State Medicaid Expansion Cessation Coverage and Number of Adult Smokers Enrolled in Expansion Coverage—United States, 2016

December 9, 2016 / Vol. 65 / No. 48

MMWR Introduction

In 2015, 27.8% of adult Medicaid enrollees were current cigarette smokers, compared with 11.1% of adults with private health insurance, placing them at greater risk for smoking-related disease and death. Individual, group, and telephone counseling and seven Food and Drug Administration (FDA)-approved medications are effective treatments for helping tobacco users quit. State Medicaid coverage of cessation treatments has not been reported among the newly eligible Medicaid expansion population in the 32 states (including the District of Columbia) that had expanded Medicaid eligibility through the Patient Protection and Affordable Care Act (ACA) as of July 1, 2016. These states elected to expand coverage to a new eligibility group of adults younger than 65 years.

As of December 2015, about 3.3 million adult smokers were enrolled in Medicaid expansion coverage nationally, including about 2.3 million who were newly eligible for Medicaid expansion. As of July 1, 2016, all of the 32 states that have expanded Medicaid eligibility covered some cessation treatments for all Medicaid expansion enrollees, with nine states covering all nine cessation treatments for all enrollees. All 32 states with Medicaid expansion imposed one or more barriers on at least one cessation treatment for at least some enrollees.

The 32 states that have expanded Medicaid eligibility under the ACA are providing Medicaid cessation coverage to 2.3 million adult smokers who were not previously eligible. These states can take a further step towards helping these and other smokers with Medicaid coverage quit by covering cessation treatments, removing barriers to accessing these treatments, promoting coverage, and monitoring use of covered treatments. State Medicaid programs that take these actions can substantially reduce tobacco use and tobacco-related disease and health care costs among a vulnerable population. Opportunities exist for the 19 states that have not expanded Medicaid eligibility to reduce smoking among low-income adults by making their cessation coverage more broadly available.

MMWR Highlights

Total adult smokers and newly eligible adult smokers enrolled in Medicaid expansion coverage, by state.

  • The number of adult smokers enrolled in Medicaid expansion coverage ranged from 2,567 in Alaska to 618,395 in New York.
  • The number of newly eligible adult smokers enrolled in this coverage ranged from 2,567 in Alaska to 291,351 in Pennsylvania.

Medicaid expansion coverage of tobacco cessation counseling treatments and medications by state.

  • Of the 32 states that had expanded Medicaid eligibility through the ACA by July 31, 2016
    • Nine covered all nine cessation treatments for all Medicaid expansion enrollees (Colorado, Connecticut, Indiana, Massachusetts, Minnesota, North Dakota, Ohio, Pennsylvania, and Vermont).
    • Seventeen covered individual counseling for all enrollees.
    • Eleven covered group counseling for all enrollees.
    • Nineteen covered all seven FDA-approved cessation medications for all enrollees.

Barriers to Medicaid expansion coverage of tobacco cessation treatments by state.

  • Of the 32 states that had expanded Medicaid eligibility through the ACA by July 31, 2016
    • Six required copayments for all enrollees to obtain at least one cessation treatment, with an additional seven requiring copayments for some enrollees.
    • Twelve required prior authorization for all enrollees to obtain at least one cessation treatment, with an additional 14 requiring prior authorization for some enrollees.
Page last reviewed: March 9, 2018 (archived document)