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State Medicaid Coverage for Tobacco Dependence Treatments — United States, 1998 and 2000
November 9, 2001 / Vol. 50 / No. 44
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The
Guide
to
Community
Preventive
Services
(1)
recommends
reducing
the
cost
of
tobacco-dependence
treatments
because
these
interventions
increase
both
the
use
of
treatment
by
smokers
during
attempts
to
stop
smoking
and
the
number
of
smokers
who
actually
stop.
The
Public
Health
Service
(PHS)
Clinical
Practice
Guideline
(2)
supports
insurance
coverage
for
tobacco-dependence
treatment
(i.e.,
individual,
group,
and
telephone
counseling,
and
Food
and
Drug
Administration-approved
pharmacotherapy)
(2).
One
of
the
2010
national
health
objectives
(3)
is
to
provide
coverage
in
the
50
states
and
District
of
Columbia
(DC)
for
nicotine-dependence
treatment
by
Medicaid
(objective
27.8b)
(3).
In
2000,
approximately
32
million
low-income
persons
in
the
United
States
received
their
health
insurance
coverage
through
the
federal-state
Medicaid
program
(4);
approximately
11.5
million
(36%)
of
these
persons
smoked
(CDC,
unpublished
data,
2000).
Medicaid
recipients
have
approximately
50%
greater
smoking
prevalence
than
the
overall
U.S.
population.
To
assess
the
amount
and
type
of
coverage
for
tobacco
dependence
offered
by
Medicaid,
the
Center
for
Health
and
Public
Policy
Studies
at
the
University
of
California,
Berkeley,
conducted
state
surveys
in
1998
and
2000.
In
1998,
24
states
and
DC
offered
some
coverage
for
tobacco-dependence
treatment;
in
2000,
nine
started
offering
some
coverage.
In
1998
and
2000,
one
state
offered
coverage
for
all
the
counseling
and
pharmacotherapy
treatments
recommended
by
PHS.
These
findings
indicate
that
states
can
reduce
smoking
prevalence
among
Medicaid
recipients
by
implementing
more
extensive
Medicaid
coverage
for
treatment
of
tobacco
dependence.
To
obtain
and
update
information
on
Medicaid
coverage
of
specific
tobacco-dependence
treatments,
a
survey
was
faxed
to
the
50
states
and
DC
Medicaid
programs
during
1998
and
2000.
State
Medicaid
program
directors
were
asked
to
identify
staff
members
most
knowledgeable
about
tobacco-dependence
treatment
coverage
and
programs.
A
10-page
survey
was
faxed
to
the
identified
staff
member
in
each
state.
Additional
follow-up
was
conducted;
the
final
response
rate
in
both
1998
and
2000
was
100%.
The
survey
included
26
questions
about
coverage
of
tobacco-dependence
treatments,
awareness
of
clinical
practice
guidelines
for
treatment
of
tobacco
dependence,
and
state
activities
to
document
and
support
providers
and
health
plans
in
delivering
tobacco-dependence
treatment
services
to
Medicaid
recipients.
The
only
difference
in
the
two
surveys
was
that
on
the
2000
survey
form,
a
question
was
asked
about
bupropion,
the
generic
name
for
Wellbutrin®
and
Zyban®
(GlaxoSmithKline,
Research
Triangle
Park,
North
Carolina).
To
validate
state
Medicaid
program
responses
to
survey
questions,
all
reporting
areas
were
asked
to
submit
a
written
copy
of
their
coverage
policies
for
tobacco-dependence
treatment.
Of
the
34
Medicaid
programs
that
reported
offering
coverage
in
2000,
39
states
and
DC
(91%)
provided
supporting
documentation;
11
noted
that
pharmacotherapy
was
covered
under
standard
drug
benefits;
three
states
(9%)
did
not
provide
a
coverage
policy
statement.
In
2000,
a
total
of
33
states
and
DC
offered
some
coverage
for
tobacco-dependence
treatments;
one
state
offered
coverage
for
all
treatments
recommended
by
PHS.
In
2000,
some
pharmacotherapy
coverage
was
offered
by
31
states,
an
increase
of
35%
from
1998.
