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Developing a culturally competent public health workforce

By:

Luci Veilleux is a consultant on BerryDunn’s State Government Public Health Consulting team. She has a background in public health policy and health equity work, and is passionate about supporting states’ work to improve public health outcomes.

Luci Veilleux
02.01.22

Read this if you are at a public health agency.

As public health workforce challenges worsen through retirements, burnout, and added need for public health workers highlighted by the COVID-19 pandemic, funding levels for public health remain increased for the time being. This provides opportunities for states to leverage federal programs and funding streams to help ensure a strong and capable public health workforce to meet the needs of all communities. An important consideration for states is the level of cultural competence among their public health workforce.

Cultural competence: Definition and benefits

Cultural competence refers to the capacity to function effectively, both as an individual and an organization, in relation to community members’ cultural beliefs, behaviors, and needs. It allows public health professionals to provide more effective public health services to individuals and communities with cultures different from their own—through awareness, respect, and willingness to learn about cultural differences. The necessity of cultural competence in public health is especially timely due to new and existing disparities that have been highlighted by COVID-19 outcomes and the ripple effects of the pandemic.

Benefits of a culturally competent public health workforce include greater public trust in the public health system, more equitable and effective public health services, improved understanding of existing barriers and community health status, and the potential to reduce disparities and improve both healthcare access and health outcomes in historically marginalized communities.

As many states face significant workforce gaps and challenges in recruiting, training, and retaining staff, it is important to leverage best practices and key indicators of success to inform a sustainable and effective approach for workforce development. States may benefit from assessing gaps in cultural competence and related skills, and by identifying specific cultural competency areas and abilities they aim to achieve in the workforce. A strategic approach is necessary for maximizing the sustainability and long-term benefit of federal funding opportunities, such as those for public health workforce development in rural areas. 

Strategies and best practices for developing a culturally competent public health workforce 

There are many steps you can take toward building cultural competence in your agency. Some of them include:

  • Develop and implement a periodic assessment of workforce cultural competence, and training to measure improvement and incorporate up-to-date best practices
  • Recruit diverse staff to reflect the culture and demographics of communities, including the provision of linguistic support
  • Create and improve pipeline training programs by collaborating with local colleges, universities, and schools of public health and identifying existing gaps in the workforce and in public health educational opportunities 
  • Support inter-professional education and teams for community-based interventions, to foster collaboration between public health and healthcare professionals in the community to better meet needs 

Important first steps to improve and foster cultural competence in the public health workforce include setting goals related to building community partnerships and what those partnerships will achieve. 

Other steps for building cultural competence 

Additionally, collecting diversity data and demographic characteristics of the public health workforce, measuring and evaluating performance of the public health workforce and public health services, and reflecting community diversity within the workforce are necessary for developing a workforce that supports community cohesion and trust of community members. These steps can help you assess where you can strengthen services and how communities can be better reflected in the public health services they receive. Effective communication and language access are also critical steps to improve and foster cultural competence in the public health workforce.

BerryDunn can provide state public health and human services agencies with strategic policy and programmatic guidance and management support to maximize the benefits of federal programs to facilitate public health workforce development. 

If you have any questions about your specific situation, or would like more information, please contact our Public Health Consulting team. We’re here to help.

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Read this if your organization offers health insurance through a health insurance exchange.

When the Affordable Care Act (ACA) was passed in 2010, it contained a known gap which made healthcare premiums unaffordable for some families covered under Medicare or employer-sponsored health insurance plans. The gap in the law, commonly referred to as the family glitch, was formalized in 2013 as the result of a Final Rule issued by the IRS. 

The “family glitch” calculates the affordability of an employer-sponsored health insurance plan based on the cost for the employee, not additional family members. An article published in April 2022 on healthinsurance.org estimated that the cost of health insurance for a family covered by an employer-sponsored plan could end up being 25% or more of the household’s income, even if the plan was considered affordable (less than 9.61% of the household’s income) for the employee alone. Almost half of the people impacted by the family glitch are children.

