds true even when controlling for other demographic variables including party identification and income.


In addition to work requirements, five states are currently seeking Medicaid waivers to impose lifetime limits on the benefits that non-disabled adults could receive under the Medicaid program. The poll finds the public skeptical of such a shift, with two thirds (66%) saying Medicaid should be available to low-income people as long as they qualify, twice the share (33%) as say it should only provide temporary help for a limited time.

Substantial majorities of Democrats (84%) and independents (64%) say Medicaid should be available without lifetime limits, while Republicans are divided with similar shares favoring time limits (51%) and opposing them (47%).

These views may reflect people’s personal experiences with Medicaid and the generally positive views the public has toward the current program, which provides health coverage and long-term care to tens of millions of low-income adults and children nationally.

Seven in 10 Americans report a personal connection to Medicaid at some point in their lives – either directly through their own health insurance coverage (32%) or their child being covered (9%), or indirectly through a friend or other family member (29%).

Three in four (74%) hold favorable views of Medicaid, including significant majorities of Democrats (83%), independents (74%) and Republicans (65%). About half (52%) of the public say the current Medicaid program is working well for low-income enrollees, while about a third (32%) say it is not working well.

Most Residents of Non-Expansion States Favor Medicaid Expansion to Cover More Low-Income People

Under the Affordable Care Act, most states expanded their Medicaid programs to cover more low-income adults. In the 18 states that have not done so, a majority (56%) say that their state should expand Medicaid to cover more low-income adults, while nearly four in 10 (37%) say their state should keep Medicaid as it is today.

Slightly more than half of Republicans living in the 18 non-expansion states (all of which have either Republican governors, Republican-controlled legislatures or both) say their state should keep Medicaid as it is today (54%) while four in 10 (39%) say their state should expand their Medicaid program.

Favorable Views of the ACA Reach New High in More Than 80 KFF Polls

The poll finds 54 percent of the public now holds a favorable view of the Affordable Care Act, the highest share recorded in more than 80 KFF polls since the law’s enactment in 2010. This reflects a slight increase in favorable views since January (50%), while unfavorable views held steady at 42 percent.

The shift toward more positive views comes primarily from independents (55% view the ACA favorably this month, up slightly from 48% in January).


Public Remains Confused about Repeal of the ACA’s Individual Mandate

The poll also probes the public’s awareness about the repeal of the ACA’s requirement that nearly all Americans have health insurance or pay a fine, commonly known as the individual mandate. The tax legislation enacted in December 2017 eliminated this requirement beginning in 2019.

About four in 10 people (41%) are aware that Congress repealed the individual mandate, a slight increase from January, when 36 percent were aware of the provision’s repeal.

However, misunderstandings persist. Most (61%) of the public is either unaware that the requirement has been repealed (40%) or is aware of its repeal but mistakenly believes the requirement will not be in effect during 2018 (21%). Few (13%) are both aware that it has been repealed and that it remains in effect for this year.

Costs are Voters’ Top Health Care Concern ahead of the 2018 Midterm Elections

Looking ahead to this year’s midterm elections, the poll finds Democratic, Republican and independent voters most often cite costs as the health care issue that they most want candidates to address.

When asked to say in their own words what health care issue that they most want candidates to discuss, more than twice as many voters mention health care costs (22%) as any other issue, including repealing or opposing the Affordable Care Act (7%).  Costs are the clear top issue for Democrats (16%) and independents (25%), and one of the top issues for Republicans (22%) followed by repealing or opposing the ACA (17%).

Designed and analyzed by public opinion researchers at the Kaiser Family Foundation, the poll was conducted from February 15-20, 2018 among a nationally representative random digit dial telephone sample of 1,193 adults. Interviews were conducted in English and Spanish by landline (422) and cell phone (771). The margin of sampling error is plus or minus 3 percentage points for the full sample. For results based on subgroups, the margin of sampling error may be higher.

Read the article.

 Kaiser Family Foundation (1 March 2018). "Poll: Public Mixed on Whether Medicaid Work Requirements Are More to Cut Spending or to Lift People Up; Most Do Not Support Lifetime Limits on Benefits" [Web Poll Post]. Retrieved from address https://www.kff.org/medicaid/press-release/poll-public-mixed-medicaid-work-requirements-more-to-cut-spending-lift-people-up-most-do-not-support-lifetime-limits/

While Talk About Opioids Continues In D.C., Addiction Treatment Is In Peril In States

How is Washington handling the opioid crisis? Let's find out in this article from Kaiser Health News.

