State Medicaid Programs Can and Must Do More to Help Smokers Quit

While state efforts to help Medicaid enrollees quit smoking improved from 2014 to 2015, a new report co-authored by the American Lung Association and the U.S. Centers for Disease Control and Prevention (CDC) in today’s Morbidity and Mortality Weekly Report finds that Medicaid cessation coverage continues to fall substantially short.

The new “State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Coverage—United States, 2014-2015” report finds that coverage across the country continues to fall substantially short of the Healthy People 2020 goal of comprehensive coverage in all 50 states and the District of Columbia. Meanwhile, almost 6 million Medicaid enrollees continue to smoke cigarettes, with the smoking rate for Medicaid enrollees twice as high as that of privately insured Americans. This is a costly pattern as smoking-related diseases accounted for more than 15 percent of annual Medicaid spending from 2006–2010, amounting to more than $39 billion per year.

“Tobacco use kills close to half a million people each year. While progress is being made in Medicaid coverage of cessation treatment, it’s too little, too slowly,” said Harold P. Wimmer, President and CEO of the American Lung Association. “Quitting smoking is hard, and many people need help from counselors, peers or even medications. Most states are missing a crucial opportunity to save lives and money by not providing this help through Medicaid.”

To monitor the most recent trends in state Medicaid cessation coverage, the American Lung Association collected data on coverage of nine of the evidence-based cessation treatments [seven U.S. Food and Drug Administration (FDA)-approved medications (including nicotine replacement therapies like the patch and gum) and individual and group counseling] by state Medicaid programs, as well as data on barriers to accessing these treatments from January 31, 2014 through June 30, 2015. Findings include:

• As of June 30, 2015, all 50 states covered some cessation treatments for at least some Medicaid enrollees.
• From 2014–2015, some states did show improvement. Increases were observed in the number of states covering individual counseling (from 27 to 31 states), group counseling (from 7 to 10 states) and all seven FDA-approved cessation medications (from 26 to 30 states) for all Medicaid enrollees.
• However, only nine states covered all nine treatments for all enrollees, up from six states in 2014.
• Common barriers to accessing covered treatments for Medicaid enrollees included prior authorization requirements (39 states for at least some populations or plans), limits on treatment duration (38 states), annual limits on quit attempts (36 states) and required copayments (34 states).

“It is extremely concerning that so many states still charge low-income Medicaid enrollees copays for the help they need to quit tobacco,” Wimmer said. “The Affordable Care Act doesn’t allow copays on preventive services in most private health insurance plans for higher-income individuals. States need to step up and correct this inequity – making it easier for Medicaid enrollees to quit smoking will save lives and taxpayer dollars.”

According to the report, state Medicaid programs can maximize tobacco cessation among Medicaid enrollees by covering all evidence-based cessation treatments, removing barriers that impede access to these treatments, promoting their coverage to Medicaid tobacco users and health-care providers, and monitoring use of covered treatments.

For media interested in speaking with an expert about the new report or lung health, tobacco use and tobacco policies and cessation coverage, contact the American Lung Association at [email protected] or 312-801-7628.