The family glitch was allowed to stand in 2013 partly because of concerns that resolving the issue could push more people off employer-sponsored plans and onto marketplace qualified health plans, ultimately raising the cost of subsidies. Since then, several attempts have been made to fix the issue, which affects around five million Americans. The most recent attempt was an executive order issued by President Biden soon after taking office in January 2021. The Office of Management and Budget has been reviewing regulatory changes proposed by the Treasury Department and IRS, details of which were published in April 2022. 

These regulatory changes would alter the way health insurance exchanges calculate a family’s eligibility for subsidies when the family has access to an employer-sponsored health insurance plan. If the changes go into effect in 2023 as proposed, audits of the 2023 fiscal year will need to account for the new regulations and potentially conduct different testing protocols for different parts of the year. 

Our team is closely following these proposed changes to help ensure our clients are prepared to follow the new regulations. Earlier this week, we attended a public hearing held by the Treasury Department, where representatives of various groups spoke in support of, or in opposition to the proposed regulatory change. Supporters noted that families with plans that offer expensive coverage for dependents would benefit from this change through reduced costs and more coverage options, including provider networks that may more closely align with the family members’ needs. Those in favor of the change anticipate that families with children would see the most benefit. 

Those opposed to the change expressed that due to the way the law is currently written, they do not see the regulatory flexibility for the administration to make this change through administrative action. Additionally, concerns were raised that families covered by multiple health insurance plans could be faced with higher out-of-pocket-costs due to having separate deductibles that must be met on an annual basis. Lastly, not all families that have unaffordable insurance would see financial relief under this proposal. 

The Treasury Department is expected to announce its decision in time for open enrollment for plan year 2023 which is scheduled to begin on November 1, 2022. Our team will continue to monitor the situation closely and provide updates on how the changes may impact our clients. 

For more information

If you have more questions or have a specific question about your situation, please reach out to us. There is more information to consider when evaluating the effects these changes will have on the landscape of healthcare access and affordability, and we’re here to help.

Article
Fixing the "family glitch": How a proposed change to the ACA will affect healthcare subsidies 

Editor's note: read this if you are a CFO, controller, accountant, or business manager.

We auditors can be annoying, especially when we send multiple follow-up emails after being in the field for consecutive days. Over the years, we have worked with our clients to create best practices you can use to prepare for our arrival on site for year-end work. Time and time again these have proven to reduce follow-up requests and can help you and your organization get back to your day-to-day operations quickly. 

  1. Reconcile early and often to save time.
    Performing reconciliations to the general ledger for an entire year's worth of activity is a very time consuming process. Reconciling accounts on a monthly or quarterly basis will help identify potential variances or issues that need to be investigated; these potential variances and issues could be an underlying problem within the general ledger or control system that, if not addressed early, will require more time and resources at year-end. Accounts with significant activity (cash, accounts receivable, investments, fixed assets, accounts payable and accrued expenses and debt), should be reconciled on a monthly basis. Accounts with less activity (prepaids, other assets, accrued expenses, other liabilities and equity) can be reconciled on a different schedule.
  2. Scan the trial balance to avoid surprises.
    As auditors, one of the first procedures we perform is to scan the trial balance for year-over-year anomalies. This allows us to identify any significant irregularities that require immediate follow up. Does the year-over-year change make sense? Should this account be a debit balance or a credit balance? Are there any accounts with exactly the same balance as the prior year and should they have the same balance? By performing this task and answering these questions prior to year-end fieldwork, you will be able to reduce our follow up by providing explanations ahead of time or by making correcting entries in advance, if necessary. 
  3. Provide support to be proactive.
    On an annual basis, your organization may go through changes that will require you to provide us documented contractual support.  Such events may include new or a refinancing of debt, large fixed asset additions, new construction, renovations, or changes in ownership structure.  Gathering and providing the documentation for these events prior to fieldwork will help reduce auditor inquiries and will allow us to gain an understanding of the details of the transaction in advance of performing substantive audit procedures. 
  4. Utilize the schedule request to stay organized.
    Each member of your team should have a clear understanding of their role in preparing for year-end. Creating columns on the schedule request for responsibility, completion date and reviewer assigned will help maintain organization and help ensure all items are addressed and available prior to arrival of the audit team. 
  5. Be available to maximize efficiency. 
    It is important for key members of the team to be available during the scheduled time of the engagement.  Minimizing commitments outside of the audit engagement during on site fieldwork and having all year-end schedules prepared prior to our arrival will allow us to work more efficiently and effectively and help reduce follow up after fieldwork has been completed. 

