Medicaid Insurance Coverage of Tobacco Cessation Treatments

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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 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, 2023, only 22 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 while reducing barriers to treatment access (e.g., copays, duration limits on treatment) is still needed.

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.

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

  • 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.

Quitting Resources
2008-2023
2019-2023
Rising
Rising
Tobacco Policy/Regulatory Factors