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State Medicaid Coverage for Tobacco Dependence Treatments
— United States, 1998 and 2000
MMWR Highlights
November 9, 2001 / Vol. 50 / No. 44
The Problem and Potential of Quitting Smoking Among Medicaid Enrollees
- More than 32 million low-income Americans received their health
insurance coverage through the Federal-State Medicaid program in 2000,
and 11.5 million of these enrollees (36 percent) smoked cigarettes.
- Medicaid recipients are disproportionately affected by tobacco use and
tobacco-related disease and disability. Medicaid recipients have a
smoking prevalence of 50% greater than the overall population.
- Treatment with either counseling or medication doubles quit rates
according to the Public Health Service Guideline.
- A major barrier to using treatment for low-income smokers is lack of
access to effective treatment. Reducing out-of-pocket costs of
treatment, such as through insurance coverage, increases access and
potentially increases successful quitting.
- The total cost of smoking to Medicaid in 1997 was estimated to be more
than $17 billion or 12 percent of all Medicaid expenditures.
Extent of Coverage for Tobacco-Use Treatments In State Medicaid Programs
- In 2000, 17 states offered no coverage for tobacco-use treatments
under Medicaid
- In 1998, 24 states and the District of Columbia offered limited
coverage for tobacco dependence treatments. Only one state, Oregon,
offered coverage for all tobacco use treatments recommended by the
Public Health Service (PHS) Clinical Practice Guideline: Treating
Tobacco Use and Dependence.
- In 2000, nine additional states began offering limited coverage for
tobacco dependence treatments but still only Oregon offered
comprehensive coverage.
- In 2000, state Medicaid programs were more likely to offer some
limited coverage for pharmacotherapy such as nicotine replacement gum,
nicotine patches, nasal sprays and inhalers, and bupropion SR (Zyban
®).
- 31 Medicaid programs covered prescription drugs for tobacco dependence
while 23 programs covered over-the-counter medications. Only 10 states
offered coverage for all recommended medications.
- 13 states offered coverage for some form of counseling.
- 13 states offered special tobacco dependence treatment programs for
pregnant women.
- Smoking is a major cause of low-birthweight babies. Counseling is the
primary treatment for smoking cessation in pregnant women. The fact that
counseling is covered in only 13 states means that the primary treatment
for tobacco dependence is not available to many pregnant Medicaid
enrollees.
State Medicaid Coverage for Tobacco
Dependence Treatments — United States, 1998 and 2000 50(44)
November 9, 2001
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