Careful consideration and performance of these tasks will help your organization better prepare for the year-end audit engagement, reduce lingering auditor inquiries, and ultimately reduce the time your internal resources spend on the annual audit process. See you soon. 

Article
Save time and effort—our list of tips to prepare for year-end reporting

Read this if you are interested in GASB updates. 

The Governmental Accounting Standards Board (GASB) issued GASB Statement No. 99, Omnibus 2022 on May 9, 2022. The statement enhances comparability in accounting and financial reporting and improves the consistency of authoritative literature by addressing (1) practice issues that have been identified in previous GASB Statements, and (2) adding guidance on accounting and financial reporting for financial guarantees.

We’ve reviewed the statement in its entirety, and broken down key components for you to know. Here are the highlights.  

Accounting and financial reporting for exchange or exchange-like financial guarantees

Financial guarantees is a guarantee of an obligation of a legally separate entity or individual, including a blended or discretely presented component unit, that requires the guarantor to indemnify a third-part obligation holder under specified conditions, in an exchange or exchange-like transactions. 

An entity that extends an exchange or exchange-like financial guarantee should recognize a liability and expense related to the guarantee when qualitative factors and historical data indicate that is it more than likely not a government will be required to make a payment related to the guarantee.

Statement 99 excludes guarantees related to special assessment debt, financial guarantee contracts within the scope of Statement 53, or guarantees related to conduit debt obligations. 

Certain derivative instruments that are neither hedging derivative instruments nor investment derivative instruments

Derivative instruments that are within the scope of Statement 53, but do not meet the definition of an investment derivative instrument or the definition of a hedging derivative instrument are considered other derivative instruments. These “other derivative instruments” should now be accounted for as follows:

  1. Changes in fair value should be reported on the “resource flows statement” separately from the investment revenue classification.
  2. Information should be disclosed in the notes to financial statements separately from hedging instruments and investment derivative instruments.
  3. Governments should disclose the fair values of derivative instruments that were reclassified from hedging derivative instruments to other derivative instruments. 

Leases

If your entity has leases please review the following as Statement 99 clarifies numerous issues from Statement 87, specifically:

  • Lease terms as it relates to options to terminate and option to purchase the underlying assets, in paragraph 12 of Statement 87 has been clarified;
  • Short-term leases in paragraph 12 of Statement 87 has been clarified as it relates to an option to terminate the lease;
  • Lessee and lessor recognition and measurement for leases other than short-term leases that transfer ownership has been clarified, and
  • Lease incentives in paragraph 61 of Statement 87 has been further defined.

Public Private and Public-Public Partnerships (PPPs)

If your entity has PPPs, Statement 99 clarifies the following: 

  • PPP terms
  • Receivable for installment payments (transferor recognition)
  • Receivable for the underlying PP Asset (transferor recognition)
  • Liability for installment payments (operator recognition)
  • Deferred outflow of resources (operator recognition)

Subscription-Based Information Technology Arrangements (SBITAs)

Subscription terms and definitions have been clarified, specifically as it relates with options to terminate, short-term SBITAs, and measurement of subscription liabilities.

If your entity has SBITAs, review the provisions of each SBITA to ensure compliance with Statement 99 paragraphs 23–25.

Replacement of LIBOR

Check with your banking institutions to confirm when they have phased out of LIBOR. Confirm with your banking institutions what specifically has replaced LIBOR and update Financial Statement disclosures as needed. 

SNAP

State governments should recognize distributions of benefits from Supplemental Nutrition Assistance Program (SNAP) as a nonexchange transaction. Review Financial Statement disclosure and determine if a disclosure is needed. 

Disclosure of Nonmonetary Transactions

If you engage in one or more nonmonetary transactions during the fiscal year, you will need to disclose those transactions in the notes to the financial statements the measurement of attribute(s) applied to the assets transferred, rather than basis of accounting for those assets.