Sixteen
states
offered
coverage
for
all
recommended
pharmacotherapy
treatments
in
2000.
In
1998,
a
total
of
23
states
offered
some
coverage
for
prescription
drugs
and
17
for
over-the-counter
drugs;
in
2000,
a
total
of
31
states
offered
coverage
for
prescription
drugs
and
23
for
over-the-counter
drugs.
In
2000,
a
total
of
13
states
offered
special
tobacco-dependence
treatment
programs
for
pregnant
women;
in
two
states,
counseling
services
were
covered
for
pregnant
women
only.
In
2000,
two
states
covered
some
form
of
counseling
services
without
coverage
for
any
drug
treatments.
During
1998--2000,
one
state
dropped
Medicaid
coverage
for
bupropion
and
one
state
stopped
Medicaid
coverage
for
counseling.
In
2000,
a
total
of
11
states
covered
at
least
one
type
of
pharmacotherapy
and
one
type
of
counseling.
In
2000,
a
total
of
17
state
Medicaid
programs
reported
no
coverage
for
tobacco-dependence
treatments
(Table
1).
Reported
by:
HH
Schauffler,
PhD,
J
Mordavsky,
MPH,
Univ
of
California-Berkeley
School
of
Public
Health,
Berkeley;
D
Barker,
MHS,
Barker
Bi-Coastal
Health,
Calabasas,
California.
CT
Orleans,
PhD,
Robert
Wood
Johnson
Foundation,
Princeton,
New
Jersey.
Epidemiology
Br,
Office
on
Smoking
and
Health,
National
Center
for
Chronic
Disease
Prevention
and
Health
Promotion,
CDC.
Editorial
Note:
Coverage
of
tobacco-use
treatment
under
Medicaid
remains
low
despite
available
and
effective
treatments
for
tobacco
dependence
(2)
and
evidence
that
decreasing
the
cost
of
treatment
increases
successful
cessation
(1).
Two
major
barriers
to
using
treatment
for
low-income
smokers
are
the
lack
of
access
to
and
cost
of
effective
treatment
(5).
In
2000,
a
total
of
17
states
offered
no
coverage
for
tobacco-use
treatment
and
only
Oregon
provided
coverage
for
all
cessation
interventions
recommended
by
PHS.
Strategies
to
increase
access
include
incorporating
tobacco-use
treatment
into
routine
health-care
visits,
and
offering
coverage
of
treatment
costs
and
access
to
telephone
quit
lines
(1).
Tobacco-use
treatment
is
one
of
the
most
cost-effective
prevention
services
(2,6,7).
Based
on
disease
impact,
intervention
effectiveness,
and
cost
effectiveness,
a
recent
study
ranked
tobacco-use
treatment
second
(after
childhood
vaccination)
among
30
prevention
services
recommended
by
the
Guide
to
Clinical
Preventive
Services.
Because
the
current
provision
of
service
is
low,
tobacco-use
treatment
was
also
the
service
that
had
the
potential
for
the
greatest
improvement
(8).
The
findings
in
this
report
are
subject
to
at
least
one
limitation.
The
data
were
self-reported.
Among
the
34
Medicaid
programs
reporting
coverage
in
2000,
three
could
not
document
coverage.
The
absence
of
written
policy
increases
the
likelihood
of
reporting
errors.
These
results
might
differ
from
other
ratings
of
coverage
as
the
result
of
interpretations
of
unwritten
policies.
Tobacco
use
is
the
leading
preventable
cause
of
death
in
the
United
States
(9).
Because
smoking
prevalence
is
high
among
Medicaid
recipients,
they
are
affected
disproportionately
by
tobacco
and
tobacco-related
disease
and
disability.
CDC
supports
efforts
to
assist
state
Medicaid
programs
in
meeting
the
PHS
and
Community
Preventive
Services
Task
Force
recommendations
and
the
national
health
objective
for
tobacco-dependence
treatment
coverage.
Substantial
action
to
improve
coverage
will
be
needed
if
the
United
States
is
to
reach
the
2010
national
health
objective
to
reduce
from
24%
in
1998
to
12%
the
prevalence
of
current
cigarette
smoking
among
persons
aged
>18
years.