Opioids were on the White House agenda Thursday — President Trump convened a summit with members of his administration about the crisis. And Congress authorized funds for the opioid crisis in its recent budget deal — but those dollars aren’t flowing yet, and states say they are struggling to meet the need for treatment.

The Oklahoma agency in charge of substance abuse has been told by the state’s legislature to cut more than $2 million from this fiscal year’s budget.

“Treatment dollars are scarce,” said Randy Tate, president of the Oklahoma Behavioral Health Association, which represents addiction treatment providers.

It’s like dominoes, Tate said. When you cut funding for treatment, other safety-net programs feel the strain.

“Any cuts to our overall contract,” he said, “really diminish our ability to provide the case management necessary to advocate for homes, food, shelter, clothing, primary health care and all the other things that someone needs to really be successful at tackling their addiction.”

In just three years, Oklahoma’s agency in charge of funding opioid treatment has seen more than $27 million dollars chipped away from its budget — thanks to legislative gridlock, slashed state taxes and a drop in oil prices (with the additional loss in state tax revenue that resulted).

Jeff Dismukes, a spokesman for Oklahoma’s Department of Mental Health and Substance Abuse Services, says the already lean agency has few cost-cutting options left.

“We always cut first to administration,” he said, “but there’s a point where you just can’t cut anymore.”

The agency may end up putting off payments to treatment providers until July — the next fiscal year. Tate says that could be devastating.

“Very thinly financed, small rural providers are probably at risk of going out of business entirely — up to and including rural hospitals,” he said.

Getting treatment providers to open up shop in rural areas is really hard, even in good times, and more financial uncertainty could make that problem worse. In the meantime, according to an Oklahoma state commission’s opioid report, just 10 percent of Oklahomans who need addiction treatment are getting it.

That statistic is similar in Colorado. And as 2018 began, Colorado’s escalating opioid crisis got worse, when the state’s largest drug and alcohol treatment provider, Arapahoe House, shut its doors.

The facility provided recovery treatment to 5,000 people a year. Denise Vincioni, who directs another treatment center, the Denver Recovery Group, says other facilities have scrambled to pick up the patients.

Most of Arapahoe’s clients were on Medicaid. Autumn Haggard-Wolfe, a two-time Arapahoe House client who is now in recovery, worries the facility’s closing will have dire consequences, especially for people who need inpatient care, as she did.

“I feel like the only other option right now in therapy would be jail for people,” she said, “and people die in there from withdrawing.”

Arapahoe House’s CEO blamed its closure on the high cost of care and poor government reimbursement for services.

The mother of Colorado state lawmaker Brittany Pettersen struggled with addiction, and was treated at Arapahoe House. Pettersen says treatment centers rely on a crazy quilt of funding sources and are chronically underfunded — often leaving people with no treatment options.

“We have a huge gap in Colorado,” Pettersen said, “and that was before Arapahoe House closed.”

She is pushing legislation in the state to increase funding for treatment. But to get tens of millions of dollars in federal matching funds, Colorado lawmakers need to approve at least $34 million a year in new state spending.

That price tag may simply be too high for some lawmakers. But either way, she added, “It’s going to take a lot to climb out of where we are.”

Colorado did get new federal funds to fight the opioid crisis through the 21st Century Cures Act, passed in December of 2016, but it was just $7.8 million a year for two years — divvied up among a long list of programs.

Read the article.

 Daley J.,Fortier J. (5 March 2018). "While Talk About Opioids Continues In D.C., Addiction Treatment Is In Peril In States" [Web Blog Post]. Retrieved from address https://khn.org/news/while-talk-about-opioids-continues-in-dc-addiction-treatment-is-in-peril-in-states/

Fresh Brew With Our Newest Employee - Rob Glover

Welcome to our brand new segment, Fresh Brew, where we will be exploring the delicious coffees, teas, and snacks of some of our employees! You can look forward to our Fresh Brew blog post on the first Friday of every month.

