State Medicaid Coverage for Tobacco-Dependence Treatments—United States, 1994–2002

January 30, 2004 / Vol. 53 / No. 3

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 2002, 11 (22%) states offered no coverage for tobacco-dependence treatment under Medicaid, and only New Jersey and 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 37 (73%) in 2001 to 40 (78%) in 2002.
• In 2002, only 16 (31%) states offered some form of tobacco-dependence counseling services, the primary recommendation for pregnant women.
• Only 11 (28%) state Medicaid programs that provided coverage for tobacco-dependence treatment benefits informed their recipients that these benefits were available to them.
• Of the 40 states that offered any coverage in 2002, all but one covered at least one pharmacotherapy treatment (i.e., Zyban®, nicotine nasal spray, nicotine inhaler, nicotine patch, or nicotine gum).
• Data show that co-payments result in decreased use of treatment; however, 20 (57%) states required some form of patient cost sharing, which ranged from $1 to $3 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.