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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.
Background
Medicaid enrollees have a higher smoking prevalence than the general population. Smoking-related diseases are a major contributor to Medicaid costs. Providing people who use tobacco access to evidence-based tobacco dependence treatments can reduce morbidity and mortality from cancers and other tobacco-related diseases and reduce Medicaid costs.
All state Medicaid programs must provide tobacco cessation services (both counseling and medications) for pregnant women under section 4107 of the 2010 Patient Protection and Affordable Care Act (ACA). Additionally, effective 2014, section 2502 of the ACA barred state Medicaid programs that participate in the Medicaid drug rebate program from excluding coverage for cessation medications approved by the U.S. Food and Drug Administration. However, coverage of cessation counseling still varies widely by state. As of September 30, 2021, only 20 states provided comprehensive coverage of all 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.
Measure
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. 1
The number of states that provide coverage under Medicaid for smoking cessation medications. Over-the-counter medications include Nicotine Patch, Nicotine Gum, and/ or Nicotine Lozenge; Prescription medications include Nicotine Oral Inhaler, Nicotine Nasal Spray, Bupropion (Zyban®) and/or Varenicline (Chantix®). 1
1 Definitions
Covered: This service is provided for all individuals enrolled in Medicaid through either fee-for-service, managed care plans, or both.
Coverage Varies by Plan: If the managed care plans vary, or if the fee-for-service plan and managed care plans had different coverage, it was classified as “Varies by Plan.”
Pregnant Women Only: This service is provided only for pregnant women
Note: Both fee-for-service and managed care plans were considered. If a state reported “Not Applicable” for one plan, what was reported for the other plan was used.
Healthy People 2030 Target
- Increase comprehensive Medicaid insurance coverage of evidence-based treatment for nicotine dependency in States and the District of Columbia.
Healthy People 2030 is a set of goals set forth by the Department of Health and Human Services.
Data Source
Data from 2009 to present: Centers for Disease Control and Prevention. State Tobacco Activities Tracking and Evaluation (STATE) System.
Data through 2008: McMenamin SB, Halpin HA, Bellows MN, Husten CG, Rosenthal A. State Medicaid coverage for tobacco-dependance treatments - United States, 2007. Morbidity and Mortality Weekly Report 2009;58(43);1199-1204.
Trends and Most Recent Estimates
Medicaid Coverage of Cessation Treatments
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2021) | |
|---|---|---|---|
| Number of States | 95% Confidence Interval | ||
|
Medicaid Coverage of Cessation Treatments
|
51.0 | Not available |
Medicaid Coverage for Group Cessation Counseling
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
|---|---|---|---|
| Number of U.S. states | 95% Confidence Interval | ||
|
Covered
|
18.0 | Not available |
Coverage Varies by Plan
|
16.0 | Not available | |
Pregnant Women Only
|
0.0 | Not available | |
Medicaid Coverage for Individual Cessation Counseling
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
|---|---|---|---|
| Number of U.S. states | 95% Confidence Interval | ||
|
Covered
|
33.0 | Not available |
Coverage Varies by Plan
|
14.0 | Not available | |
Pregnant Women Only
|
3.0 | Not available | |
Medicaid Coverage for Cessation Aids
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2020) | |
|---|---|---|---|
| Number of U.S. states | 95% Confidence Interval | ||
|
Over-the-Counter Aids Covered
|
48.0 | Not available |
Prescription Aids Covered
|
50.0 | Not available | |
OTC Coverage Varies by Plan
|
1.0 | Not available | |
Prescription Coverage Varies by Plan
|
1.0 | Not available | |
Additional Information on Medicaid Coverage of Tobacco Dependence Treatments
- Tobacco and Cancer. American Cancer Society.
- Surgeon General’s Reports on Smoking and Tobacco Use. Centers for Disease Control and Prevention.
- Tobacco Cessation. Medicaid.gov.
- Tobacco Products. U.S. Food and Drug Administration.
Quitting Resources
- Tobacco. National Cancer Institute.
- Smokefree.gov. National Cancer Institute.
- How to Quit Smoking or Smokeless Tobacco. American Cancer Society.
- North American Quitline Consortium.
- Treating Tobacco Use and Dependence: 2008 Update. Agency for Healthcare Research and Quality.
- Healthcare Provider Resources: Smoking and Tobacco Use. Centers for Disease Control and Prevention.
- Tobacco Use. Million Hearts.
- Policies affecting Medicaid beneficiaries’ smoking cessation behaviors. Brantley E, Greene J, Bruen B, Steinmetz E, Ku L. Nicotine Tob Res 2018:00(00):1-8.
- State Medicaid expansion tobacco cessation coverage and number of adult smokers enrolled in expansion coverage—United States, 2016. DiGiulio A, Haddix M, Jump Z et al. MMWR Morb Mortal Wkly Rep 2016;65(48):1364-1369.
- State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments — United States, 2008–2018. DiGiulio A, Jump Z, Babb S et al. MMWR Morb Mortal Wkly Rep 2020;69(6):155-160.
- The Affordable Care Act Medicaid Expansion and Smoking Cessation Among Low-Income Smokers. Donahoe JT, Norton EC, Elliott MR et al. Am J Prev Med 2019;57(6):e203-e210.
- Impact of Medicaid expansion on smoking prevalence and quit attempts among those newly eligible, 2011-2019. Hilts KE, Blackburn J, Gibson PJ, et al. Tob Prev Cessat. 2021 Aug 5;7:16.
- Does state Medicaid coverage of smoking cessation treatments affect quitting? Kostova D, Xu X, Babb S, McMenamin SB, King BA. Health Serv Res 2018;53(6):4725-4746.
- 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.
- 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.
- The Affordable Care Act's Medicaid Expansion and Impact Along the Cancer-Care Continuum: A Systematic Review. Moss HA, Wu J, Kaplan SJ, Zafar SY. J Natl Cancer Inst. 2020 Aug 1;112(8):779-791.
- Current smoking and quit-attempts among US adults following Medicaid expansion. Valvi N, Vin-Raviv N, Akinyemiju T. Prev Med Rep. 2019; epub.
- Smoking prevalence in Medicaid has been declining at a negligible rate. Zhu SH, Anderson CM, Zhuang YL et al. PLoS One 2017;12(5): e0178279.
- Current Cigarette Smoking Among Adults in the United States. Centers for Disease Control and Prevention.
- State Tobacco Activities Tracking and Evaluation (STATE) System: Map of Comprehensive Medicaid Coverage of Cessation Treatments. Centers for Disease Control and Prevention.