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Cancer Trends Progress Report – 2011/2012 Update

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Medicaid Coverage of Tobacco
Dependence Treatments
Prevention: Behavioral Factors

All state Medicaid programs must provide tobacco cessation services for pregnant women as part of the Affordable Care Act (section 4107), but coverage is still limited in some states for other populations.

On this page:

Medicaid Coverage of Tobacco Dependence Treatments

Providing tobacco users access to evidence-based tobacco dependence treatments can reduce morbidity and mortality from cancers and other diseases caused by tobacco use. Low-income Americans are more likely than other Americans to be addicted to tobacco products. Beginning October 1, 2010, state Medicaid programs must fully cover tobacco cessation services (both counseling and pharmacotherapy) for pregnant women as part of the Affordable Care Act (section 4107). However, expansion of coverage to more treatments, expansion of the groups eligible for treatment, and a reduction of barriers to accessing treatment is needed.

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Measure

Number of states that report providing coverage under Medicaid for any evidence-based tobacco dependence treatment (pharmacotherapy or counseling), either to their entire Medicaid population or to pregnant women only.

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Period – 1990–2010

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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.

Download: data (Excel) | image (JPEG)

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Most Recent Estimates

In 2010, all 51 Medicaid programs provided coverage for at least one tobacco-dependence treatment for at least some segment of their Medicaid eligible population. Data from 2009 revealed that only 8 Medicaid programs offered coverage of all medications and some form of counseling for all Medicaid enrollees. Twelve Medicaid programs added or expanded coverage between 2007 and 2009.

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Healthy People 2020 Target

There is no Healthy People target for Medicaid coverage of tobacco dependence treatments.

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Why is Medicaid Coverage of Tobacco Dependence Treatments Important to Reducing Cancer?

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 adult smokers is significantly higher among Medicaid recipients than among the general population; in 2008, 37 percent of Medicaid enrollees reported being current smokers (compared to 18 percent with private health insurance and 33 percent who were uninsured). This highlights the importance of providing tobacco dependence treatment to Medicaid recipients in all states.

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Key Issues

Tobacco-dependence treatment is highly cost-effective. Effective tobacco dependence treatments include both medication and counseling. In addition, many states employ measures that limit access such as co-payments and limitations on number of treatment courses. Some states also require prior authorization or require that individuals enroll in a behavioral modification program to gain coverage for pharmacotherapy. In 2009, only five states reported policies that require coverage of all recommended pharmacotherapies and individual and group counseling for all Medicaid enrollees. Effective on October 1, 2010, all state Medicaid programs were required to fully cover tobacco cessation services for pregnant women as part of the Affordable Care Act (section 4107). Coverage of pharmacotherapy for all Medicaid enrollees will be enhanced by January 2014, when tobacco dependence cessation drugs will no longer be excluded from covered benefits.

Enhanced access to tobacco dependence treatment among the Medicaid population will help more low-income tobacco users quit and will contribute to reducing cancer deaths and cancer-related health disparities in this population.

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Additional Information

  • Center for Medicaid, CHIP and Survey & Certification. New Medicaid Tobacco Cessation Services. http://www.cms.gov/smdl/downloads/SMD11-007.pdf
  • Fiore MC, Jaen CR, Baker TB et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
  • Giovino GA, Chaloupka FJ, Hartman AM, et.al. Cigarette Smoking Prevalence and Policies in the 50 States: An Era of Change – The Robert Wood Johnson Foundation ImpacTeen Tobacco Chart Book. Buffalo, NY: University at Buffalo, State University of New York; 2009. http://www.impacteen.org/tobaccodata.htm External link
  • Jha P, Peto R, Zatonski W, Boreham J, Jarvis MJ, Lopez AD. Social inequalities in male mortality, and in male mortality from smoking: indirect estimation from national death rates in England and Wales, Poland, and North America. Lancet 2006; 368: 367-370
  • Pleis JR, Lucas JW, Ward BW. Summary health statistics for U.S. adults: National Health Interview Survey, 2008. National Center for Health Statistics. Vital Health Stat 10(242). 2009.
  • U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. State Medicaid coverage for tobacco-dependence treatments – United States, 2007. MMWR November 6, 2009; 58: 1199-1204.
  • United States Centers for Disease Control and Prevention (2008). State Medicaid Coverage for Tobacco-Dependence Treatments- United States, 2006. Morbidity and Mortality Weekly Report, 57(05); 117-122. Reported by HA Halpin, PhD, SB McMenamin, PhD, CA Cella, MPH, NM Bellows. Retrieved February 22, 2012 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5705a2.htm#top
  • United States Centers for Disease Control and Prevention (2009). State Medicaid Coverage for Tobacco-Dependence Treatments- United States, 2007. Morbidity and Mortality Weekly Report, 58(43); 1199-1204. Reported by SB McMenamin, PhD, HA Halpin, PhD, NM Bellows. Retrieved February 22, 2012 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5843a1.htm
  • United States Centers for Disease Control and Prevention (2010). State Medicaid Coverage for Tobacco-Dependence Treatments- United States, 2009. Morbidity and Mortality Weekly Report, 59(11); 1340-1343. Reported by SB McMenamin, PhD, HA Halpin, PhD, M Ingram Retrieved February 22, 2012 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5941a4.htm

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Back: Clinicians’ Advice to Quit Smoking

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