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By gulfsouthb32553561, Feb 1 2019 07:58PM

Two Republican lawmakers are calling for further investigation after a Louisiana Medicaid audit showed that extremely high numbers of recipients may make too much money to qualify for the program.

Sen. Ron Johnson (R-Wis.) and Rep. Jim Jordan (R-Ohio) sent a letter to Seema Verma, administrator for the Centers for Medicaid and Medicare Services alerting her of the findings and asking for answers about what CMS plans to do about it.

"If these improper (over) payments are occurring in one state, it is logical to assume overpayments are occurring in other states," the two wrote in their letter. "We respectfully request information about what the Centers for Medicare and Medicaid Services (CMS) plans to do to determine where overpayments are being made, steps CMS will take to recover overpayments, and controls CMS will put in place to ensure federal Medicaid dollars are only paid to those who qualify."

What did the audit reveal?

According to the congressmen's letter, Louisiana auditors first identified nearly 20,000 Medicaid recipients whose income was higher than the amount to qualify for Medicaid.

So, the auditors took a selection of 100 single-person households receiving Medicaid under expansion created by Obamacare. of those 100 households, 93 of them were ineligible for benefits between 2016 and 2018, and 14 of them were making more than $100,000 per year.

Next, auditors took a random sample of 100 more Medicaid expansion recipients, and 82 of those were ineligible sometime between 2016 and 2018.

According to the auditors, the state may have paid as much as $85 million for ineligible Medicaid recipients from 2016 through 2018.

How does that happen?

The auditors reported that Medicaid expansion recipients may be "lowballing their income" and then failing to provide updated information when they start making more money.

Louisiana apparently "relies on Medicaid recipients to self-report their wages," and there are questions about whether that policy violates laws that require states to ensure Medicaid beneficiaries provide up-to-date information.

By gulfsouthb32553561, Dec 21 2018 03:01PM

As this year comes to a close, we all tend to find ourselves striving to finish one last task (but if you are like me the one last thing turns into one more and then one more - and it never ends).

However, I am working on implementing a new system. Each day I email my business coach three things. I tell her what I am grateful for that day, what I accomplished, and what my top priorities are for the following day. This keeps me balanced and focused. I have to stop and reflect each day, instead of running through my day like a tornado, rushing home, cooking dinner, helping with homework, washing clothes, then falling into bed exhausted without a clue what I have actually accomplished that day, and wondering what was left undone for the next day.

This sounds simple - almost too simple to do. But I challenge you to make it a habit. Find someone to be accountable to, and send that email every day. It helps me in many ways, some I had not even expected. One afternoon as I was about to get on the internet and look something up (not work related I am sure), I thought to myself, “Oh no - I need to see if I have done everything I told Amy I would do today!”. I quickly went through my sent emails to see what I had committed myself to for the day, and realized I had not finished two of my top priorities. So I got right to work!

This tool is a godsend for those of us who may have a little bit of ADD somewhere inside. I can start a task, and easily wander from it to something urgent that pops up, but that may not truly be important. We often hear about judging between what is urgent and important. This tool helps decipher which task is moving us toward our desired end, and which is merely compelling us to immediate action, without real productivity. When I am setting priorities the night before I am not rushed or being pulled in multiple directions. I am simply looking at what is most important for me to accomplish the next day, and I move that direction.

I am certainly not where I need to be, but I am learning to look back at my day in reality. Sometimes we spend a whole day “feeling busy”, but we have not really done anything. So, I am learning to be grateful, count my wins, and prioritize for the next day.

Need direction prioritizing your financial future? Give us a call today at Gulf South Benefits 337-656-3255

By gulfsouthb32553561, Dec 13 2018 01:05PM

The Trump administration is offering welcome relief to Americans struggling with high premiums under Obamacare premiums and a lack of insurance choices.

The administration has taken a series of regulatory actions to do the following:

Make short-term, limited duration policies widely available and give consumers the right to renew those policies.

Make it easier for small businesses and independent contractors to band together for greater insurance purchasing power.

Propose to allow employers to contribute to tax-advantaged accounts, which their workers could then use to purchase portable insurance coverage.

The Department of Health and Human Services also has made it easier for states to promote more affordable, flexible insurance coverage options by obtaining waivers from restrictive Obamacare regulations.

These “State Empowerment and Relief Waivers” enable states to tap money that the federal government would have paid directly to insurance companies in the form of premium subsidies. States could repurpose this money to design and implement their own premium assistance programs. Such programs could distribute subsidies through defined contributions to consumer-directed accounts established for low-income individuals.

