TED'S TAKE: BENEFICIARY OR RECIPIENT?

In public policy conversations the terms beneficiary and recipient are used interchangeably but they shouldn’t be.

The Medicare program is an entitlement program. That means that folks quality for Medicare by satisfying certain criteria and are thereby “entitled” often by virtue of becoming 65 years of age.. Once in the program, you receive  a select set of benefits to which you are entitled. Thus, you benefit from the program - beneficiaries.

The Medicaid program is very different. This program is jointly funded by the federal government and the states. Each state has a state Medicaid plan that was approved by the federal government and defines who  is eligible to receive services under that state’s Medicaid plan. It can vary by state. Folks are not categorically entitled for Medicaid as they are for Medicare. For this reason, folks that are on Medicaid are referred to as a recipient - they are receiving services under that state’s plan.

As you can see, those on Medicare and very different than those on Medicaid. Medicare entitled for certain benefits; Medicaid receiving certain services.

In many discussions, these terms (beneficiary and recipient) are used inaccurately to describe those in either program, but I believe that leads to confusion regarding the status of those on Medicaid specifically. Medicaid recipients are not entitlees. They “qualified” for a particular state’s criteria to receive services.

Simply put Medicare beneficiaries are “entitled” to receive the benefits they are getting whereas Medicaid folks “qualified” to receive services under a state’s Medicaid plan.

As the national discussion around Medicare and Medicaid continues, we need to keep our terminology accurate, so we don’t confuse the benefit status of those receiving services under Medicaid with those who are entitled to Medicare benefits. These are important conversations. Let’s do our best to keep things clear.