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Morbidity and Mortality Weekly Reports (MMWRs)

State Medicaid Coverage for Tobacco Dependence Treatments—United States, 1998 and 2000

November 9, 2001 / Vol. 50 / No. 44


MMWR Highlights

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%) 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% 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.
 
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