State Medicaid Coverage for Tobacco-Dependence Treatments—United States, 1994–2001

May 30, 2003 / Vol. 52 / No. 21

MMWR Highlights

Need for Tobacco-Dependence Treatment Among Medicaid Enrollees

• Because rates of smoking are highest among people living in poverty, the negative health effects of tobacco use are of major concern for State Medicaid programs.
• Medicaid recipients have approximately 50% greater smoking prevalence than the overall U.S. population.
• In 2000, approximately 11.5 million (36%) adult Medicaid recipients smoked cigarettes.

Extent of Coverage for Tobacco-Use Treatments In State Medicaid Programs

• In 2001, 15 states offered no coverage for tobacco-dependence treatment under Medicaid, and only Oregon provided coverage for all treatment options recommended by the PHS Clinical Practice Guideline.
• The number of Medicaid programs providing some coverage for counseling or medication increased from 34 (67%) in 2000 to 36 (71%) in 2001.
• In 2001, only 10 states offered some form of tobacco-dependence counseling services, the primary recommendation for pregnant women.
• Only 12 (33%) state Medicaid programs that provided coverage for tobacco-dependence treatment benefits informed their recipients that these benefits were available to them.
• Of the 36 states that offered any coverage in 2001, all but one covered at least one pharmacotherapy treatment (i.e., Zyban®, Wellbutrin®, bupropion sustained release, nicotine nasal spray, nicotine inhaler, nicotine patch, or nicotine gum).
• Data show that co-payments result in decreased use of treatment; however, 16 states required some form of patient cost sharing, that ranged from $0.50 to $3.00 per prescription.
• According to the Public Health Service (PHS) Clinical Practice Guideline, Treating Tobacco Use and Dependence, treatment with either counseling or medication doubles quit rates.
• The Guide to Community Preventive Services recommends reducing the cost of tobacco-dependence treatments, especially in low-income populations, to increase the use of treatment by smokers attempting to quit and the number of successful quitters.