Exploring Factors Associated With Full Implementation of the Affordable Care Act's Medicaid Tobacco Cessation Provisions

Abstract

Medicaid enrollees use tobacco at rates more than double that of the general population. To address this disparity, the Affordable Care Act (ACA) contained provisions to increase access to tobacco cessation treatments for Medicaid enrollees. There have been relatively low levels of implementation of these provisions by Medicaid programs. This research aims to evaluate the potential political, economic, and policy factors associated with implementation of each of the four tobacco‐cessation‐related ACA provisions. In 2017, UC San Diego researchers collected survey data from 51 Medicaid programs on tobacco cessation treatment policies and state‐level variables from publicly available sources. Implementation of these provisions was associated with state‐level variables such as having a budget shortfall during the recession years, Democratic control of the Governorship or legislature, and higher state cigarette taxes. Further guidance from the Centers for Medicare and Medicaid Services will be necessary to achieve full implementation of these ACA provisions.