“Don’t worry about all the Medicare options. I’ll help make it clear and simple.”

Before joining Saxon Financial, Rob trained and worked as an independent sales agent specializing in UnitedHealthcare Medicare plans. He is excited to be joining Saxon in the Senior Solutions department and build on his experience by serving people with added carrier options.

Rob focuses on listening, understanding and educating his clients since Medicare is not one-size-fits-all. When you meet with Rob, his goals are to help you feel like family and have the confidence and understanding to select the perfect Medicare plan for you.

Favorite Brew


“Ethiopian Harrar Coffee made with a French Press, hand ground and prepared at home.”


“British Blend black tea brewed at home. Cold but no ice!”


“Stout, home brewed.”

Rob notes: “If I don’t make it myself, then Cappie’s in Loveland or Jungle Jim’s in Eastgate.”

Favorite Snack

“Forget snacks; give me pizza!”

Give It A Try & Share It!

Is a Health Savings Account Worth Your Time? The Best Advice from an Experienced Group Benefits Consultant.

This month’s CenterStage features Kelley Bell, a Group Benefits Consultant at Saxon. With over 25 years of experience in the financial industry, Kelley knows a thing or two on HSAs or Health Savings Accounts – what they are, who is eligible, how they’re funded, and when they can be used.

Kelley enjoys partnering with business owners and human resources managers to be their Healthcare Consultant. She understands that each business is unique and is dedicated, accessible and proactive in serving the needs of each client.

So, is an HSA a right fit for you? Let’s find out!

The Break-Down

Very similar to personal savings accounts, money in a Health Savings Account (HSA) is used to pay for eligible healthcare expenses (medical, dental and vision). You, not your employer or insurance company, own and control the money in your HSA. To be eligible for an HSA, you must have a special type of health insurance called a high-deductible health plan (HDHP).

With an HSA you can make tax-deductible contributions each year to pay for current and future healthcare costs. What you don't use in any given year will stay invested and continue to grow tax-free, assuming you eventually pull it out to use for medical costs. -CNN Money

Saxon offers HDHP group plans from one person on up that can be paired with the HSA. Here are some different highlights you should know if you are considering this type of Health Savings Account:

  • HSA's aren't ideal for everyone. If having a high deductible seems too risky to you – or if you anticipate having significant healthcare expenses – a plan with a lower deductible and lower co-pays might make more sense.
  • There are tax advantages, because deductibles on the HDHP are higher, premiums are generally lower.
  • There is a maximum contribution limit per calendar year of $3,400 for individuals and $6,850 for families for 2018. Sometimes, these maximums do not reach your deductible. A personal tip: “Try to add a small amount via pre-tax payroll.  You can change the amount anytime and if you have a significant procedure, try adding the funds to the account before the payment is due
  • If you’re over the age of 55, you can make an additional “catch-up” contribution of $1,000 to that account.
  • It is your account. You make the decisions about the contributions and its use. If the funds are not used, the money rolls over to the next year and continues to grow over time.
  • If your employer switches to a different plan, your HSA is still your HSA. The money within your HSA is yours and can continue to be used for eligible medical expenses until it runs out.
  • Most banks provide you with access to your HSA through a checkbook and debit card. You can use these to pay your doctor, as well as for prescriptions at the pharmacy.

Whether an HSA is a good fit for you is determined through each of these highlights, but it comes down to personal preference and your overall health. There’s a lot of freedom with HSAs – which is why it’s important to take your time considering every perk and downfall.

Contributions, Withdrawals, Earnings, & Roll Over

The money you deposit into the account is not taxed. The idea is people will spend their healthcare dollars more wisely if they're using their own money.

However, others can contribute to your HSA. Contributions can come from various sources, including you, your employer, a relative and anyone else who wants to add to your HSA. However, if you exceed the maximum contribution limit, you could be penalized by the IRS.

  • Pre-tax contributions. Contributions made through payroll deposits (through your employer) are typically made with pre-tax dollars, which means they are not subject to federal income taxes. In most states, contributions are not subject to state income taxes either. Your employer can also make contributions on your behalf, and the contribution is not included in your gross income.
  • Tax-deductible contributions. Contributions made with after-tax dollars can be deducted from your gross income on your tax return, which means you may owe less tax at the end of the year.

