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

DiGiulio, Anne; Haddix, Meredith; Jump, Zach; Babb, Stephen; Schecter, Anna; Williams, Kisha-Ann S.; Asman, Katherine; Armour, Brian S.

doi:10.15585/mmwr.mm6548a2

Cited by 29 publications

(28 citation statements)

References 9 publications

(21 reference statements)

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“…17 Approximately 15 million adults in participating states gained Medicaid coverage this way, 18 including about 3.3 million smokers as of December 2015. 19 California embraced this opportunity early, pre-enrolling individuals in a temporary health program before expansion even began. 12 More than 1.1 million new adults entered California's Medicaid program in the first month alone.…”

Section: Discussionmentioning

confidence: 99%

“…38,39 To maximize their impact, state Medicaid programs should provide all members with barrier-free access to these medications. 19,40 Studies have found that many programs fall short of this standard. 19,40 Besides cost sharing, additional barriers that could be eliminated include prior authorization, counseling requirements, stepped care requirements, limits on duration of use, and annual or lifetime limits on quit attempts.…”

Section: Discussionmentioning

confidence: 99%

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The Growing Proportion of Smokers in Medicaid and Implications for Public Policy

Zhu

Anderson

Wong

et al. 2018

American Journal of Preventive Medicine

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Introduction: This study examined survey data from before and after California expanded its Medicaid program under the Affordable Care Act. It assessed changes in the insurance status of smokers, the proportion of smokers in Medicaid, and the health and well-being of those smokers relative to their counterparts in other insurance groups. Methods: The study compared two data sets from the California Health Interview Study, the 2011−2012 (N=42,935) and 2016 (N=21,055) surveys. Measures include health insurance status, smoking status, chronic health conditions, frequency of doctors' visits, and psychological distress. Data were analyzed in 2018. Results: From 2011−2012 to 2016, the estimated number of California smokers in Medicaid nearly doubled from 738,113 to 1,447,945, and the proportion of smokers covered by Medicaid increased from 19.3% to 41.5%. Compared with those with private insurance, smokers in Medicaid were more likely to have chronic disease, have made five or more doctors' visits in the past year, and be in severe psychological distress. In 2016, a total of 51.4% of all adult smokers with chronic disease conditions and 57.8% of those in severe psychological distress were covered by Medicaid. Conclusions: With Medicaid covering a much higher proportion of smokers, especially of those smokers with chronic disease and in psychological distress, state Medicaid programs and plans must make tobacco cessation a top priority. They should encourage clinicians to ask, advise, and assist all smokers, track progress in reducing smoking prevalence, employ mass communication strategies to drive quit attempts, improve access to medications, and develop or expand programs to help smokers quit. Supplement information: This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Growing Proportion of Smokers in Medicaid and Implications for Public Policy

Zhu

Anderson

Wong

et al. 2018

American Journal of Preventive Medicine

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“…NRT patches, gum, and lozenges are available OTC, while nasal sprays and inhalers (“Nicotrol”) require a prescription. While many state Medicaid programs were already providing coverage for these services prior to the ACA (DiGiulio et al ), use of these medications within Medicaid was limited: just 10% of Medicaid smokers received any cessation medications (Ku et al ). States may not use cost sharing for these drugs for newly eligibles and pregnant women, but states may use cost sharing for other Medicaid enrollees.…”

Section: Medicaid Conceptual Framework and Related Literaturementioning

confidence: 99%

“…By 2020, the federal contribution will decline to 90%. The ACA requires Medicaid to cover Food and Drug Administration (FDA)‐approved prescription cessation medications, and, for newly eligibles, Medicaid must cover these drugs with no cost sharing (DiGiulio et al ; Gates, Ranji, and Snyder ). These medications are efficacious (Aubin et al ; Biazzo et al ; Cummings and Hyland ; Ruger and Lazar ; Stead et al ) but are expensive without insurance.…”

Section: Introductionmentioning

confidence: 99%

“…In this study, we examine the effect of ACA Medicaid expansions to newly eligible populations on Medicaid‐financed FDA‐approved prescription medications for smoking cessation and associated changes in financing, both crowd‐out from private insurance and reductions in out‐of‐payments from uninsured patients. The newly eligible have higher smoking rates than traditionally eligible Medicaid populations, are very low income, and had little access to insurance (public or private) prior to the ACA (DiGiulio et al ; National Center for Health Statistics ). Given these characteristics, the newly eligible may benefit from coverage obtained through ACA‐related Medicaid expansions.…”

Section: Introductionmentioning

confidence: 99%

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Public Insurance Expansions and Smoking Cessation Medications

2019

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We study the effect of public insurance on smoking cessation medication prescriptions and financing. We leverage variation in insurance coverage generated by recent Affordable Care Act expansions to Medicaid. We estimate differences‐in‐differences models using administrative data on the universe of Medicaid‐financed prescriptions sold in retail and online pharmacies 2011–2017. Our findings suggest that these expansions increased Medicaid‐financed smoking cessation prescriptions by 34%. This increase reflects new medication use and a shift in payment from private insurers and self‐paying patients to Medicaid. Adjusting our estimate for changes in financing implies that Medicaid expansion led to a 24% increase in new medication use. (JEL I1, I13, I18)

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

Yoeun,

Cummins,

McMenamin

2023

World Med & Health Policy

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Although 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.

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

Cited by 29 publications

References 9 publications

The Growing Proportion of Smokers in Medicaid and Implications for Public Policy

The Growing Proportion of Smokers in Medicaid and Implications for Public Policy

Public Insurance Expansions and Smoking Cessation Medications

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

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