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Medicaid Coverage of Tobacco Cessation Services

July 28, 2011: Cessation: Emerging Interventions and Innovations

Jerry Zelinger, M.D., Medical Advisor and Technical Director, Division of Benefits and Coverage, Disabled and Elderly Health Programs Group, Centers for Medicare and Medicaid Services

Dr. Zelinger began by providing an overview of Medicaid and the populations served: disabled, aged, blind, pregnant women, children, single parents and other caretakers and beginning in 2014, childless adults. This is a joint federal/state entitlement program, and states have considerable discretion and control over their programs. Currently, tobacco cessation services for pregnant women are included in the mandatory service category. In the optional service category, preventive services—including tobacco cessation treatment—is included and states can decide whether and to what extent these services will be covered. In addition, tobacco cessation quitlines are currently considered an allowable Medicaid administrative activity. A recent addition to coverage includes face-to-face tobacco cessation counseling which is mandatory when provided to pregnant women and can be delivered by any health professional that is enrolled in Medicaid as a provider of services. This coverage for face-to-face counseling is optional when provided to non-pregnant individuals as a preventive service under the supervision of a physician or another licensed practitioner authorized to provide such counseling. Furthermore, states can now opt to cover quitline counseling and cessation drugs (prescription and OTC) as an allowable administrative activity (although OTCs provided through quitlines are not covered). In 2014, coverage of tobacco cessation prescription drugs will be mandatory for all Medicaid beneficiaries.

At the conclusion of the panel's presentations, Dr. Riley invited comments and questions from the Committee.

Ms. Wohr was congratulated on the good work being undertaken by the Indian Health Service although tax evasion is still a very big concern and certainly affects the ability to reduce rates of smoking among tribal populations. Ms. Wohr responded that there are tribes such as the Navajo Nation that are making some progress around both tax and smoke-free policy.

Several Committee members commented on the link between alcohol and smoking and the challenge of helping people address both addictions simultaneously.

Mr. Tipperman was asked whether there was a plan to expand beyond SAMHSA's "100 Pioneers" and he responded that there was indeed a big interest in moving beyond the original applicants but that this was a good starting point.

In response to a question about the variance between Medicare and Medicaid coverage of over-the-counter tobacco dependence medication, the response was that this was related to Congressional decision-making but not necessarily with any specific rationale.

Following questions and comments, the Committee took a ten minute break and reconvened at 2:45 p.m.

Surgeon General Benjamin introduced Dr. Tim McAfee, Director of the CDC's Office on Smoking at Health to moderate the final afternoon panel.

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