It’s also key to understand withdrawals, earnings, and roll over with HSAs:

  • Tax-free withdrawals. Withdrawals from your HSA are not subject to federal (or in most cases, state) income taxes if they are used for qualified medical expenses.
  • Earnings are tax-fee. Any interest or other earnings on the assets in the account are tax free.
  • Funds roll over. If you have money left in your HSA at the end of the year, it rolls over to the next year.
  • Investment tool. Many people use it as an investment tool, not just for current or future medical expenses, but for long-term retirement planning.

Keep your receipts in the event that you are audited by the IRS to show that you used the funds in your HSA for eligible medical expenses.


A Health Savings Account can be a great choice for people who wish to limit their upfront healthcare costs while saving for future expenses. HSAs go together with HDHPs. In addition, favorable tax treatment means you may owe less in taxes on your income tax return. What’s more, an HSA may allow you to pay in pre-tax dollars for items your employer’s other insurance options don’t cover, such as eyeglasses.

HSAs have the potential to become “more compelling than a 401(k)” due to tax-deductible and tax-deferred incentives. Does it sound like you’re a perfect match for a Health Savings Account? Still not sure if a HSA a good fit for you? Contact Kelley at 513-774-5493 for more information on taking this step towards a better health plan.

Download The Full Article

Algorithmic Bias – What is the Role of HR?

How should HR professionals deal with the forthcoming algorithmic bias issue? Find out in this article.

Merriam-Webster defines ‘algorithm’ as step-by-step procedure for solving a problem…In an analog world, ask anyone to jot down a step-by-step procedure to solve a problem – and it will be subject to bias, perspective, tacit knowledge, and a diverse viewpoint. Computer algorithms, coded by humans, will obviously contain similar biases.

The challenge before us is that with Moore’s Law, cloud computing, big data, and machine learning, these algorithms are evolving, increasing in complexity, and these algorithmic biases are more difficult to detect – “the idea that artificially intelligent software…often turns out to perpetuate social bias.”

Algorithmic bias is shaping up to be a major societal issue at a critical moment in the evolution of machine learning and AI. If the bias lurking inside the algorithms that make ever-more-important decisions goes unrecognized and unchecked, it could have serious negative consequences, especially for poorer communities and minorities.”What is the role of HR in reviewing these rules? What is the role of HR in reviewing algorithms and code? What questions to ask?

In December 2017, New York City passed a bill to address algorithmic discrimination.Some interesting text of the bill, “a procedure for addressing instances in which a person is harmed by an agency automated decision system if any such system is found to disproportionately impact persons;” and “making information publicly available that, for each agency automated decision system, will allow the public to meaningfully assess how such system functions and is used by the city, including making technical information about such system publicly available where appropriate;”

Big data, AI, and machine learning will put a new forward thinking ethical burden on the creators of this technology, and on the HR professionals that support them. Other examples include Google Photos incorrect labeling or Nikon’s facial detection. While none of these are intentional or malicious, they can be offensive, and the ethical standards need to be vetted and reviewed. This is a new area for HR professionals, and it’s not easy.

As Nicholas Diakopoulos suggests, “We’re now operating in a world where automated algorithms make impactful decisions that can and do amplify the power of business and government. As algorithms come to regulate society and perhaps even implement law directly, we should proceed with caution and think carefully about how we choose to regulate them back.”

The ethical landscape for HR professionals is changing rapidly.

Read more.


Smith R. (15 February 2018). "Algorithmic Bias – What is the Role of HR?" [Web Blog Post]. Retrieved from address https://blog.shrm.org/blog/algorithmic-bias-what-is-the-role-of-hr

A New Approach to Paid Leave: WorkFlex in the 21st Century Act

From SHRM, let's take a look a this innovative approach toward paid leave using WorkFlex.

Do you ever sit in your office and wonder about everyone else? Ponder whether anyone is dealing with the same things that you are in that very moment? The simple fact is that everyone independent of age, gender, race or title, wants to be there to support their family. For myself, that means advocating for clients, while caring for my mother and doing all that I can for my wife and two boys. It is quite a balancing act on the best of days. To be fair, I know that I am not alone in this balancing act. As I write this I am wondering if you know exactly what I mean. Perhaps not for yourself, but a colleague or a friend.