Pledges of future revenues when resources are not received by the pledging government

When blending the financial statement of a debt-issuing component unit into the financial statements of a primary government pledging revenue for the component unit’s debt, the primary government should reclassify an amount due to the component as an interfund payable and an interfund transfer out simultaneously with the recognition of the revenues that are pledged.

Focus of the government-wide financial statement

Statement 99 reiterates that there should be a total overall government-wide column within the MD&A, Statement of Net Position, and Statement of Activities. This column should exclude all fiduciary activities, including custodial funds. 

Terminology updates

No action is needed. Terminology has been updated in previous pronouncements, for terminology as it relates to Statements 63 and 53. 


Effective dates

The requirements related to the extension of the use of LIBOR, accounting for SNAP distributions, disclosures of nonmonetary transactions, pledges of future revenues by pledging governments, clarification of certain provisions in Statement 34 and terminology updates related to GASB 53 and 63 are effective upon issuance.

The requirements related to leases, PPPs, and SBITAs, are effective for fiscal years beginning after June 15, 2022.

The requirements related to financial guarantees and the classification and reporting of derivative instruments within the scope of Statement 53 are effective for fiscal years beginning after June 15, 2023.

Earlier application is encouraged and permitted for all.

If you would like more information regarding Statement 99, please contact our Audits of Governmental Component Units team. We’re here to help.

Article
Key considerations from GASB Statement No. 99 

Read this if you are at a state Medicaid agency.

The Covid-19 Public Health Emergency (PHE) placed US state and territory Medicaid programs on the front line of reorganizing what healthcare looks like for millions of Medicaid enrollees. Each Medicaid program shifted automation and manual procedures in order to comply with and benefit from the increased federal funding in early 2020. With the PHE winding down, every Medicaid program must look at how to return to regular operations and unwind, or undo, the continuous coverage requirement temporarily put in place by the Centers for Medicare and Medicaid Service (CMS). BerryDunn has collaborated with Medicaid programs to identify best practices and consider new opportunities to implement rollback methods in an effort to lower risk during the unwinding period and beyond. 

New learning programs considered

Administrators who have been assessing their staff and operational readiness to support the expected influx of renewals, policy changes, and staffing changes are considering launching learning programs ahead of the unwinding efforts. Using this time to engage with staff has uncovered the need to redeploy fundamental learning programs to prepare for the anticipated high volume of two-years of renewals. Administrators have also begun to engage with community leaders and health plan organizations in ways that provide coordinated and complete communication to beneficiaries. Many programs have looked at expanding benefits within the guidelines of CMS, such as extending post-partum coverage to a full 12 months and increasing reasonable compatibility to a larger percentage, recognizing the economy has evolved since 2020.

Other outreach efforts

During the pandemic, many beneficiaries moved without notifying the Medicaid program of the address change. Proactive Medicaid programs are working directly with health programs and medical facilities to ensure the most updated addresses are captured, and are using public transportation advertisements, online website reminders, and email notifications to encourage beneficiaries to update addresses.

In other locations with a high rate of unemployment in specific industries, Medicaid programs are working with identified outreach partners like unions and industry associations to communicate messaging of Medicaid benefits. Thousands of employees may have lost full-time employment during the pandemic and have returned to work with reduced hours and less benefits. As a sign of changing times, some programs are employing social media campaigns to connect with existing and new enrollees. 

Medicaid programs across the states and territories are finding creative ways to reach impacted communities. Program administrators are organizing staff and systems to be well positioned to undo the effects of the temporary policies. The dismantling of the two-plus years of PHE is expected to be performed within a 12-month period. As administrators eagerly anticipate the announcement of an extension or the pending PHE unwinding start date, one thing is certain: US states and territories are preparing to support an extensive population of Medicaid beneficiaries post pandemic.

BerryDunn is partnering with many states and territories to help ensure a successful unwind of temporary services and return to normal operations. If you would like to discuss how BerryDunn can support your needs, contact the Medicaid consulting team.
 

