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Abstract
IntroductionState Medicaid programs can cover tobacco cessation therapies for millions of low-income smokers in the United States, but use of this benefit is low and varies widely by state. This article assesses the effects of changes in Medicaid benefit policies, general tobacco policies, smoking norms, and public health programs on the use of cessation therapy among Medicaid smokers.MethodsWe used longitudinal panel analysis, using 2-way fixed effects models, to examine the effects of changes in state policies and characteristics on state-level use of Medicaid tobacco cessation medications from 2010 through 2014.ResultsMedicaid policies that require patients to obtain counseling to get medications reduced the use of cessation medications by approximately one-quarter to one-third; states that cover all types of cessation medications increased usage by approximately one-quarter to one-third. Non-Medicaid policies did not have significant effects on use levels.ConclusionsStates could increase efforts to quit by developing more comprehensive coverage and reducing barriers to coverage. Reductions in barriers could bolster smoking cessation rates, and the costs would be small compared with the costs of treating smoking-related diseases. Innovative initiatives to help smokers quit could improve health and reduce health care costs.
Highlights
Introduction StateMedicaid programs can cover tobacco cessation therapies for millions of low-income smokers in the United States, but use of this benefit is low and varies widely by state
Under the Affordable Care Act (ACA), every US state covers at least some Medicaid tobacco cessation benefits, including medications and counseling
We examined the effects of 1) state Medicaid smoking cessation coverage policies, such as medications covered; 2) state Medicaid limitations, such as copayments, prior authorization, or requirements for counseling; 3) other state tobacco policies that may affect smoking, such as cigarette taxes or laws that restrict smoking in public places; 4) state smoking norms, based on the prevalence of smoking; and 5) other public health programs, such as the availability of medications through statesponsored quitlines
Summary
Introduction StateMedicaid programs can cover tobacco cessation therapies for millions of low-income smokers in the United States, but use of this benefit is low and varies widely by state. The Centers for Disease Control and Prevention (CDC), the American Lung Association (ALA), and many other organizations encourage coverage of all Food and Drug Administration (FDA)–approved cessation medications and counseling and elimination of barriers that might limit access [5,6,7]. These benefits may go unused if patients and physicians are unaware that they are available or are not sufficiently engaged to attempt quitting. Fewer than half of smokers in Medicaid-managed care plans reported that their physicians offered assistance, such as medications or counseling, to quit [8]
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