Factors associated with the implementation of a comprehensive tobacco cessation benefit among California Medicaid managed care plans

Abstract

AbstractAlthough tobacco control efforts have been successful at reducing the rate of tobacco use in the general population, rates of use among low‐income populations persist. As a leader in tobacco control efforts, the U.S. state of California recently issued regulations regarding comprehensive tobacco cessation service requirements for state Medicaid plans (i.e., Medi‐Cal MCPs) providing health care to low‐income Californians. This research aims to evaluate the potential factors associated with the adoption of a comprehensive tobacco control program among Medi‐Cal's MCPs. In 2018, UC San Diego researchers distributed a survey to a listserv of 25 Medi‐Cal MCP health educators, for a response rate of 96%. The survey was comprised of questions related to All Plan Letter (APL) implementation of tobacco cessation services and policies. Health educators were also recruited to participate in a semi‐structured interview upon survey completion. Two years postrelease of the APL, Medi‐Cal's MCPs demonstrate low implementation of tobacco cessation services and related policies, with only one MCP (5%) fully implementing all 10 core provisions. Five consistent patterns were identified as being associated with implementation: larger MCP enrollment and staffing, lower median household income, noncapitated provider payment, participation in county tobacco control meetings, and high‐quality scores for preventive care and treatment of chronic disease. Small‐sized MCPs have been slow in fully implementing tobacco cessation services. State policymakers and tobacco control stakeholders may consider providing support to small‐sized MCPs to aid in their continued adoption of comprehensive tobacco cessation services. DHCS should also consider releasing guidance on how to engage in activities to ensure APL compliance.