Article
How Medicaid programs are preparing for the operational challenges of the PHE unwinding

Read this if you use QuickBooks Online.

With gas prices so high, you need to track your travel costs as closely as possible. Consider getting a tax deduction for your business mileage.

If you drive even a little for business, it’s easy to let mileage costs slide. After all, it’s a pain to keep track of your tax-deductible mileage in a little notebook and do all the calculations required. If you do rack up a lot of business miles, you probably forget to track some trips and end up losing money.

QuickBooks Online offers a much better way. Its Mileage tools include simple fill-in-the-blank records that allow you to document individual trips. You can either enter the starting point and destination and let the site calculate your mileage and deduction or enter the number of miles yourself.

If you use QuickBooks Online’s mobile app, it can track your miles automatically as you drive (as long as you have the correct settings turned on). Here’s a look at how all of this works.

Setting up 

To get started, click the Mileage link in QuickBooks Online’s toolbar. The screen that opens will eventually display a table that contains information about your trips, but you need to do a little setup first. Click the down arrow next to Add Trip in the upper right corner and select Manage vehicles. A panel will slide out from the right. Click Add vehicle.

 
You’ll need to supply information about your vehicles before you can start entering trips.

You’ll need to supply the vehicle’s year, make, and model. Do you own or lease it, and on what date was the vehicle purchased or leased and put into service? Do you want to have your annual mileage calculated by entering odometer readings or have QuickBooks Online track your business miles driven automatically? When you’re done making your selections and entering data, click Save.

Entering trip data

You can download trips as CSV files or import them from Mile IQ, but you’re probably more likely to enter them manually. Click Add Trip in the upper right corner. In the pane that opens, you’ll enter the date of the trip and either the total miles or start and end point. You’ll select the business purpose and vehicle and indicate whether it was a round trip. When you’re done, click Save. The trip will appear in the table on the opening screen, and your current possible total deduction will be in the upper left corner, along with your total business miles and total miles.

If you want to designate a trip as personal, click the box in front of the trip in that table. In the black horizontal box that appears, click the icon that looks like a little person, then click Apply. Now, the trip will appear in the Personal column and will not count toward your business tax-deductible mileage. 

When you select a trip in the Mileage table, you can mark it as personal so it’s not included in your business tax-deductible miles.

Personal trips can count, too

If you use your vehicle(s) for personal as well as business purposes, tracking some of those miles can also mean a tax deduction. For tax year 2022, you can deduct 18 cents per mile for your travel to and from medical appointments. Note: Medical mileage is only deductible if medical exceeds a certain percent of AGI. Be sure to check with the IRS yearly tax code, as they update the mileage amounts annually.

And if you do volunteer work for a qualified charitable organization, the miles you drive in service of it can be deducted at the rate of 14 cents per mile. You can also claim the cost of parking and tolls, as long as you weren’t reimbursed for any of these expenses. Obviously, the IRS wants you to keep careful records of your charitable mileage, and QuickBooks Online can provide them.

QuickBooks Online doesn’t track these deductions, but you’ll at least have a record of the miles driven.

Auto-track your miles

The easiest way to track your mileage in QuickBooks Online is by using its mobile app. You can launch this and have it record your mileage automatically as you’re driving. Versions are available for both Android and iOS, and they’re different from each other. They also have more features than the browser-based version of QuickBooks Online, like maps, rules, and easier designation of trips as business or personal.

 
The iOS version of Mileage in the QuickBooks Online app

In both versions, you’ll need to click the menu in the lower right corner after you’ve opened the QuickBooks Online app and select Mileage. Make sure Auto-Tracking is turned on. Your phone’s location services tool must be turned on, too. There are other settings that vary between the two operating systems. You can search the help system of either app to make sure you get your settings correct if the onscreen instructions aren’t clear enough.

Of course, you won’t see the fruits of your mileage deductions until you file your 2022 taxes. But you can factor these savings in as you’re doing your tax planning during the year. Please contact the Outsourced Accounting team if you’re having any trouble with QuickBooks Online’s Mileage tools, or if you have questions with other elements of the site.