States
are
encouraged
to
cover
all
recommended
pharmacotherapy
and
counseling
for
Medicaid
populations.
References
- Hopkins
DP,
Briss
PA,
Ricard
CJ,
et
al.
Reviews
of
evidence
regarding
interventions
to
reduce
tobacco
use
and
exposure
to
environmental
tobacco
smoke.
Am
J
Prev
Med
2001;20:
16S—66S.
- Fiore
MC,
Bailey
WC,
Cohen
SJ,
et
al.
Treating
tobacco
use
and
dependence,
clinical
practice
guideline.
Rockville,
Maryland:
US
Department
of
Health
and
Human
Services,
Public
Health
Service,
2000.
- US
Department
of
Health
and
Human
Services.
Healthy
people
2010
(2nd
ed.,
2
vols).
Washington,
DC:
US
Department
of
Health
and
Human
Services,
November
2000.
- Kaiser
Family
Foundation
Medicaid
enrollment:
Kaiser
Commission
on
Medicaid
and
the
uninsured.
Washington,
DC:
Kaiser
Family
Foundation;
October
2000.
- Schauffer
HH,
Parkinson
MD.
Health
insurance
coverage
for
smoking
cessation
services.
Health
Education
Quarterly
1993;20:185—206.
- Cummings
SR,
Rubin
SM,
Oster
G.
The
cost
effectiveness
of
counseling
smokers
to
quit.
JAMA
1989;261:75—9.
- Cromwell
J,
Bartosch
WJ,
Fiore
MC,
Hasselblad
V,
Baker
T.
Costeffectiveness
of
the
clinical
practice
recommendations
in
the
Agency
for
Health
Care
Policy
and
Research
guideline
for
smoking
cessation.
JAMA
1997;278:1759—66.
- Coffield
AB,
Maciosek
MV,
McGinnis
M.
Priorities
among
recommended
clinical
preventive
services.
Am
J
Prev
Med
2001;21:1—9.
- McGinnis
JM,
Foege
WH.
Actual
causes
of
death
in
the
United
States.
JAMA
1993;270:2207—12.
State Medicaid Coverage for Tobacco
Dependence Treatments — United States, 1998 and 2000
50(44)
November 9, 2001
Table 1 - State Medicaid programs
State |
Any Treatment |
Over-the- counter Medication |
Prescription
Medication |
Counseling |
Gum |
Patch |
Any |
Spray |
Inhaler |
Zyban |
Wellbutrin |
Bupropion |
Any |
Group |
Individual |
Phone |
Arizona |
YES§ |
+ |
+ |
–** |
— |
— |
– |
— |
— |
+ |
+ |
+ |
— |
Arkansas |
+ |
— |
— |
+ |
— |
— |
+ |
+ |
— |
— |
— |
— |
— |
California†† |
YES |
YES |
YES |
YES |
YES |
YES |
YES |
+ |
+ |
– |
— |
— |
— |
Colorado†† |
YES |
YES |
YES |
YES |
YES |
YES |
YES |
+ |
+ |
— |
— |
— |
— |
Delaware†† |
YES |
+ |
+ |
YES |
YES |
YES |
YES |
+ |
+ |
— |
— |
— |
— |
District of Columbia |
YES |
— |
— |
YES |
YES |
— |
YES |
+ |
+ |
— |
— |
— |
— |
Florida |
YES |
YES |
YES |
YES |
— |
— |
YES |
— |
— |
— |
— |
— |
— |
Hawaii |
+ |
— |
— |
+ |
+ |
+ |
+ |
+ |
+ |
— |
— |
— |
— |
Illinois†† |
+ |
+ |
+ |
+ |
+ |
+ |
+ |
+ |
+ |
— |
— |
— |
— |
Indiana†† |
+ |
+ |
+ |
+ |
+ |
+ |
+ |
+ |
+ |
+ |
— |
+ |
— |
Kansas |
