State Medicaid Coverage for Tobacco-Dependence Treatments—United States, 2005

One of the national health objectives for 2010 is to increase insurance coverage of evidence-based treatments for tobacco dependence in all 51 Medicaid programs.
In 2004, 29% of adult Medicaid recipients smoked cigarettes.
Because Medicaid recipients have approximately 38% greater smoking prevalence than the overall U.S. adult population, they are disproportionately affected by tobacco-related disease and disability.
According to the Public Health Service (PHS) Clinical Practice Guideline: Treating Tobacco Use and Dependence, treatment with either counseling or medication doubles quit rates.
State Medicaid programs are encouraged to cover all PHS guideline recommended treatments, cover two courses of treatment per year, eliminate or minimize co-pays, and promote the benefit to recipients in order to reduce the adverse health effects in this high-risk population and to reduce Medicaid costs.

In 2005, 41 states and the District of Columbia offered some Medicaid coverage for tobacco-dependence treatment including cessation counseling and/or pharmacotherapy, while 9 states offered none.
Of the 41 states and District of Columbia that provided Medicaid coverage for tobacco-dependence treatment, 38 offered at least one form of treatment for all Medicaid recipients, while 4 offered coverage for pregnant women only.
The number of states providing all Medicaid recipients with coverage for tobacco-dependence counseling or medication increased from 37 (73%) in 2003 to 38 (75%) in 2005.
In 2005, only one state (Oregon) provided coverage for all treatment options recommended by the PHS Clinical Practice Guideline.
All 38 states that offered tobacco-dependence coverage to their entire Medicaid population covered at least one medication treatment (i.e., Zyban®, nicotine nasal spray, nicotine inhaler, nicotine patch, or nicotine gum). Only 14 states also offered cessation counseling services to all recipients, and 12 additional states offered cessation counseling services only for pregnant women.
Research shows that co-payments result in decreased use of treatment; however, in 2005, 25 (66%) states required some form of patient cost sharing, which ranged from $.50 to $4.00 per prescription.