Article
How QuickBooks Online helps you track mileage

Read this if you are a Police Executive, City/County Administrator, or elected government official responsible for a law enforcement agency. 

Are your officers overwhelmed with workload? Have you been asked to do more with less? Is your agency struggling with maintaining sworn staffing levels? Has your community been questioning why the police respond to things that might be more appropriately handled by others?

If you answered yes to one or more of these questions, your agency might benefit from a comprehensive analysis of your police call-for-service (CFS) response model. 

Increasing CFS workloads

Many police agencies in the US have been struggling with increasing CFS workloads, while simultaneously facing ever-tightening budgets and unprecedented attrition and vacancy rates. As a result of these challenges and national trends calling for police response reform, many police departments have started to ask a very simple question: “Is there a better way?”

Considering alternatives to police CFS response is not new. In fact, many agencies already use some form of CFS diversion, whether through a telephone response unit (TRU), online reporting, mobile apps, or the use of non-sworn personnel. What is different and new in the most recent discussion is the understanding that this conversation is not simply about providing these alternatives as possible options.

It is about considering fundamental changes to how police departments do business, including identifying collaboration opportunities with other organizations and in some cases outsourcing certain CFS types entirely.

Despite growing interest among police agencies in identifying alternatives to the traditional police CFS model, many have struggled to deliver an objective process that can produce meaningful results, and in some cases, suggested revisions have met with resistance from staff, elected officials, and community members.   

Best-practices approach to call for service response model

The best-practices approach to conducting an Essential CFS Evaluation should be one that is highly collaborative, but also expand beyond the walls of the police department. The 21st Century Policing Task Force final report explains:

Law enforcement agencies should work with community residents to identify problems and collaborate on implementing solutions that produce meaningful results for the community… and do things with residents in the co-production of public safety rather than doing things to or for them. 

Determining possible alternatives to traditional CFS police response requires substantial data collection and analysis to inform and guide outcomes and recommendations. It also requires a thorough and comprehensive process that considers:

  • Legal mandates
  • Immediate response needs
  • Potential risk
  • Workload volumes by CFS type
  • Operational policies and training
  • Alternative resources, whether or not they currently exist
  • Community priorities and expectations
  • Fiscal impacts

The cost of providing consistent and effective public safety services is one of the more critical reasons for considering CFS response alternatives. Although officer salaries vary by state, region, or department, the cost of staffing a non-sworn position is typically 40%-45% of the cost of a sworn officer.  

There is a common reason why the legal profession has attorneys and paralegals, the medical profession has doctors and physician’s assistants, and why many ambulance companies have moved to a paramedic and emergency medical technician (EMT) team, as opposed to staffing two paramedics in one ambulance. Cost is a driving force in these examples and the same circumstances are present in the law enforcement industry (among others). A well-trained non-sworn police staff member can handle a variety of CFS that do not require the presence of a sworn officer—likely at half the cost. Shifting the work burden from sworn to non-sworn personnel benefits officers by freeing them up to perform tasks that require an officer to respond, and it benefits the department and community by reducing costs. 

Beyond the issue of cost, there is also increasing conversation about the effectiveness and appropriateness of using police personnel to manage a variety of CFS types, including mental health incidents and those involving the unhoused, for example. Regardless of the CFS type, it is critical to use a process that involves influential participation by both providers and consumers. 

Making changes to the traditional police CFS response model is involved and it requires a thoughtful approach. BerryDunn has developed an Essential CFS Evaluation process that considers numerous critical factors to produce data that police staff, community and elected leaders can rely upon in making critical decisions about future public safety needs. 

If you are curious or have questions about our Essential CFS Evaluation process, our dedicated Justice & Public Safety team is available to discuss your organization’s needs.

Article
Challenge accepted: Fixing the traditional call-for-service model

Read this if you use QuickBooks Online.

You should be running reports in QuickBooks Online on a weekly—if not daily—basis. Here’s what you need to know.

You can do a lot of your accounting work in QuickBooks Online by generating reports. You can maintain your customer and vendor profiles. Create and send transactions like invoices and sales receipts, and record payments. Enter and pay bills. Create time records and coordinate projects. Track your mileage and, if you have employees, process payroll.