YES |
— |
+ |
YES |
— |
— |
YES |
+ |
+ |
+ |
+ |
+ |
— |
Louisiana |
YES |
— |
— |
YES |
YES |
YES |
YES |
+ |
+ |
— |
— |
— |
— |
Maine†† |
YES |
YES |
YES |
YES |
YES |
YES |
YES |
+ |
+ |
YES |
YES |
YES |
— |
Maryland |
YES |
— |
— |
YES |
YES |
YES |
YES |
+ |
+ |
X§§ |
X |
X |
— |
Massachusetts |
+ |
— |
— |
— |
— |
— |
— |
— |
— |
+ |
+ |
+ |
— |
Michigan |
YES |
YES |
YES |
+ |
— |
— |
+ |
+ |
— |
— |
— |
— |
—— |
Minnesota†† |
YES |
YES |
YES |
YES |
YES |
YES |
YES |
+ |
+ |
YES |
YES |
YES |
— |
Montana |
YES |
YES |
YES |
YES |
— |
— |
YES |
— |
— |
— |
— |
— |
— |
Nevada†† |
YES |
YES |
YES |
YES |
YES |
YES |
YES |
+ |
+ |
— |
— |
— |
— |
New Hampshire†† |
YES |
YES |
YES |
YES |
YES |
YES |
YES |
+ |
+ |
+ |
+ |
+ |
— |
New Jersey†† |
YES |
+ |
+ |
YES |
YES |
YES |
YES |
+ |
+ |
— |
— |
— |
— |
New Mexico†† |
YES |
YES |
YES |
YES |
YES |
YES |
YES |
+ |
+ |
X |
X |
X |
X |
New York†† |
+ |
+ |
+ |
+ |
+ |
+ |
+ |
+ |
+ |
— |
— |
— |
— |
North Carolina |
YES |
— |
— |
YES |
YES |
YES |
YES |
+ |
+ |
— |
— |
— |
— |
North Dakota |
YES |
YES |
YES |
YES |
— |
— |
YES |
+ |
+ |
— |
— |
— |
— |
Ohio |
YES |
YES |
YES |
YES |
— |
YES |
YES |
+ |
+ |
— |
— |
— |
— |
Oklahoma |
YES |
— |
— |
YES |
— |
— |
YES |
+ |
+ |
— |
— |
— |
— |
Oregon¶¶ |
YES |
YES |
YES |
YES |
YES |
YES |
YES |
+ |
+ |
YES |
YES |
YES |
YES |
Rhode Island |
+ |
— |
— |
— |
— |
— |
— |
— |
— |
+ |
+ |
+ |
— |
Texas†† |
YES |
YES |
YES |
YES |
YES |
YES |
YES |
+ |
+ |
— |
— |
— |
— |
Vermont†† |
YES |
YES |
YES |
YES |
YES |
YES |
YES |
+ |
+ |
— |
— |
— |
— |
Virginia |
+ |
— |
— |
+ |
+ |
+ |
+ |
+ |
+ |
— |
— |
— |
— |
West Virginia†† |
+ |
+ |
+ |
+ |
+ |
+ |
+ |
+ |
+ |
+ |
— |
+ |
+ |
Wisconsin |
YES |
— |
— |
YES |
YES |
YES |
YES |
+ |
+ |
YES |
— |
YES |
— |
No. states in 2000 |
34 |
22 |
23 |
31 |
23 |
23 |
31 |
29 |
27 |
13 |
10 |
11 |
3 |
% states in 2000 |
67% |
43% |
45% |
61% |
45% |
45% |
61% |
57% |
53% |
26% |
20% |
24% |
6% |
*
States
offering
no
coverage
were
Alabama,
Alaska,
Connecticut,
Georgia,
Idaho,
Iowa,
Kentucky,
Mississippi,
Missouri,
Nebraska,
Pennsylvania,
South
Carolina,
South
Dakota,
Tennessee,
Utah,
Washington,
and
Wyoming.
†
Bupropion
question
added
in
2000.
§
Offered
coverage
in
1998
and
2000.
¶
Added
coverage
in
2000.
**
Dropped
coverage
in
2000.
††
Offered
all
pharmacotherapy
recommended
in
Public
Health
Service
Clinical
Practice
Guideline
for
Treating
Tobacco
Use
and
Dependence.
§§
Covered
pregnant
women
only.
Offered
all
treatments. |
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