Medicaid Smoking Cessation Coverage

The National Cancer Institute has reported in 2009 that coverage for tobacco dependence treatments have increased at a steady pace since the mid-1990s for state Medicaid programs. As of 2007, there were 44 states that covered some form of treatment, compared to only 3 in 1995.

This is a significant development, considering the fact that the cigarette smoking rate among adult Medicaid beneficiaries is higher at 37 percent, than the general adult population which is at 21 percent. It is estimated that about one-third of all cancer deaths is caused by smoking. Smoking-related medical costs make up a big chunk of Medicaid spending.

However, it appears that state Medicaid programs are still lagging on tobacco cessation coverage. A study done by Sara B. McMenamin, PhD, of the University of California Berkeley, and her colleagues in conjunction with the CDC found that even though a vast majority of all states covered some form of tobacco dependence treatments, a greater number of states only offered very limited treatments for Medicaid beneficiaries.

In its Healthy People 2010 target, the federal government recommended that Medicaid programs should cover all FDA-approved prescriptions and counseling for tobacco dependency treatment.

Smoking cessation coverage under Medicaid varies from one state to another:

  • Nicotine patch – 34 states
  • Generic bupropion or brand name Zyban – 33 states
  • Nictotine gum – 32 states
  • Varenicline (Chantix) – 32 states
  • Nicotine nasal spray – 28 programs
  • Nicotine inhalers – 27 programs
  • Nicotine lozenges – 25 programs

Counseling coverage was not as extensive, however.

  • Only 18 states covered individual counseling
  • 6 states covered individual counseling on a fee-for-service basis (of which 2 are restricted to pregnant women)
  • 1 state covered individual counseling only for managed care enrollees
  • 6 states covered individual counseling only for pregnant women
  • Only 8 states covered group counseling for all Medicaid recipients
  • 3 states covered group counseling on a fee-for service basis (of which 2 are restricted to pregnant women)
  • 2 states only covered group counseling for managed care enrollees
  • 5 states covered group counseling only for pregnant women

Out of all the states with Medicaid smoking cessation coverage, only 5 covered all the suggested pharmacotherapies as well as individual and group counseling for all Medicaid recipients. These are Indiana, Massachusetts, Minnesota, Montana and Pennsylvania.

4 states did not have Medicaid smoking cessation coverage programs at all. These are Connecticut, Georgia, Missouri and Tennessee.

Massachusetts has released a study that evidences how comprehensive tobacco dependency treatment programs are effectively saving lives and money. In 2006, the state of Massachusetts began granting comprehensive smoking cessation programs to their approximately 190,000 Medicaid recipients who smoked. The study showed the dramatic effects of the program, where in after only 2 years, 26 percent of these smokers (33,000 Medicaid recipients) quit smoking. Furthermore, as a result of this, a remarkable decline in the use of other costly medical care services was observed.

In all, Massachusetts perceived a:

  • 38 percent decrease in hospitalizations for heart attacks
  • 17 percent decrease in ER and clinic visits due to asthma
  • 17 percent decrease in claims for adverse maternal birth complications including pre-term labor

It can be safely stated that cost-conscious states would benefit more from spending money on comprehensive smoking cessation coverage for Medicaid recipients. As evidenced by the decrease in spending from health care services related to smoking, it is money well-spent in exchange for the opportunity to improve health, save lives and in the end, save millions of dollars in healthcare costs.