The importance of eligibility and enrollment services on the heels of the Great Resignation
Given the millions of people who have left their jobs as part of the Great Resignation or have found themselves unemployed for other reasons, your health system’s ability to improve its eligibility and enrollment processes in the revenue cycle is essential.
The Great Resignation continues its historic march toward outpacing all previously reported years of quits data as reported by the Bureau of Labor Statistics, which began reporting the number of U.S. workers who quit their jobs in December 2000.
In 2021, 47.8 million workers quit their jobs — an average of nearly 4 million each month — giving 2021 the distinction of the highest average on record, topping the 2019 average of 3.5 million.
Exacerbating the issue, on the heels of the Great Resignation we find that job growth is slowing, vacancies are down, cuts are being made, hiring plans are put on hold and unemployment claims are rising. First-time filings for unemployment benefits rose by 7,000 in mid-July and are up 51% from mid-March, Labor Department data show.
Recently released data from the 2020 National Health Interview Survey were used to estimate health insurance coverage. The survey found that in 2020, 31.6 million (9.7%) people of all ages were uninsured at the time of the interview. This includes 31.2 million (11.5%) people under age 65. Among children, 3.7 million (5.0%) were uninsured and among working-age adults (age 18–64), 27.5 million (13.9%) were uninsured.
Among people under age 65, 64.3% were covered by private health insurance, including 56.6% with employment-based coverage and 6.7% with directly purchased coverage. Moreover, 4% were covered by exchange-based coverage, a type of directly purchased coverage.
The potential impact on your net revenue is clear: shifts in payer mix, increases in bad debt and charity care from caring for more people without health insurance. That is, unless you do something about it – specifically, by investing in your eligibility and financial counseling programs.
Many U.S. adults have trouble affording healthcare costs. While lower income and uninsured adults are the most likely to report this, those with health insurance and those with higher incomes are not immune to the high cost of medical care. About half of U.S. adults say that it is very or somewhat difficult for them to afford their healthcare costs (47%). Among those under age 65, uninsured adults are much more likely to say affording healthcare costs is difficult (85%) compared to those with health insurance coverage (47%). Additionally, at least six in ten Black adults (60%) and Hispanic adults (65%) report difficulty affording healthcare costs compared to about four in ten White adults (39%). Adults in households with annual incomes under $40,000 are more than three times as likely as adults in households with incomes over $90,000 to say it is difficult to afford their healthcare costs (69% versus 21%).
National Center for Health Statistics, which is part of the Centers for Disease Control and Prevention, conducted a survey on why adults (age 18-64) did not have healthcare coverage.
Percentage Reason for not having coverage
73.7% Coverage was unaffordable
25.3% Not eligible for coverage
21.3% Did not need or want coverage
18.4% Signing up for coverage was too difficult or confusing
18% Couldn’t find coverage that meets their needs
8.5% Applied for coverage that hasn’t started yet
The Congressional Budget Office (CBO) also released a report in September 2020 that said of the 12% of people under 65 (about 29.8 million) who were not enrolled in a health insurance plan or a governmental program that provided financial protection from major medical risks in 2019, two-thirds were actually eligible for subsidized health insurance benefits from various sources. Specifically, the CBO found that :
- 9.24 million, or 31%, were eligible for subsidized employment-based coverage
- 5.66 million, or 19%, were eligible for subsidized coverage through state exchanges
- 2.98 million, or 10%, were eligible for Medicaid or CHIP
- 2.09 million, or 7%, were eligible for Medicaid via ACA-expanded Medicaid programs
Together, the NCHS and CBO reports give support to the idea that by improving eligibility and enrollment programs, you can better help your uninsured patients obtain health benefits, provide them with peace of mind and help your financial performance.
Three ways to boost your eligibility and enrollment program
With the number of uninsured people poised to once again increase, it is critical that your organization work diligently to secure third-party coverage for them.
1. Determine eligibility
Your organization must have the ability to determine a person’s eligibility for a public health insurance program like Medicaid or Children’s Health Insurance Program (CHIP). Do you have the technology and resources to screen all your self-pay patients? Once you confirm eligibility, you should take an active approach in assisting that person to enroll in the program immediately.
2. Explore cost options
If affordability is a concern, your program should excel at researching, identifying and presenting low-cost health insurance options to an uninsured person who may not know that these options exist. That could be a subsidized bronze-level plan through a state insurance exchange or a new short-term health plan to protect the person until they can afford longer-term coverage.
Patient education is a key component to improving the health literacy of patients. Understanding terms like benefit levels, drug tiers, co-payments, deductibles, co-insurance, covered benefits, coverage limits and out-of-pocket maximums is challenging for anyone, not just the uninsured. So is the actual process of signing up for benefits. You can remove these barriers with an effective patient education campaign to improve health literacy and by simplifying the enrollment process.
The number of Americans without health coverage is set to increase as unemployment rises. To prevent those newly uninsured patients from increasing your bad debt costs, you need to optimize your eligibility and enrollment services. Those services may include enrolling patients in public insurance programs, determining patients’ eligibility for community and financial assistance programs, identifying low-cost health insurance options, and educating patients on health insurance benefits and helping them with enrollment processes.