Now since we generally live, work or both in New Jersey and in particular within the Delaware Valley there are some things that impact our ability to balance. For example, if you work for an organization that has offices in Philadelphia, PA; Wilmington, DE; Trenton, NJ; Montclair, NJ and Haddonfield, NJ exactly how do you provide equal paid leave to employees? Why should you care? Because these specific locations differ in how they require paid leave to be provided to employees. Are you concerned about this? You are not alone, clients regularly ask what to do as it relates to dealing with paid leave. Often this is more challenging for us than in most places around the country due to the varying ways that towns as opposed to States or the Commonwealth deal with this issue.

Some time ago I was asked to assist SHRM with the creation of federal legislation to address the issue of varying applications of paid leave laws around the country.  After a significant amount of discussions, revisions and hard work by a host of individuals we came up with a legitimate proposal to address our respective concerns.  Recently the “Workflex in the 21st Century Act” (HR 4219) was introduced in the House by Representative Mimi Walters. This bill is designed to support the goals of everyone, not just employers or employees. You can read more about the specifics at: http://www.advocacy.shrm.org/workflex.

For now, allow me to give you three specific reasons (although there are more) that both you and your organization should support this legislation:

First, unlike federal mandates under the FMLA, FLSA, or ADA, this legislation is OPT-IN, which means as an employer in order for your organization to be held responsible under the bill it would have to decide to agree to it first. Put another way, an employer is not required to do it if it chooses to go in another direction.

Second, many federal employment laws bring with them a threshold beyond which every employer is held to the same standard, however that is not the case with the “Workflex in the 21st Century Act.”  It is designed to grow with your organization. As a result the benefit thresholds change based on the number of employees in an organization, so that it supports growth rather than stifling expansion.

Third, contrary to the way things are currently going in our region, this bill provides a level of certainty and flexibility for both employers and employees alike to know the threshold of their leave benefits, which will result in more productive employees and organizations. Part of the reason for this certainty is that the various local leave laws would be preempted by this bill.

What does all this mean? I would suggest that this bill is a good compromise of interests across the spectrum of both employers and employees, as well as unions, who want to do the right thing. Allow for realistic time to care for a child, parent or for yourself. No one needs to change jobs to get a specific type of benefit and employers can choose if it makes sense for their workplace, rather than being dictated to in terms of the benefits to provide their employees.

Now I would like to challenge you to join me. This is the first piece of legislation that SHRM has created for the workplace and as you can see the goal is to address concerns that all workers have, independent of title, so we can all have the balance that we need and want in order to be better contributors in our respective organizations, supportive of our parents, children and ourselves. How can we achieve this together? We can all reach out to our federal legislators and let them know that you support the “Workflex in the 21st Century Act” (HR 4219). You can find more information on http://www.advocacy.shrm.org/workflex or on the SHRM Advocacy App. Let’s take this opportunity to make the workplace better for everyone, together.

Read more.


Lessig L. (February 8th, 2018). "A New Approach to Paid Leave: WorkFlex in the 21st Century Act" [Web Blog Post]. Retrieved from address http://www.advocacy.shrm.org/shrm/app/document/26467137

4 trends in financial education

Having financial wellness within your business is incredibly valuable for its overall growth and success. In this article, we are going to take a look at four trends contributing towards financial wellness in the employee benefits realm. Read more below.

Employees’ financial well-being is a hot topic these days. Right now, it’s top-of-mind with most employees. And it’s becoming more so with employers, not only because they are realizing the effect employee financial stress has on their bottom line, but also because industry surveys are revealing that employees want their employers to help by providing financial education and benefits.

Benefit advisers have a definite role in helping employers take steps toward building a more financially-secure workforce through financial wellness benefits. What should advisers expect to see this year in financial wellness benefits?

Industry research confirms the impact employee financial stress has on a company’s bottom line, including lower productivity, higher absenteeism and more healthcare claims. Only about half of employers offered some kind of counseling or instruction about money last year, according to SHRM and IFEBP surveys. Certainly, more employers will want to add financial education benefits this year. Benefit advisers can help by bringing this to the attention of their clients.

