How Medicaid and Other Public Policies Affect Use of Tobacco Cessation Therapy, United States, 2010–2014

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.

Smoking Cessation among Female and Male Veterans before and after a Randomized Trial of Proactive Outreach

“…Despite these improvements in physician advice to quit, baseline satisfaction with cessation care was relatively low for both women and men. System-level changes to create a more streamlined, accessible process for obtaining cessation medications have been shown to increase use of cessation medications (Ku, Brantley, Bysshe, Steinmetz, & Bruen, 2016). Satisfaction with the process of obtaining cessation medications was significantly lower for women than men; the reason for this disparity was unclear from our data.…”

State Medicaid Expansion Tobacco Cessation Coverage and Number of Adult Smokers Enrolled in Expansion Coverage — United States, 2016

“…Several states that currently require copayments for some cessation treatments for Medicaid expansion enrollees have indicated that they are planning to remove this requirement. More comprehensive state Medicaid coverage of cessation treatments is associated with increased use of cessation medications and increased quit rates among smokers enrolled in Medicaid (6,8). Moreover, removing barriers such as copayments, which pose a financial obstacle, and prior authorization, which can delay accessing services unless a process is in place to expedite authorization, further increases access to these treatments (3,5).…”

“…All 32 states imposed one or more barriers on at least one cessation treatment for at least some enrollees. Providing barrier-free access to cessation treatments and promoting their use can increase use of these treatments and reduce smoking and smoking-related disease, death, and health care costs among Medicaid enrollees (4,(6)(7)(8).…”

Financial incentives to Medicaid smokers for engaging tobacco quit line treatment: maximising return on investment

“…Greater smoking prevalence rates put individuals with income below the poverty line at disproportionally higher risk for cancer and other smoking-associated morbidity and mortality 3. Furthermore, socioeconomically disadvantaged smokers experience greater difficulty in quitting smoking than do other smokers,4–7 and it has proven difficult to increase their engagement in evidence-based smoking cessation treatments 8–14…”

“…While it is clear that financial incentives work to engage low-income smokers in cessation treatment and increases quit rates, it is unclear how financial incentives programme could be optimised to engage the greatest number of socioeconomically disadvantaged smokers in evidence-based treatment and thereby increase cessation rates at the lowest intervention cost. This is especially important given that low-income smokers are especially unlikely to use evidence-based smoking treatments 7 23–25. Such information will provide an evidence base for informed decisions about incentivises for low-income smokers to engage in cessation treatment.…”