What’s in a name: Medicaid “beneficiaries” edition

Maybe I should have known this. Maybe I did know it and forgot. Maybe there’s a good reason for that.

Surely the ACA’s implementers knew what they were doing when they began a campaign to convert all relevant Code of Federal Regulations language from Medicaid enrollees to Medicaid beneficiaries. Medicaid enrollees have always just been that—unlike Medicare beneficiaries—a naming convention emphasizing the provisional, conditional nature of the Medicaid entitlement. And the announcement accompanying the change acknowledged as much.

The Code of Federal Regulations was revised on 15 and 16 July 2012 to change the word “recipient” to “beneficiary.” The following is excerpted from 77 FR 29002-01, which appeared on May 16, 2012 in the Federal Register:

Removal of the Term “Recipient” for Medicaid: We have removed the term “recipient” from current CMS regulations and made a nomenclature change to replace “recipient” with “beneficiary” throughout the CFR. In response to comments from the public to discontinue our use of the unflattering term “recipient” under Medicaid, we have been using the term “beneficiary” to mean all individuals who are eligible for Medicare or Medicaid services.

Just what is unflattering about the term “recipient” may be understood only in context; similarly, what is empowering about “beneficiary” may also only be understood in context. Medicare and Medicaid beneficiaries now stand on equal dignatorial ground.

That’s from Ann Marie Marciarille’s “The Medicaid Gamble.”

By and large, I tend to call people on Medicaid “enrollees,” and probably still will. There are two problems with “beneficiary.” First, it’s considered jargon and, apparently, is confusing or foreign to readers not steeped in health policy. Still, I do use the term, typically for people on Medicare, for which no active effort is required to receive the benefit.* Second, despite what they’re called, that’s just not the case for people on Medicaid. They really do have to enroll to benefit. So, I take issue with “beneficiary” even if it’s the regulation.

* UPDATE: This is only true for age-based Medicare eligibility.


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