Another trend to consider is that financial education benefits are becoming more holistic. Financial education benefits should be more than planning for retirement and having access to supplemental medical benefits. Financial education benefits today should include financial education tools and resources as well as voluntary benefits that are designed to address both physical and emotional struggles while working to help employees with short-term financial needs.

Look for more student loan repayment benefits to become available in the industry this year. In 2017, more Americans were burdened by student loan debt than ever before. It’s a major concern among today’s millennials, the largest generation in today’s workforce. This year we likely will see more student loan repayment benefits appear, including programs in which employers are making contributions to loan balances or providing methods for employees to refinance their debt.

Increased attention to helping employees with short-term financial issues also will be a focus this year. In spite of the improved economy, employees are still struggling financially. Statistics show the alarming number of employees that continue to live paycheck-to-paycheck and do not have even $1,000 in savings for emergency needs.

While financial education benefits can help employees with budgeting and debt reduction needs, employers should offer additional voluntary benefits that provide employees some financial assistance in the short-term. Benefit advisers should bring short-term financial assistance voluntary benefits to the attention of their clients. Among these are employee purchase programs and low interest installment loans and credit that help employees avoid payday loans and cash advances from credit cards when they have emergency needs such as a broken refrigerator or unexpected out-of-pocket medical expenses.

Employers are realizing the important role that financial education plays in an employee’s overall well-being and will look to increase their financial wellness benefits on several levels. Benefit advisers not only can bring the need to the attention of their clients, but can also offer benefit recommendations to round out their clients’ employee benefits programs.

Read the original article.

Halkos E. (February 9th, 2018). "4 trends in financial education" [Web Blog Post]. Retrieved from address https://www.employeebenefitadviser.com/opinion/4-trends-in-financial-education

How Are Health Centers Responding to the Funding Delay?

Unfortunately, the funding delay is impacting healthcare centers everywhere - and not in a great way. Get the information you need to know in this article.

Health centers play an important role in our health care system, providing comprehensive primary care services as well as dental, mental health, and addiction treatment services to over 25 million patients in medically underserved rural and urban areas throughout the country. Health care anchors in their communities and on the front lines of health care crises, including the opioid epidemic and the current flu outbreak, health centers rely on federal grant funds to support the care they provide, particularly to patients who lack insurance coverage. However, the Community Health Center Fund (CHCF), a key source of funding for community health centers, expired on September 30, 2017, and has since been extended through only March 31, 2018. The CHCF provides 70% of grant funding to health centers. With these funds at risk, health centers have taken or are considering taking a number of actions that will affect their capacity to provide care to their patients. This fact sheet presents preliminary findings on how health centers are responding to the funding uncertainty.


The Community Health Center Fund represents 70% of federal grant funding for health centers. Established by the Affordable Care Act, the CHCF increased federal grant fund support for health centers, growing from $1 billion in 2011 to $3.6 billion in 2017.1Authorized for five years beginning in 2010, and extended for two years through September 2017, the CHCF also provided a more stable source of grant funding for health centers that was separate from the annual appropriations process. Prior to the CHCF, federal 330 grant funds were appropriated annually. In fiscal year 2017, federal section 330 grant funding totaled $5.1 billion, $3.6 billion from the CHCF and $1.5 billion from the annual appropriation.

Federal health center grants represent nearly one-fifth of health center revenues. Federal Section 330 grant funds are the second largest source of revenues for health centers behind revenues from Medicaid. Overall, 19% of health center revenues (including US territories) come from federal grants; however, reliance on 330 grant funds varies across health centers. Federal grant funds are especially important for health centers in southern and rural non-expansion states where Medicaid accounts for a smaller share of revenue (Figure 1).2 These funds finance care for uninsured patients and support vital services, such as transportation and case management, that are not typically covered by insurance

Figure 1: Federal Section 330 Grants as a Share of Total Health Center Revenues, 2016


Health centers have taken or are considering taking a number of actions that will affect their ability to serve their patients. Overall, seven in ten responding health centers indicated they had taken or planned to take action to put off large expenditures or curtail expenses in face of reduced revenue. Some of these actions involve delaying or canceling capital projects and other investments or tapping into reserve funds. Other actions, however, have or will reduce the number of staff or the hours they work, which may in turn, affect the availability of services. Already 20% of health centers reported instituting a hiring freeze and 4% have laid off staff. Another 45% are considering a hiring freeze and 53% said they might lay off staff. While health centers seemed to focus on shorter-term actions that could easily be reversed were funding to be restored, 3% of responding health centers had already taken steps to close one or more sites and an additional 36% indicated they are considering doing so (Figure 2).