These activities help you document your daily financial workflow. But if you’re not using QuickBooks Online’s reports, you can’t know how individual elements of your business like sales and purchases are doing. And you don’t know how all of those individual pieces fit together to create a comprehensive picture of how your business is performing. 

QuickBooks Online’s reports are plentiful. They’re customizable. They’re easy to create. And they’re critical to your understanding of your company’s financial state. They answer the small questions, like, How many widgets do I need to order?, and the larger, all-encompassing questions like, Will my business make a profit this year?

Getting the lay of the land

Let’s look at how reports are organized in QuickBooks Online. Click Reports in the toolbar. You’ll see they are divided into three areas that you can access by clicking the labeled tabs. Standard refers to the comprehensive list of reports that QuickBooks Online offers, displayed in related groups. Custom reports are reports that you’ve customized and saved so you can use the same format later. And Management reports are very flexible, specialized reports that can be used by company owners and managers.


A partial view of the list of QuickBooks Online’s Standard reports 

Standard reports

The Standard Reports area is where you’ll do most—if not all—of your reporting work. The list of available reports is divided into 10 categories. You’re most likely to spend most of your time in just a few of them, including:

  • Favorites. You’ll be able to designate reports that you run often as Favorites and access them here, at the top of the list.
  • Who owes you. These are your receivables reports. You’ll come here when you need to know, for example, who is behind on making payments to you, how much individual customers owe you, and what billable charges and time haven’t been billed.
  • Sales and customers. What’s selling and what’s not? What have individual customers been buying? Which customers have accumulated billable time?
  • What you owe. These are your payables reports. They tell you, for example, which bills you haven’t paid, the total amount of your unpaid bills (grouped by days past due), and your balances with individual vendors.
  • Expenses and vendors. What have I purchased (grouped by vendor, product, or class)? What expenses have individual vendors incurred? Do I have any open purchase orders?

The Business Overview contains advanced financial reports that we can run and analyze for you. The same goes for the For my accountant reports. Sales tax, Employees, and Payroll will be important to you if they’re applicable for your company.

Working with individual reports


Each individual report in QuickBooks Online has three related task options.

To open any report, you just click its title. If you want more information before you do that, just hover your cursor over the label. Click the question mark to see a brief description of the report. If you want to make the report a Favorite, click the star so it turns green. And clicking the three vertical dots opens the Customize link. 

When you click the Customize link, a vertical panel slides out from the right, and the actual report is behind it, grayed out. Customization options vary from report to report. Some are quite complex, and others offer fewer options. The Sales by Customer Detail report, for example, provides a number of ways for you to modify the content of your report so it represents exactly the “slice” of data you want. So you can indicate your preferences in areas like:

  • Report period
  • Accounting method (cash or accrual)
  • Rows/columns (you can select which columns should appear and in what order, and group them by Account, Customer, Day, etc.)
  • Filter (choose the data group you want represented from several options, including Transaction Type, Product/Service, Payment Method, and Sales Rep)

Once you’ve run the report, you can click Save customization in the upper right corner and complete the fields in the window that opens. Your modification options will then be available when you click Custom reports, so you can run it again anytime with fresh data.


You can customize QuickBooks Online’s reports in a variety of ways.

We’ll go into more depth about report customization in a future article. For now, we encourage you to explore QuickBooks Online’s reports and their modification options so that you’re familiar with them and can put them to use anytime. Contact our Outsourced Accounting team if you have any questions about the site’s reports, or if you need help making your use of QuickBooks Online more effective and productive.

Article
Getting started with reports in QuickBooks Online

Read this if you are at a state Medicaid agency. 

As the end of the Public Health Emergency becomes more likely, much attention has been paid to the looming coverage cliff as state Medicaid agencies re-determine eligibility for their programs. The impacts can be mitigated in part by planning and taking proactive steps.

In the unsettling initial days of the COVID-19 Public Health Emergency (PHE), the Centers for Medicare and Medicaid Service (CMS) temporarily increased federal matching funds for state Medicaid programs. In exchange, states would suspend redeterminations of enrollees’ eligibility for the duration of the PHE. 