The liberal Left continue to push their radical agenda against American values. The good news is there is a solution. Find out more >>

States also could provide premium subsidies for insurance policies that don’t conform to Obamacare’s rigid requirements.

States that obtain these waivers would be able to reduce premiums and increase health insurance choices for their residents, while still protecting vulnerable people such as those with pre-existing conditions

The Department of Health and Human Services is establishing this waiver program under Section 1332 of the Obamacare statute, which permits states to deviate from the Obamacare framework so long as their plan maintains coverage rates, assures the availability of policies offering coverage that meet Obamacare requirements, and makes insurance more affordable, all without increasing the federal deficit.

The Obama administration had placed excessively restrictive conditions on these waivers, inhibiting state innovation. Health and Human Services earlier this fall relaxed those requirements, and last month issued what it called “waiver concepts,” which describe categories of waivers the administration would be inclined to approve. These include:

Account-based subsidies. Under this concept, states would repackage Obamacare subsidies to go directly to individuals. This would be a change from today’s approach, which sends money directly to insurance companies. Subsidized individuals would get their money in accounts they own and control, and could use these accounts to pay premiums as well as cover medical expenses. The account also would allow recipients to aggregate funding from nongovernment sources, including individual and employer contributions.

State-specific premium assistance. Obamacare subsidies are income-related and offer little relief for those with incomes above 200 percent of the federal poverty level (roughly $24,000 in annual income). A state could restructure the subsidies in ways that work better for the unique needs of its population. It could offer assistance to a broader swath of its population and use them to make policies more attractive to young adults.

New plan options. Obamacare limits the choices available to premium recipients, only allowing them to use their subsidies to buy policies that meet all of the law’s requirements. Under this waiver option, a state could give subsidy-eligible individuals the right to use their subsidies to buy the coverage of their choice.

Protecting people with high medical costs through risk stabilization strategies. States could also obtain waivers to establish programs that direct public resources to those in greatest medical need. A state could, for example, establish a separate pool for consumers with specified medical conditions that make them more likely to incur large medical bills. Public resources would be directed to that pool to better serve those with the greatest health care costs, while providing premium relief to those in better health. Seven states already have obtained waivers to operate programs of this sort. Premiums have come down in all of those states.

States can advance proposals that combine these ideas. They could, for example, fund a high-risk pool and provide premium subsidies in the form of contributions to consumer-directed, individual accounts.

These waiver concepts could spur a wave of patient-centered innovation. One of Obamacare’s core conceits was that what (allegedly) worked in Massachusetts would also work in Mississippi, Missouri, and Montana. That hasn’t borne out.

Under Obamacare, premiums have skyrocketed, networks have narrowed, insurance choices have contracted, and people have fled the individual market by the millions. As of December 2017, there were 2.3 million fewer unsubsidized people with individual policies than in December 2013, the month before Obamacare took full effect. An estimated 2.3 million unsubsidized people left the market between March 2017 and March 2018.

Individuals and states have been bystanders as a Washington-imposed regime wreaked havoc on their insurance markets. State Empowerment and Relief Waivers offer states the opportunity to implement innovative ideas that bring at least a measure of relief to beleaguered residents.

Congress should go further and enact the Health Care Choices Proposal, which would provide states with resources and more flexibility to breathe life into their ailing insurance markets. The proposal would replace Obamacare entitlements with grants to states, which would design consumer-centered programs to make insurance affordable, regardless of income or health status.

The new waivers, while a helpful first step toward these goals, still force states to obtain Washington’s permission to deviate a bit from federal guidelines. Under the Health Care Choices Proposal, each state would take the lead in assuring that its residents—including those who need assistance to afford coverage—would be free to choose among a range of affordable insurance products.

The Health Care Choices Proposal would reverse Obamacare’s polarity, empowering state governments, rather than Washington bureaucrats, to set insurance policy.

Because State Empowerment and Relief Waivers must function within Obamacare’s architecture, they offer states only a small measure of flexibility. They are nevertheless a step in the right direction.

States should seize the opportunity to provide their consumers lower costs and more health care choices.

By gulfsouthb32553561, Dec 12 2018 10:47PM

Check out our December Newsletter...!

By gulfsouthb32553561, Oct 30 2018 09:02PM

Many of your employer clients feel stuck without options when it comes to offering a health plan to their employees, unsure of where to turn for advice about cutting costs, without cutting benefits. Enter the Employer Bill of Rights.

Across the country, inflated medical costs and balance billing for medical care have become the norm, leaving businesses to pick up the hefty tab or pass along the costs to their employees. Many of your employer clients feel stuck without options when it comes to offering a health plan to their employees, unsure of where to turn for advice about cutting costs, without cutting benefits.