Figure 2: Actions Taken or Considered by Health Centers in Response to Funding Uncertainty

Health centers are considering cuts to patient services. While most health centers have not yet taken steps to cut or reduce patient care services, many reported they are weighing such actions if funding is not restored (Figure 3). Over four in ten indicated they might eliminate or reduce some enabling services, such as case management, translation, or transportation services. Additionally, over a third of reporting health centers indicated they might have to reduce the dental, medical, and/or mental health services they provide while 29% said cuts to addiction treatment services are being contemplated. Fewer health centers reported that cuts to pharmacy services might be made.

Figure 3: Services Health Centers Are Considering Eliminating or Reducing in Response to Funding Uncertainty


Continued delays in restoring funding will likely lead to cuts in health center services and staff. To date, health centers have tried to mitigate the effects of the funding delay by forgoing major investments or dipping into reserve funds. However, the longer the funding delay continues, the greater the likelihood health centers will be compelled to cut services and staff, actions they are currently considering but have not yet adopted in large numbers. These cuts could reverse gains health centers have made in recent years in increasing patient care capacity and expanding the range of services they provide, particularly in the areas of mental health and addiction treatment. Health centers play a particularly important role in rural and medically underserved areas. The failure to reauthorize the CHCF and restore health center funding could jeopardize access to care for millions of vulnerable patients.

Read the full report.

Kaiser Family Foundation (1 February 2018). "How Are Health Centers Responding to the Funding Delay?" [Web Blog Post]. Retrieved from address https://www.kff.org/medicaid/fact-sheet/how-are-health-centers-responding-to-the-funding-delay/


Understanding the Intersection of Medicaid and Work

Sometimes, healthcare is confusing. We know this, which is why today we are focusing on Medicaid and work. Check out the snippet below, and check out the link for the full article.

Medicaid is the nation’s public health insurance program for people with low incomes. Overall, the Medicaid program covers one in five Americans, including many with complex and costly needs for care. Historically, nonelderly adults without disabilities accounted for a small share of Medicaid enrollees; however, the Affordable Care Act (ACA) expanded coverage to nonelderly adults with income up to 138% FPL, or $16,642 per year for an individual in 2017. As of December 2017, 32 states have implemented the ACA Medicaid expansion.1 By design, the expansion extended coverage to the working poor (both parents and childless adults), most of whom do not otherwise have access to affordable coverage. While many have gained coverage under the expansion, the majority of Medicaid enrollees are still the “traditional” populations of children, people with disabilities, and the elderly.

Some states and the Trump administration have stated that the ACA Medicaid expansion targets “able-bodied” adults and seek to make Medicaid eligibility contingent on work. Under current law, states cannot impose a work requirement as a condition of Medicaid eligibility, but some states are seeking waiver authority to do so.  These types of waiver requests were denied by the Obama administration, but the Trump administration has indicated a willingness to approve such waivers. This issue brief provides data on the work status of the nearly 25 million non-elderly adults without SSI enrolled in Medicaid (referred to as “Medicaid adults” throughout this brief) to understand the potential implications of work requirement proposals in Medicaid.  Key takeaways include the following:

  • Among Medicaid adults (including parents and childless adults — the group targeted by the Medicaid expansion), nearly 8 in 10 live in working families, and a majority are working themselves. Nearly half of working Medicaid enrollees are employed by small firms, and many work in industries with low employer-sponsored insurance offer rates.
  • Among the adult Medicaid enrollees who were not working, most report major impediments to their ability to work including illness or disability or care-giving responsibilities.
  • While proponents of work requirements say such provisions aim to promote work for those who are not working, these policies could have negative implications on many who are working or exempt from the requirements. For example, coverage for working or exempt enrollees may be at risk if enrollees face administrative obstacles in verifying their work status or documenting an exemption.

Get the full report and findings.

