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 your 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.1

By improving the eligibility and enrollment programs at your health system, your organization can better help your uninsured patients obtain health benefits, provide them with peace of mind and help your financial performance.

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 percent from mid-March, Labor Department data shows.2

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 (aged 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, 4.0% were covered by exchange-based coverage, a type of directly purchased coverage.3

The potential impact on your net revenue is clear: shifts in payer mix, increases in bad debt and charity from caring for more people without health insurance. That is, unless you do something about it – specifically invest in your eligibility and financial counseling programs.

Many U.S. adults have trouble affording health care 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 health care costs (47%). Among those under age 65, uninsured adults are much more likely to say affording health care 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 health care 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 health care costs (69% v. 21%).4

National Center for Health Statistics, which is part of the Centers for Disease Control and Prevention, conducted a survey on why adults (aged 18-64) did not have health care coverage.

Survey results on why adults did not have health care coverage:

73.7%said coverage was unaffordable

25.3%said they were not eligible for coverage

21.3%said they did not need or want coverage

18.4%said signing up for coverage was too difficult or confusing

18%said they couldn’t find coverage that meets their needs

8.5%said they’ve 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 percent 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 said:

  • 9.24 million, or 31 percent, were eligible for subsidized employment-based coverage
  • 5.66 million, or 19 percent, were eligible for subsidized coverage through state exchanges
  • 2.98 million, or 10 percent, were eligible for Medicaid or CHIP
  • 2.09 million, or 7 percent, were eligible for Medicaid via ACA-expanded Medicaid programs

Together, the NCHS and CBO reports gives support that by improving the eligibility and enrollment programs at your health system, your organization 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

Two women wearing face masks reviewing information on a laptop
With the number of uninsured people increasing due to COVID-19, it is critical that your organization work diligently to secure third-party coverage for them.


The number of Americans without health coverage is poised 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.


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