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Providing tobacco users access to evidence-based tobacco dependence treatments can reduce morbidity and mortality from cancers and other diseases caused by tobacco use. Low-income Americans are more likely than other Americans to be addicted to tobacco products. Beginning October 1, 2010, state Medicaid programs must fully cover tobacco cessation services (both counseling and pharmacotherapy) for pregnant women as part of the Affordable Care Act (section 4107). However, expansion of coverage to more treatments, expansion of the groups eligible for treatment, and a reduction of barriers to accessing treatment is needed.
Number of states that report providing coverage under Medicaid for any evidence-based tobacco dependence treatment (pharmacotherapy or counseling), either to their entire Medicaid population or to pregnant women only.
Trends – State Medicaid programs have steadily increased their coverage of tobacco dependence treatments over time. They have also expanded the number of treatments for which coverage is provided, over time.
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In 2010, all 51 Medicaid programs provided coverage for at least one tobacco-dependence treatment for at least some segment of their Medicaid eligible population. Data from 2009 revealed that only 8 Medicaid programs offered coverage of all medications and some form of counseling for all Medicaid enrollees. Twelve Medicaid programs added or expanded coverage between 2007 and 2009.
There is no Healthy People target for Medicaid coverage of tobacco dependence treatments.
Approximately one-half of all long-term smokers, especially those who began smoking as teenagers, will die prematurely from a disease caused by smoking. Quitting smoking as early in life as possible is the only proven way to reduce the enormous health risk incurred by smoking. Smoking is more common among Americans of low socio-economic status, and smoking contributes significantly to health disparities. In addition, the proportion of adult smokers is significantly higher among Medicaid recipients than among the general population; in 2008, 37 percent of Medicaid enrollees reported being current smokers (compared to 18 percent with private health insurance and 33 percent who were uninsured). This highlights the importance of providing tobacco dependence treatment to Medicaid recipients in all states.
Tobacco-dependence treatment is highly cost-effective. Effective tobacco dependence treatments include both medication and counseling. In addition, many states employ measures that limit access such as co-payments and limitations on number of treatment courses. Some states also require prior authorization or require that individuals enroll in a behavioral modification program to gain coverage for pharmacotherapy. In 2009, only five states reported policies that require coverage of all recommended pharmacotherapies and individual and group counseling for all Medicaid enrollees. Effective on October 1, 2010, all state Medicaid programs were required to fully cover tobacco cessation services for pregnant women as part of the Affordable Care Act (section 4107). Coverage of pharmacotherapy for all Medicaid enrollees will be enhanced by January 2014, when tobacco dependence cessation drugs will no longer be excluded from covered benefits.
Enhanced access to tobacco dependence treatment among the Medicaid population will help more low-income tobacco users quit and will contribute to reducing cancer deaths and cancer-related health disparities in this population.