Kaiser Family Foundation (5 January 2018). "Understanding the Intersection of Medicaid and Work" [Web Blog Post]. Retrieved from address https://www.kff.org/medicaid/issue-brief/understanding-the-intersection-of-medicaid-and-work/


Personalizing health plans with technology

Technology offers advanced opportunities to make your health plan customized to your employees. Check out this article from Employee Benefit Advisor by Cort Olsen for more information.

Many advisers are using digital monitoring to evaluate the status of wellbeing within a given employer’s employee population.

Craig Schmidt, senior wellness consultant for EPIC, says one of the ways he is able to identify the companies that are offering strong digital wellness plans is through their ability to integrate such programs with claims data. He utilizes a push style notification to a mobile device to inform individual employees about specific plans that can coordinate well with their conditions as a further enhancement.

Samantha Gardiner, director of product management at Health Advocate, says her company has combined wellness, chronic condition management and client outreach all into one program to improve the health of employees and reduce claims and pharmaceutical costs for employer-provided health plans.

“We take the data and provide alerts via our website, email or mobile push notifications to keep employees informed about their personal health conditions,” Gardiner says. “If we have the data, we can really target and personalize the program toward company goals and members’ personal goals.”

In order to identify the best in class among the programs offered by wellness providers, Schmidt says he looks at the number and quality of interfaces and outcomes from the program as well as success stories that employees can share that can flesh out an employer’s return on investment.

“We can look at results six months or even a year after an employee has participated in the program to see if behavior changes have taken place,” Schmidt says. “If the plan integrates and reacts to the systems the employer has in place for his or her employees, then we will know if the program is a right match.”


Monica Majors, vice president of marketing and communications of health plan products at Sutter Health, says a digital wellness program needs to integrate with a multitude of personal devices.

“The site must be responsive to all technology, such as a mobile device, a tablet, or for those who are deskbound, from their computer,” Majors says. “The flexibility of offering individual trackers as well as key based activity challenges through a wide range of activities will keep retention.”

The program can then offer a health assessment that can be aggregated into an overall employer report, which can then serve as a basis for customization for that specific workforce.

Marcia Otto, vice president of product strategy at Health Advocate, says her company offers biometric screenings that can be done onsite, which can then factor into an employee’s health risk assessment to further customize the personal health program.

“If we get biometric data from our biometric data collection or if the employee sends us the data from a third party, that is another data source we can look at to determine if they need further attention for diabetes, hyper tension or so on,” Otto says. “We can also collect data on what their last blood test reported, right down to how many fruits or vegetables they eat, which is then prioritized based on how sick the employee is.”


To influence employees to remain on the wellness plan, employers have offered incentives. These incentives can range from gift cards and cash rewards to funding a HSA or a HRA.

Paul Sterling, vice president of emerging products at UnitedHealthcare, says users who are enrolled in the UnitedHealthcare Motion program – an app programmed to encourage employees to remain active throughout the workday using a smart phone or smart watch – rewards employees by funding money into an HSA or HRA as a way to retain users.

“We have three daily walking objectives through our FIT criteria – frequency, intensity and tenacity – that each of our members try to achieve,” Sterling says. “Each one of those objectives is tied to or associated with an incentive amount.”

For each objective the employee completes, UnitedHealthcare deposits $1 into the user’s HSA or HRA, depending what they have.

Each day, the employee can complete each of the objectives. It resets daily, allowing the employee to continue to receive up to $3 per day.

Over the course of one year, Sterling says participation in the Motion program has held at a steady 67%. “If you think about other products in the health and wellness space, that’s arguably 10 times the level of engagement achieved over that period of time others would achieve,” Sterling says.

While Gardiner says she cannot pin point the number of employees engaged in her program for an extended period of time yet, she thinks incentives do drive continued engagement for some employees who need the extra push to be active or engage in a healthier lifestyle.

“An incentive program that provides at least a $300 incentive to participate is where we see our most engagement,” Gardiner says. “It all depends on the goals of the employer.”

Read more.

Olsen C. (4 February 2018). "Personalizing health plans with technology" [Web Blog Post]. Retrieved from address https://www.employeebenefitadviser.com/news/personalizing-health-plans-with-technology?feed=00000152-175f-d933-a573-ff5f3f230000