State Medicaid Programs Not Doing Enough to Help Smokers Quit

Inadequate coverage keeps Medicaid programs from saving lives and money

Washington, D.C. (March 27, 2014)

State efforts to help Medicaid enrollees who smoke fall woefully short of helping smokers quit, according to a study published by the U.S. Centers for Disease Control and Prevention (CDC) in today’s Morbidity and Mortality Weekly Report. The study, which was led by the American Lung Association, also found that states are making it difficult for smokers enrolled in Medicaid to use their quit-smoking benefits.  As a result, most states are missing a crucial opportunity to save lives and money by helping their smokers quit.

The study used data from the American Lung Association’s State Tobacco Cessation Coverage Database, to look at changes in Medicaid cessation (quit-smoking) coverage over a six-year period – from 2008 to 2014.   Key findings include that 33 states acted to increase coverage of tobacco cessation treatments to Medicaid enrollees, however, only seven states currently cover all medications for tobacco cessation and group and individual counseling. 

A comprehensive tobacco cessation benefit includes all seven Food And Drug Administration (FDA)-approved medications for smoking cessation (including prescription and over-the-counter medications) as well as individual, group and phone cessation counseling. All of these treatments have been recommended as effective by the U.S. Public Health Service.

States that made changes to make it easier for their smokers to quit include Alabama, Connecticut, Georgia, Missouri and Tennessee.  Six years ago, these state Medicaid programs did not provide any quit-smoking treatments to all enrollees. As of 2014, those states now cover multiple treatments for smokers on Medicaid who want to quit.  

States Making It More Difficult for Smokers on Medicaid to Quit

The study also found that, during the same time period, 29 states made it more difficult for Medicaid patients to access quit-smoking treatments by creating new barriers. Currently, 40 states limit how long smokers can use quit-smoking treatments, 38 states limit the number of times they can quit with treatment per year, and 36 states require prior authorization for these treatments.  Most troubling is that 35 states still charge a copay for tobacco cessation medications and/or counseling to a group of people that is, by definition, very low income.

“We know Medicaid enrollees smoke at high rates, and quitting is hard,” said Harold Wimmer, National President and CEO of the American Lung Association. “State Medicaid programs must make it as easy as possible for smokers on Medicaid to get the help they need to quit, by covering a comprehensive quit-smoking benefit and making treatment easily accessible.”

The Affordable Care Act expands access to preventive services with no copays, including tobacco cessation treatment, for many Americans – but still allows copays to be charged to the lowest income Americans who are enrolled in Medicaid. Enrollees in “traditional” Medicaid have annual income levels below or around the federal poverty line.

Today’s study also found that Medicaid programs have taken other steps in the last five years to make it more difficult for smokers on Medicaid to get treatment for their addiction. Fifteen states added prior authorization requirements on tobacco cessation treatments, which can delay treatment for patients and may cause potential quitters to lose their motivation. Fourteen states added policies that limit the number of times a smoker can get cessation treatment per year, even though studies show that quitting successfully is a process that often requires multiple attempts.

“States that help smokers on Medicaid quit save lives and see a great financial return on investment,” Wimmer added. “When Massachusetts Medicaid provided easy access to a comprehensive tobacco cessation benefit for all enrollees, a study showed the state saved $3 in healthcare costs for every $1 spent on treatment.”

According to the 32nd Surgeon General’s report on smoking and health released in January, smoking is even more deadly today than it was 50 years ago. Smoking kills 480,000 Americans each year and costs up to $333 billion each year in healthcare costs and lost productivity.  Smoking is responsible for more than 87 percent of all lung cancer deaths and 61 percent of all lung disease deaths, as well as heart disease and stroke.   

The American Lung Association has numerous policy resources on cessation, which can be found at Additional materials about smoking cessation in the Affordable Care Act can be found at


About the American Lung Association
The American Lung Association is the leading organization working to save lives by improving lung health and preventing lung disease, through research, education and advocacy. The work of the American Lung Association is focused on four strategic imperatives: to defeat lung cancer; to improve the air we breathe; to reduce the burden of lung disease on individuals and their families; and to eliminate tobacco use and tobacco-related diseases.  For more information about the American Lung Association, a holder of the Better Business Bureau Wise Giving Guide Seal, or to support the work it does, call 1-800-LUNGUSA (1-800-586-4872) or visit: