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Medicaid enrollees have a higher smoking prevalence than the general population. Smoking-related diseases are a major contributor to Medicaid costs. Providing tobacco users access to evidence-based tobacco dependence treatments can reduce morbidity and mortality from cancers and other tobacco-related diseases and reduce Medicaid costs (Source: https://www.cdc.gov/coordinatedchronic/pdf/tobacco_cessation_factsheet_508_compliant.pdf).
All state Medicaid programs must provide tobacco cessation services (both counseling and pharmacotherapy) for pregnant women under section 4107 of the 2010 Patient Protection and Affordable Care Act (ACA). Additionally, effective January 2014, section 2502 of the ACA barred state Medicaid programs from excluding coverage for cessation medications approved by the U.S. Food and Drug Administration. However, coverage still varies widely by state. As of June 2015, only nine states cover nine evidence-based cessation treatments (seven medications, individual, and group counseling) for all Medicaid enrollees. As of September 2017, only 11 states provided comprehensive coverage of all nine evidence-based cessation treatments (medications, individual and group counseling) for all Medicaid enrollees. Expansion of treatment coverage and eligibility while reducing barriers to treatment access (e.g. copays, duration limits on treatment) are still needed.
The number of states that provide coverage under Medicaid for any evidence-based tobacco dependence treatment (pharmacotherapy or counseling), either to their entire Medicaid population or to only pregnant women.
The number of states that provide coverage under Medicaid for individual or group tobacco cessation counseling.
The number of states that provide coverage under Medicaid for tobacco cessation medications.
Healthy People 2020 Target
- Increase comprehensive Medicaid insurance coverage of evidence-based treatment for nicotine dependency in States and the District of Columbia.
Healthy People 2020 is a set of goals set forth by the Department of Health and Human Services.
Note: Goals are indicated as blue line on Detailed Trend Graphs.
Centers for Disease Control and Prevention. State Medicaid coverage for tobacco-cessation treatments and barriers to coverage – United States, 2014-2015. MMWR 2015;64(42):1194-9.
Medicaid Coverage of Cessation Aids
Medicaid Coverage of Cessation Counseling
|Overview graph||Counseling Type||Number of States (2016)|
Medicaid Coverage of Smoking Cessation Medications
|Overview graph||Medication||Number of States (2016)|
|Nicotine Nasal Spray||33||0||13||5|
Additional Information on Medicaid Coverage of Tobacco Dependency Treatments
For the public
- Tobacco Cessation. Medicaid.gov.
- Tobacco and Cancer. American Cancer Society.
- Surgeon General’s Reports on Smoking and Tobacco Use. Centers for Disease Control and Prevention.
- Tobacco Products. U.S. Food and Drug Administration.
For health professionals
- Treating Tobacco Use and Dependence: 2008 Update. Agency for Healthcare Research and Quality.
- State-level Medicaid expenditures attributable to smoking. Armour BS, Finkelstein EA, Fiebelkorn IC. Prev Chronic Dis 2009;6:A84.
- State Medicaid coverage for tobacco-cessation treatments and barriers to coverage – United States, 2008–2014. Centers for Disease Control and Prevention. MMWR 2014;63(12):264–269.
- State Medicaid coverage for tobacco-dependence treatments – United States, 2009. Centers for Disease Control and Prevention. MMWR 2010;59(41):1340–1343.
- The impact of tobacco dependence treatment coverage and copayments in Medicaid. Greene J, Sacks RM, McMenamin SB. Am J Prev Med 2014;46:331–6.
- How Medicaid and other public policies affect use of tobacco cessation therapy, United States, 2010–2014. Ku L, Brantley E, Bysshe T, Steinmetz E, Bruen BK. Prev Chronic Dis 2016;13:E150.
- Medicaid tobacco cessation: big gaps remain in efforts to get smokers to quit. Ku L, Bruen BK, Steinmetz E, Bysshe T. Health Aff (Millwood) 2016;35:62–70.
- Cigarette smoking, desire to quit, and tobacco-related counseling among patients at adult health centers. Lebrun-Harris LA, Fiore MC, Tomoyasu N, Ngo-Metzger Q. Am J Public Health 2014.
- Helping smokers quit—opportunities created by the Affordable Care Act. McAfee T, Babb S, McNabb S, Fiore MC. N Engl J Med 2015;372:5–7.
- Annual healthcare spending attributable to cigarette smoking: an update. Xu X, Bishop EE, Kennedy SM, Simpson SA, Pechacek TF. Am J Prev Med 2015;48:326–33.
- Quit interest, quit attempt and recent cigarette smoking cessation in the U.S. working population, 2010. Yong LC, Luckhaupt SE, Li J, Calvert GM. Occup Environ Med 2014.
- Adult Cigarette Smoking in the United States: Current Estimates. Centers for Disease Control and Prevention.
- Adult Tobacco Use Information. Centers for Disease Control and Prevention. National Health Interview Survey.
- Healthy People 2020, 2020 Topics & Objectives – Tobacco Use.
- Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings . Substance Abuse and Mental Health Services Administration.