Medicaid Insurance Coverage of Tobacco Cessation Treatments

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In 2022, 20 states provided comprehensive insurance coverage of evidence-based tobacco cessation treatments (seven FDA-approved smoking cessation medications plus individual and group cessation counseling) for all standard Medicaid enrollees.

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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 with access to evidence-based tobacco cessation treatments can reduce morbidity and mortality from cancers and other tobacco-related diseases and reduce Medicaid costs. Individual, group, and telephone counseling are effective in helping people who use tobacco to quit. In addition, the U.S. Food and Drug Administration (FDA) has approved seven medications for smoking cessation, including five nicotine replacement therapies (the nicotine patch, gum, lozenge, nasal spray, and oral inhaler) and two non-nicotine medications (bupropion and varenicline). The U.S. Surgeon General has concluded that, with adequate promotion, comprehensive, barrier-free, insurance coverage of evidence-based cessation treatment increases both the availability and use of cessation services, leads to higher rates of successful quitting, and is cost effective.

There is considerable variation in states’ Medicaid insurance coverage of tobacco cessation treatments for standard (vs. expansion) Medicaid enrollees. All state Medicaid programs are required to cover 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 FDA. Telephone counseling is available for free to callers to state quitlines (including Medicaid enrollees) in all 50 states and the District of Columbia via 1-800-QUIT-NOW. However, coverage of individual and group cessation counseling for non-pregnant standard Medicaid enrollees varies widely by state. As of December 31, 2022, only 20 states provided comprehensive insurance coverage of all evidence-based cessation treatments (all seven FDA-approved smoking cessation medications, individual and group cessation counseling) for standard 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 state Medicaid programs that provide comprehensive insurance coverage of evidence-based tobacco cessation treatments (all seven FDA-approved smoking cessation medications plus individual and group cessation counseling) for standard Medicaid enrollees.

The number of state Medicaid programs that provide insurance coverage for individual or group tobacco cessation counseling for standard Medicaid enrollees.1

The number of state Medicaid programs that provide insurance coverage for all seven FDA-approved smoking cessation medications including the nicotine patch, nicotine gum, nicotine lozenge, nicotine oral inhaler, nicotine nasal spray, bupropion (Zyban®) and varenicline (Chantix®) for standard Medicaid enrollees.1

1Definitions

Standard Medicaid Enrollees: Persons who are enrolled in Medicaid under standard Medicaid eligibility criteria; does not include enrollees who are eligible under the income-only eligibility criteria for expanded Medicaid coverage.
Covered (individual counseling, group counseling): Service was covered for all standard Medicaid enrollees, including those enrolled in fee-for-service and managed care plans.
Varies (individual counseling, group counseling): Service coverage was different between managed care and fee-for-service plans, coverage varied among fee-for-service plans or among managed care plans, or coverage varied by pregnancy status.
Not Covered (individual counseling, group counseling): This service was not covered under applicable fee-for-service and managed care plans, or information was not available for both plans.
Covered (smoking cessation medications): All seven FDA-approved smoking cessation medications were covered for all standard Medicaid enrollees, including those enrolled in fee-for-service and managed care plans.
Varies (smoking cessation medications): Coverage of all seven FDA-approved smoking cessation medications was different between managed care and fee-for-service plans, coverage varied among fee-for-service plans or among managed care plans, or coverage varied by pregnancy status.
Not Covered (smoking cessation medications): Any of the seven FDA-approved smoking cessation medications was not covered under applicable fee-for-service and managed care plans, or information was not available for both plans.

Healthy People 2030 Target

  • Increase comprehensive Medicaid insurance coverage of evidence-based treatment for nicotine dependency to include all 50 U.S. 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

Centers for Disease Control and Prevention. State Tobacco Activities Tracking and Evaluation (STATE) System. Annual quarter 4 estimates.

Trends and Most Recent EstimatesHelp with navigating the graphs and data tables

Comprehensive Coverage of Cessation Treatments

Number of states (including the District of Columbia) with comprehensive Medicaid insurance coverage for evidence-based tobacco cessation treatments, 2008-2022
Overview Graph Detailed Trend Graphs Most Recent Estimates (2022)
Number of states 95% Confidence Interval
Thumbnail of graph for Number of states (including the District of Columbia) with comprehensive Medicaid insurance coverage for evidence-based tobacco cessation treatments, 2008-2022 Comprehensive Coverage of Cessation TreatmentsClick to see the detailed trend graph for Comprehensive Coverage of Cessation Treatments 20.0 Not available

Group Cessation Counseling

Number of states (including the District of Columbia) with Medicaid insurance coverage for group tobacco cessation counseling, 2008-2022
Overview Graph Detailed Trend Graphs Most Recent Estimates (2022)
Number of U.S. states 95% Confidence Interval
Thumbnail of graph for Number of states (including the District of Columbia) with Medicaid insurance coverage for group tobacco cessation counseling, 2008-2022 CoveredClick to see the detailed trend graph for Covered 21.0 Not available
VariesClick to see the detailed trend graph for Varies 12.0 Not available
Not CoveredClick to see the detailed trend graph for Not Covered 18.0 Not available

Individual Cessation Counseling

Number of states (including the District of Columbia) with Medicaid insurance coverage for individual tobacco cessation counseling, 2008-2022
Overview Graph Detailed Trend Graphs Most Recent Estimates (2022)
Number of U.S. states 95% Confidence Interval
Thumbnail of graph for Number of states (including the District of Columbia) with Medicaid insurance coverage for individual tobacco cessation counseling, 2008-2022 CoveredClick to see the detailed trend graph for Covered 39.0 Not available
VariesClick to see the detailed trend graph for Varies 12.0 Not available
Not CoveredClick to see the detailed trend graph for Not Covered 0.0 Not available

Smoking Cessation Medications

Number of states (including the District of Columbia) with Medicaid insurance coverage for all seven FDA-approved smoking cessation medications, 2008-2022
Overview Graph Detailed Trend Graphs Most Recent Estimates (2022)
Number of U.S. states 95% Confidence Interval
Thumbnail of graph for Number of states (including the District of Columbia) with Medicaid insurance coverage for all seven FDA-approved smoking cessation medications, 2008-2022 CoveredClick to see the detailed trend graph for Covered 43.0 Not available
VariesClick to see the detailed trend graph for Varies 6.0 Not available
Not CoveredClick to see the detailed trend graph for Not Covered 2.0 Not available

Additional Information on Medicaid Insurance Coverage of Tobacco Cessation Treatments

Quitting Resources

Year Range

2008-2022

Recent Summary Trend Year Range

2018-2022

Summary Tables

Tobacco Company Marketing Expenditures

Recent Summary Trend

Rising

Desired Direction

Rising