For Medicaid, states were in effect prohibited from disenrolling an individual from Medicaid programs. The result, according to CMS data, is 14.8 million more people were enrolled in Medicaid as of late 2021 than before the pandemic, reaching a total of nearly 79 million Medicaid enrollees.  According to one estimate, the end of the PHE could bring a decline in the number of Medicaid enrollees by as many as 15 million. This number includes an estimated 8.7 million adults and 5.9 million children. 

Local and state government eligibility staff will need to review the submitted documents and determine if these members qualify for continued Medicaid coverage. The potential exists for members to lose coverage, due to factors such as having moved, not realizing their circumstances have otherwise changed, or being unable or unaware to return the required paperwork within appropriate timeframes.

State Medicaid agencies strive to maintain an equitable program while remaining trusted stewards of public funds. With a large base of beneficiaries, this change is expected to impact the community and the healthcare market, with broad implications for public health. Similarly, the federal requirement for continuous health coverage has also helped state Medicaid agencies by easing the strain on organizations during pandemic-related disruptions. 

For these reasons state Medicaid agencies may search for routes to limit the loss of coverage. This can be accomplished through finding policy levers to retain members, establishing routes to alternative forms of insurance, and mitigating the risk of coverage loss for members. 

Mitigating the likelihood of becoming uninsured

State Medicaid agencies can reduce the risk that members lose their coverage and become uninsured through a number of steps. 

  • Designing comprehensive, multi-pronged, and targeted communication strategies. States can help Medicaid members understand the requirements and timelines required to maintain their coverage.
  • Updating systems to automate and reduce administrative burden. Maximizing ex parte renewals through the use of existing data that is stored in integrated systems.
  • Making key decisions early. States can minimize coverage loss by carefully planning the unwinding process and their approach to resuming Medicaid eligibility renewals.
  • Coordinating with other forms of coverage. Confirm or design user-friendly pathways by which a member is transferred or referred to other alternatives like the Marketplace or CHIP.
  • Leveraging their health plans. Particularly when it comes to coordinating outreach and updating member information. Managed care plans are also able to refer members who are losing coverage to other qualified health plans.

Policy levers for retaining members

States may consider reviewing emergency state plan amendments and appendix k amendments completed during the PHE to determine what flexibilities are possible to continue under existing authorities. At the same time, states should consider what other policy options may help retain coverage for existing members- for example:

  • Adopt 12 months continuous eligibility. This can be done for children via a State Plan Amendment (SPA), for adults through an 1115 waiver, and for individuals enrolled in BHP (via BHP Blueprint revision) 
  • Establish 12 months of postpartum coverage. This can be done through several paths, including SPAs 
  • Review operational policy for efficiencies. For example, a State could consider modifying the frequency of periodic data matching 

Next steps

The US Department of Health and Human Service has previously indicated its intention to provide notification to states of the end of the PHE 60 days before its scheduled end. The PHE was renewed in April 2022, and as of this writing will last until mid-July, meaning enrollees could lose Medicaid coverage as soon as August 1. The enhanced FMAP and the Maintenance of Eligibility (MOE) requirements are in place until the end of the quarter in which the PHE ends. In the case of a July 2022 end date to the PHE, the enhanced FMAP would last through September 30, 2022. 

Regardless, Medicaid agencies will need to begin reviewing all enrollees’ eligibility, performing outreach, and designing system updates this summer. In terms of next steps, states should consider the following:

  • Evaluate your program and identify initiatives to prioritize in the coming year. Ask your CMS contact about the latest applicable guidance. 
  • Develop Advanced Planning Documents (APDs) to help fund technology needs for initiatives, along with training your SMA team and providers. 
  • Implement a communications management approach to engage stakeholders, and inform affected Medicaid members.
  • Marshal project management resources and develop a realistic and achievable roadmap to success.  
  • Explore agency contracting vehicles, cooperative contracts, and other procurements tools. 

We’re here to help. If you have more questions or want to have an in-depth conversation about your specific situation, please contact the Medicaid consulting team.

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Medicaid coverage gap: Tools and strategies for Medicaid agencies to help retain members