State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments—United States, 2008–2018

MMWR Introduction

The prevalence of current cigarette smoking is approximately twice as high among adults enrolled in Medicaid (23.9%) as among privately insured adults (10.5%), placing Medicaid enrollees at increased risk for smoking-related disease and death. Medicaid spends approximately $39 billion annually on treating smoking-related diseases. To monitor changes in state Medicaid cessation coverage for traditional Medicaid enrollees over the past decade, the American Lung Association collected data on coverage of nine cessation treatments by state Medicaid programs during December 31,2008– December 31, 2018: individual counseling, group counseling, and the seven FDA-approved cessation medications; states that cover all nine of these treatments are considered to have comprehensive coverage. The American Lung Association also collected data on seven barriers to accessing covered treatments. Comprehensive, barrier-free, widely promoted coverage of these treatments increases use of cessation treatments and quit rates and is cost-effective.

MMWR Highlights

Medicaid Coverage for Tobacco Cessation Treatments, by State, 2008 and 2018

• As of December 31, 2018, all 50 states and the District of Columbia covered at least some cessation treatments for all Medicaid enrollees, up from 47 states as of December 31, 2008.
• As of December 31, 2018, 36 states covered all seven FDA-approved cessation medications for all Medicaid enrollees, up from 20 states as of December 31, 2008.
• As of December 31, 2018, 16 states covered both individual and group counseling for all Medicaid enrollees, up from 13 states as of December 31, 2008.
• As of December 31, 2018, 15 states (California, Colorado, Connecticut, Indiana, Kansas, Kentucky, Maine, Massachusetts, Minnesota, Missouri, Ohio, Oregon, Rhode Island, South Carolina, and Wisconsin) covered all nine cessation treatments for all Medicaid enrollees, up from six states as of December 31, 2008.

Medicaid Coverage Barriers to Accessing Tobacco Cessation Treatments, by State, 2008 and 2018

• Between December 31, 2008 and December 31, 2018, the number of states with none of the seven barriers to cessation treatment examined in this study increased from zero to two.
• Thirteen of the 15 states that covered all nine cessation treatments as of December 31, 2018 had barriers in place for some treatments; the remaining two states (Kentucky and Missouri) have removed all seven barriers examined in this study.
• Between December 31, 2008, and December 31, 2018, the number of states that do not require copayments for any cessation treatment for any Medicaid enrollees almost tripled, from 10 to 28.
• As of December 31, 2018, the most common barriers were limits on duration of treatment, annual limits on quit attempts, and prior authorization requirements, with 44, 37, and 35 states, respectively, reporting these barriers.