State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Coverage United States, 2008–2014

March 28, 2014 / Vol. 63 / No. 12

MMWR Introduction

Medicaid enrollees have a higher smoking prevalence than the general population, and smoking-related disease is a major contributor to increasing Medicaid costs. The evidence suggests that states could reduce smoking-related morbidity, mortality, and health care costs among Medicaid enrollees by providing Medicaid coverage for all evidence-based cessation treatments, removing all barriers to access these treatments, promoting cessation coverage, and monitoring treatment use.

To monitor trends in state Medicaid cessation coverage, the American Lung Association collected data on coverage of evidence-based cessation methods for nine treatments, except telephone counseling, by state Medicaid programs, as well as data on barriers to access these treatments from December 31, 2008 to January 31, 2014. As of 2014, all 50 states and the District of Columbia offer cessation treatments for at least some Medicaid enrollees. Common barriers in 2014 included duration limits, prior authorization, annual limits, and co-payments.

Insurance coverage of evidence-based cessation treatments leads to increases in quit attempts, use of cessation treatments, and successful smoking cessation. Provisions in coverage such as co-payments, prior authorization, and limitations on the number and duration of treatments pose barriers for people to access cessation treatments and reduce treatment use and cessation rates. These provisions are commonly used by private and public health insurers, often to limit use of benefits because of overuse and cost concerns., but removing these barriers increases use of these treatments and cessation rates.