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Providing tobacco users access to evidence-based tobacco dependence treatments can reduce morbidity and mortality from cancers caused by tobacco use. Low-income Americans are more likely than other Americans to be addicted to tobacco products. Most state Medicaid programs provide at least some coverage of tobacco dependence treatment to at least some tobacco users. However, expansion of coverage to more treatments, expansion of the groups eligible for treatment, and a reduction of barriers to accessing treatment is needed.
Number of states that report providing coverage under Medicaid for any evidence-based tobacco dependence treatment (medication or counseling), either to their entire Medicaid population or to pregnant women only.
Trends – State Medicaid programs have steadily increased their coverage of tobacco dependence treatments over time. They have also expanded the number of treatments for which coverage is provided, over time.
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In 2007, 44 states and the District of Columbia (Washington, D.C.) provided Medicaid coverage for at least one tobacco dependence treatment for at least some segment of their Medicaid eligible population. In 2007, 42 states and Washington, D.C., offered coverage for at least one form of tobacco dependence treatment for their entire Medicaid population. In addition, two states reported offering coverage to pregnant women only.
Medicaid programs in all 50 states and Washington, D.C., will include coverage of evidence-based treatment for nicotine dependency.
Approximately one-half of all long-term smokers, especially those who began smoking as teenagers, will die prematurely from a disease caused by smoking. Quitting smoking, as early in life as possible is the only proven way to reduce the enormous health risk incurred by smoking. Smoking is more common among Americans of low socio-economic status, and smoking contributes significantly to health disparities. In addition, the proportion of smokers is significantly higher among Medicaid recipients than among the general population; in 2007, 33 percent of Medicaid enrollees reported being current smokers. This highlights the importance of providing tobacco dependence treatment to Medicaid recipients in all states.
Tobacco-dependence treatment is highly cost-effective, and is cost-saving in certain populations. Effective tobacco dependence treatments include both medication and counseling.
As of 2007, only six state Medicaid programs reported providing no Medicaid coverage for tobacco dependence treatments, and two states reported providing tobacco-dependence treatment to pregnant women only. In addition, many states employ measures that limit access such as copayments, limitations on number of treatment courses, requiring prior authorization, and requiring enrollment in a behavioral modification program to gain coverage for pharmacotherapy. In 2007, only six states provided coverage for all FDA-approved medications and individual and group counseling, and only two states reported access to tobacco-dependence treatments without any limitations or restrictions.
Enhanced access to tobacco dependence treatment among the Medicaid population will assist more low-income tobacco users to quit and will contribute to reducing cancer deaths and cancer-related health disparities in this population.