Medicaid Tobacco Cessation: Big Gaps Remain In Efforts To Get Smokers To Quit

Abstract

Medicaid enrollees are about twice as likely as the general US population to smoke tobacco: 32 percent of people in the program identify themselves as smokers. This article provides the first data about the effectiveness of state Medicaid programs in promoting smoking cessation. Our analysis of Medicaid enrollees’ use of cessation medications found that about 10 percent of current smokers received cessation medications in 2013. Every state Medicaid program covers cessation benefits, but the use of these medications varies widely, with the rate in Minnesota being thirty times higher than that in Texas. Most states could increase their efforts to help smokers quit, working with public health agencies, managed care plans, and others. In 2013 Medicaid spent $103 million on cessation medications—less than 0.25 percent of the estimated cost to Medicaid of smoking-related diseases. Additionally, states that have not expanded Medicaid eligibility in the wake of the Affordable Care Act have higher smoking prevalence and lower utilization rates of cessation medication, compared to expansion states. Given these factors, nonexpansion states will have a greater public health burden related to smoking. Medicaid and public health agencies should work together to make smoking cessation a priority for Medicaid beneficiaries.

State Medicaid Expansion Tobacco Cessation Coverage and Number of Adult Smokers Enrolled in Expansion Coverage — United States, 2016

“…Communicating to smokers and health care providers that cessation treatments are covered is also important to ensure that they are aware of and use covered treatments (5,7). A recent study found that only approximately 10% of Medicaid enrollees who smoked received a prescription for a tobacco cessation medication in 2013, with wide variation in use of cessation medications across states (10). Medicaid cessation coverage has the greatest effect when it is available to large numbers of smokers and is widely used (5,7).…”

The effectiveness of tobacco control policies on vulnerable populations in the USA: a review

“…Healthcare costs from smoking-related chronic diseases place a huge burden on Medicaid, the largest public health insurance programme in the USA 119 120. An estimated 15% of all Medicaid expenditures, or $10 billion annually, are attributable to smoking 119 121.…”

“…In 2013, only 10% of Medicaid enrolees who were smokers had received cessation medications, and most states spent significantly less on cessation medications in comparison with the estimated cost to Medicaid from smoking-related diseases 120. Disparities in smoking prevalence and use of state Medicaid cessation resources were greatest among non-expansion Medicaid states (19 states have not adopted the ACA Medicaid expansion) compared with those that expanded Medicaid eligibility 120…”

Capsule Commentary on Bailey et al., Effect of Gaining Insurance Coverage on Smoking Cessation in Community Health Centers: A Cohort Study

“…Primary care providers have consistently under performed in providing tobacco cessation services despite evidence-based guidelines. 3 As Bailey and colleagues point out, this higher rate of prescriptions does not fully explain their results, particularly since the trend toward higher quit rates occurred even among patients in which no cessation medication was ordered. 2 One possibility is referral to smoking cessation counseling, a variable not captured in this study.…”