Medicaid Coverage for Smoking Cessation Improves, but Barriers Remain, CDC Finds

More states cover all recommended evidence-based treatments, although many require copayments or put annual limits on care.

Those in Medicaid have smoking rates twice that of Americans with private insurance—30.4% compared with 14.7%. So, if state governments want to cut healthcare costs related to smoking, it would make sense to help people in Medicaid quit, right?

It’s not as obvious as it should be, according to results from CDC and the American Lung Association, which looked what Medicaid coverage states offer to help people kick the habit. However, the findings, which appeared in today’s Mortality and Morbidity Weekly Report, did find some good news.

The analysis featured a 50-state breakdown of 9 types of evidence-based cessation treatments, except for telephone counseling. As of June 30, 2015, all 50 states had some coverage for Medicaid enrollees, and during 2014-2015 several states approved increases.

However, only 9 states covered all 9 treatments for all enrollees, and barriers are common. These include prior authorization, limits on duration of treatment, annual limits on quit attempts, and copayments. According to the authors, research shows that Medicaid could boost quit rates and reduce smoking-related healthcare costs by removing these barriers, and by doing more to let Medicaid enrollees know that they can get help quitting.

The 9 types of coverage evaluated in the report are: individual counseling, group counseling, nicotine gum, nicotine patches, nicotine lozenge, nicotine nasal spray, nicotine inhaler, bupropion, and varenicline.

Bright spots. The 9 states that cover all treatments are Connecticut, Indiana, Maine, Massachusetts, Minnesota, North Dakota, Ohio, Pennsylvania, and Vermont (Maine, North Dakota and Ohio joined the list from 2014).

As of June 2015, 31 states covered individual counseling in all plans, up from 27 states. Ten states covered group counseling, up from 7 states in 2014. Also, 30 states covered all 7 FDA-approved cessation medications, an increase of 4 states. Most states require prior authorization to get coverage (39 states), have limits on how long coverage lasts (38 states), limits on how many quit attempts can be made each year (36 states), or copayments (34 states).

What the ACA Says. As of January 2014, the Affordable Care Act required state Medicaid programs to include FDA approved medications that aid smoking cessation. Some states have improved coverage of medication in the past year. However, there remain states that have not expanded Medicaid to those earning up to 138% of the federal poverty line, so persons in these states who fall into the “coverage gap” would lack access to medication.

Reference

Singleterry J, Jump Z, DiGuilio A, et al. State Medicaid coverage for tobacco cessation treatments and barriers to coverage—United States, 2014-2015. MMWR. 2015;64(42):1194-1199.