Enter the Employer Bill of Rights, an initiative created to inspire and empower businesses to understand and exercise their rights as they make health plan decisions and manage health care costs within today’s complex health care system — decisions which affect their businesses and the employees who rely on these critical benefits. Businesses across the country can rally behind these rights and take an activist role as they seek alternatives to the status quo.

Know your rights

The Employer Bill of Rights is rooted in the mission that businesses have the right to:

receive transparent information about the costs of health care services

audit medical bills

defend fair health care payments

make direct connections with providers to achieve agreeable outcomes

Let’s take a look at the eight rights that make up the Employer Bill of Rights:

Pay a fair amount for health care.

Paying for health care should be treated like any other business expense — especially since it often represents the second largest operating expense after employee wages. Employers do not have to accept the status quo for their health plan and pay medical expenses that are inflated.

Know what health care services actually cost.

A traditional PPO health plan typically leaves the employer in the dark about how plan parameters were set by the insurer and medical provider. Businesses have a right to know the cost of medical services.

Audit medical bills.

Billing mistakes and inflation of medical charges are common. Businesses and individuals have a right to carefully evaluate health care expenses. A line-by-line auditing of medical bills helps ensure the charges are accurate and fair.

Explore your health plan options.

By partnering with an informed and experienced health care consultant, employers can discover health plan options beyond the traditional PPO model. A self-funded health plan, where employers pay for medical claims as services are rendered instead of providing ongoing and advanced payments to an insurance company, can take employers on the path toward more control over healthcare spending.

Offer your employees a comprehensive and affordable benefits program.

Employees count on their employer-sponsored health plans to be reliable and financially feasible. Employers have a right to offer health care solutions that minimize the financial burden on the plan member.

Design a health plan to meet your unique needs.

The best health plans are well-rounded and flexible. Employers have the right to customize their health plan to determine the approach that best suits the needs of their business and team. Unlike traditional health plans, self-funded plans are customizable.

Defend the best interests of your business and your employees when paying for health care.

Surprise medical bills and inflated prices are common, but health care finances do not have to be handled alone. Employers and individuals have the right to access advocacy services that support fair and reasonable health care payments and help employers meet their fiduciary responsibility.

Make direct connections with providers and health systems.

Fair outcomes can be achieved when people work together. By creating direct partnerships with providers and health systems in their communities, employers can become good stewards of health care by building bridges and driving quality health care experiences for all.

Traditional plans are not serving employers and employees

The Employer Bill of Rights is a stark contrast to the traditional health insurance experience. When employers embrace these rights, many may realize that the plans they offer are not serving their employees well and are costing their businesses too much money.

More than one-quarter of insured adults, about 41 million people, are “underinsured.” Health plans hardly cover plan members against exorbitant out-of-pocket costs or deductibles. This is creating an unsustainable burden for employers and employees alike.

Unexpected medical bills are a top concern for Americans, with 4 in 10 insured adults reporting that they have received an unexpected medical bill in the past year, according to the Kaiser Family Foundation.

Employer health care costs have risen 24 percent between 2001 and 2015, according to the Society for Human Resource Management.

Alternatives to PPO plans are showing tremendous promise and gaining nationwide attention. The California Public Employees’ Retirement System (CalPERS) manages the largest public employee benefit fund in the U.S. After adapting a reference-based pricing program in 2013, the organization saw a $5.5 million cost savings over a two-year period.

And CalPERS isn’t alone. Organizations of every size are looking to make changes, including the big three of Amazon, Berkshire Hathaway and JP Morgan Chase, who recently established a new health venture to improve the cost for healthcare for their employees.

The path to choosing transparency

Businesses can stand up against out-of-control costs by adopting the Employer Bill of Rights and turning away from traditional insurance plans, which have failed to adapt to the changing health care landscape.

One option for a transparent solution for decision-makers seeking an alternative to PPOs is reference-based pricing, also known as metric-based pricing.

Reference-based pricing is a bottom-up approach to health care charges that starts with the actual cost amount and adds a fair profit margin for the provider to calculate the bill. This is contrary to a PPO model, which starts at the top with a potentially inflated price from a facility’s chargemaster and offers a fluctuating, inconsistent discount.

Self-funded employers looking to make a change can consider a reference-based pricing plan to save up to 30 percent in costs in their first year and rest assured knowing they are working with transparent providers.

Steve Kelly is the co-founder and CEO of ELAP Services, a leading health care solution for self-funded employers based in Wayne, Pa. He is a recognized expert in the insurance, employee benefits and risk management industry, bringing more than three decades of experience solving his clients’ complex healthcare challenges.

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