CDC: States Drag on Medicaid Coverage for Quitting Tobacco

Smoking-related health costs account for 11 percent of all Medicaid costs, but states offer only patchy support for tobacco cessation therapies, MedPage Today reported Oct. 22. 

Research conducted by the University of California at Berkeley for the Centers for Disease Control and Prevention (CDC) in all 50 states and the District of Columbia showed that 47, or 92 percent, had at least some coverage for tobacco cessation for those enrolled in Medicaid. 

Only five states – Indiana, Massachusetts, Minnesota, Montana, and Pennsylvania — covered counseling and all medications for all enrollees without restriction. All remaining states and the District of Columbia limited types of coverage for quitting tobacco or restricted coverage to certain populations. Connecticut, Georgia, Missouri, and Tennessee offered no coverage at all.

The authors of the report said that state coverage had improved since 2007, but noted that by excluding participants, most were missing out on big cost savings. Smoking rates are nearly twice as high among Medicaid enrollees as in the general population (37 percent vs. 21 percent), and tobacco cessation treatments have been shown to improve public health and  reduce costs.

“In Massachusetts, for example,” the authors wrote, “a mandate for Medicaid coverage of tobacco-dependence cessation treatments was associated with a 26% decline in smoking rates among Medicaid enrollees.”

Medicaid programs from state to state paid for different combinations of cessation medications and individual or group counseling. Researchers found various eligibility factors, from pregnancy to whether plan participants were enrolled in a fee-for-service program or in a managed care program. 

The variation was considerable. Oregon, for example, covered all medications and group and individual counseling, so long as participants were in its fee-for-service plan. Alabama, however, covered nothing except for individual counseling for pregnant women.

Researchers stated that changes are coming. Under the Affordable Care Act, all pregnant women enrolled in Medicaid must have access to tobacco-dependence treatment as of Oct. 1. Also, states that offer federally recommended tobacco cessation treatments without requiring a co-pay will qualify for higher reimbursements from Medicaid after Jan. 1, 2013.  Finally, states will no longer be able to exclude tobacco-cessation drugs from Medicaid benefits after January 2014.

Authors of the study noted that it had methodological limitations. Contracts from managed care organizations and written documentation of state Medicaid policies were not obtained in all cases, allowing some room for error. Also, it is possible the number of tobacco cessation programs may have been underreported because some managed care organizations offered them even when their state Medicaid contract did not require it.

The study, “State Medicaid Coverage for Tobacco-Dependence Treatments — United States, 2009,” appeared online in the Oct. 22, 2010 issue of Morbidity and Mortality Weekly.